Background Researchers are required to determine whether a person has capacity to consent to a research study before they are able to participate. The Mental Capacity Act and accompanying Code of Practice for England and Wales provide some guidance on this process, but researchers have identified that it can be difficult to determine capacity to consent when a person has complex cognitive or communication needs. This study aimed to understand the experiences and opinions of researchers who recruit people with dementia (...) to research projects, to inform the future development of training resources. Methods A mixed method, cross-sectional, electronic survey was circulated via social media and research networks in England and Wales. The survey remained open for ten weeks and included open and closed questions exploring respondents’ confidence in determining capacity in the context of recruiting people with dementia to consent, their views on training and support they have experienced and their suggestions for future training and support needs. Results 60 respondents completed the survey from across England and Wales. Although 75% of respondents had experience of determining capacity to consent with people with dementia to research, only 13% rated themselves as feeling ‘very confident’ in this. Qualitative content analysis of open responses led to the generation of six themes, explaining researchers’ confidence, competence and future training needs in this area: (1) Researcher uncertainties, (2) Lack of time, (3) Balancing information complexity with accessibility, (4) Gatekeepers, (5) Existing enablers and (6) Envisioning future training. Conclusions Researchers would benefit from specific training in undertaking conversations around consent with people with dementia. People with dementia may have fluctuating capacity, and despite support from caregivers, researchers have little practical guidance on methods of determining a person’s ability to understand or appreciate the information they have provided during the consent process. Given the development of large complex trials within dementia research, there is an urgency to develop specific and practical guidance and training for researchers working with people with dementia and their families. (shrink)

Research involving adults who lack capacity to consent relies on proxy (or surrogate) decision making. Proxy decisions about participation are ethically complex, with a disparity between normative accounts and empirical evidence. Concerns about the accuracy of proxies’ decisions arise, in part, from the lack of an ethical framework which takes account of the complex and morally pluralistic world in which proxy decisions are situated. This qualitative study explored the experiences of family members who have acted as a research proxy in (...) order to develop an understanding of the ethical concepts involved, and the interactions between those concepts. Proxies described a complex process of respecting the wishes and preferences of the person they represented, whist integrating preferences with what they viewed as being in the interests of the person. They aimed to make a decision that was ‘best’ for the person and protected them from harm; they also aimed to make the ‘right’ decision, viewed as being authentic to the person’s values and life. Decisions were underpinned by the relationship between the person and their proxy, in which both trust and trustworthiness were key. Proxies’ decisions, based both on respect for the person and the need to protect their interests, arose out of their dual role as both proxy and carer. The findings raise questions about accounts which rely on existing normative assumptions with a focus on accuracy and discrepancy, and which fail to take account of the requirement for proxies to make authentic decisions that arise out of their caring obligations. (shrink)

ObjectiveTo examine health and social care professionals’ understanding of the legislation governing research involving adults lacking mental capacity in England and Wales.MethodsA cross-sectional online survey was conducted using a series of vignettes. Participants were asked to select the legally authorised decision-maker in each scenario and provide supporting reasons. Responses were compared with existing legal frameworks and analysed according to their level of concordance.ResultsOne hundred and twenty-seven professionals participated. Levels of discordance between responses and the legal frameworks were high across all (...) five scenarios. Nearly half of the participants provided responses that were discordant in all scenarios. Only two participants provided concordant responses across all five scenarios.DiscussionParticipants demonstrated a lack of knowledge about the legal frameworks, the locus of authority and the legal basis for decision-making. The findings raise concern about the accessibility of research for those who lack capacity, the ability to conduct research involving such groups and the impact on the evidence base for their care.ConclusionThis is the first study to examine health and social care professionals’ knowledge and understanding of the dual legal frameworks in the UK. Health and social care professionals’ understanding and attitudes towards research involving adults with incapacity may warrant further in-depth exploration. The findings from this survey suggest that greater training and education is required. (shrink)

People who are unable to make decisions about participating in research rely on proxies to make a decision based on their wishes and preferences. However, patients rarely discuss their preferences about research and proxies find it challenging to determine what their wishes would be. While the process of informed consent has traditionally been the focus of research to improve consent decisions, the more conceptually complex area of what constitutes ‘good’ proxy decision-making for research has remained unexplored. Interventions are needed to (...) improve and support proxy decision-making for research but are hampered by a lack of understanding about what constitutes decision quality in this context. A global increase in conditions associated with cognitive impairment such as dementia has led to an urgent need for more research into these conditions. The COVID-19 pandemic and subsequent necessity to conduct research with large numbers of critically ill patients has made this need even more pressing. Much of the empirical research centres on the desire to improve decision accuracy, despite growing evidence that authenticity is more reflective of the aim of proxy decisions and concerns about the methodological flaws in authenticity-focused studies. Such studies also fail to take account of the impact of decision-making on proxies, or the considerable body of research on improving the quality of healthcare decisions. This paper reports a concept synthesis of the literature that was conducted to develop the first conceptualisation of ‘good’ proxy decisions about research participation. Elements of decision quality were identified across three stages of decision-making: proxy preparedness for decision-making which includes knowledge and understanding, and values clarification and preference elicitation; the role of uncertainty, decisional conflict, satisfaction and regret in the decision-making process; and preference linked outcomes and their effect. This conceptualisation provides an essential first step towards the future development of interventions to enhance the quality of proxy decision-making and ensure proxy decisions represent patients’ values and preferences. (shrink)

Society is failing in its moral obligation to improve the standard of healthcare provided to vulnerable populations, such as people who lack decision making capacity, by a misguided paternalism that seeks to protect them by excluding them from medical research. Uncertainties surround the basis on which decisions about research participation is made under dual regulatory regimes, which adds further complexity. Vulnerable individuals’ exclusion from research as a result of such regulation risks condemning such populations to poor quality care as a (...) result of ‘evidence biased’ medicine. This paper explores the research regulation provisions for proxy decision making for those unable to provide informed consent for themselves, and the subsequent legal and practical difficulties for decision-makers. There are two separate regulatory regimes governing research involving adults who lack capacity to consent in England and Wales. The Mental Capacity Act 2005 governs how incapacitated adults can be involved in research, however clinical trials of medicinal products are separately regulated by the Medicines for Human Use Regulations 2004. There are significant differences under these dual regimes in the provisions for those lacking capacity to participate in medical research. The level of risk permitted differs, with a greater requirement for justification for participation in a clinical trial than other types of research. Who acts as proxy decision maker, how much information is provided to the person lacking capacity, and whether they retain the power of veto also significantly differs. The development of two separate regulatory regimes has resulted in significant differences between the provisions for clinical trials and other forms of research, and from usual medical practice. The resulting uncertainty has reinforced the tendency of those approving and conducting research to exclude adults lacking capacity to avoid difficult decisions about seeking consent for their participation. Future developments, such as the incoming EU Regulations, may address some of these differences, however the justification and level of risk permitted requires review to ensure that requirements are appropriate and proportionate to the burdens and risks for the individual, and also to the benefits for the wider population represented. (shrink)

Background: Research involving adults lacking mental capacity relies on the involvement of a proxy or surrogate, although this raises a number of ethical concerns. Empirical studies have examined attitudes towards proxy decision-making, proxies’ authority as decision-makers, decision accuracy, and other relevant factors. However, a comprehensive evidence-based account of proxy decision-making is lacking. This systematic review provides a synthesis of the empirical data reporting the ethical issues surrounding decisions made by research proxies, and the development of a conceptual framework of proxy (...) decision-making for research. Methods: A systematic review was conducted according to PRISMA guidelines. Databases including MEDLINE, EMBASE, and CINAHL were searched using a combination of search terms, and empirical data from eligible studies were retrieved. The review followed the framework synthesis approach to refine and develop a conceptual framework. Results: Thirty-four studies were included in the review. Two dimensions of proxy decision-making emerged. The ethical framing criteria of decision-making used by proxies: use of a substituted judgement, use of a best interests approach, combination of substituted judgement and best interests, and ‘something else’, and the active elements of proxy decision-making: ‘knowing the person’, patient-proxy relationship, accuracy of the decision, and balancing risks, benefits and burdens, and attitudes towards proxy decision-making. Interactions between the framing criteria and the elements of decision-making are complex and contextually-situated. Conclusions: The findings from this systematic review challenge the accepted reductionist account of proxy decision-making. Decision-making by research proxies is highly contextualized and multifactorial in nature. The choice of proxy and the relational features of decision-making play a fundamental role: both in providing the proxy’s authority as decision-maker, and guiding the decision-making process. The conceptual framework describes the relationship between the framing criteria used by the proxy, and the active elements of decision-making. Further work to develop, and empirically test the proposed framework is needed. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:"The Fittest Man in the Kingdom":Thomas Reid and the Glasgow Chair of Moral PhilosophyPaul Wood (bio)Paul Wood Paul Wood is at the Department of History, University of Victoria, PO Box 3045, MS 7381, Victoria BC V8W 3P4 Canada. email: [email protected] August 1996Revised January 1997Notes. An earlier version of this paper was delivered at a plenary session of the 23rd International Hume Conference held at the University of (...) Nottingham. For comments and/or references, the author wishes to thank Roger Emerson, Carol Gibson-Wood, Knud Haakonssen, Ian Simpson Ross, Stephen Snobelen, M. A. Stewart, and the anonymous Hume Studies referees. For permission to cite and quote from manuscripts, he is grateful to the Keeper of the Manuscripts of Scotland as well as to the Librarians of Aberdeen University Library, Edinburgh University Library, Glasgow University Archives and Business Records Centre, Glasgow University Library (Department of Special Collections), the Mitchell Library Glasgow, and Dr. Williams' Library.1. Although little information survives regarding Law's teaching, we do know that he discussed Pufendorf in his classes; see Christine Mary King [Shepherd], "Philosophy and Science in the Arts Curriculum of the Scottish Universities in the Seventeenth Century," (Unpublished Ph.D. Dissertation, University of Edinburgh, 1974), 177. Carmichael's edition of Pufendorf first appeared in Glasgow in 1718, and a second edition was published in Edinburgh in 1724 while Hume was still a student there.2. The surviving correspondence between the two men from this period is to be found in The Letters of David Hume, ed. J.Y.T. Greig, 2 vols. (Oxford: Clarendon Press, 1932), I 32-35; 36-40; 45-48 (hereafter abbreviated as HL).3. The first detailed discussion of the 1745 election appeared in the introduction to David Hume, A Letter from a Gentleman to His Friend in Edinburgh, edited by Ernest C. Mossner and John V. Price (Edinburgh: Edinburgh University Press, 1967). This account has recently been challenged in Roger L. Emerson, "The 'Affair' at Edinburgh and the 'Project' at Glasgow: The Politics of Hume's Attempts to become a Professor," in Hume and Hume's Connexions, edited by M. A. Stewart and John P. Wright (Edinburgh: Edinburgh University Press, 1994), 1-22; and M. A. Stewart, The Kirk and the Infidel (Lancaster: Lancaster University Publications Office, 1995). For historically sensitive contextual analysis of Hume's philosophical relations with Hutcheson, see inter alia James Moore, "Hume and Hutcheson," in Stewart and Wright, 23-57, and M. A. Stewart, Warmth in the Cause of Virtue (Edinburgh: Edinburgh University Press, forthcoming).4. In January 1752, "Mr. Smith read an Account of some of Mr. David Hume's Essays on Commerce" to the Society, and Hume was elected a member in 1753; see Notices and Documents Illustrative of the Literary History of Glasgow, During the Greater Part of Last Century, edited by W. J. Duncan (Glasgow: T. D. Morison, 1886), 132-133. Hume's failed candidacy is discussed in Emerson, "The 'Affair' at Edinburgh," 14-16, and Ian Simpson Ross, The Life of Adam Smith (Oxford: Clarendon Press, 1995), 112-113. Smith's Glasgow colleague from 1751 to 1755, William Cullen, was also sympathetic to Hume's philosophy, as was John Millar, who was elected Professor of Law in 1761. On Cullen and Hume see J.R.R. Christie, "Ether and the Science of Chemistry: 1740-1790," in Conceptions of Ether: Studies in the History of Ether Theories 1740-1900, edited by G. N. Cantor and M.J.S. Hodge (Cambridge: Cambridge University Press, 1981), 90-96.5. David Hume to William Strahan, 26 October 1775, HL II 301.6. See, for example, The Works of Thomas Reid, D.D., edited by Sir William Hamilton, 4th ed. (Edinburgh: Maclachlan and Stewart, 1854), 30n; James McCosh, The Scottish Philosophy, Biographical, Expository, Critical, from Hutcheson to Hamilton (London: Macmillan, 1875), 36; James Veitch, "Philosophy in the Scottish Universities," Mind 2 (1877): 207-234 (209).7. John Rae, Life of Adam Smith (London and New York: Macmillan, 1895); William Robert Scott, Francis Hutcheson: His Life, Teaching and Position in the History of Philosophy (Cambridge: Cambridge University Press, 1900); idem., Adam Smith as Student and Professor (Glasgow: Jackson... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:"The Fittest Man in the Kingdom":Thomas Reid and the Glasgow Chair of Moral PhilosophyPaul Wood (bio)Paul Wood Paul Wood is at the Department of History, University of Victoria, PO Box 3045, MS 7381, Victoria BC V8W 3P4 Canada. email: [email protected] August 1996Revised January 1997Notes. An earlier version of this paper was delivered at a plenary session of the 23rd International Hume Conference held at the University of (...) Nottingham. For comments and/or references, the author wishes to thank Roger Emerson, Carol Gibson-Wood, Knud Haakonssen, Ian Simpson Ross, Stephen Snobelen, M. A. Stewart, and the anonymous Hume Studies referees. For permission to cite and quote from manuscripts, he is grateful to the Keeper of the Manuscripts of Scotland as well as to the Librarians of Aberdeen University Library, Edinburgh University Library, Glasgow University Archives and Business Records Centre, Glasgow University Library (Department of Special Collections), the Mitchell Library Glasgow, and Dr. Williams' Library.1. Although little information survives regarding Law's teaching, we do know that he discussed Pufendorf in his classes; see Christine Mary King [Shepherd], "Philosophy and Science in the Arts Curriculum of the Scottish Universities in the Seventeenth Century," (Unpublished Ph.D. Dissertation, University of Edinburgh, 1974), 177. Carmichael's edition of Pufendorf first appeared in Glasgow in 1718, and a second edition was published in Edinburgh in 1724 while Hume was still a student there.2. The surviving correspondence between the two men from this period is to be found in The Letters of David Hume, ed. J.Y.T. Greig, 2 vols. (Oxford: Clarendon Press, 1932), I 32-35; 36-40; 45-48 (hereafter abbreviated as HL).3. The first detailed discussion of the 1745 election appeared in the introduction to David Hume, A Letter from a Gentleman to His Friend in Edinburgh, edited by Ernest C. Mossner and John V. Price (Edinburgh: Edinburgh University Press, 1967). This account has recently been challenged in Roger L. Emerson, "The 'Affair' at Edinburgh and the 'Project' at Glasgow: The Politics of Hume's Attempts to become a Professor," in Hume and Hume's Connexions, edited by M. A. Stewart and John P. Wright (Edinburgh: Edinburgh University Press, 1994), 1-22; and M. A. Stewart, The Kirk and the Infidel (Lancaster: Lancaster University Publications Office, 1995). For historically sensitive contextual analysis of Hume's philosophical relations with Hutcheson, see inter alia James Moore, "Hume and Hutcheson," in Stewart and Wright, 23-57, and M. A. Stewart, Warmth in the Cause of Virtue (Edinburgh: Edinburgh University Press, forthcoming).4. In January 1752, "Mr. Smith read an Account of some of Mr. David Hume's Essays on Commerce" to the Society, and Hume was elected a member in 1753; see Notices and Documents Illustrative of the Literary History of Glasgow, During the Greater Part of Last Century, edited by W. J. Duncan (Glasgow: T. D. Morison, 1886), 132-133. Hume's failed candidacy is discussed in Emerson, "The 'Affair' at Edinburgh," 14-16, and Ian Simpson Ross, The Life of Adam Smith (Oxford: Clarendon Press, 1995), 112-113. Smith's Glasgow colleague from 1751 to 1755, William Cullen, was also sympathetic to Hume's philosophy, as was John Millar, who was elected Professor of Law in 1761. On Cullen and Hume see J.R.R. Christie, "Ether and the Science of Chemistry: 1740-1790," in Conceptions of Ether: Studies in the History of Ether Theories 1740-1900, edited by G. N. Cantor and M.J.S. Hodge (Cambridge: Cambridge University Press, 1981), 90-96.5. David Hume to William Strahan, 26 October 1775, HL II 301.6. See, for example, The Works of Thomas Reid, D.D., edited by Sir William Hamilton, 4th ed. (Edinburgh: Maclachlan and Stewart, 1854), 30n; James McCosh, The Scottish Philosophy, Biographical, Expository, Critical, from Hutcheson to Hamilton (London: Macmillan, 1875), 36; James Veitch, "Philosophy in the Scottish Universities," Mind 2 (1877): 207-234 (209).7. John Rae, Life of Adam Smith (London and New York: Macmillan, 1895); William Robert Scott, Francis Hutcheson: His Life, Teaching and Position in the History of Philosophy (Cambridge: Cambridge University Press, 1900); idem., Adam Smith as Student and Professor (Glasgow: Jackson... (shrink)

Many women wrote philosophy in nineteenth-century Britain, and they wrote across the full range of philosophical topics. Yet these important women thinkers have been left out of the philosophical canon and many of them are barely known today. The aim of this book is to put them back on the map. It introduces twelve women philosophers - Mary Shepherd, Harriet Martineau, Ada Lovelace, George Eliot, Frances Power Cobbe, Helena Blavatsky, Julia Wedgwood, Victoria Welby, Arabella Buckley, Annie Besant, Vernon (...) Lee, and Constance Naden. Alison Stone looks at their views on naturalism, philosophy of mind, evolution, morality and religion, and progress in history. She shows how these women interacted and developed their philosophical views in conversation with one another, not only with their male contemporaries. The rich print and periodical culture of the period enabled these women to publish philosophy in forms accessible to a general readership, despite the restrictions women faced, such as having limited or no access to university education. Stone explains how these women became excluded from the history of philosophy because there was a cultural shift at the end of the nineteenth century towards specialised forms of philosophical writing, which depended on academic credentials that were still largely unavailable to women. (shrink)

Many philosophical theories of causation are egalitarian, rejecting a distinction between causes and mere causal conditions. We sought to determine the extent to which people's causal judgments discriminate, selecting as causes counternormal events—those that violate norms of some kind—while rejecting non-violators. We found significant selectivity of this sort. Moreover, priming that encouraged more egalitarian judgments had little effect on subjects. We also found that omissions are as likely as actions to be judged as causes, and that counternormative selectivity appears to (...) apply equally to actions and omissions. (shrink)

Recent work in cognitive science suggests that conscious thought plays a much less central role in the production of human behavior than most think. Partially on the basis of this work, Peter Carruthers has advanced the claim that humans never consciously decide to act. This claim is of independent interest for action theory, and its potential truth poses a problem for theories of free will and autonomy, which often take our capacity to consciously decide to be of central importance. In (...) this article, I examine the nature of conscious deciding and I argue that Carruthers fails to establish the claim that humans never consciously decide to act. (shrink)

This very long book sets out to track and trace the working-class men and, less commonly, women who, against the limited expectations of their social position, learned Greek and Latin as an aspiration for personal change. The ideology of the book is clear and welcome: these figures “offer us a new ancestral backstory for a discipline sorely in need of a democratic makeover.” The book's twenty-five chapters explore how classics and class were linked in the educational system of Britain and (...) in its cultural performativity: Is he a gentleman? Does he have Greek? became the paradigmatic questions, as the study of classics became a sign of cultural attainment and social exclusion. This book sets out to explore the counterstory of the cobblers and shepherds who, like Jude the Obscure, fought against society's oppressiveness to access classical learning.The book's breadth is exemplary. It looks at the issue through genres and media, through different communities and national identities, through the prosopography of ragged-trousered philanthropists, beggar-lecturers, body-building performers, and through other institutions and people who helped, including adult-education teachers, kind bosses, supportive vicars, and fiery communists. This breadth, and the fascinating research that it encapsulates, will make this book a fantastic resource for future scholarship: it outlines the richness of a field that has been all too rarely explored properly. If you do not know Stephen Duck, “the thresher poet,” or Hawkie, the crutch-wielding beggar who performed from the books he sold on the streets of Glasgow, then this book is the place to the meet them. The cast list alone is worth the entrance ticket.Yet this very breadth is also the source of the book's limitations. The sheer number of cases listed, treated at similar length and depth, repeatedly conceals the complexity and even the interest of individual figures or events. So, the numerous representations of Vesuvius in shows around London in the first half of the nineteenth century—after the discoveries at Pompeii—are duly noted as a source of excitement and knowledge about antiquity, but against the recent treatment by Clare Pettitt in Serial Forms (which came out the same year) this mere noting looks desperately thin. There is little discussion of how the characters themselves talked about or negotiated class. This deficiency is particularly important for someone like Charles Kingsley, who was very active in the Chartist movement but also became Queen Victoria's chaplain and the professor of history at Cambridge. There are hilarious descriptions of Kingsley's stammering engagement with the working-class leaders he actively supported, which capture how awkward the interaction of classes could be even and especially when the participants shared a goal of transformation. (Ed Richardson's Classical Victorians: Scholars, Scoundrels and Generals in the Pursuit of Antiquity is good on these moments of awkwardness but is one of several books whose absence from the notes looks pointed.) The authors list cases of working men who were picked up by fashionable society as poets or scholars, many of whom were dropped almost as quickly back into penury—but the telling description of such a case in Kingsley's Alton Locke is passed over, although it reveals an acute self-consciousness about such narratives in a best-selling novel.The very structure of the book tends toward listing cases rather than analyzing them in depth. It is not clear why “Shoemaker classicists” should take up a chapter, bar there having been some. Nor is it clear why some figures are not included. John Brown was an uneducated Scottish shepherd who taught himself Greek, Latin, and Hebrew. He was discovered by a professor, one John Pringle, when he went into a shop to buy a secondhand Greek Testament (though his own church thought this newfound and inexplicable linguistic brilliance suspicious or even satanic). Brown went on to write the wonderfully titled The Self-Interpreting Bible, which remained in print and sold very widely for more than a century after its publication in 1778—especially after it was championed by the evangelical preacher Charles Simeon. It is a pity that Brown escaped the authors’ net, but religion, one of the main reasons to learn the classical languages, is downplayed throughout this study, although its imbrication with classics is everywhere in evidence. The book, significantly enough, leads rather toward a rosy-eyed depiction of posh classical communists like Geoffrey de Ste. Croix and George Thompson, and other such heroes of the authors.The authors are much more at home in the years of ardent republicanism in the decades on either side of the turn of the nineteenth century and in the beginning of the twentieth century, when socialism and communism became embedded in British life. The last half of the nineteenth century, when classics really established itself institutionally as a discipline, and its revolutionary potential moved away from the zeal of the Romantic philhellenists into the artistic idealism of a Richard Wagner or the sexual freedom of an Oscar Wilde, are less adequately explored. The huge attendance at art galleries and the Great Exhibition at Crystal Palace as a route to encountering the past of antiquity in material form are barely addressed (Kate Nichols's Greece and Rome at the Crystal Palace would have helped); nor do shows like Astley's Circus get air time (Rachel Bryant Davies's Troy, Carthage, and the Victorians is revealing). It is particularly noticeable in such a voluminous study that there is no discussion of how turning to Greek was a crucial route for the self-understanding of what was considered transgressive male sexuality—and for a particular engagement between the classes. To understand the social force of classics requires a deeper appreciation of the dynamics between conservatism and transformation, disciplinarity and self-discovery. The big picture of how classics matters is lost in the gems picked out by the authors. Gems they are, but their facets need more attention and their setting a broader perspective. (shrink)

Policies promoted and adopted for allocating ventilators during the COVID-19 pandemic have often prioritised healthcare workers or other essential workers. While the need for such policies has so far been largely averted, renewed stress on health systems from continuing surges, as well as the experience of allocating another scarce resource—vaccination—counsel revisiting the justifications for such prioritisation. Prioritising healthcare workers may have intuitive appeal, but the ethical justifications for doing so and the potential harms that could follow require careful analysis. Ethical (...) justifications commonly offered for healthcare worker prioritisation for ventilators rest on two social value criteria: instrumental value, also known as the ‘multiplier effect’, which may preserve the ability of healthcare workers to help others, and reciprocity, which rewards past usefulness or sacrifice. We argue that these justifications are insufficient to over-ride the common moral commitment to value each person’s life equally. Institutional policies prioritising healthcare workers over other patients also violate other ethical norms of the healthcare professions, including the commitment to put patients first. Furthermore, policy decisions to prioritise healthcare workers for ventilators could engender or deepen existing distrust of the clinicians, hospitals and health systems where those policies exist, even if they are never invoked. (shrink)

Ned Block has recently pressed a new criticism of the higher-order thought (HOT) theory of consciousness. HOT proponents have responded in turn. The exchange affords a chance to find some clarity concerning the essential commitments of HOT, as well as a chance to find clarity on the issues that divide Block and HOT proponents. In this paper I discuss the recent exchange, and I draw some lessons. First, I side with HOT proponents in arguing that new criticism presents no new (...) problem for HOT. Second, I argue that the issues separating Block and HOT proponents suggest that two separate debates are being conflated, and I suggest that keeping them distinct will yield progress for consciousness studies. (shrink)

These comments, which take the form of criticism and response, were the basis of a zoom conversation at the Eastern APA, January 2021. Josh is putting them up on philpapers (with permission from all involved) in case they are helpful to people interested in the themes of this book.

Josiah Royce’s philosophical interest in religion can be traced to his earliest days, when hymn singing and reading the Bible were constant practices in the fervently evangelical household of Josiah, Sr., and Sarah Royce in Grass Valley, California.1 Royce’s mother, Sarah, in particular, was a profound influence. She burned with the Holy Spirit, sparked by the fire-and-brimstone revivalism of the Second Great Awakening in New England, where she grew up. Educated at Phipps Union Female Seminary in Albion, New York, Mrs. (...) Royce treasured the scriptures, and was an elegant and thorough interpreter of them for Josiah and his three sisters.In spite of his delight in the reading and study of scripture at home, young.. (shrink)

The question, what makes a clinician a healer? may evoke the image of a devoted physician paying a critically important home visit at the end of a long day or the image of an astute nurse—steadfast, empathic, anticipating the patient's needs before they become apparent to others. But health care is no longer provided by lone doctors or nurses. In the modern health care system, multiple professionals must work together to provide safe and effective care. The moral nature of healing (...) has not changed. But what is required of clinicians to facilitate healing has. To be a healer today, a clinician must be a good team player. Medical students have opened our eyes to this new reality. Building on their observations, we articulate a view that, over and above the role of teamwork in providing technically appropriate care and preventing errors, health care requires teamwork to promote healing. Being a good team player is now a moral imperative because it makes an essential contribution to healing. (shrink)

Why be good -- Laws and legalisms -- Moral actor, moral acts -- Paths of glory : virtues -- Moral heroes.

In this article, we explicate evidence-based nursing (EBN), critically appraise its framework and respond to nurses’ concern that EBN sidelines the caring elements of nursing practice. We use resources from care ethics, especially Vrinda Dalmiya’s work that considers care as crucial for both epistemology and ethics, to show how EBN is compatible with, and indeed can be enhanced by, the caring aspects of nursing practice. We demonstrate that caring can act as a bridge between ‘external’ evidence and the other pillars (...) of the EBN framework: clinical expertise; patient preferences and values. Drawing on an influential EBN handbook, section 1 presents the aims and features of EBN, including the normative principle that EBN should take place within a ‘context of caring’. We aim to understand this context and whether it can be neatly detached from the EBN framework, as the handbook seems to suggest. In section 2, we highlight the grounds for resistance to EBN from the nursing community, before mounting the argument that nursing practices can be understood fruitfully through feminist care ethics and/or virtue ethics lenses. In section 3, we deepen that analysis using Dalmiya’s concepts of care-knowing and care as a hybrid ethico-epistemic virtue, which are ideally suited to the complex practices of nursing. In section 4, we bring this rich understanding of care into conversation with EBN, showing that its framework cannot be adequately theorised without paying proper attention to care. Caring can be neither an innocuous background assumption of nor an afterthought to the EBN framework. (shrink)

Many philosophers treat mental imagery as a kind of perceptual representation – it is either a perceptual state, or a representation of a perceptual state. In the sciences, writers point to mental imagery by way of a standard gloss – mental imagery is said to be (often, early) perceptual processing not directly caused by sensory stimuli (Kosslyn et al. 1995). Philosophers sometimes adopt this gloss, which I will call the basic view. Bence Nanay endorses it, and appeals to it in (...) a number of places to argue that mental imagery plays various functional or explanatory roles, as well as to argue that some mental phenomena should be seen as forms of mental imagery. In places he goes even further, relying on this view of mental imagery to explain how mental imagery is a unified kind despite heterogeneous appearances, and using this view to support his claim that mental imagery is a natural kind. Nanay’s book – which is a both a useful introduction to the many ways that mental imagery appears in discussions across philosophy, neuroscience, and psychology, as well as an extended argument for the multi-faceted relevance of mental imagery to a range of projects in the philosophy of mind and psychology – thus also serves as a nice test case for whether this basic view of mental imagery is good enough to aid theorizing across philosophy and the sciences. I think not. I will illustrate why by looking at two areas. First, I will discuss Nanay’s argument regarding mental imagery and object files. Second, I will discuss an issue Nanay raises, regarding the relationship between mental and motor imagery. A longer discussion might look to many more areas – as already mentioned, Nanay’s book covers a wide range of mental phenomena – with the same lesson emerging. The nature of mental imagery cannot be fully understood without facing an array of choice points, many of which push us to make commitments beyond the basic view. (shrink)

Common-sense folk psychology and mainstream philosophy of action agree about decisions: these are under an agent's direct control, and are thus intentional actions for which agents can be held responsible. I begin this paper by presenting a problem for this view. In short, since the content of the motivational attitudes that drive deliberation and decision remains open-ended until the moment of decision, it is unclear how agents can be thought to exercise control over what they decide at the moment of (...) deciding. I note that this problem might motivate a non-actional view of deciding?a view that decisions are not actions, but are instead passive events of intention acquisition. For without an understanding of how an agent might exercise control over what is decided at the moment of deciding, we lack a good reason for maintaining commitment to an actional view of deciding. However, I then offer the required account of how agents exercise control over decisions at the moment of deciding. Crucial to this account is an understanding of the relation of practical deliberation to deciding, an understanding of skilled deliberative activity, and the role of attention in the mental action of deciding. (shrink)

Consciousness-based approaches to non-human moral status maintain that consciousness is necessary for (some degree or level of) moral status. While these approaches are intuitive to many, in this paper I argue that the judgment that consciousness is necessary for moral status is not secure enough to guide policy regarding non-humans, that policies responsive to the moral status of non-humans should take seriously the possibility that psychological features independent of consciousness are sufficient for moral status. Further, I illustrate some practical consequences (...) of calling consciousness-based views into question. (shrink)

Mary Shepherd's An Essay upon the Relation of Cause and Effect, first published in 1824, was a pioneering work in metaphysics and epistemology. Together with her 1827 Essays on the Perception of an External Universe, they make her one of the most important philosophers of her era. Although widely neglected by the history of philosophy in the decades after her death, her works have recently begun to attract the attention and sustained study they deserve. In the course of her (...) writings, Shepherd offers trenchant and detailed rebuttals of the arguments and conclusions of many prominent predecessors-including George Berkeley, Thomas Reid, Dugald Stewart, Thomas Brown, William Lawrence, and especially David Hume-but she is no merely negative thinker. On the contrary, her critiques are always in the service of her own distinctive and highly original doctrines, which are of striking contemporary interest. Appearing two hundred years after its original publication, this is the first full modern edition of her first book, which presents and defends the theory of causation and scientific knowledge that constitutes the cornerstone of her entire philosophy. The edition includes an extensive introduction and scholarly notes throughout that provide historical and philosophical context while explaining the central ideas of the work. It also includes Shepherd's two essays published in 1828 and all of her known letters-all but one of them published here for the first time-which shed significant additional light on her philosophical ideas. (shrink)

The medicalisation of pregnancy and childbirth has been encouraged by the continuing growth of technology that can be applied to the reproductive journey. Technology now has the potential to fully separate reproduction from the human body with the prospect of ectogenesis—the gestation of a fetus outside of the human body. This paper considers the issues that have been caused by the general medicalisation of pregnancy and childbirth and the impact that ectogenesis may have on these existing issues. The medicalisation of (...) pregnancy and childbirth is criticised for its impact on the relationship between doctors and pregnant women and the way in which doctors treat fetuses. It is argued that ectogenesis may cause more imbalance in the doctor and intended parent relationship and may result in an increased lack of clarity regarding a doctor’s duty to the fetus. This paper finds that extensive guidance and revised legislation will be necessary to minimise the impact of ectogenesis on the existing issues caused by the medicalisation of reproduction. (shrink)

This is the first modern edition of the works of Lady Mary Shepherd, one of the most important women philosophers of the early modern period. Shepherd has been widely neglected in the history of philosophy, but her work engaged with the dominant philosophers of the time - among them Hume, Berkeley, and Reid. In particular, her 1827 volume Essays on the Perception of an External Universe outlines a theory of causation, perception, and knowledge which Shepherd presents as (...) an alternative to what she sees as the mistaken views of Berkeley and Hume. What she ultimately presents is an original and systematic metaphysics and epistemology. Shepherd's Essays consists of two parts. The first is a theory of perception and knowledge of the external world, which is designed to rebut idealism and skepticism about the external world and show that our ordinary beliefs are based on reason. The second is a collection of essays on topics in metaphysics and epistemology, including the immateriality and eternity of the mind, the relationship between mind and body, the possibility of miracles, the association of ideas, the relationship between physical and mathematical reasoning, and the epistemology of testimony. Antonia LoLordo's edition of Shepherd's Essays includes scholarly notes throughout the text that provide historical and philosophical context and expand on the major concepts of Shepherd's system. Her extensive introduction to Shepherd's life and works surveys some of the major points of Shepherd's system, points out directions for future research, and offers guidance for readers planning to teach her work in their courses. This volume is an invaluable primary resource for scholars, graduate students, and undergraduates interested in metaphysics, epistemology, and early modern philosophy. (shrink)

I seek an explanation for the etiology and the function of mind wandering episodes. My proposal – which I call the cognitive control proposal – is that mind wandering is a form of non-conscious guidance due to cognitive control. When the agent’s current goal is deemed insufficiently rewarding, the cognitive control system initiates a search for a new, more rewarding goal. This search is the process of unintentional mind wandering. After developing the proposal, and relating it to literature on mind (...) wandering and on cognitive control, I discuss explanations the proposal affords, testable predictions the proposal makes, and philosophical implications the proposal has. (shrink)

Numerous societal issues, from climate change to pandemics, require public engagement with scientific research. Such engagement reveals challenges that can arise when experts communicate with laypeople. One of the most common frameworks for framing these communicative interactions is the deficit model of science communication, which holds that laypeople lack scientific knowledge and/or positive attitudes towards science, and that imparting knowledge will fill knowledge gaps, lead to desirable attitude/behavior changes, and increase trust in science. §1 introduces the deficit model in more (...) detail and shows that adhering to this model often fails to achieve its aims, which motivates the main question of this chapter: how can Ludwik Fleck’s theory of thinking collectives address the persistent problem of deficit approaches in science communication? I suggest that it can do so by exposing the deficit model’s implicit assumption of an expert-lay divide. Accordingly, §2 lays out Fleck’s theory and §3 contrasts it with contemporary debates about science communication. Following this descriptive work, §4 draws on Fleck’s ideas to make four concrete suggestions for further questioning the expert-lay divide. (shrink)

This article focuses on the interpretative complexities encountered in the work of Lidwien van de Ven. First, it aims to map out the always porous nature of the relationships between aesthetics, politics and religion that make up her palimpsest-like images. Second, it aims to tease out a three-part analytics of photography. Third, it attempts to flesh out a difficult notion of spectacle that is inherent to her wide-ranging practice, and which distinguishes her project from liberal photojournalism with its obeisance to (...) identity politics and its weak notion of ethics. Finally, it aims to isolate, within the dialectical machinery of spectacle that is so often put to work by western democracies, a pragmatic moment in our encounter with her photographs that has real political purchase. With a variable notion of close reading at the crux of the operation, the article probes the efficacy of this moment so akin to philosophical aesthetics. (shrink)

McNamara hypothesized that a 4-step sequential decentering process characterized the phenomenology of religious and spiritual experiences and was rooted in dreams and nightmares. We content analyzed 50 RSES, 50 dreams, and 50 nightmares for presence and ordering of elements of the decentering process. Thirty-six percent of RSES, 48% of dreams, and 44% of nightmares had all four decentering elements. The sense of success occurred most frequently in RSES and least frequently in nightmares. Conversely, diminishment of agency occurred least often in (...) RSES and most often in nightmares. For RSES 66% of instances of effort occurred, as hypothesized, after liminality and diminishment. We conclude that an orderly 4-step decentering process is reliably detectable in many, but not all, RSES, and that randomly ordered decentering elements occur abundantly in dreams and nightmares. (shrink)

This paper is divided into two parts. In Section 1, I explore and defend a “regulative view” of folk-psychology as against the “standard view”. On the regulative view, folk-psychology is conceptualized in fundamentally interpersonal terms as a “mind-making” practice through which we come to form and regulate our minds in accordance with a rich array of socially shared and socially maintained sense-making norms. It is not, as the standard view maintains, simply an epistemic capacity for coming to know about the (...) mental states and dispositions already there. Importantly, the regulative view can meet and beat the standard at its own epistemic game. But it also does more. In Section 2, I show how the regulative view makes progress on two other problems that remain puzzling on the standard view: the problem of “first-person authority” – accounting for the special features of self-knowledge; and the problem of “reactive.. (shrink)

This paper examines the methodological claim made famous by P.F. Strawson: that we understand what features are required for responsible agency by exploring our attitudes and practices of holding responsible. What is the presumed metaphysical connection between holding responsible and being fit to be held responsible that makes this claim credible? I propose a non-standard answer to this question, arguing for a view of responsible agency that is neither anti-realist (i.e. purely 'conventionalist') nor straightforwardly realist. It is instead ‘constructivist’. On (...) the ‘Scaffolding View’ I defend, reactive attitudes play an essential role in developing, supporting, and thereby maintaining the capacities that make for responsible agency. While this view has relatively novel implications for a metaphysical understanding of capacities, its chief virtue, in contrast with more standard views, is providing a plausibly defensible account of how so-called responsible agents genuinely deserve to be treated as such. (shrink)

The Shape of Agency offers interlinked explanations of the basic building blocks of agency, as well as its exemplary instances. The first part offers accounts of a collection of related phenomena that have long troubled philosophers of action: control over behaviour, non-deviant causation, and intentional action. These accounts build on earlier work in the causalist tradition, and undermine the claims made by many that causalism cannot offer a satisfying account of non-deviant causation, and therefore fails as an account of intentional (...) action. The second part turns to modes of agentive excellence—ways that agents display quality of form—providing a novel account of skill, including an account of the ways that agents display more or less skill. Shepherd discusses the role of knowledge in skill, and concludes that while knowledge is often important, it is inessential. This leads to a discussion of the way that knowledge of action and knowledge of how to act informs action execution. Knowledgeable action includes a unique epistemic underpinning: in knowledgeable action, the agent has authoritative knowledge of what she is doing and how she is doing it when and because she is poised to control her action by way of practical reasoning. (shrink)

Philosophers and social scientists have focussed a great deal of attention on our human capacity to trust, but relatively little on the capacity to hope. This is a significant oversight, as hope and trust are importantly interconnected. This paper argues that, even though trust can and does feed our hopes, it is our empowering capacity to hope that significantly underwrites—and makes rational—our capacity to trust.

In a recent paper, Gray, Knickman, and Wegner present three experiments which they take to show that people perceive patients in a persistent vegetative state to have less mentality than the dead. Following on from Gomes and Parrott, we provide evidence to show that participants' responses in the initial experiments are an artifact of the questions posed. Results from two experiments show that, once the questions have been clarified, people do not ascribe more mental capacity to the dead than to (...) PVS patients. There is no reason to think that people perceive PVS patients as more dead than dead. (shrink)

The rise of experimental philosophy has placed metaphilosophical questions, particularly those concerning concepts, at the center of philosophical attention. X-phi offers empirically rigorous methods for identifying conceptual content, but what exactly it contributes towards evaluating conceptual content remains unclear. We show how x-phi complements Rudolf Carnap’s underappreciated methodology for concept determination, explication. This clarifies and extends x-phi’s positive philosophical import, and also exhibits explication’s broad appeal. But there is a potential problem: Carnap’s account of explication was limited to empirical and (...) logical concepts, but many concepts of interest to philosophers are essentially normative. With formal epistemology as a case study, we show how x-phi assisted explication can apply to normative domains. (shrink)

We call systematic disputes that are particularly hard to resolve deep disagreements. We can divide most theories of deep disagreements in analytic epistemology into two camps: the Wittgensteinian view and the fundamental epistemic principles view. This essay analyzes how both views deal with two of the most pressing issues a theory of deep disagreement must address: their source and their resolution. After concluding that the paradigmatic theory of each camp struggles on both fronts, the essay proceeds to show that, despite (...) their differences, these theories share some core assumptions and think of deep disagreements similarly: as grounded in fundamental epistemic differences between the parties. This underlying conception of deep disagreements the author calls “the fundamental model.” The essay provides reasons to be wary of this conception, and hence, mainstream epistemologists’ treatment of the issue. (shrink)

Some of the things we do intentionally we do halfheartedly. I develop and defend an account of halfheartedness with respect to action on which one is halfhearted with respect to an action A if one’s overall motivation to A is weak. This requires getting clear on what it is to have some level of overall motivation with respect to an action, and on what it means to say one’s overall motivation is weak or strong. After developing this account, I defend (...) the claim that one key functional expression of halfhearted action is the possession of impaired control over the action in question. Finally, I elucidate a puzzle that sometimes arises with respect to halfhearted action. The puzzle arises when an agent’s commitment in acting conflicts with an agent’s acceptance of poor performance. (shrink)

The commentaries in response to our feature paper1 are indicative of the varied perspectives that can be taken towards artificial amnion and placenta technology (AAPT) and more specifically its relationship with pregnancy (loss). Kennedy rightly argues that empirical research is essential for understanding the experiences of pregnancy loss and AAPT2 and our own advocacy of empirical research is evident in previous work.3–5 Kennedy also acknowledges the current impossibility of researching AAPT experiences since it has not yet been applied in clinical (...) settings. It is precisely for this reason that we draw on the reported experiences of neonatal intensive care (NICU) parents since they present the closest analogy which can be drawn with the technology.1 What we reject in Kennedy’s response, however, is the claim that the experiences of NICU parents have been ‘exploited’ by us.2 Studies documenting the experiences of NICU parents were drawn on to indicate that our considerations are more than mere speculation. As stated, the experiences of NICU parents, particularly the pregnant individual who experiences pregnancy loss, are the closest indication we have of how AAPT and what it entails may be experienced. To claim that this data is being exploited by us is to undermine the very purpose that such research is undertaken—to indicate how future care may be improved. It would be much more harmful to not use this information. While we believe that experiences of …. (shrink)