This volume covers a wide range of conceptual, epistemological and methodological issues in the philosophy of science raised by reflection upon medical science and practice.

This paper critically examines a particular strategy for resolving the central ethical dilemma associated with randomized clinical trials — the “community equipoise” strategy . The dilemma is that RCTs appear to violate a physician's duty to choose that therapy which there is most reason to believe is in the patient's best interest, randomizing patients even once evidence begins to favor one treatment. The community equipoise strategy involves the suggestion that our judgment that neither treatment is to be preferred is to (...) be assessed according to a community rather than an individual standard. Thus, though a physician may personally believe that there is some reason to prefer one treatment, patients can legitimately be randomized if there remains disagreement in the community of medical professionals. Rationales in favor of this conception include the following: medical knowledge is best understood as residing in the community, the judgments of others count as evidence, and so should change one's own opinion, subjects would not be better off outside the trial, and the point of any trial is the resolution of dispute in the medical community. I critically examine these rationales and argue that they are insufficient. Amongst the problems are tensions between various of these underlying rationales, and important ambiguities in just what the CE criterion is to amount to. Finally, I argue that even if use of CE was justified, it would not justify carrying out RCTs anywhere near long enough to discharge our duty to gain reliable knowledge on which to base safe and effective medical practice. Hence, we need some different justification for carrying out RCTs. (shrink)

Recognizing that all traits are the result of an interaction between genes and environment, I offer a set of criteria for nevertheless making sense of our practice of singling out certain traits as genetic ones, in effect making a distinction between causes and mere conditions. The central criterion is that a trait is genetic if it is genetic differences that make the differences in that trait variable in a given population. A second criterion requires that genetic traits be individuated in (...) a way that matches what some genetic factors cause specifically. Clarifying our causal and classificatory language here can help us to avoid confusions of both theoretical and practical significance. (shrink)

The central dilemma concerning randomized clinical trials (RCTs) arises out of some simple facts about causal methodology (RCTs are the best way to generate the reliable causal knowledge necessary for optimally-informed action) and a prima facie plausible principle concerning how physicians should treat their patients (always do what it is most reasonable to believe will be best for the patient). A number of arguments related to this in the literature are considered. Attempts to avoid the dilemma fail. Appeals to informed (...) consent and mechanisms for minimizing the resulting harm are important for policy, but informed consent is problematic and mechanisms for minimization of harm do not address the dilemma. Appeals to some sort of contract model of justification are promising and illuminating. Keywords: randomized clinical trials, ethics CiteULike Connotea Del.icio.us What's this? (shrink)

This paper critically examines a particular strategy for resolving the central ethical dilemma associated with randomized clinical trials (RCTs) — the “community equipoise” strategy (CE). The dilemma is that RCTs appear to violate a physician's duty to choose that therapy which there is most reason to believe is in the patient's best interest, randomizing patients even once evidence begins to favor one treatment. The community equipoise strategy involves the suggestion that our judgment that neither treatment is to be preferred (that (...) there obtains a state of “equipoise”) is to be assessed according to a community rather than an individual standard. Thus, though a physician may personally believe that there is some reason to prefer one treatment, patients can legitimately be randomized if there remains disagreement in the community of medical professionals. Rationales in favor of this conception include the following: (i) medical knowledge is best understood as residing in the community, (ii) the judgments of others count as evidence, and so should change one's own opinion, (iii) subjects would not be better off outside the trial, and (iv) the point of any trial is the resolution of dispute in the medical community. I critically examine these rationales and argue that they are insufficient. Amongst the problems are tensions between various of these underlying rationales, and important ambiguities in just what the CE criterion is to amount to. Finally, I argue that even if use of CE was justified, it would not justify carrying out RCTs anywhere near long enough to discharge our duty to gain reliable knowledge on which to base safe and effective medical practice. Hence, we need some different justification for carrying out RCTs. (shrink)

In this article, I review and expand upon arguments showing that Freedman's so-called "clinical equipoise" criterion cannot serve as an appropriate guide and justification for the moral legitimacy of carrying out randomized clinical trials. At the same time, I try to explain why this approach has been given so much credence despite compelling arguments against it, including the fact that Freedman's original discussion framed the issues in a misleading way, making certain things invisible: Clinical equipoise is conflated with community equipoise, (...) and several versions of each are also conflated. But a misleading impression is given that, rather than distinct criteria being arbitrarily conflated, a puzzle is solved and a number of features unified. Various issues are pushed under the rug, hiding flaws of the "clinical equipoise" approach and thus deceiving us into thinking that we have a solution when we do not. Particularly significant is the ignoring of the crucial distinction between the individual patient decision and the policy decision. (shrink)

It is often claimed that a clinical investigator may ethically participate (e.g., enroll patients) in a trial only if she is in equipoise (if she has no way to ground a preference for one arm of the study). But this is a serious problem, for as data accumulate, it can be expected that there will be a discernible trend favoring one of the treatments prior to the point where we achieve the trial's objective. In this paper, I critically evaluate Benjamin (...) Freedman's 'clinical equipoise' solution to this dilemma. I argue that Freedman actually puts forth at least two distinct contrasts - one in terms of community vs. individual equipoise, and another concerning clinical vs. theoretical equipoise - and that neither of them resolves the dilemma. I then make a proposal for a more adequate account of how to think about the circumstances under which entering subjects in trials would be justified - a 'sliding-scale equipoise' that arises out of a discussion of patients' values. (shrink)

The public attitude to animal use in Australia and New Zealandcan be inferred from survey results and political activity. The publicis concerned about the rights of animals as far as any uses causing painare concerned, but takes a more utilitarian view of the taking of lifewhere no suffering is involved. Many of the participants in two recentANZCCART conferences fall short in their knowledge of and attitudetoward these concerns. Animal welfare legislation and standards need tobe reformed so that painful animal use (...) is eliminated, even if economicgrowth suffers as a result. (shrink)

This paper examines some criticisms that have been made of two standard genetic methodologies: heritability and path analysis. I conclude that the criticisms should be taken seriously, concerning both the accuracy of heritability measures and their significance. In light of the fact that such studies remain prominent in the literature, I consider what possible rationale they can retain consistent with these criticisms. In particular, I consider (1) a role in the identification of high-risk individuals and (2) a heuristic role in (...) the planning of research strategy. (shrink)

This paper is a preliminary exploration concerning how the ethics of research on human subjects may differ when we move from the well-discussed context of research on therapies to the less-discussed context of research on enhancements. A number of differences are described. There are some features that make such research more morally problematic in certain ways, but some of the features may actually ameliorate some of the moral tensions that exist in human subjects research. It is hoped that this analysis (...) will aid and encourage discussion of the topic that could help guide those who intend to carry out such this research. (shrink)

With both the cost and quality of health care under scrutiny, many in the health care industry have turned to outcomes research and practice guidelines for answers. But many physicians have resisted, claiming their clinical judgment is a better guide. Both camps may be right.

: As clinicians, researchers, bioethicists, and members of society, we face a number of moral dilemmas concerning randomized clinical trials. How we manage the starting and stopping of such trials—how we conceptualize what evidence is sufficient for these decisions—has implications for both our obligations to trial participants and for the nature and security of the resultant medical knowledge. One view of how this is to be done, "clinical equipoise," recently has been given an extended defense by Paul Miller and Charles (...) Weijer in their article "Rehabilitating Equipoise." The present paper critiques this position and Miller and Weijer's defense of it. I argue that their attempted rehabilitation fails. Their analysis suffers from a number of confusions, as well as a failure to make crucial distinctions, adequately to clarify key concepts, or to think through exactly what needs to be established to justify their claim. We are left with little reason to uphold the clinical equipoise criterion. (shrink)

Sober argues that the units of selection problem in evolutionary biology is to be understood and solved by applying the general analysis of what it means for C to cause E in a population. The account he utilizes is the unanimity account, according to which C causes E in a population when C raises the probability of E in each causal context. I argue that he does not succeed here, both because the unanimity account is not well grounded in the (...) general case, and because there are important differences between cases of population causation which do involve selection and those which do not. (shrink)

The units of selection problem is an issue within evolutionary theory (or the philosophy thereof) and concerns the question of what units or objects are acted upon by natural selection -- for example, whether these are genes, organisms or groups of organisms. One of the central theses of Elliot Sober’s recent book, The Nature of Selection, is that the philosophical problem of what it means for something to be a unit of selection is to be understood by applying the correct (...) account of what it is in general for a factor to be a cause in a population.The account of population-causation that Sober utilizes for this purpose comes from the recent literature on probabilistic causality. This account requires that for C to cause E in a population, a unanimity condition must be satisfied: C must raise the probability of E in each causal context. (shrink)

We are pleased to once again present to the readers of Theoretical Medicine and Bioethics papers from the Philosophy of Medicine Roundtable. Previous issues have followed the 3rd and 4th Roundtables, and the current issue presents a selection from the more than 20 papers presented at the 5th Philosophy of Medicine Roundtable, which took place in New York, at Columbia University, in November 2013. Like its predecessors, held in Birmingham, AL, Rotterdam, and San Sebastian, this Roundtable attracted speakers from around (...) the world. It also featured keynote presentations from Rita Charon of Columbia University and Ross Upshur of the University of Toronto.It may seem somewhat odd to feature a special issue on philosophy of medicine in a journal that effectively has philosophy of medicine in its title. However, a review of the contents of this journal and similar ones, such as the Journal of Medicine and Philosophy, will quickly reveal such an issue’s purpose. The dominant content of these j .. (shrink)

During the last few years two major volumes have been published, both greatly revised versions of earlier Gifford Lectures: Charles Taylor’s A Secular Age ( 2007 ) and Raimon Panikkar’s The Rhythm of Being ( 2010 ). The two volumes are similar in some respects and very dissimilar in others. Both thinkers complain about the glaring blemishes of the modern, especially the contemporary age; both deplore above all a certain deficit of religiosity. The two authors differ, however, both in (...) the details of their diagnosis and in their proposed remedies. Taylor views the modern age—styled as “secular age”—as marked by a slide into secular agnosticism, into “exclusive humanism”, and above all into an “immanent frame” excluding theistic “transcendence”. Although sharing the concern about “loss of meaning”, Panikkar does not find its source in the abandonment of (mono)theistic transcendence; on the contrary, both radical transcendence and agnostic immanence are responsible for the deficit of genuine faith. For him, recovery of faith requires an acknowledgment of our being in the world, as part of the “rhythm of being” happening in a holistic or “cosmotheandric” mode. In classical Indian terminology, while Taylor’s emphasis on the transcendence-immanence tension reflects ultimately a dualistic perspective (dvaita), Panikkar’s holistic notion of the rhythm of being captures the core of Advaita Vendanta. (shrink)

Recently, Fred Gifford attempted to explicate the meaning of the term genetic as applied to phenotypic traits. He takes as his primary goal the explication of how the term is used and tries to avoid conclusions about how it should be used. He proposes two independent criteria (DF and PI) which together capture much of what biologists mean when they describe traits as genetic. Although Gifford's approach is extremely insightful in many ways, I argue that his analysis (...) is not sufficiently critical concerning the adequacy of common usage.In particular, while DF is a perfectly legitimate and useful measure of heritability in populations, it is not necessarily a genetic one and should not be labeled as such. PI on the other hand, although very intuitive, depends on an extremely problematic distinction between causes and mere conditions (e.g., genes and epigenetic factors). Both criteria will be highly relative and both, via what I term the new problem of genetics, will inspire contradictory analyses based on the same data. (shrink)

: The authors respond to objections Fred Gifford has raised against their paper "Rehabilitating Equipoise." They situate this exchange in the wider context of recent debate over equipoise, highlighting substantial points of agreement between themselves and Gifford. The authors offer a brief restatement of "Rehabilitating Equipoise" in which they amplify some of its core arguments. They then assess Gifford's objections. Finding each to be unfounded, they argue that there is no justification for "pulling the plug" on (...) clinical equipoise. (shrink)

Explores some steps toward non-assimilative encounters in the "global village.".

Philosophical interest in situated cognition has been focused most intensely on the claim that human cognitive processes extend from the brain into the tools humans use. As we see it, this radical hypothesis is sustained by two kinds of mistakes, confusing coupling relations with constitutive relations and an inattention to the mark of the cognitive. Here we wish to draw attention to these mistakes and show just how pervasive they are. That is, for all that the radical philosophers have said, (...) the mind is still in the head. (shrink)

Philosophical interest in situated cognition has been focused most intensely on the claim that human cognitive processes extend from the brain into the tools humans use. As we see it, this radical hypothesis is sustained by two kinds of mistakes, the confusion of coupling relations with constitutive relations and an inattention to the mark of the cognitive. Here we wish to draw attention to these mistakes and show just how pervasive they are. That is, for all that the radical philosophers (...) have said, the mind is still in the head. (shrink)

Causal theories of mental content attempt to explain how thoughts can be about things. They attempt to explain how one can think about, for example, dogs. These theories begin with the idea that there are mental representations and that thoughts are meaningful in virtue of a causal connection between a mental representation and some part of the world that is represented. In other words, the point of departure for these theories is that thoughts of dogs are about dogs because dogs (...) cause the mental representations of dogs. (shrink)

This chapter discusses the flaws of Clark’s extended mind hypothesis. Clark’s hypothesis assumes that the nature of the processes internal to an object has nothing to do with whether that object carries out cognitive processing. The only condition required is that the object is coupled with a cognitive agent and interacts with it in a certain way. In making this tenuous connection, Clark commits the most common mistake extended mind theorists make; alleging that an object becomes cognitive once it is (...) connected to a cognitive agent is a “coupling-constitution fallacy.” From this fallacy, many hastily proceed to the conclusion that the object or process constitutes part of the agent’s cognitive apparatus or cognitive processing. (shrink)

This book provides an introduction to measurement theory for non-specialists and puts measurement in the social and behavioural sciences on a firm mathematical foundation. Results are applied to such topics as measurement of utility, psychophysical scaling and decision-making about pollution, energy, transportation and health. The results and questions presented should be of interest to both students and practising mathematicians since the author sets forth an area of mathematics unfamiliar to most mathematicians, but which has many potentially significant applications.

The diverse essays in this volume speak to the relevance of phenomenological and psychological questioning regarding perceptions of the human. This designation, human, can be used beyond the mere identification of a species to underwrite exclusion, denigration, dehumanization and demonization, and to set up a pervasive opposition in Othering all deemed inhuman, nonhuman, or posthuman. As alerted to by Merleau-Ponty, one crucial key for a deeper understanding of these issues is consideration of the nature and scope of perception. Perception defines (...) the world of the perceiver, and perceptual capacities are constituted in engagement with the world – there is co-determination. Moreover, the distinct phenomenology of perception in the spectatorial mode in contrast to the reciprocal mode, deepens the intersubjective and ethical dimensions of such investigations. -/- Questions motivating the essays include: Can objectification and an inhuman gaze serve positive ends? If so, under what constraints and conditions? How is an inhuman gaze achieved and at what cost? How might the emerging insights of the role of perception into our interdependencies and essential sociality from various domains challenge not only theoretical frameworks, but also the practices and institutions of science, medicine, psychiatry and justice? What can we learn from atypical social cognition, psychopathology and animal cognition? Could distortions within the gazer’s emotional responsiveness and habituated aspects of social interaction play a role in the emergence of an inhuman gaze? -/- Perception and the Inhuman Gaze will interest scholars and advanced students working in phenomenology, philosophy of mind, psychology, psychiatry, sociology and social cognition. -/- Table of Contents -/- Introduction -/- Part I. The Gaze in Classical Phenomenology: Perspectives on Objectification -/- 1. Defending the Objective Gaze as a Self-transcending Capacity of Human Subjects -/- Dermot Moran -/- 2. Two Orders of Bodily Objectification: The Look and the Touch -/- Sara Heinämaa -/- 3. On Eliminativism’s Transient Gaze -/- Timothy Mooney -/- 4. Not wholly human. Reading Maurice Merleau-Ponty with Jacques Lacan. -/- Dorothée Legrand -/- 5. Disclosure and the Gendered Gaze in Simone de Beauvoir's Ethics -/- Christinia Landry -/- Part II. Vision, Perception and Gazes -/- 6. Inside the gaze -/- Shaun Gallagher -/- 7. Perception and its Objects. -/- Maurita Harney -/- 8. Technological Gaze: Understanding How Technologies Transform Perception -/- Richard Lewis -/- 9. The Inhuman Gaze and Perceptual Gestalts: The Making and Unmaking of Others and Worlds -/- Anya Daly -/- Part III. Psychiatry, Psychopathology and Inhuman Gazes -/- 10. Values and Values-based Practice in Psychopathology: Combining Analytic and Phenomenological Approaches -/- G Stanghellini and K.W.M. (Bill) Fulford -/- 11. The Inhuman and Human Gaze in Psychiatry, Psychopathology and Schizophrenia. -/- Matthew Broome -/- 12. Overcoming the Gaze: Psychopathology, Affect, and Narrative. -/- Anna Bortolan -/- 13. From excess to exhaustion : The rise of burnout in a post-modern achievement society. -/- Philippe Wuyts -/- 14. Blackout Rages: The Inhibition of Episodic Memory in Extreme Berserker Episodes -/- John Protevi -/- Part IV. Beyond the Human: Divine, Posthuman and Animal Gazes -/- 15. Wondering at the Inhuman Gaze -/- Sean. D. Kelly -/- 16. What Counts as Human/ Inhuman Right Now? -/- Rosi Braidotti -/- 17. Beyond Human and Animal: Metamorphosis in Merleau-Ponty -/- Dylan Trigg -/- Part V. Sociality and Boundaries of the Human -/- 18. Voice and gaze considered together in ‘languaging’. -/- Fred Cummins -/- 19. Ethics Beyond the Human: Disability and The Inhuman -/- Jonathan Mitchell -/- 20. Social Invisibility and Emotional Blindness -/- James Jardine -/- 21. What are you looking at? Dissonance as a window on the autonomy of participatory sense-making frames. -/- Mark James. (shrink)

Systems biology is a vigorous and expanding discipline, in many ways a successor to genomics and perhaps unprecendented in its combination of biology with a ...

This paper proposes a third meditation-category—automatic self-transcending— to extend the dichotomy of focused attention and open monitoring proposed by Lutz. Automaticself-transcending includes techniques designed to transcend their own activity. This contrasts with focused attention, which keeps attention focused on an object; and open monitoring, which keeps attention involved in the monitoring process. Each category was assigned EEG bands, based on reported brain patterns during mental tasks, and meditations were categorized based on their reported EEG. Focused attention, characterized by beta/gamma activity, (...) included meditations from Tibetan Buddhist, Buddhist, and Chinese traditions. Open monitoring, characterized by theta activity, included meditations from Buddhist, Chinese, and Vedic traditions. Automaticself-transcending, characterized by alpha1 activity, included meditations from Vedic and Chinese traditions. Between categories, the included meditations differed in focus, subject/object relation, and procedures. These findings shed light on the common mistake of averaging meditations together to determine mechanisms or clinical effects. (shrink)