Many critics of medicalization express concern that the process privileges individualised, biologically grounded interpretations of medicalized phenomena, inhibiting understanding and communication of aspects of those phenomena that are less relevant to their biomedical modelling. I suggest that this line of critique views medicalization as a hermeneutical injustice—a form of epistemic injustice that prevents people having the hermeneutical resources available to interpret and communicate significant areas of their experience. Interpreting the critiques in this fashion shows they frequently fail because they: neglect (...) the ways in which medicalization may not obscure, but rather illuminate, individuals’ experiences; and neglect the testimony of those experiencing first-hand medicalized problems, thus may be guilty of perpetrating testimonial injustice. However, I suggest that such arguments are valuable insofar as they highlight the unwarranted epistemic privilege frequently afforded to medical institutions and medicalized models of phenomena, and a consequent need for greater epistemic humility on the part of health workers and researchers. (shrink)

Industrialisation, urbanisation and economic development have produced unprecedented improvements in human health. They have also produced unprecedented exploitation of Earth’s life support systems, moving the planet into a new geological epoch, the Anthropocene—one defined by human influence on natural systems. The health sector has been complicit in this influence. Bioethics, too, must acknowledge its role—the environmental threats that will shape human health in this century represent a ‘perfect moral storm’ challenging the ethical theories of the last. The US conservationist Aldo (...) Leopold saw this gathering storm more clearly than many, and in his Land Ethic describes the beginnings of a route to safe passage. Its starting point is a reinterpretation of the ethical relationship between humanity and the ‘land community’, the ecosystems we live within and depend upon; moving us from ‘conqueror’ to ‘plain member and citizen’ of that community. The justice of the Land Ethic questions many presuppositions implicit to discussions of the topic in biomedical ethics. By valuing the community in itself—in a way irreducible to the welfare of its members—it steps away from the individualism axiomatic in contemporary bioethics. Viewing ourselves as citizens of the land community also extends the moral horizons of healthcare from a solely human focus. Taking into account the ‘stability’ of the community requires intergenerational justice. The resulting vision of justice in healthcare—one that takes climate and environmental justice seriously—could offer health workers an ethic fit for the future. (shrink)

Felicitas Kraemer draws on the experiences of patients undergoing deep-brain stimulation to propose two distinct and potentially conflicting principles of respect: for an individual's autonomy , and for their authenticity. I argue instead that, according to commonly-invoked justifications of respect for autonomy, authenticity is itself in part constitutive of an analysis of autonomy worthy of respect; Kraemer's argument thus highlights the shortcomings of practical applications of respect for autonomy that emphasise competence while neglecting other important dimensions of autonomy such as (...) authenticity, since it shows that competence alone cannot be interpreted as a reliable indicator of an individual's capacity for exercising autonomy. I draw from relational accounts to suggest how respect for a more expansive conception of autonomy might be interpreted for individuals undergoing DBS and in general. (shrink)

Most work addressing clinical workers' professional responsibilities concerns the norms of conduct within established professional–patient relationships, but such responsibilities may extend beyond the clinical context. We explore health workers' professional responsibilities in such “informal” encounters through the example of a doctor witnessing the misdiagnosis and mistreatment of a serious long-term condition in a television documentary, arguing that neither internalist approaches to professional responsibility nor externalist ones provide sufficiently clear guidance in such situations. We propose that a mix of both approaches, (...) emphasizing the noncomplacency and practical wisdom of virtue ethics, but grounding the normative authority of virtue in an external source, is able to engage with the health worker's responsibilities in such situations to the individual, the health care system, and the population at large. (shrink)

A clinical ethics fit for the Anthropocene—our current geological era in which human activity is the primary determinant of environmental change—needs to incorporate environmental ethics to be fit for clinical practice. Conservationist Aldo Leopold’s essay ‘The Land Ethic’ is probably the most widely-cited source in environmental philosophy; but Leopold’s work, and environmental ethics generally, has made little impression on clinical ethics. The Land Ethic holds that “A thing is right when it tends to preserve the integrity, stability, and beauty of (...) the biotic community. It is wrong when it tends otherwise.” I argue that a Land Ethic helps to re-frame problems in clinical ethics that more common philosophical approaches struggle to handle, and that it can be incorporated into clinical ethics without succumbing to “environmental fascism”. I motivate viewing problems in clinical ethics from the perspective of the ‘integrity of the biotic community’, then illustrate how this perspective can offer guidance where more commonly-invoked theories—such as consequentialism and Kantian-inspired approaches—struggle, using antimicrobial resistance in nosocomial infection as a case study. The Land Ethic equips us to understand human values as arising within and inseparable from a social-ecological context, and by treating communities as valuable in themselves rather than just through the aggregate welfare of their individual participants, we can avoid problems with the ‘repugnant conclusion’ and utility monster that plague utilitarian accounts. (shrink)

The clinical encounter begins with presentation of an illness experience; but throughout that encounter, something else is constructed from it – a symptom. The symptom is a particular interpretation of that experience, useful for certain purposes in particular contexts. The hermeneutics of medicine – the study of the interpretation of human experience in medical terms – has largely taken the process of symptom-construction to be transparent, focussing instead on how constellations of symptoms are interpreted as representative of particular conditions. This (...) paper examines the hermeneutical activity of symptom-construction more closely. I propose a fourfold account of the clinical function of symptoms: as theoretical entities; as tools for communication; as guides to palliative intervention; and as candidates for medical explanation or intervention. I also highlight roles they might play in illness experience. I use this framework to discuss four potential failures of symptom-interpretation: failure of symptom-type and symptom-token recognition; loss of the complete picture of illness experience through overwhelming emphasis on its symptomatic interpretation; and intersubjective feedback effects of symptom description altering the ill person’s own perceptions of their phenomenal experience. I conclude with some suggestions of potential remedies for failures in the process of symptom-construction. (shrink)

Recent criticism of the role of respect for autonomy in bioethics has focused on that principle's status as ‘dogma’ or ‘ideology’. I suggest that lying beneath many applications of respect for autonomy in medical ethics are some influential dogmas — propositions accepted, not as explicit premises or as a consequence of reasoned argument, but simply because moral problems are so frequently framed in such terms. Furthermore, I will argue that rejecting these dogmas is vital to secure and protect an autonomy (...) worthy of respect. The concept of autonomy that is widely applied in clinical ethics emphasises decision-making competence, at the expense of considering the authenticity of those decisions. Respect for such autonomy is interpreted in largely synchronic and individual terms — concerned with the isolated decisions of individual agents — and thus neglects the diachronic and social dimensions of many moral dilemmas arising in the health care context. I will examine how these unwritten rules lead to an impoverished understanding of respect and a systematic neglect in bioethics of certain kinds of ethical consideration, and draw on insights from feminist and communitarian work on autonomy to sketch an alternative approach to understanding respect, modelled on the norms of respectful conversation — a respect that is firstly concerned with engaging with the another as a potential giver and bearer or reasons, and working with them to promote both individual and social flourishing. (shrink)

The principle of respect for autonomy in clinical ethics is frequently linked to bioethics’ neglect of community-level ethical considerations. I argue that the latter is not an inevitable consequence of the former; rather, that neglect results from a common interpretation of respect for autonomy in solely synchronic and individual terms. A relational understanding of autonomy reveals the way in which respect inescapably involves diachronic and social dimensions. When these are acknowledged, the association between respect for autonomy and liberal individualism is (...) weakened. Such respect has more in common with communitarian approaches, and it need not conflict with the incorporation of collective-level values into ethical deliberation. (shrink)

In a recent paper, Hugh McLachlan argues from a deontological perspective that the most ethical means of distributing scarce supplies of an effective vaccine in the context of an influenza pandemic would be via an equal lottery. I argue that, even if one accepts McLachlan's ethical theory, it does not follow that one should accept the vaccine lottery. McLachlan's argument relies upon two suppressed premises which, I maintain, one need not accept; and it misconstrues vaccination programmes as clinical interventions targeted (...) solely at protecting the health of vaccinated individuals, rather than as public health interventions targeted at protecting the health of the population as a whole. (shrink)

Smajdor invites welcome interrogation of the distance between our philosophical justifications of how we engage people in decisions about healthcare or research, and the ways we do so.1 She notes the implicit elision made between autonomy and informed consent, and argues the latter alone cannot secure the former, proposing a more flexible approach. As researchers working with people with dementia (PwD), we share Smajdor’s reservations. We argue that an autonomy worthy of respect requires not just decision-making capacity, but also authenticity; (...) the ability to determine for oneself what is good for oneself.2 Furthermore, our relationships support or undermine both capacity and authenticity, and autonomous expression manifests throughout evolving relationships. This invites us to view respect differently—as an ongoing conversation with another person, capable of holding values that may move us. In Smajdor’s terminology, it requires that we recognise them. We describe how we operationalise this in our research. Three broad arguments usually support respect for autonomy.2 One—owed to JS Mill—holds that permitting individuals free choice promotes utility of all, by helping them fulfil ideas of the good, demonstrating ‘experiments in living’. Another draws from Kant’s categorical imperative; its Formula of Humanity holds that the capacity to determine our own values gives us reason to act, and we ought, therefore, to treat others’ values with the respect we show our own. Lastly, many simply assume ‘liberal neutrality’—an intrinsic value in people being permitted to pursue the …. (shrink)

This chapter contains section titled: Rawls and Human Rights Minimalism State Sovereignty and the Role of Human Rights Rawls's Political Liberalism and the Doctrine of Human Rights in LoP The Importance of the Role in LoP of Rawls's Narrow Doctrine of Human Rights Rawls's Arguments for the Narrow Doctrine ldquo;Ideal” and “Non‐ideal” Theory in LoP Strategies for the International Enforcement of Respect for Human Rights Conclusion Notes.

We are sceptical of concerns over the opacity of algorithmic decision tools. While transparency and explainability are certainly important desiderata in algorithmic governance, we worry that automated decision-making is being held to an unrealistically high standard, possibly owing to an unrealistically high estimate of the degree of transparency attainable from human decision-makers. In this paper, we review evidence demonstrating that much human decision-making is fraught with transparency problems, show in what respects AI fares little worse or better and argue that (...) at least some regulatory proposals for explainable AI could end up setting the bar higher than is necessary or indeed helpful. The demands of practical reason require the justification of action to be pitched at the level of practical reason. Decision tools that support or supplant practical reasoning should not be expected to aim higher than this. We cast this desideratum in terms of Daniel Dennett’s theory of the “intentional stance” and argue that since the justification of action for human purposes takes the form of intentional stance explanation, the justification of algorithmic decisions should take the same form. In practice, this means that the sorts of explanations for algorithmic decisions that are analogous to intentional stance explanations should be preferred over ones that aim at the architectural innards of a decision tool. (shrink)

How did an ancient Indian spiritual discipline turn into a £20 billion-a-year mainstay of the global wellness industry? What happened along yoga's winding path from the caves and forests of the sages to the gyms, hospitals and village halls of the modern West? This comprehensive history sets yoga in its global cultural context for the first time. It leads us on a fascinating journey across the world, from arcane religious rituals and medieval body-magic, through muscular Christianity and the British Raj, (...) to the Indian nationalist movement and the arrival of yoga in the twentieth-century West. We discover how the practice reached its present-day ubiquity and how it became embedded in powerful social currents shaping the world's future, such as feminism, digital media, celebrity culture, the stress pandemic and the quest for an authentic identity in the face of unprecedented change. Shearer's revealing history boasts a colorful cast of characters past and present, who tell an engaging tale of scholars and scandal, science and spirit, wisdom and waywardness. This is the untold story of yoga, warts and all. (shrink)

Topics in Cognitive Science, Volume 13, Issue 1, Page 187-205, January 2021.

Some say that public policy can be made without the benefit of theory--that it emerges, instead, through trial-and-error. Others see genuine philosophical issues in public affairs but try to resolve them through fanciful examples. Both, argues Robert E. Goodin, are wrong. Goodin--a political scientist who is also an associate editor of Ethics--shows that empirical and ethical theory can and should guide policy. To be useful, however, these philosophical discussions of public affairs must draw upon actual policy experiences rather than contrived (...) cases. Further, they must reflect the broader social consequences of policies rather than just the dilemmas of personal conscience. Effectively integrating the literatures of social science, policy science, and philosophy, Goodin provides a theoretically sophisticated yet empirically well-grounded analysis of public policies, the principles underlying them, the institutions shaping them, and the excuses offered for their failures. This analysis is enhanced by the author's discussion of such specific cases as the disposal of nuclear wastes and the priority accorded national defense--cases that illustrate Goodin's theoretical and methodological framework for approaching policy issues. (shrink)

Traditionally the central trope in Christian theological anthropology, “the image of God” tends to function more as a noun than a verb. While that has grounded significant interplay between specific Christian formulations and the concepts of nontheological disciplines and cultural constructs, it facilitates the withdrawal of the image and of theological anthropology more broadly from the context of active relation with God. Rather than a static rendering of the image a more interactionist, dynamic, and relational view of “imaging God” is (...) commended as a key anthropological term. Engaging with Psalm 8 suggests that, biblically, asking the anthropological question “What is humanity?” is tied to the answer to the theological question: who is God? This locates theological anthropology securely within the interactive context of being related to by God and suggests that theological anthropology might be a matter of performance rather than definition: actively imaging God. (shrink)

Margaret Archer has recently provided a persuasive account of the importance of the internal conversation to reflexivity. This raises questions about the shaping of such conversations by involuntary agential positioning. The work of Bourdieu and Bernstein is reviewed to suggest that structural influences can operate by condi-tioning the resources available for the conducting of the internal conversation. Particular emphasis is placed on the transfer of taken for granted ideas from one domain of practice to another.

The claim that similarity plays a role in representation has been philosophically discredited. Psychologists, however, routinely analyse the success of mental representations for guiding behaviour in terms of a similarity between representation and the world. I provide a foundation for this practice by developing a philosophically responsible account of the relationship between similarity and representation in natural systems. I analyse similarity in terms of the existence of a suitable homomorphism between two structures. The key insight is that by restricting attention (...) to only those homomorphisms induced by causal processes, we can solve two philosophical problems with a single assumption. First, causal structure provides an adequate source for the bias required to ensure the similarity relation is non-trivial; second, it provides an adequate source for the directionality required to move from similarity to representation. I defend this account against objections by Goodman and van Fraassen and demonstrate that it is indeed the account of similarity’s role in representation assumed by psychological practice. (shrink)

The danger of human operators devolving responsibility to machines and failing to detect cases where they fail has been recognised for many years by industrial psychologists and engineers studying the human operators of complex machines. We call it “the control problem”, understood as the tendency of the human within a human–machine control loop to become complacent, over-reliant or unduly diffident when faced with the outputs of a reliable autonomous system. While the control problem has been investigated for some time, up (...) to this point its manifestation in machine learning contexts has not received serious attention. This paper aims to fill that gap. We argue that, except in certain special circumstances, algorithmic decision tools should not be used in high-stakes or safety-critical decisions unless the systems concerned are significantly “better than human” in the relevant domain or subdomain of decision-making. More concretely, we recommend three strategies to address the control problem, the most promising of which involves a complementary coupling between highly proficient algorithmic tools and human agents working alongside one another. We also identify six key principles which all such human–machine systems should reflect in their design. These can serve as a framework both for assessing the viability of any such human–machine system as well as guiding the design and implementation of such systems generally. (shrink)

Recent articles published in this journal have highlighted the shortcomings of individualistic approaches to health promotion, and the potential contributions of relational analyses of autonomy to public health ethics. I argue that the latter helps to elucidate the former, by showing that an inadequate analysis of autonomy leads to misassignment of both forward-looking and backward-looking responsibility for health outcomes. Health promotion programmes predicated on such inadequate analyses are then ineffective, because they assign responsibility to agents whose social environment inhibits their (...) ability to act on such responsibilities; inequitable, because the social barriers to autonomous agency display a socio-economic gradient; and stigmatizing, because they license blaming of individuals for their own poor health without taking into account how reasonable it is to hold these individuals responsible, given the social barriers to autonomy they face. I further sketch how incorporating a relational understanding of autonomy could help to produce health promotion programmes that do not succumb to these difficulties, while avoiding coercive paternalism, exploring potential applications in ecological approaches to health promotion. (shrink)

Journal of Philosophy of Education, EarlyView.

The lore is that standard information theory provides an analysis of information quantity, but not of information content. I argue this lore is incorrect, and there is an adequate informational semantics latent in standard theory. The roots of this notion of content can be traced to the secret parallel development of an information theory equivalent to Shannon’s by Turing at Bletchley Park, and it has been suggested independently in recent work by Skyrms and Bullinaria and Levy. This paper explicitly articulates (...) the semantics latent in information theory and defends it as an adequate theory of information content, or natural meaning. I argue that this theory suggests a new perspective on the classic misrepresentation worry for correlation-based semantics. (shrink)

This paper explores concepts of multiple and nested identities and how these relate to citizenship and rights, and the implications of identities and rights for active citizenship education. Various theoretical conceptions of identity are analysed, and in particular ideas concerning multiple identities that are used contingently, and about identities that do not necessarily include feeling a strong affinity with others in the group. The argument then moves to the relationship between identity and citizenship, and particularly citizenship and rights. Citizenship is (...) treated non-legalistically, as one of the locations of belonging. The paper draws on three successive categorisations of citizenship rights: by T.H. Marshall in the 1950s, Karel Vasak in the late 1970s and John Urry in the 1990s, and is illustrated in part by the development of European citizenship in parallel to national identity. This is then linked to how contemporary citizenship education might use the exploration of contested rights as a way of developing practical enactive skills of citizenship. (shrink)

Working within an Archerian morphogenetic framework, I suggest that we need to pay more attention to practices. Instead of the mainstream focus on practice as action, I argue that we should pay attention to practices as a key structural and cultural element of analysis. Practices cannot be simply read-off from beliefs, that is, they are not an inevitable practical counterpart to belief. Although belief is relevant, it does not provide the full explanation for the presence of practices. Therefore, the same (...) or similar beliefs can result in significantly different practices depending on factors such as advances in technology and changes in modes of dissemination of theological doctrine. To illustrate my argument, I consider historical work on comparative religious practices, specifically the distinction between rituals and routines. A focus on the latter, as the conditions of possibility for the former, leads to some implications for the thesis of the morphogenesis of contemporary society. An analysis of the relationship between religious rituals and routines stresses the importance of placing both in their wider cultural and structural context. (shrink)

An examination of the practice of self-examination in Scottish Presbyterianism shows the value of following the later Foucault in the examination of religion as a social practice. His attention to the influence of pastoral power on governmentality is shown to have been embedded in a Roman Catholic heritage leading to a stress on the confessional. By contrast, an examination of one aspect of Protestant pastoral power indicates the genealogy of practices of self-help. An historical examination of both the structure of (...) the Scottish church and the diaries of believers indicates the emphasis placed in this tradition on accountability. It also points to the need to reassess Foucault's treatment of Seneca, whose place in the Christian tradition, as exemplified by the Scottish experience, was more important than Foucault allows. (shrink)

Several strands of contemporary cognitive science and its philosophy have emerged in recent decades that emphasize the role of action in cognition, resting their explanations on the embodiment of cognitive agents, and their embedding in richly structured environments. Despite their growing influence, many foundational questions remain unresolved or underexplored for this cluster of proposals, especially questions of how they can be extended beyond straightforwardly visuomotor cognitive capacities, and what constraints the commitment of embodiment places on the ontology of explanations. This (...) special issue aims to contribute to these foundational debates by drawing on important precursors to embodied cognition in mid-twentieth century gestalt psychology, its immediate successor ecological psychology, and their dialectical counterpart, phenomenology. Gestalt psychologists and phenomenologists wrestled with many of the same foundational questions that still haunt us today, in a manner that seems refreshing in hindsight, and poised to contribute constructively to contemporary debate. Looking back on this history reveals deep commonalities across competing embodied approaches, exposing fundamental tensions that remain unresolved, but also paving the way to a more ecumenical and conciliatory embodied cognitive science. (shrink)

Timbre is that property of a sound that distinguishes it other than pitch and loudness, for instance the distinctive sound quality of a violin or flute. While the term is obscure, the concept has played an important, implicit role in recent philosophy of sound. Philosophers have debated whether to identify sounds with properties of waves, events, or objects. Many of the intuitive considerations in this debate apply most clearly to timbre qualities. Two prominent forms of timbre physicalism have emerged: one (...) identifying timbre with the spectral composition of proximal waves; the second identifying timbre with the mechanical vibrations at a sound source. I demonstrate that the first possibility is conceptually unsatisfying, while the second fails to meet the standards of rigor established by the color physicalism literature. One response to these worries might be to adopt a more modest, non-reductive realism about timbre, such as the ecological view of J. J. Gibson. (shrink)

The new wave of ‘foundation models’—general-purpose generative AI models, for production of text (e.g., ChatGPT) or images (e.g., MidJourney)—represent a dramatic advance in the state of the art for AI. But their use also introduces a range of new risks, which has prompted an ongoing conversation about possible regulatory mechanisms. Here we propose a specific principle that should be incorporated into legislation: that any organization developing a foundation model intended for public use must demonstrate a reliable detection mechanism for the (...) content it generates, as a condition of its public release. The detection mechanism should be made publicly available in a tool that allows users to query, for an arbitrary item of content, whether the item was generated (wholly or partly) by the model. In this paper, we argue that this requirement is technically feasible and would play an important role in reducing certain risks from new AI models in many domains. We also outline a number of options for the tool’s design, and summarize a number of points where further input from policymakers and researchers would be required. (shrink)

In analysing the position adopted by the United Kingdom over therapeutic cloning, this paper will endeavour to examine the question of regulation, its necessity and extent. This will be achieved through considering different models of relevant theoretical discourse before, in applying that discourse to identified systems of regulation, the advantages and pitfalls of each system will be assessed in the hope of reaching a solution appropriate to the sensitive, yet dynamic, needs of the issue.

It will be remembered that the introductory chapter to this paper differentiated between human therapeutic cloning and embryonic stem cell research, with the former concept encapsulating the latter one. In turning to examine the current system of regulation found within the United Kingdom this has particular relevance as it is only the practice of therapeutic cloning – the creation and use of an embryo – which engages with the regulative measures adopted.

The metaphysical ethics of Levinas appeals to many philosophers of education because it seems to promise ethics and social justice without recourse to moral norms, ‘totalising’ political systems or religious belief. However, the notion that the subject can be detached from its worldly being—that one can posit a primordial metaphysical pre-conscious pre-phenomenal self which stands in ethical relation to a primordial metaphysical pre-conscious pre-phenomenal Other—is highly questionable. From an empirical perspective, our experience of the world and of ourselves can only (...) be conceived in social, cultural and linguistic terms; the self-referential lexicon Levinas employs to depict the relation between the transcendental subject and the Other ‘in his alterity’ renders his metaphysical assertions impossible to evaluate or give determinate form. From a transcendental perspective, Levinas's metaphysical abstractions simply do not have the power to motivate people to behave ethically. Instead of contributing toward the transformation of education and society envisaged by many philosophers of education, the ‘ethics of the Other’ merely generates an esoteric discourse. (shrink)