Book reviewed in this article: The Willowbrook Wars: A Decade of Struggle for Social Justice. By David J. Rothman and Sheila M. Rothman.

Introduction: making the invisible visible -- The nobility of the material -- Research at war -- The guilded age of research -- The doctor as whistle-blower -- New rules for the laboratory -- Bedside ethics -- The doctor as stranger -- Life through death -- Commissioning ethics -- No one to trust -- New rules for the bedside -- Epilogue: The price of success.

Addresses the issues at the heart of international medicine and social responsibility. A number of international declarations have proclaimed that health care is a fundamental human right. But if we accept this broad commitment, how should we concretely define the state’s responsibility for the health of its citizens? Although there is growing debate over this issue, there are few books for general readers that provide engaging accounts of critical incidents, practices, and ideas in the field of human rights, health care, (...) and medicine. Included in the book are case studies of such issues as AIDS among orphans in Romania, organ trafficking, prison conditions, health care rationing, medical research in the third world, and South Africa’s constitutionally guaranteed right of access to health care. It uses these topics to address themes of protection of vulnerable populations, equity and fairness in delivering competent medical care, informed consent and the free flow of information, and state responsibility for ensuring physical, mental, and social well-being. (shrink)

Although HIV disease has set a new model for resolving the tensions between civil liberties and public health interests, with an unprecedented commitment to individual privacy and autonomy, the resurgence of tuberculosis has sparked new and troublesome concerns. One particularly intense controversy has emerged around the value and appropriateness of single disease hospitals. In HIV disease, the single hospital turns out to be an altogether unsuitable and unnecessary innovation. In the instance of tuberculosis, however, it appears to have a critical (...) and legitimate role, particularly for involuntary commitment of patients who have been non-compliant with treatment regimens. To be sure, that role must be carefully circumscribed and the facilities themselves closely monitored. But a hospital dedicated to tuberculosis now occupies a central place in public policy that is not to be found for HIV disease. What considerations promote this difference, and how a single disease hospital for tuberculosis may avoid the pitfalls that make it so inapposite for HIV, are the two questions this essay will be exploring. (shrink)

Although HIV disease has set a new model for resolving the tensions between civil liberties and public health interests, with an unprecedented commitment to individual privacy and autonomy, the resurgence of tuberculosis has sparked new and troublesome concerns. One particularly intense controversy has emerged around the value and appropriateness of single disease hospitals. In HIV disease, the single hospital turns out to be an altogether unsuitable and unnecessary innovation. In the instance of tuberculosis, however, it appears to have a critical (...) and legitimate role, particularly for involuntary commitment of patients who have been non-compliant with treatment regimens. To be sure, that role must be carefully circumscribed and the facilities themselves closely monitored. But a hospital dedicated to tuberculosis now occupies a central place in public policy that is not to be found for HIV disease. What considerations promote this difference, and how a single disease hospital for tuberculosis may avoid the pitfalls that make it so inapposite for HIV, are the two questions this essay will be exploring. (shrink)

The Physician Payments Sunshine Act requires health care product manufacturers to report to the federal government payments more than $10 to physicians. Bringing unprecedented transparency to medicine, PPSA holds great potential for enabling medical stakeholders to manage conflicts of interest and build patient trust—crucial responsibilities of medical professionalism. The authors conducted six focus groups with 42 physicians in Chicago, IL, San Francisco, CA, and Washington, DC, to explore attitudes and experiences around PPSA. Participants valued the concept of transparency but were (...) wary of the law's design and consequences. They downplayed PPSA's potential and felt it undermined public trust. Showing broad unawareness of COI, they dismissed the notion of industry influence and welcomed company “perks.” Misapprehensions may leave physicians unprepared to advance the opportunities PPSA holds for professionalism. The authors offer recommendations for government and medicine to improve physicians' and other stakeholders' understandings and use of the data. (shrink)

This essay explores the evolution of the tension between the principles of autonomy and beneficence in American health care over the past several decades. In retrospect it is clear that the social movements of the 1960s and 70s set the tone and the goals for the emergence of a new emphasis on patient autonomy. Indeed, the impact of civil liberties-minded lawyers on the promotion of a commitment to autonomy is far more vital than the term “bioethics” commonly suggests. Tracing the (...) impact of this principle on clinical encounters over the past 25 years makes apparent that consumers have extended their influence over a wide range of treatment decisions. This influence is now being reinforced by an extraordinary information revolution, which includes the computer, the web, the dot.coms, the search engines, and such novel practices as Direct-to-Consumer advertising by pharmaceutical companies. The impact of these developments may be seen in such diverse issues as physician-assisted suicide and the failure of national health insurance initiatives. (shrink)

Book reviewed in this article: Strangers at the Bedside: A History of How Law and Bioethics Transformed Medical Decision Making. By David J. Rothman.

Book reviewed in this article: Conscience and Convenience: The Asylum and its Alternatives in Progressive America. By David J. Rothman.

I argue that virtual reality is a sort of genuine reality. In particular, I argue for virtual digitalism, on which virtual objects are real digital objects, and against virtual fictionalism, on which virtual objects are fictional objects. I also argue that perception in virtual reality need not be illusory, and that life in virtual worlds can have roughly the same sort of value as life in non-virtual worlds.

Doctors’ strikes are legally permissible in the UK, with the situation differing in other countries. But are they morally permissible? Doug McConnell and Darren Mann have systematically attempted to dismiss the arguments for the moral impermissibility of doctors’ strikes and creatively attempted to provide further moral justification for them. Unfortunately for striking doctors, they fail to achieve this. Meanwhile, junior doctors’ strikes have continued in the UK through 2023 and have now extended into 2024. In this response, which focuses on (...) the UK situation and specifically junior doctors’ strikes in the National Health Service (NHS) in England, I will demonstrate a central problem with their arguments—namely that they underplay the harms caused by prolonged doctors’ strikes by ignoring the harms to patients with cancer. This weakens their conclusion that strikes are morally permissible in terms of the conditions and thresholds they set. I then provide a psychological critique of their justification for strikes in terms of the interests of the public. It follows that invoking the controversial concept of supererogatory action is ungrounded but also absurd when you consider time-critical cancer care. If those representing striking doctors wish to maintain a modicum of moral respectability, they should mitigate for patients with cancer and negotiate reasonably and with urgency. (shrink)

I reply to seven commentaries on “The Virtual and the Real”. In response to Claus Beisbart, Jesper Juul, Peter Ludlow, and Neil McDonnell and Nathan Wildman, I clarify and develop my view that virtual are digital objects, with special attention to the nature of digital objects and data structures. In response to Alyssa Ney and Eric Schwitzgebel, I clarify and defend my spatial functionalism, with special attention to the connections between space and consciousness. In response to Marc Silcox, I clarify (...) and develop my view of the value of virtual worlds, with special attention to the case where we experience these worlds as virtual. (shrink)

The book is an extended study of the problem of consciousness. After setting up the problem, I argue that reductive explanation of consciousness is impossible , and that if one takes consciousness seriously, one has to go beyond a strict materialist framework. In the second half of the book, I move toward a positive theory of consciousness with fundamental laws linking the physical and the experiential in a systematic way. Finally, I use the ideas and arguments developed earlier to defend (...) a form of strong artificial intelligence and to analyze some problems in the foundations of quantum mechanics. (shrink)

[This is an edited version of a keynote talk at the conference on Neural Information Processing Systems (NeurIPS) on November 28, 2022, with some minor additions and subtractions.] -/- There has recently been widespread discussion of whether large language models might be sentient or conscious. Should we take this idea seriously? I will break down the strongest reasons for and against. Given mainstream assumptions in the science of consciousness, there are significant obstacles to consciousness in current models: for example, their (...) lack of recurrent processing, a global workspace, and unified agency. At the same time, it is quite possible that these obstacles will be overcome in the next decade or so. I conclude that while it is somewhat unlikely that current large language models are conscious, we should take seriously the possibility that successors to large language models may be conscious in the not-too-distant future. (shrink)

There is a long tradition in philosophy of using a priori methods to draw conclusions about what is possible and what is necessary, and often in turn to draw conclusions about matters of substantive metaphysics. Arguments like this typically have three steps: first an epistemic claim , from there to a modal claim , and from there to a metaphysical claim.

Does consciousness collapse the quantum wave function? This idea was taken seriously by John von Neumann and Eugene Wigner but is now widely dismissed. We develop the idea by combining a mathematical theory of consciousness (integrated information theory) with an account of quantum collapse dynamics (continuous spontaneous localization). Simple versions of the theory are falsified by the quantum Zeno effect, but more complex versions remain compatible with empirical evidence. In principle, versions of the theory can be tested by experiments with (...) quantum computers. The upshot is not that consciousness-collapse interpretations are clearly correct, but that there is a research program here worth exploring. (shrink)

This chapter analyzes aspects of the relationship between consciousness and intentionality. It focuses on the phenomenal character and the intentional content of perceptual states, canvassing various possible relations among them. It argues that there is a good case for a sort of representationalism, although this may not take the form that its advocates often suggest. By mapping out some of the landscape, the chapter tries to open up territory for different and promising forms of representationalism to be explored in the (...) future. In particular, it argues for a nonreductive, narrow, and Fregean variety of representationalism, which contrasts strongly with more widely explored varieties. It concludes with some words about the fundamental relationship between consciousness and intentionality. (shrink)

In the Garden of Eden, we had unmediated contact with the world. We were directly acquainted with objects in the world and with their properties. Objects were simply presented to us without causal mediation, and properties were revealed to us in their true intrinsic glory.

Why is two-dimensional semantics important? One can think of it as the most recent act in a drama involving three of the central concepts of philosophy: meaning, reason, and modality. First, Kant linked reason and modality, by suggesting that what is necessary is knowable a priori, and vice versa. Second, Frege linked reason and meaning, by proposing an aspect of meaning (sense) that is constitutively tied to cognitive signi?cance. Third, Carnap linked meaning and modality, by proposing an aspect of meaning (...) (intension) that is constitutively tied to possibility and necessity. (shrink)

The basic question of ontology is “What exists?”. The basic question of metaontology is: are there objective answers to the basic question of ontology? Here ontological realists say yes, and ontological anti-realists say no. (Compare: The basic question of ethics is “What is right?”. The basic question of metaethics is: are there objective answers to the basic question of ethics? Here moral realists say yes, and moral anti-realists say no.) For example, the ontologist may ask: Do numbers exist? The Platonist (...) says yes, and the nominalist says no. The metaontologist may ask: is there an objective fact of the matter about whether numbers exist? The ontological realist says yes, and the ontological anti-realist says no. Likewise, the ontologist may ask: Given two distinct entities, when does a mereological sum of those entities exist? The universalist says always, while the nihilist says never. The metaontologist may ask: is there an objective fact of the matter about whether the mereological sum of two distinct entities exists? The ontological realist says yes, and the ontological anti-realist says no. Ontological realism is often traced to Quine (1948), who held that we can determine what exists by seeing which entities are endorsed by our best scientific theory of the world. In recent years, the practice of ontology has often presupposed an ever-stronger ontological realism, and strong versions of ontological realism have received explicit statements by Fine (this volume), Sider (2001; this volume), van Inwagen (1998; this volume), and others. (shrink)

What happens when machines become more intelligent than humans? One view is that this event will be followed by an explosion to ever-greater levels of intelligence, as each generation of machines creates more intelligent machines in turn. This intelligence explosion is now often known as the “singularity”. The basic argument here was set out by the statistician I.J. Good in his 1965 article “Speculations Concerning the First Ultraintelligent Machine”: Let an ultraintelligent machine be defined as a machine that can far (...) surpass all the intellectual activities of any man however clever. Since the design of machines is one of these intellectual activities, an ultraintelligent machine could design even better machines; there would then unquestionably be an “intelligence explosion”, and the intelligence of man would be left far behind. Thus the first ultraintelligent machine is the last invention that man need ever make. The key idea is that a machine that is more intelligent than humans will be better than humans at designing machines. So it will be capable of designing a machine more intelligent than the most intelligent machine that humans can design. So if it is itself designed by humans, it will be capable of designing a machine more intelligent than itself. By similar reasoning, this next machine will also be capable of designing a machine more intelligent than itself. If every machine in turn does what it is capable of, we should expect a sequence of ever more intelligent machines. This intelligence explosion is sometimes combined with another idea, which we might call the “speed explosion”. The argument for a speed explosion starts from the familiar observation that computer processing speed doubles at regular intervals. Suppose that speed doubles every two years and will do so indefinitely. Now suppose that we have human-level artificial intelligence 1 designing new processors. Then faster processing will lead to faster designers and an ever-faster design cycle, leading to a limit point soon afterwards. The argument for a speed explosion was set out by the artificial intelligence researcher Ray Solomonoff in his 1985 article “The Time Scale of Artificial Intelligence”.1 Eliezer Yudkowsky gives a succinct version of the argument in his 1996 article “Staring at the Singularity”: “Computing speed doubles every two subjective years of work.. (shrink)

Is there progress in philosophy? A glass-half-full view is that there is some progress in philosophy. A glass-half-empty view is that there is not as much as we would like. I articulate a version of the glass-half-empty view, argue for it, and then address the crucial question of what explains it.

The term ‘emergence’ often causes confusion in science and philosophy, as it is used to express at least two quite different concepts. We can label these concepts _strong_ _emergence_ and _weak emergence_. Both of these concepts are important, but it is vital to keep them separate.

When I say ‘Hesperus is Phosphorus’, I seem to express a proposition. And when I say ‘Joan believes that Hesperus is Phosphorus’, I seem to ascribe to Joan an attitude to the same proposition. But what are propositions? And what is involved in ascribing propositional attitudes?

What is involved in the meaning of our expressions? Frege suggested that there is an aspect of an expression.

The search for neural correlates of consciousness (or NCCs) is arguably the cornerstone in the recent resurgence of the science of consciousness. The search poses many difficult empirical problems, but it seems to be tractable in principle, and some ingenious studies in recent years have led to considerable progress. A number of proposals have been put forward concerning the nature and location of neural correlates of consciousness. A few of these include.

Confronted with the apparent explanatory gap between physical processes and consciousness, there are many possible reactions. Some deny that any explanatory gap exists at all. Some hold that there is an explanatory gap for now, but that it will eventually be closed. Some hold that the explanatory gap corresponds to an ontological gap in nature.

The Matrix presents a version of an old philosophical fable: the brain in a vat. A disembodied brain is floating in a vat, inside a scientist’s laboratory. The scientist has arranged that the brain will be stimulated with the same sort of inputs that a normal embodied brain receives. To do this, the brain is connected to a giant computer simulation of a world. The simulation determines which inputs the brain receives. When the brain produces outputs, these are fed back (...) into the simulation. The internal state of the brain is just like that of a normal brain, despite the fact that it lacks a body. From the brain’s point of view, things seem very much as they seem to you and me. (shrink)

In Philosophy Without Intuitions, Herman Cappelen focuses on the metaphilosophical thesis he calls Centrality: contemporary analytic philosophers rely on intuitions as evidence for philosophical theories. Using linguistic and textual analysis, he argues that Centrality is false. He also suggests that because most philosophers accept Centrality, they have mistaken beliefs about their own methods.To put my own views on the table: I do not have a large theoretical stake in the status of intuitions, but unreflectively I find it fairly obvious that (...) many philosophers, including myself, appeal to intuitions. Cappelen’s arguments make a provocative challenge to this unreflective background conception. So it is interesting to work through the arguments to see what they might and might not show.In what follows I aim to articulate a minimal notion of intuition that captures something of the core everyday philosophical usage of the term, and that captures the sense .. (shrink)

Chapter 1: Two Concepts of Mind. I distinguish the phenomenal and psychological concepts of mind. I argue that every mental state is a phenomenal state, a psychological state, or a hybrid of the two. I discuss the two mind-body problems corresponding to the two concepts of mind, and discuss the various senses of the term “consciousness”. Chapter 2: Supervenience and Explanation. I distinguish varieties of supervenience, especially logical and natural supervenience, where supervening properties covary with base properties across either logically (...) possible or naturally possible worlds. Materialism is the thesis that all positive properties globally metaphysically supervene on microphysical properties. A property is reductively explainable in terms of physical properties if it globally logically supervenes on those properties. (shrink)

In the carefully argued central chapters of Adapting Minds, Buller scrutinizes several of evolutionary psychology's most highly publicized "...

Does the capacity to think require the capacity to sense? A lively debate on this topic runs throughout the history of philosophy and now animates discussions of artificial intelligence. Many have argued that AI systems such as large language models cannot think and understand if they lack sensory grounding. I argue that thought does not require sensory grounding: there can be pure thinkers who can think without any sensory capacities. As a result, the absence of sensory grounding does not entail (...) that large language models cannot think or understand. I also consider to what extent quasi-sensory grounding can at least boost the performance of a language model. (shrink)