Clinical research with adults who are unable to provide informed consent has the potential to improve understanding and care of a number of devastating conditions. This research also has the potential to exploit some of society's most vulnerable members. Recently, a number of task forces and individual writers have proposed guidelines to ensure that such research is both possible and ethical. Yet, there is widespread disagreement over which safeguards should be adopted. In the present paper, I consider to what extent (...) these disagreements can be resolved by appeal to a general account of the interests of subjects who are unable to consent and the conditions that must be satisfied for research enrollment to constitute exploitation of their inability to make their own decisions. (shrink)

Clinical research with adults who are unable to provide informed consent has the potential to improve understanding and care of a number of devasting conditions. This research also has the potential to exploit some of society's most vulnerable members. Recently, a number of task forces and individual writers have proposed guidelines to ensure that such research is both possible and ethical. Yet, there is widespread disagreement over which safeguards should be adopted. In the present paper, I consider to what extent (...) these disagreements can be resolved by appeal to a general account of the interests of subjects who are unable to consent and the conditions that must be satisfied for research enrollment to constitute exploitation of their inability to make their own decisions. (shrink)

The philosophical literature would have us believe that the conservative view on abortion is based on the claim that the fetus is a person from the time of conception. Given the widespread acceptance of this analysis, it comes as something of a surprise to learn that it conflicts with a number of major arguments offered in support of the conservative view. I argue, in the present paper, that a careful examination of these inconsistencies establishes that the personhood analysis is mistaken: (...) the conservative view is based on the natural process of fetal development, not the personhood of the fetus. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:When Should “Riskier” Subjects Be Excluded from Research Participation?*Dave Wendler** (bio)AbstractThe exclusion of potential subjects based on increased risks is a common practice in human subjects research. However, there are no guidelines to ensure that this practice is conducted in a systematic and fair way. This gap in the literature and regulations is addressed by a specific account of a “condition on inclusion risks” (CIR), a condition (...) under which potential subjects should be excluded from research on the basis of increased risks. This account provides a general framework for assessing standard exclusions as well as more controversial ones such as the exclusion of pregnant women and women of childbearing potential from certain types of research.The exclusion of potential subjects on the basis of increased risks is a common and, in most instances, noncontroversial practice in human subjects research. Investigators routinely exclude potential subjects with reduced kidney function, bleeding disorders, and allergies to the drugs under investigation. Surprisingly, this use of exclusion criteria takes place in the absence of any explicit guidelines. In the present paper, I attempt to fill this gap in the literature and regulations by offering a specific account of the conditions under which potential subjects should be excluded from research on the basis of increased risk. This account serves two purposes.First, subjects who are excluded on the basis of increased risk are prevented from making their own enrollment decisions. Therefore, it is important to ensure, in spite of the broad range of potential subjects and the varied reasons for excluding them, that potential subjects are excluded in [End Page 307] a systematic and fair way. Second, certain instances of subject exclusion, most notably the exclusion of pregnant women and women of childbearing potential, raise more difficult issues. By providing a general framework for assessing the exclusion of potential subjects based on increased risks, the present analysis covers these cases as well and, thus, offers a solution to one of the thornier ethical dilemmas facing investigators and IRBs today.Briefly, I argue that standard exclusion practices suggest that whenever two groups of potential research subjects offer the same opportunity for scientific and individual benefit, but different levels of risk, the group that would introduce greater risks should be excluded. With this framework in place, I consider potential subjects, such as men and women of child-parenting potential, whose research participation introduces increased risks to third parties. I argue that the present approach is justified, not because it reduces harms to specific individuals, but because it reduces aggregate harms. Therefore, it should be applied to all riskier potential subjects regardless of who faces the risks in question. After defending this approach, I consider several objections.First, I argue that the present approach is not paternalistic; the exclusions it calls for are not justified by what is thought to be in the best interests of the individuals excluded. Rather, the argument is that these exclusions minimize the aggregate harm of human subjects research. In addition, the present approach does not violate the obligation of researchers to respect subject autonomy because it does not reduce the number of potential subjects who are given the opportunity to enroll in a particular protocol. Finally, the exclusions are consistent with reasonable side constraints on attaining the goals of research.“Riskier” SubjectsWhen it comes to evaluating risks, most guidelines on human subjects research stipulate simply that the risks entailed must be reasonable given the potential for benefit. The Australian National Health and Medical Research Council’s guidelines, for instance, require only that “the investigator... must be satisfied that the possible advantage to be gained from the work justifies any discomfort or risk involved” (ANMRC 1992, Clause 3). To determine whether the risks of a protocol are justified, one sums the risks of the various procedures in the protocol, whatever those procedures may be, and compares the result to the procedures’ potential for benefit. This evaluation of risks assumes that the aggregate risks of a [End Page 308] given protocol are fixed and thus will not help to determine whether and when the risks of particular protocols should be reduced by excluding riskier subjects. The United States Department of Health... (shrink)

Volume 20, Issue 10, October 2020, Page 94-96.

The philosophical literature would have us believe that the conservative view on abortion is based on the claim that the fetus is a person from the time of conception. Given the widespread acceptance of this analysis, it comes as something of a surprise to learn that it conflicts with a number of major arguments offered in support of the conservative view. I argue, in the present paper, that a careful examination of these inconsistencies establishes that the personhood analysis is mistaken: (...) the conservative view is based on the natural process of fetal development, not the personhood of the fetus. (shrink)

In Grimes v. Kennedy Krieger Institute (KKI), the Maryland Court of Appeals, while noting that U.S. federal regulations include risk standards for pediatric research, endorses its own risk standards. The Grimes case has implications for the debate over whether the minimal risk standard should be interpreted based on the risks in the daily lives of most children (the objective interpretation) or the risks in the daily lives of the children who will be enrolled in a given study (the subjective interpretation). (...) The court's use of the objective interpretation to block studies like the KKI study protects individual children who are worse off than the average child. Unfortunately, this approach also may block research intended to improve the lives of these same individuals. A similar dilemma arises in the context of multinational research, suggesting that a "modified objective standard," proposed to address this dilemma in the multinational setting, may offer a framework for addressing the dilemma in the context of pediatric research as well. (shrink)

Die gängige Unterscheidung zwischen 'Modellen von etwas' und 'Modellen für etwas' basiert weitgehend auf der Zuordnung der einen zu den Wissenschaften, der anderen zu den Künsten und den entwerfenden Disziplinen. Diese Aufteilung hält einer näheren Untersuchung nicht Stand. Zudem hat sie die Einsicht vereitelt, dass und wie Forschen und Entwerfen im Modell ineinander verflochten sind.

Neurotheology is a fast-growing field of research. Combining philosophy of mind, neuroscience, and religious studies, it takes a new approach to old questions on religion. What is religion and why do we have it? Neurotheologists focus on the search for the neural correlate of religious experiences. If we can trace religious experiences to specific parts of the brain, chances are we can reduce religion as such to that grey soggy matter as well. This article predicts neurotheology will not be able (...) to locate the neural correlate of religious experiences. As we cannot decide phenomenally what makes an experience religious, neurologically we cannot find its correlate either. That is, if there are fixed neural correlates to begin with, because their existence is still a matter of debate. In addition, religious experiences seem to be a kind of experience, like emotional or relational experiences, making them indistinguishable from similar nonreligious experiences. Even if one manages to trace the neural correlate of religious experiences, neurotheology will still not be able to account for the rise of religion without resorting to theories from other disciplines. In the end, we do not know enough about consciousness and the way it relates to the brain to make conclusive claims about the search for religious states of consciousness. It seems, however, that even though neurotheology could provide fascinating insights in the workings of the religious brain, on its own, it will prove unable to explain religion fully. (shrink)

Inner membranes of mitochondria are extensively folded, forming cristae. The observed overall correlation between efficient eukaryotic ATP generation and the area of internal mitochondrial inner membranes both in unicellular organisms and metazoan tissues seems to explain why they evolved. However, the crucial use of molecular oxygen (O2) as final acceptor of the electron transport chain is still not sufficiently appreciated. O2 was an essential prerequisite for cristae development during early eukaryogenesis and could be the factor allowing cristae retention upon loss (...) of mitochondrial ATP generation. Here I analyze illuminating bacterial and unicellular eukaryotic examples. I also discuss formative influences of intracellular O2 consumption on the evolution of the last eukaryotic common ancestor (LECA). These considerations bring about an explanation for the many genes coming from other organisms than the archaeon and bacterium merging at the start of eukaryogenesis. (shrink)

This introduction to a special issue of Topoi introduces and summarises the relationship between three main varieties of 'enactivist' theorising about the mind: 'autopoietic', 'sensorimotor', and 'radical' enactivism. It includes a brief discussion of the philosophical and cognitive scientific precursors to enactivist theories, and the relationship of enactivism to other trends in embodied cognitive science and philosophy of mind.

Ethical challenges in genomic epidemiology are the direct result of novel tools used to confront scientific challenges in the field. An orders-of-magnitude increase in scale of genetic data collection has created the need for establishing diffuse international partnerships, sometimes across developed- and developing-world countries, with ramifications for assigning research ownership, distributing intellectual property rights, and encouraging capacity-building. Meanwhile, the fact that genomic epidemiological research is so far upstream in the pipeline of therapy development has implications for the privacy rights of (...) research participants and for a rigorous definition of valid informed consent, particularly in resource-poor settings. From these scientific underpinnings, we distill out two main categories of ethical issues: (1) How should researchers ensure that the subjects of research are appropriately protected? and (2) What is the structure of an equitable and fair system for distributing the financial and scientific rewards of research? We attempt to delineate the contours of specific problems in each category and propose steps toward solutions with reference to a particular project, known as gMap.net, that focuses on genomic epidemiological studies of malaria. (shrink)

This article aims to demonstrate how the formation of ethical subjectivity must be considered in conjunction with the techno-politics of secrecy and disclosure, and it proposes an account of the ways in which the technical transition and ‘democratization’ of archival upload/download capacity associated with digital communications fundamentally challenges the existing structure of control over such things as censorship and cultural memory understood in terms of power of recall. It argues that it is against this background and in view of the (...) mediality of communications that the question of responsibility with respect to secrets and their disclosure must ultimately be posed. It seeks to establish the difference between a purely political and an ethico-political understanding of the secrecy/disclosure dyad as this functions, on the one hand, in relation to philosophical inquiry itself and, on the other, in relation to normative representations of informational events, and it contextualizes its theoretical account of this difference in relation to the ‘Wikileaks phenomenon’ viewed as a disclosive event. It examines how ethical subjectivity is formed in relation to ‘information’ and in the wider context of a digital culture of archivization, characterized by the ubiquitous recording of communications of all kinds. Drawing centrally on the ethical philosophy of Emmanuel Levinas, for whom ‘infinite responsibility’ is ‘incarnated’ as the ‘ultimate secret of subjectivity’ in me, and Derrida’s account of both the necessary technicity of the human and the impossibility of ‘saying the event’, it proposes a way of thinking the ethico-techno-politics of secrecy and disclosure in terms of the singularity of the event and the unique responsibility of the ethical Subject in relation to that. (shrink)

Although informed consent is important in clinical research, questions persist regarding when it is necessary, what it requires, and how it should be obtained. The standard view in research ethics is that the function of informed consent is to respect individual autonomy. However, consent processes are multidimensional and serve other ethical functions as well. These functions deserve particular attention when barriers to consent exist. We argue that consent serves seven ethically important and conceptually distinct functions. The first four functions pertain (...) principally to individual participants: (1) providing transparency; (2) allowing control and authorization; (3) promoting concordance with participants' values; and (4) protecting and promoting welfare interests. Three other functions are systemic or policy focused: (5) promoting trust; (6) satisfying regulatory requirements; and (7) promoting integrity in research. Reframing consent around these functions can guide approaches to consent that are context sensitive and that maximize achievable goals. (shrink)

Net‐risk pediatric research encompasses interventions and studies that pose risks and do not offer a compensating potential for clinical benefit. These interventions and studies are central to efforts to improve pediatric clinical care. Yet critics argue that it is unethical to expose children to research risks for the benefit of unrelated others. While a number of ethical justifications have been proposed, none have received widespread acceptance. This leaves funders with uncertainty over whether they should support and institutional review boards with (...) uncertainty over whether they should approve net‐risk pediatric research. To try to answer these questions, this article describes a justification that I previously proposed and considers two objections to it. This analysis reveals that the opportunity to contribute to a valuable project can justify exposing children to risks even though some trials turn out to be valueless and others turn out to be harmful. It follows that, to protect pediatric participants, institutional review boards need to assess whether trials have the potential to collect socially valuable information and whether they are likely to enroll and retain a sufficient number of participants. (shrink)

Key texts on beauty and its revival in contemporary art.

Many teacher candidates get their first taste of life as a full-time teacher in their practicums, during which they confront a host of challenges, pedagogical and ethical. Because ethics is fundamental to the connection between teachers and students, teacher candidates are often required to negotiate dilemmas in ways that keep with the ethical ideals espoused both by the professional body and the community at large. Presenting the case of a teacher candidate who finds herself emotionally depleted in her devotion to (...) students, we look to the ethics of care and virtue for clarifying insights. Care ethics extols intersubjectivity and reciprocity, while virtue ethics enjoins commitment to a noble ideal for its own sake; both perspectives offer useful insights for our case. We argue that the perspectives and practices of contemplative traditions can facilitate the integration of care and virtue ethics, mitigating the risk of disruption in caring relations while minimizing the possibility of a personal p... (shrink)

Guidelines around the world require children to provide assent for their participation in most research studies. Yet, little further guidance is provided on how review committees should implement this requirement, including which children are capable of providing assent and when the requirement for assent may be waived on the grounds that the research offers participating children the potential for important clinical benefit. The present paper argues that the assent requirement is supported by the importance of allowing children who are capable (...) to make their own decisions. This suggests children are capable of assent when they become able to understand the research in question. While development varies across individual children, existing data suggest most children develop this ability by approximately age 14. Until instruments are developed to assess the assent capacity of individual children, this age should be used as the threshold for assent. In addition, the importance of protecting children from harm suggests that the sustained dissent of all children, including those who are unable to provide assent, should be respected. While the assent requirement may be waived when research participation offers the potential for important medical benefit that is unavailable outside the research context, analysis suggests that children’s sustained dissent should be respected in all cases. (shrink)

What is it to be an agent? One influential line of thought, endorsed by G. E. M. Anscombe and David Velleman, among others, holds that agency depends on practical rationality—the ability to act for reasons, rather than being merely moved by causes. Over the past 25 years, Velleman has argued compellingly for a distinctive view of agency and the practical rationality with which he associates it. On Velleman’s conception, being an agent consists in having the capacity to be motivated by (...) a drive to act for reasons. Your bodily movements qualify as genuine actions insofar as they are motivated in part by your desire to behave in a way that makes sense to yourself. However, there are at least two distinct ways of spelling out what this drive towards self-intelligibility consists in, both present in Velleman’s work. It might consist in a drive towards intelligibility in causal-psychological terms: roughly, a drive to maximize the rational coherence of your psychological states. Alternatively, it might consist in a drive towards narrative intelligibility: a drive to make your ongoing activity conform to a recognizable narrative structure, where that structure is understood emotionally. Velleman originally saw these options as basically equivalent, but later came to prioritize the drive towards causal-psychological intelligibility over that towards narrative intelligibility. I argue that this gets things the wrong way round—we should instead understand our capacities to render ourselves intelligible in causal-psychological terms as built upon a bedrock of emotionally suffused narrative understanding. In doing so, we resolve several problems for Velleman’s view, and pave the way for an embodied, embedded and affective account of practical rationality and agency. According to the picture that emerges, practical rationality is essential to agency, narrative understanding is essential to practical rationality, and the rhythms and structures patterning the ebb and flow of our emotional lives are essential to narrative understanding. (shrink)

An eye-opening tour of the political tricks that subvert scientific progress. The Butter-Up and Undercut. The Certain Uncertainty. The Straight-Up Fabrication. Dave Levitan dismantles all of these deceptive arguments, and many more, in this probing and hilarious examination of the ways our elected officials attack scientific findings that conflict with their political agendas. The next time you hear a politician say, "Well, I’m not a scientist, but…," you’ll be ready.

The development of immersive media-communication environments, and their theorization in terms of the `haptic', calls for a reconsideration of the relationship between sensuality and the ethics of contact. For the most part, the cultural theorization of the virtual which remains preoccupied with the visual has tended to limit its scope to the paradoxes, politics and ethics of representation. Much of media and cultural studies work, for instance, has adopted, directly or indirectly, the traditional visual and ocularcentric paradigm in its analyses (...) of cultural forms and technologies as these have become integrated into contemporary life. Whilst it has been argued, for instance by Mark Hansen in his recent books, that this paradigm is inadequate to digital media and the developments of human-machine interactions the digital introduces, few comentators have addressed how new developments in immersive sensory media environments bear on the ethics of communication. By way of a reflection on the themes of the tactility of contact and the ethics of touch in the work of Emmanuel Levinas, this article critically evaluates the ethical significance of the `sensory extension' haptic media represent. It identifies and argues against the neo-positivist tendency of Hansen's reliance on the empiricism of the neurosciences whilst locating the resources for an ethics of touch in Levinas' concept of time as `diachrony'. (shrink)

In this richly argued and provocative book, David Davies elaborates and defends a broad conceptual framework for thinking about the arts that reveals important continuities and discontinuities between traditional and modern art, and between different artistic disciplines. Elaborates and defends a broad conceptual framework for thinking about the arts. Offers a provocative view about the kinds of things that artworks are and how they are to be understood. Reveals important continuities and discontinuities between traditional and modern art. Highlights core topics (...) in aesthetics and art theory, including traditional theories about the nature of art, aesthetic appreciation, artistic intentions, performance, and artistic meaning. (shrink)

We present a specific elaboration and partial defense of the claims that cognition is enactive, embodied, embedded, affective and (potentially) extended. According to the view we will defend, the enactivist claim that perception and cognition essentially depend upon the cognizer’s interactions with their environment is fundamental. If a particular instance of this kind of dependence obtains, we will argue, then it follows that cognition is essentially embodied and embedded, that the underpinnings of cognition are inextricable from those of affect, that (...) the phenomenon of cognition itself is essentially bound up with affect, and that the possibility of cognitive extension depends upon the instantiation of a specific mode of skillful interrelation between cognizer and environment. Thus, if cognition is enactive then it is also embodied, embedded, affective and potentially extended. (shrink)

Social and linguistic perceptions are linked. On one hand, talker identity affects speech perception. On the other hand, speech itself provides information about a talker's identity. Here, we propose that the same probabilistic knowledge might underlie both socially conditioned linguistic inferences and linguistically conditioned social inferences. Our computational–level approach—the ideal adapter—starts from the idea that listeners use probabilistic knowledge of covariation between social, linguistic, and acoustic cues in order to infer the most likely explanation of the speech signals they hear. (...) As a first step toward understanding social inferences in this framework, we use a simple ideal observer model to show that it would be possible to infer aspects of a talker's identity using cue distributions based on actual speech production data. This suggests the possibility of a single formal framework for social and linguistic inferences and the interactions between them. (shrink)

Shows how ethical subjectivity is not based on individual morals but contemporary cultureTaking his lead from the philosophy of Emmanuel Levinas, and engaging with a number of ethical thinkers, Dave Boothroyd addresses a number of key contemporary ethical subjects. In doing so, he reveals how responsibility is grounded in the everyday encounters and situations we are all familiar with.

Guidelines for health research focus on protecting individual research subjects. It is also vital to protect the communities involved in health research. In particular, a number of studies have been criticized on the grounds that they exploited host communities. The present paper attempts to address these concerns by providing an analysis of community exploitation and, based on this analysis, determining what safeguards are needed to protect communities in health research against exploitation. (edited).

In lieu of an abstract, here is a brief excerpt of the content:Rhetoric and Power: An Inquiry into Foucault’s Critique of ConfessionDave TellOn October 10, 1979, Michel Foucault revised his thesis on confession. On that day, some three years after the publication of his magisterial treatment of confession in the first volume of The History of Sexuality, Foucault argued that the Pythagoreans, Stoics, and Epicureans had, before the advent of Christianity, their own practices of confession. Yet these practices, unlike their (...) Christian variants, were not complicit with practices of domination (OS 310, 312). In the context of Foucault’s thought theretofore, in which the confession consistently figured as an essential component in the exercise of modern power, this is a radical shift. In lectures given at both Berkeley and Dartmouth in the fall of 1980, Foucault made similar arguments. On these occasions he argued that Seneca’s De ira constituted a “stoic confession,” the object of which was to enable the subject to “live differently, better, more happily, than other people” (AB 210, 205). Judith Butler captures the gravity of the shift: “In the last years of his life, Foucault returned to the question of confession, reversing his earlier critique in the first volume of the History of Sexuality, where he indicts confession as a forcible extraction of sexual truth, a practice in the service of a regulatory power” (2005, 112).This reversal was short lived. Although Foucault would celebrate ancient Greek techniques of the self for the rest of his life, he would not [End Page 95] long refer to these techniques in terms of confession. Thus, in another reading of De ira, this one in March 1982, Foucault again noted that the Stoics have “confessional practices” that are “very close to what is found in Christianity” (Herm 482). This time, however, he insisted that the Stoic practices were fundamentally different: “However, all these elements seem to me to be profoundly different from what we should call ‘confession’ in the strict, or anyway, spiritual sense of the word” (Herm 365). In The Care of the Self, Foucault again conceded that De ira—what he now called “the most detailed description” of antique practices of the self—looked “at first glance” like a Christian confession, but he again maintained that it is something quite different: “The purpose of the examination is not therefore to discover one’s own guilt, down to its most trifling forms” (CS 61–62). Foucault concluded that the various “discourses of the self”—the confession and the Greek techniques of the self—could not be placed into a single category (see GE 250). Indeed, the “profound difference” (Herm 299) between these two discourses of the self was perhaps Foucault’s most repeated claim of the 1980s (see Herm 222, 237–44, 299, 308; GE 247–48; WS 237; AB 207–8; RFT 27; UP 89; CS 239; SS 5; FI 5, 12; FS 30, 35, 44, 87, 96, 97, 143–45, 147).It is worth asking why Foucault returned so consistently to the distinction between these two discursive forms. This question gains even more relevance for readers of this journal when we remember that, on at least two occasions, Foucault defined one of these forms, the ancient techniques of the self, in terms of its opposition to rhetoric: the techniques of the self, he claimed, are “nonrhetorical” (Herm 368; FS 20). Thus the question that drives this essay is not so much why Foucault attached such importance to the distinction but rather how rhetoric itself might differentiate the confession from the techniques of the self. Stated differently, Foucault’s work on the confession vis-à-vis the technologies of the self provides a valuable opportunity to study the role of rhetoric in Foucault’s thought—not because they are both rhetorical forms but, curiously, because Foucault insists that one is not.In order to foreground the work of rhetoric in Foucault’s thought, I situate his discourses of the self in the context of Nietzsche’s critique of metonymy. Although this may seem arbitrary, it gains initial plausibility from three facts. First, we know that Foucault understood rhetoric in terms of tropes (OT 84; Cooper 1988, 4). Second, we know too that Foucault had a deep... (shrink)

How do questions concerning consciousness and phenomenal experience relate to, or interface with, questions concerning plans, knowledge and intentions? At least in the case of visual experience the relation, we shall argue, is tight. Visual perceptual experience, we shall argue, is fixed by an agent’s direct unmediated knowledge concerning her poise (or apparent poise) over a currently enabled action space. An action space, in this specific sense, is to be understood not as a fine-grained matrix of possibilities for bodily movement, (...) but as a matrix of possibilities for pursuing and accomplishing one’s intentional actions, goals and projects. If this is correct, the links between planning, intention and perceptual experience are tight, while (contrary to some recent accounts invoking the notion of ‘sensorimotor expectations’) the links between embodied activity and perceptual experience, though real, are indirect. What matters is not bodily activity itself, but our practical knowledge (which need not be verbalized or in any way explicit) of our own possibilities for action. Such knowledge, selected, shaped and filtered by the grid of plans, goals, and intentions, plays, we argue, a constitutive role in explaining the content and character of visual perceptual experience. (shrink)

The standard approach to treatment decision making for incapacitated patients often fails to provide treatment consistent with the patient’s preferences and values and places significant stress on surrogate decision makers. These shortcomings provide compelling reason to search for methods to improve current practice. Shared decision making between surrogates and clinicians has important advantages, but it does not provide a way to determine patients’ treatment preferences. Hence, shared decision making leaves families with the stressful challenge of identifying the patient’s preferred treatment (...) option. To address this concern, the present paper proposes to incorporate the use of a “Patient Preference Predictor” (PPP) into the shared decision-making process between surrogates and clinicians. A PPP would predict which treatment option a given incapacitated patient would most likely prefer, based on the individual’s characteristics and information on what treatment preferences are correlated with these characteristics. Use of a PPP is likely to increase the chances that incapacitated patients are treated consistent with their preferences and values and might reduce the stress and burden on their surrogates. Including a PPP in the shared decision-making process therefore has the potential to realize important ethical goals for making treatment decisions for incapacitated patients. The present paper justifies this approach on conceptual and normative grounds. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Rhetoric and Power: An Inquiry into Foucault’s Critique of ConfessionDave TellOn October 10, 1979, Michel Foucault revised his thesis on confession. On that day, some three years after the publication of his magisterial treatment of confession in the first volume of The History of Sexuality, Foucault argued that the Pythagoreans, Stoics, and Epicureans had, before the advent of Christianity, their own practices of confession. Yet these practices, unlike their (...) Christian variants, were not complicit with practices of domination (OS 310, 312). In the context of Foucault’s thought theretofore, in which the confession consistently figured as an essential component in the exercise of modern power, this is a radical shift. In lectures given at both Berkeley and Dartmouth in the fall of 1980, Foucault made similar arguments. On these occasions he argued that Seneca’s De ira constituted a “stoic confession,” the object of which was to enable the subject to “live differently, better, more happily, than other people” (AB 210, 205). Judith Butler captures the gravity of the shift: “In the last years of his life, Foucault returned to the question of confession, reversing his earlier critique in the first volume of the History of Sexuality, where he indicts confession as a forcible extraction of sexual truth, a practice in the service of a regulatory power” (2005, 112).This reversal was short lived. Although Foucault would celebrate ancient Greek techniques of the self for the rest of his life, he would not [End Page 95] long refer to these techniques in terms of confession. Thus, in another reading of De ira, this one in March 1982, Foucault again noted that the Stoics have “confessional practices” that are “very close to what is found in Christianity” (Herm 482). This time, however, he insisted that the Stoic practices were fundamentally different: “However, all these elements seem to me to be profoundly different from what we should call ‘confession’ in the strict, or anyway, spiritual sense of the word” (Herm 365). In The Care of the Self, Foucault again conceded that De ira—what he now called “the most detailed description” of antique practices of the self—looked “at first glance” like a Christian confession, but he again maintained that it is something quite different: “The purpose of the examination is not therefore to discover one’s own guilt, down to its most trifling forms” (CS 61–62). Foucault concluded that the various “discourses of the self”—the confession and the Greek techniques of the self—could not be placed into a single category (see GE 250). Indeed, the “profound difference” (Herm 299) between these two discourses of the self was perhaps Foucault’s most repeated claim of the 1980s (see Herm 222, 237–44, 299, 308; GE 247–48; WS 237; AB 207–8; RFT 27; UP 89; CS 239; SS 5; FI 5, 12; FS 30, 35, 44, 87, 96, 97, 143–45, 147).It is worth asking why Foucault returned so consistently to the distinction between these two discursive forms. This question gains even more relevance for readers of this journal when we remember that, on at least two occasions, Foucault defined one of these forms, the ancient techniques of the self, in terms of its opposition to rhetoric: the techniques of the self, he claimed, are “nonrhetorical” (Herm 368; FS 20). Thus the question that drives this essay is not so much why Foucault attached such importance to the distinction but rather how rhetoric itself might differentiate the confession from the techniques of the self. Stated differently, Foucault’s work on the confession vis-à-vis the technologies of the self provides a valuable opportunity to study the role of rhetoric in Foucault’s thought—not because they are both rhetorical forms but, curiously, because Foucault insists that one is not.In order to foreground the work of rhetoric in Foucault’s thought, I situate his discourses of the self in the context of Nietzsche’s critique of metonymy. Although this may seem arbitrary, it gains initial plausibility from three facts. First, we know that Foucault understood rhetoric in terms of tropes (OT 84; Cooper 1988, 4). Second, we know too that Foucault had a deep... (shrink)

How should accounts that stress the embodied, embedded and engaged character of human minds accommodate the role of rationality in human subjectivity? Drawing on Matthew Boyle’s contrast between ‘additive’ and ‘transformative’ conceptions of rationality, I argue that contemporary work on embodied cognition tends towards a problematic ‘additivism’ about the relationship between mature human capacities to think and act for reasons, and sensorimotor capacities to skillfully engage with salient features of the environment. Additivists view rational capacities to reason and reflect as (...) a distinct ‘layer’ or ‘storey’ of human cognition, with a normative structure that differs from that of the sensorimotor coping skills which support it. I argue that emphasizing the embodied and engaged character of human minds is better combined with a ‘transformative’ conception of rationality – one which holds that acquiring abilities to give and ask for reasons transforms the normative structure of our unreflective embodied dealings with the environment. And I argue that a transformative embodied cognitive science of human rationality is not only possible, but underway. Integrating existing work on embodied cognition with work on the cultural and developmental contexts that shape human minds suggests how human immersion in culture transforms the structure of sensorimotor engagements by bringing about the communicability and negotiability of the meanings to which those engagements attune us. (shrink)

A primary goal of clinical practice is to respect patient autonomy. To promote this goal for patients who have lost the ability to make their own decisions, commentators recommend that surrogates make their treatment decisions based on the substituted judgment standard. This standard is commonly interpreted as directing surrogates to make the decision the patient would have made in the circumstances, if the patient were competent. However, recent commentators have argued that this approach—attempting to make the decision the patient would (...) have made if competent—is theoretically problematic, practically infeasible, and ignores the interests of the patient9s family and loved ones. These commentators conclude that the substituted judgment standard should be revised significantly, or abandoned altogether. While this response would avoid the cited problems, it also would require substantial changes to clinical practice and would raise significant problems of its own. The present paper thus considers the possibility that the criticisms do not point to problems with the substituted judgment standard itself; instead, they point to problems with the way it is most commonly interpreted. This analysis suggests that the substituted judgment standard need not be dramatically revised or abandoned. Instead, it should be interpreted in a way that effectively promotes respect for the autonomy of incompetent patients. The ‘endorsed life’ interpretation described here helps clinicians and surrogates to achieve this important goal. To clarify this approach, we explain how it differs from three other recently proposed alternatives to the standard interpretation of the substituted judgment standard. (shrink)

It has recently been proposed to incorporate the use of a “Patient Preference Predictor” (PPP) into the process of making treatment decisions for incapacitated patients. A PPP would predict which treatment option a given incapacitated patient would most likely prefer, based on the individual’s characteristics and information on what treatment preferences are correlated with these characteristics. Including a PPP in the shared decision-making process between clinicians and surrogates has the potential to better realize important ethical goals for making treatment decisions (...) for incapacitated patients. However, developing and implementing a PPP poses significant practical challenges. The present paper discusses these practical challenges and considers ways to address them. (shrink)

I shall characterize normative functionalism and contrast it with its causal counterpart. After tracing both stripes of functionalism to the work of the classical American pragmatists, I then argue that they are not exclusive alternatives. Instead, both might be required for an appropriately illuminating account of human rational activity.

Abstract:Although inquiry-based instruction has been a centerpiece of progressive visions of social studies education almost since its inception as a school subject a century ago, teachers often struggle to conceptualize it in ways that make true inquiry possible for their students. In this essay I suggest that social educators strengthen their connection with John Dewey’s pragmatic epistemology as the foundation of inquiry-based teaching in social studies, arguing in support of an approach that holds the promise of advancing goals associated with (...) meaningful democratic citizenship education. (shrink)

The transparency of perceptual experience has been invoked in support of many views about perception. I argue that it supports a form of enactivism—the view that capacities for perceptual experience and for intentional agency are essentially interdependent. I clarify the perceptual phenomenon at issue, and argue that enactivists should expect to find a parallel instance of transparency in our agentive experience, and that the two forms of transparency are constitutively interdependent. I then argue that i) we do indeed find such (...) parallels: the way in which an action is directed towards its goal through our bodily movements parallels the way in which an experience is directed towards its object through our perceptual sensation, and ii) reflecting on sensorimotor skills shows why the two instances of transparency are constitutively interdependent. Section 4 gives reasons for generalizing beyond the cases considered so far by applying the enactive view to Kohler's landmark studies of perceptual adaptation. The final section clarifies the form of enactivism to which the previous sections point. The view that emerges is one whereby our perceptual and practical skills are interrelated aspects of a single capacity to have one's mind intentionally directed upon the world. The transparency of experience, on this view, is achieved in virtue of our capacities as agents as much as it is given in virtue of our capacities as perceivers. (shrink)

Skepticism about the limits of online learning is as old as online learning itself. As with other technologically-driven innovations in pedagogy, there are deep-seated worries that important educational goods might be effaced or obscured by the ways of teaching and learning that online methods allow. One family of such worries is inspired by reflections on the bodily basis of an important kind of understanding, and skepticism over whether this bodily basis can be inculcated in the absence of actual, flesh-and-blood, classroom (...) interactions. This paper focuses on the ways in which such worries arise in the influential work of Hubert Dreyfus. The negative conclusion for which I argue is that endorsing Dreyfus's Merleau-Pontian picture of the relationship between bodily skill and understanding does not commit us to his general pessimism concerning online learning—bodily, emotional, and interactive dimensions might be essential to learning, but we lack reasons to think that online learning necessarily lacks these dimensions. The negative argument motivates a positive claim: rather than giving up on online learning we should focus on designing courses and pedagogies that scaffold the bodily, affective and interactive dynamics constitutive of understanding in a particular domain. (shrink)

I argue that the phenomenal properties of conscious visual experiences are properties of the mind-independent objects to which the subject is perceptually related, mediated by the subject's practical understanding of their sensorimotor relation to those properties. This position conjoins two existing strategies for explaining the phenomenal character of perceptual experiences: accounts appealing to perceivers’ limited, non-inferential access to the details of their sensory relation to the environment, and the relationalist conception of phenomenal properties. Bringing these two positions together by emphasizing (...) their sensorimotor common ground allows each one to respond to damaging objections using the resources of the other. The resulting ‘sensorimotor relationalism’ about conscious vision provides a promising schema for explaining phenomenal properties of perceptual states, replacing ‘Hard’ questions with tractable ones about the perceptual relation and its sensorimotor underpinnings. (shrink)

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

Meyer and Brancazio make an important distinction between two enactivist projects: “utopian” and “scientific.” I agree that contemporary enactivists would benefit from more clearly distinguishing these projects and their success conditions. However, I wonder whether there are times when letting these projects merge with each other might be helpful, or even necessary.

When patients cannot make their own treatment decisions, surrogates typically step in to do it for them. Surrogate decision‐making is far from ideal, of course, as the surrogate may not know what the patient prefers or what best promotes her interests. One way to improve it would be to arm surrogates with information about what patients in similar circumstances tend to prefer, allowing them to make empirically grounded predictions about what their patient would want.