Abstract Both parties in the active philosophical debate concerning the conceptual character of perception trace their roots back to Kant's account of sensible intuition in the Critique of Pure Reason. This striking fact can be attributed to Kant's tendency both to assert and to deny the involvement of our conceptual capacities in sensible intuition. He appears to waver between these two positions in different passages, and can thus seem thoroughly confused on this issue. But this is not, in fact, the (...) case, for, as I will argue, the appearance of contradiction in his account stems from the failure of some commentators to pay sufficient attention to Kant's developmental approach to philosophy. Although he begins by asserting the independence of intuition, Kant proceeds from this nonconceptualist starting point to reveal a deeper connection between intuitions and concepts. On this reading, Kant's seemingly conflicting claims are actually the result of a careful and deliberate strategy for gradually convincing his readers of the conceptual nature of perception. (shrink)

In the transcendental deduction, the central argument of the Critique of Pure Reason, Kant seeks to secure the objective validity of our basic categories of thought. He distinguishes objective and subjective sides of this argument. The latter side, the subjective deduction, is normally understood as an investigation of our cognitive faculties. It is identified with Kant’s account of a threefold synthesis involved in our cognition of objects of experience, and it is said to precede and ground Kant’s proof of the (...) validity of the categories in the objective deduction. I challenge this standard reading of the subjective deduction, arguing, first, that there is little textual evidence for it, and, second, that it encourages a problematic conception of how the deduction works. In its place, I present a new reading of the subjective deduction. Rather than being a broad investigation of our cognitive faculties, it should be seen as addressing a specific worry that arises in the course of the objective deduction. The latter establishes the need for a necessary connection between our capacities for thinking and being given objects, but Kant acknowledges that his readers might struggle to comprehend how these seemingly independent capacities are coordinated. Even worse, they might well believe that in asserting this necessary connection, Kant’s position amounts to an implausible subjective idealism. The subjective deduction ismeant to allay these concerns by showing that they rest on a misunderstanding of the relation between these faculties. This new reading of the subjective deduction offers a better fit with Kant’s text. It also has broader implications, for it reveals the more philosophically plausible account of our relation to the world as thinkers that Kant is defending – an account that is largely obscured by the standard reading of the subjective deduction. (shrink)

Attempts to justify the special moral status of human beings over other animals face a well-known objection: the challenge of marginal cases. If we attempt to ground this special status in the unique rationality of humans, then it becomes difficult to see why nonrational humans should be treated any differently than other, nonhuman animals. We respond to this challenge by turning to the social contract tradition. In particular, we identify an important role for the concept of recognition in attempts to (...) secure rights through a social contract. Recognition, which involves identifying with or seeing ourselves as others, is the key to establishing the scope of justice, and we argue that this scope extends to all humans—even the so-called marginal cases—but not to other animals. If this is correct, then we have a principled reason for why all humans have certain rights that other animals lack. (shrink)

Plato’s tripartite soul plays a central role in his account of justice in the Republic. It thus comes as a surprise to find him apparently abandoning this model at the end of the work, when he suggests that the soul, as immortal, must be simple. I propose a way of reconciling these claims, appealing to neglected features of the city-soul analogy and the argument for the soul’s division. The original true soul, I argue, is partitioned, but in a finer manner (...) than how we encounter it in our everyday lives. (shrink)

This work examines Kant’s remarkable decision to rewrite the core argument of the first Critique, the Transcendental Deduction of the Categories. I identify a two-part structure common to both versions: first establishing an essential role for the categories in unifying sensible intuitions; and then addressing a worry about how the connection between our faculties asserted in the first part is possible. I employ this structure to show how Kant rewrote the argument, focusing on Kant’s response to the concerns raised in (...) an early review by Johann Schultz. Schultz’s dissatisfaction with the original Deduction lies in its second part, and Kant’s subsequent revisions are focused on providing a better answer to this how-possible question. The new Deduction offers a more direct and convincing account of how our faculties work together to make experience possible. (shrink)

This book’s lead title seemed to make it a natural for review in the Journal of Scientific Exploration; but it is the subtitle that properly describes the contents: It deals almost exclusively with South African controversies, about HIV/AIDS in particular and medical matters more generally. Still, there are points of general interest. When a belief does not correspond to reality, the believers can go far astray in their actions and their recounting and explicating of events. So it is with this (...) book, which is based on the mistaken notion that a retrovirus designated HIV causes fatal illness—AIDS—by destroying the immune system. Readers should also beware of the frequently used but entirely misleading terms “AIDS denialist” and “AIDS denialism”: No one denies the existence of AIDS. What is denied is that AIDS is a new syndrome and that HIV is its cause. “Cognitive dissonance” refers to the fact of human psychology that makes it essentially impossible for true believers to recognize—to see, to take in—evidence that falsifies their belief. The classic description was by Festinger, Riecken, and Schachter (1956). Cognitive dissonance is rampant among those who have accepted HIV/AIDS theory, and this book illustrates it. (shrink)

In “Justice at the Margins: The Social Contract and the Challenge of Marginal Cases” (Southern Journal of Philosophy, 55.1), Nathan Bauer and David Svolba appeal to a concept of recognition found in social contract theory to argue that all humans, including humans who lack certain unique cognitive abilities, so‐called marginal cases, have rights that nonhuman animals lack. The main reason is that we can recognize ourselves in all humans, but not in nonhuman animals. I argue (i) that it (...) is unclear that we can recognize ourselves in certain types of marginal cases, such as corpses and embryos; (ii) that Bauer and Svolba’s reason for why we cannot recognize ourselves in nonhuman animals is questionable; and (iii) if we can recognize ourselves in any types of marginal cases, then we should be able to recognize ourselves in nonhuman animals. (shrink)

I defend the widely-held view that morally worthy action need not be motivated by a desire to promote rightness as such. Some have recently come to reject this view, arguing that desires for rightness as such are necessary for avoiding a certain kind of luck thought incompatible with morally worthy action. I show that those who defend desires for rightness as such on the basis of this argument misunderstand the relationship between moral worth and the kind of luck that their (...) argument employs. Consequently, the argument provides no reason to doubt the popular view that a desire for rightness as such is no part of virtue. I conclude by suggesting that a family of worries about merely accidentally right action presuppose one side of the recent debate about objectivism and perspectivism about moral rightness. (shrink)

Inflicting harm is generally preferable to inflicting death. If you must choose between the two, you should generally choose to harm. But prenatal harm seems different. If a mother must choose between harming her fetus or aborting it, she may choose either, at least in many cases. So it seems that prenatal harm is particularly objectionable, sometimes on a par with death. This paper offers an explanation of why prenatal harm seems particularly objectionable by drawing an analogy to the all-or-nothing (...) problem. It then argues that this analogy offers independent support for the ‘voluntarist’ view that at least some parental role obligations are grounded in the choice to be a parent. (shrink)

The concept of a reason is now central to many areas of contemporary philosophy. Key theses in ethics, epistemology, political philosophy, philosophy of action, and the philosophy of the emotions, among others, have come to be framed in terms of reasons. And yet, despite their centrality, theorists seem to take inconsistent things for granted about how reasons work, what kinds of things can be reasons, what reasons favor, and more. Somehow reasons have come to be both indispensable and impenetrable. -/- (...) The Fundamentals of Reasons offers a comprehensive introduction to the philosophy of reasons. Focusing on the twin roles of reasons in explanation and deliberation, the book not only emphasizes what has made reasons central across philosophy but it also explores why philosophers have such incompatible pictures about what reasons are and how they work. Working from the inside out, Howard and Schroeder identify contentious assumptions about not only the internal structure of reasons but also their relationship to other important concepts, and then show how these contentious assumptions shape the many downstream applications of reasons in ethics, epistemology, political philosophy, and beyond. -/- This mildly opinionated exploration of key questions about the significance and nature of reasons helps the reader to navigate this important part of the philosophical landscape and to get clearer about why reasons seem important and what their import, ultimately, is. (shrink)

I argue that Davidson's conception of motivating reasons as belief-desire pairs suggests a model of normative reasons for action that is superior to the orthodox conception according to which normative reasons are propositions, facts, or the truth-makers of such facts.

While it is tempting to suppose that an act has moral worth just when and because it is motivated by sufficient moral reasons, philosophers have, largely, come to doubt this analysis. Doubt is rooted in two claims. The first is that some facts can motivate a given act in multiple ways, not all of which are consistent with moral worth. The second is the orthodox view that normative reasons are facts. I defend the tempting analysis by proposing and defending a (...) heterodox account of both normative and motivating reasons that is inspired by Donald Davidson’s primary reasons. We should adopt the heterodox view, I argue, because it addresses an overlooked but fatal defect in the orthodox conception of reasons, of which challenges to the tempting analysis are a special case. (shrink)

This book argues that Hume is a radical epistemic skeptic who gives only practical reasons for retaining belief in sensory beliefs and the deliverances of reason. He advises us to take a moderate approach to the demands of philosophy, since they sometimes diverge from the demands of life.

Philosophers have recently come to focus on explaining the phenomenon of ​bad beliefs,​ beliefs that are apparently true and well-evidenced but nevertheless objectionable. Despite this recent focus, a consensus is already forming around a particular explanation of these beliefs’ badness called ​moral encroachment​, according to which, roughly, the moral stakes engendered by bad beliefs make them particularly difficult to justify. This paper advances an alternative account not just of bad beliefs but of bad attitudes more generally according to which bad (...) beliefs’ badness originates not in a failure of sufficient evidence but in a failure to respond adequately to reasons. I motivate this alternative account through an analogy to recent discussions of moral worth centered on the well-known grocer case from Kant’s ​Groundwork​, and by showing that this analogy permits the proposed account to generalize to bad attitudes beyond belief. The paper concludes by contrasting the implications of moral encroachment and of the proposed account for bad attitudes’ blameworthiness. (shrink)

I propose and defend a novel view called “de se consequentialism,” which is noteworthy for two reasons. First, it demonstrates—contra Doug Portmore, Mark Schroeder, Campbell Brown, and Michael Smith, among others—that agent-neutral consequentialism is consistent with agent-centered constraints. Second, it clarifies the nature of agent-centered constraints, thereby meriting attention from even dedicated nonconsequentialists. Scrutiny reveals that moral theories in general, whether consequentialist or not, incorporate constraints by assessing states in a first-personal guise. Consequently, de se consequentialism enacts constraints through the (...) very same feature that nonconsequentialist theories do. (shrink)

This paper is broadly concerned with Deleuze’s distinction between ‚la loi et les lois’ on the one hand, and jurisprudence on the other. Jurisprudence is the␣creative action of legal practice, the process by which it is forced to think constructively and anew. In such circumstances legal thought is akin to Deleuze’s concept of the event. I explore the distinction between law and jurisprudence by way of Deleuze’s comments on control societies, arguing that, under control, law ceases to be a juridical (...) hierarchy conforming to disciplinary modes to become a regulatory practice of interminable modulation. In order to begin to explore the relations and connections between law/jurisprudence and control, the paper will look to the semiotics of C.S. Peirce (who influenced Deleuze’s work on cinema). In particular it will argue that control operates predominantly through icons. As a consequence I argue that the proper ground of the sign, the event, is co-opted and, following from this, that control functions through the confusing of sense and meaning. (shrink)

A major point of debate about morally good motives concerns an ambiguity in the truism that good and strong-willed people desire to do what is right. This debate is shaped by the assumption that “what’s right” combines in only two ways with “desire,” leading to distinct de dicto and de re readings of the truism. However, a third reading of such expressions is possible, first identified by Janet Fodor, which has gone wholly unappreciated by philosophers in this debate. I identify (...) Fodor’s nonspecific reading of “desire to do what’s right” and briefly discuss its merits. (shrink)

Need considerations play an important role in empirically informed theories of distributive justice. We propose a concept of need-based justice that is related to social participation and provide an ethical measurement of need-based justice. The β-ε-index satisfies the need-principle, monotonicity, sensitivity, transfer and several »technical« axioms. A numerical example is given.

In his recent article, Ben-Moshe offers an account of conscientious objection in terms of the truth of the underlying moral objections, as judged by the standards of an impartial spectator. He seems to advocate for the view that having a valid moral objection to X is the sole criteria for the instantiation of a right to conscientiously object to X, and seems indifferent to the moral status of the prevailing moral attitudes. I argue that the moral status of the prevailing (...) moral attitudes is relevant, and that a good faith disagreement between those who condone the relevant act and those who object to it is a criterion for CO. In this light, I suggest that CO is a sociopolitical device for managing differing ethical perspectives, particularly in the context of collective moral change. Thus, it is misguided to equate having a valid moral objection with the recognition of a CO. (shrink)

InWhere the ethical action is, Hardman and Hutchinson make some interesting and compelling points about the way in which ‘the ethical’—various values and various kinds of values—are embedded in everyday life, including the everyday life one finds in clinical interactions, understood as scientific or scientifically informed activities. However, even when one considers ‘the ethical’ from within the horizon of understanding adopted in their essay, they neglect several important features of healthcare and medical education. In this rejoinder, I argue that a (...) fuller understanding would go some way to indicating the complexity of ethics and ‘ethical action’ in the clinic, as well as the nature of and need for ‘expert’ analysis and philosophical reflection on the ethical questions that modern healthcare continues to engender. (shrink)

This volume represents an important contribution to Peirce’s work in mathematics and formal logic. An internationally recognized group of scholars explores and extends understandings of Peirce’s most advanced work. The stimulating depth and originality of Peirce’s thought and the continuing relevance of his ideas are brought out by this major book.

This volume represents an important contribution to Peirce’s work in mathematics and formal logic. An internationally recognized group of scholars explores and extends understandings of Peirce’s most advanced work. The stimulating depth and originality of Peirce’s thought and the continuing relevance of his ideas are brought out by this major book.

Policies and position statements regarding decision-making for extremely premature babies exist in many countries and are often directive, focusing on parental choice and expected outcomes. These recommendations often state survival and handicap as reasons for optional intervention. The fact that such outcome statistics would not justify such approaches in other populations suggests that some other powerful factors are at work. The value of neonatal intensive care has been scrutinized far more than intensive care for older patients and suggests that neonatal (...) care is held to a higher standard of justification. The relative value placed on the life of newborns, in particular the preterm, is less than expected by any objective medical data or any prevailing moral frameworks about the value of individual lives. Why do we feel less obligated to treat the premature baby? Do we put newborns in a special and lesser moral category? We explore this question from a legal and ethical perspective and offer several hypotheses pertaining to personhood, reproductive choices, “precious children,” and probable evolutionary and anthropological factors. (shrink)

The wrong kind of reason (WKR) problem is a problem for attempts to analyze normative properties using only facts about the balance of normative reasons, a style of analysis on which the ‘Reasons First’ programme depends. I argue that this problem cannot be solved if the orthodox view of reasons is true --- that is, if each normative reason is numerically identical with some fact, proposition, or state-of-affairs. That’s because solving the WKR problem requires completely distinguishing between the right- and (...) wrong-kind reasons for an attitude. I argue that some facts give both right- and wrong-kind reasons for an attitude. Consequently, no such distinction between the two types of reasons is complete if reasons are facts or the like. I conclude by suggesting that reasons and facts are related by constitution, not identity. (shrink)

While there is a great deal to agree with in the essay Expanded Terminal Sedation in End-of-Life Care there is, we think, a need to more fully appreciate the humanistic side of both palliative and end-of-life care.1 Not only does the underlying philosophy of palliative care arguably differ from that which guides curative medicine,2 dying patients are in a uniquely vulnerable position given our cultural disinclination towards open discussions of death and dying. In this brief response, we critically engage Gilbertson (...) et al ’s essay and seek to contextualise the perspective they put forward. According to Cassell, we should distinguish between pain and suffering.3 The former often gives rise to the latter, but suffering has other causes. This includes existential distress, indicating that, unlike pain, suffering is not simply physiological phenomena. Suffering involves the disintegration of the person, meaning that it can impact patient autonomy. Certainly, that a patient is suffering does not equate to a lack autonomy. Nevertheless, we should take care when making decisions in circumstance where the integrity of our embodied personhood is under threat, something that is clearly the case for those who are dying, particularly those who have refractory symptoms while doing so. Generally speaking, refractory symptoms are those which are intractable. They persist despite attempts at palliation. While this implies that such symptoms—and the suffering they cause—cannot be reversed this is not necessarily the case. Not only can the symptoms experienced by dying patients change …. (shrink)

With few exceptions, the literature on withdrawing and withholding life-saving treatment considers the bare fact of withdrawing or withholding to lack any ethical significance. If anything, the professional guidelines on this matter are even more uniform. However, while no small degree of progress has been made toward persuading healthcare professionals to withhold treatments that are unlikely to provide significant benefit, it is clear that a certain level of ambivalence remains with regard to withdrawing treatment. Given that the absence of clinical (...) benefit means treating patients is not only ethically questionable but also taxing on resources that could meet the needs of others, this ambivalence is troubling. Equally, the enduring ambivalence of professionals might be taken to indicate that the issue warrants further attention. In this paper, we review the academic literature on the ethical equivalence of withdrawing and withholding medical treatment. While we are not in outright disagreement with the arguments presented, we suggest that asserting theoretical and decontextualized claims about the ethical equivalence of withdrawing and withholding life-saving treatment does not fully illuminate the moral questions associated with the relevant clinical realities. We argue that what is required is a broader perspective, one rooted in an understanding that withdrawing and withholding life-saving treatment are different practices, the meanings of which are fully comprehensible only through an appreciation of their place within the practice of healthcare more generally. Such an account suggests that if one is to engage with the inappropriate protraction of life-saving treatment resulting from healthcare professionals’ disinclination to withdraw it, then the differences between these practices should be taken seriously. (shrink)

Until recently, Northern Ireland was infamous for having one of the most restrictive legal frameworks for abortion in Europe. This meant that few were performed in the country, and those who wished to terminate a pregnancy were forced to travel to other parts of the UK or further afield. In 2019 a continuing political stalemate in Northern Ireland has indirectly resulted in the relevant legislation recently being repealed by the UK government. For a short time, this meant that the legal (...) position in Northern Ireland regarding abortion became one of the most permissive in Europe. This short paper sets out the current position and, in the light of the political and legislative roadmap set out by the Northern Ireland Office, identifies and briefly discusses some potential problems that might arise. Most notable are the points raised with regard to conscientious objection. Specifically, the potential for developments in Northern Ireland to further calls for healthcare professional’s ability to rely upon conscientious objection to be removed. (shrink)

This paper takes the philosophical notion of suberogatory acts or morally permissible moral mistakes and, via a reinterpretation of a thought experiment from the medical ethics literature, offers an initial demonstration of their relevance to the field of medical ethics. That is, at least in regards to this case, we demonstrate that the concept of morally permissible moral mistakes has a bearing on medical decision-making. We therefore suggest that these concepts may have broader importance for the discourse on medical ethics (...) and should receive fuller consideration by those working the field. The focus of the discussion we present is on a particular thought experiment originally presented by Sulmasy and Sugarman. Their case formed the basis of an exchange about the moral equivalence of withdrawing and withholding life-saving treatment. The analysis Sulmasy and Sugarman set out is significant because, contrary to common bioethical opinion, it implies that the difference between withdrawing and withholding life-saving treatment holds, rather than lacks, moral significance. Following a brief discussion of rejoinders to Sulmasy and Sugarman’s article, we present a constructive reinterpretation of the thought experiment, one that draws on the idea of suberogatory acts or “morally permissible moral mistakes.” Our analysis, or so we suggest, accounts for the differing moral intuitions that the case prompts. However, it also calls into question the degree to which this thought experiment can be thought of as illustrating the moral equivalence of withdrawing and withholding life-saving treatment. Rather, we conclude that it primarily illuminates something about the ethical parameters of healthcare when family members, particularly parents, are involved in decision-making. (shrink)

Steve Awodey and Audrej Bauer. Sheaf Toposes for Realizability.

Sperm sharing arrangements involve a man (‘the sharer’) allowing his sperm to be used by people seeking donor sperm (‘the recipients’) in exchange for reduced price in vitro fertilisation. Clinics in the UK have offered egg sharing since the 1990s and the arrangement has been subjected to regulatory oversight and significant ethical analysis. By contrast, until now no published ethical or empirical research has analysed sperm sharing. Moreover the Human Fertilisation and Embryology Authority (HFEA) does not record the number of (...) sperm sharing arrangements taking place.This paper describes the sperm sharing process providing an analysis of all the UK clinics advertising sperm sharing services. The ethical rationale for egg sharing is described: reducing the number of women exposed to the risks of stimulation and retrieval. This advantage is absent in sperm sharing where donation has no physical drawbacks. The key adverse social and emotional outcome of gamete sharing arises when the sharer’s own treatment is unsuccessful and the recipient’s is successful. This outcome is more likely in sperm sharing than in egg sharing given sperm from sharers can be used by up to 10 families whereas shared eggs only go to one other family.Given its morally relevant differences from egg sharing, sperm sharing requires its own ethical analysis. The HFEA should begin recording sperm sharing arrangements in order to enable meaningful ethical and policy scrutiny. (shrink)

Some rules seem more important than others. The moral rule to keep promises seems more important than the aesthetic rule not to wear brown with black or the pool rule not to scratch on the eight ball. A worrying number of metaethicists are increasingly tempted to explain this difference by appealing to something they call “authoritative normativity” – it’s because moral rules are “authoritatively normatively” that they are especially important. The authors of this chapter argue for three claims concerning “authoritative (...) normativity”: (1) that motivation for it originates in a parochial conception of “normative flavours”; (2) that arguments against alternative ways of explaining e.g., morality’s importance are overblown; and (3) that there are strong reasons against theorizing in terms of “authoritative normativity”. The overarching aim is not to show that “authoritative normativity” is incoherent or entirely unmotivated. Rather, it is to discuss some of “authoritative normativity’s” deeper commitments to correct the impression that is it largely benign or that it is entailed by familiar and popular “metanormative” positions. Authoritative normativity, it seems to us, is a solution in search of a problem. (shrink)

Hume is justly famous for his criticisms of theistic proofs. However, what is less well-known is that Hume also criticized the claim that belief in God, simply because it is natural, is justified without supporting argument. Hume certainly encountered this claim in his own Protestant milieu, as various textual clues throughout his corpus indicate. His own endorsement of natural beliefs raises the possibility that religious belief might be justified without argument. One of Hume's chief aims in The Natural History of (...) Religion was to show that religious belief is not natural in a way that makes it justified without argument. (shrink)

This paper considers the roles and definitions of expert and lay members of ethics committees, focussing on those given by the National Research Ethics Service which is mandated to review all research conducted in National Health Service settings in the United Kingdom. It questions the absence of a specified position for the ‘professional ethicist’ and suggests that such individuals will often be lay members of ethics committees, their participation being a reflection of their academic interest and expertise. The absence of (...) a specified position for professional ethicists and the concomitant but implicit denial of ethical expertise appear to be an anomalous state of affairs if one considers that the training offered to members of ethics committees is often delivered by academic ethicists. It is suggested that this is based on a misunderstanding of the concept ‘ethical expertise’ and that properly understood the ethicist can assist the work of ethics committees by drawing on their expert knowledge. (shrink)

Although some doctors celebrated when the Court of Appeal overturned Hadiza Bawa-Garba’s erasure from the medical register, it is argued here that in many ways the ruling is by no means good news for the medical profession. Doctors’ interests are served by transparent professional tribunals but the Court of Appeal’s approach to the GMC Sanctions Guidance risks increasing opacity in decision-making. Close attention to systemic factors in the criminal trial protects doctors yet the Court of Appeal states that the structural (...) circumstances surrounding Bawa-Garba’s failings were only of peripheral relevance to her conviction. Public confidence in the profession is undermined when convicted doctors return to work because the public de facto do not understand the nuance of gross negligence manslaughter law. Rather than changing the law to make the regulator more lenient towards doctors, it would be better to ensure that doctors are only convicted of gross negligence manslaughter when their conduct is so serious that they ought to be struck off. (shrink)

We previously showed that owner personality and human-dog relationship predicted the performance of a human-dog dyad in a practical task. Based on the same data set we presently investigate the effects of individual and social factors on the social attraction of dogs to their owners. Twenty-two male and female owners and their intact male dogs were observed during a “picture viewing” test, where we diverted the owner's attention away from their dog whilst it was permitted to move freely around the (...) room. Owner personality axis “neuroticism” and dog personality axis “vocal and aggressive” were, respectively, positively and negatively related to the time the dog stayed in proximity to the owner. Quality of relationship and attachment also had significant effects on this proximity. We conclude that personality and the nature of the human-dog relationship may all influence dogs' social attraction to their owners. (shrink)

BACKGROUND Patients with chronic pain face significant barriers in finding clinicians to manage long-term opioid therapy (LTOT). For patients on LTOT, it is increasingly common to have them sign opioid treatment agreements (OTAs). OTAs enumerate the risks of opioids, as informed consent documents would, but also the requirements that patients must meet to receive LTOT. While there has been an ongoing scholarly discussion about the practical and ethical implications of OTA use in the abstract, little is known about how clinicians (...) use them and if OTAs themselves modify clinician prescribing practices. OBJECTIVE To determine how clinicians use OTAs and the potential impacts of OTAs on opioid prescribing. DESIGN We conducted qualitative analysis of four focus groups of clinicians from a large Midwestern academic medical center. Groups were organized according to self-identified prescribing patterns: two groups for clinicians who identified as prescribers of LTOT, and two who did not. PARTICIPANTS 17 clinicians from General Internal Medicine, Family Medicine, and Palliative Care were recruited using purposive, convenience sampling. APPROACH Discussions were recorded, transcribed, and analyzed for themes using reflexive thematic analysis by a multidisciplinary team. KEY RESULTS Our analysis identified three main themes: (1) OTAs did not influence clinicians’ decisions whether to use LTOT generally but did shape clinical decision-making for individual patients; (2) clinicians feel OTAs intensify the power they have over patients, though this was not uniformly judged as harmful; (3) there is a potential misalignment between the intended purposes of OTAs and their implementation. CONCLUSION This study reveals a complicated relationship between OTAs and access to pain management. While OTAs seem not to impact the clinicians’ decisions about whether to use LTOT generally, they do sometimes influence prescribing decisions for individual patients. Clinicians shared complex views about OTAs’ purposes, which shows the need for more clarity about how OTAs could be used to promote shared decision-making, joint accountability, informed consent, and patient education. (shrink)

I argue that the vulgar belief in continued and distinct existences, as Hume describes it in Treatise 1.4.2, “Of Scepticism with Regard to the Senses,” is defeasibly justified. Prior to and apart from the rebutting defeater that Hume brings forward as an argument from perceptual relativity in paragraphs 44 and 45, the vulgar belief is perfectly in order, philosophically speaking. For Hume, a belief is defeasibly justified if and only if it is produced by permanent, irresistible, and universal principles of (...) the imagination. The vulgar belief meets these conditions and thus is defeasibly justified—even though it suffers eventual defeat. (shrink)

"... a first-rate edition, which supersedes all other portable Peirces.... all the Peirce most people will ever need." —Louis Menand, The New York Review of Books "The Monist essays are included in the first volume of the compact and welcome Essential Peirce; they are by Peirce’s standards quite accessible and splendid in their cosmic scope and assertiveness."—London Review of Books A convenient two-volume reader’s edition makes accessible to students and scholars the most important philosophical papers of the brilliant American thinker (...) Charles Sanders Peirce. This first volume presents twenty-five key texts from the first quarter century of his writing, with a clear introduction and informative headnotes. Volume 2 will highlight the development of Peirce’s system of signs and his mature pragmatism. (shrink)

Understanding individual differences in cognitive performance is an important part of understanding how variations in underlying cognitive processes can result in variations in task performance. However, the exploration of individual differences in the components of the decision process—such as cognitive processing speed, response caution, and motor execution speed—in previous research has been limited. Here, we assess the heritability of the components of the decision process, with heritability having been a common aspect of individual differences research within other areas of cognition. (...) Importantly, a limitation of previous work on cognitive heritability is the underlying assumption that variability in response times solely reflects variability in the speed of cognitive processing. This assumption has been problematic in other domains, due to the confounding effects of caution and motor execution speed on observed response times. We extend a cognitive model of decision‐making to account for relatedness structure in a twin study paradigm. This approach can separately quantify different contributions to the heritability of response time. Using data from the Human Connectome Project, we find strong evidence for the heritability of response caution, and more ambiguous evidence for the heritability of cognitive processing speed and motor execution speed. Our study suggests that the assumption made in previous studies—that the heritability of cognitive ability is based on cognitive processing speed—may be incorrect. More generally, our methodology provides a useful avenue for future research in complex data that aims to analyze cognitive traits across different sources of related data, whether the relation is between people, tasks, experimental phases, or methods of measurement. (shrink)