In this paper, I claim that the personal/subpersonal distinction is first and foremost a distinction between two kinds of psychological theory or explanation: it is only in this form that we can understand why the distinction was first introduced, and how it continues to earn its keep. I go on to examine the different ontological commitments that might lead us from the primary distinction between personal and subpersonal explanations to a derivative distinction between personal and subpersonal states. I argue that (...) on one of the most common metaphysical interpretations of the explanatory distinction, talk of a distinction between personal and subpersonal states simply makes no sense. When people insist on applying the personal/subpersonal terminology to psychological states, I allow that they are often making a genuine distinction, but one that it is best understood in terms of Stich's (1978) distinction between doxastic and subdoxastic states. I end the paper by considering some other common misinterpretations of the personal/subpersonal distinction, such as those involving consciousness, normativity, or autonomy. (shrink)

Fictionalists propose that some apparently fact-stating discourses do not aim to convey factual information about the world, but rather allow us to engage in a fiction or pretense without incurring ontological commitments. Some philosophers have suggested that using mathematical, modal, or moral discourse, for example, need not commit us to the existence of mathematical objects, possible worlds, or moral facts. The mental fictionalist applies this reasoning to our mental discourse, suggesting that we can use ‘belief’ and ‘desire’ talk without committing (...) to the existence of beliefs and desires as mental entities. Most arguments for mental fictionalism are based on two key suppositions: first, that there are ontological concerns about mental entities; and second, that these ontological concerns justify a fictionalist interpretation of mental discourse. This paper challenges both suppositions and argues that the standard arguments for mental fictionalism are substantially weaker than arguments for other forms of fictionalism in the philosophical literature. (shrink)

Two very different forms of externalism about mental states appear prima facie unrelated: Williamson’s (1995, 2000) claim that knowledge is a mental state, and Clark & Chalmers’ (1998) extended mind hypothesis. I demonstrate, however, that the two approaches justify their radically externalist by appealing to the same argument from explanatory generality. I argue that if one accepts either Williamson’s claims or Clark & Chalmers’ claims on considerations of explanatory generality then, ceteris paribus, one should accept the other. This conclusion has (...) implications for philosophy of mind, epistemology, and cognitive science. (shrink)

There are two distinct approaches to Bayesian modelling in cognitive science. Black-box approaches use Bayesian theory to model the relationship between the inputs and outputs of a cognitive system without reference to the mediating causal processes; while mechanistic approaches make claims about the neural mechanisms which generate the outputs from the inputs. This paper concerns the relationship between these two approaches. We argue that the dominant trend in the philosophical literature, which characterizes the relationship between black-box and mechanistic approaches to (...) Bayesian cognitive science in terms of the dichotomy between instrumentalism and realism, is misguided. We propose that the two distinctions are orthogonal: black-box and mechanistic approaches to Bayesian modelling can each be given either an instrumentalist or a realist interpretation. We argue that the current tendency to conflate black-box approaches with instrumentalism and mechanistic approaches with realism stems from unwarranted assumptions about the nature of scientific explanation, the ontological commitments of scientific theories, and the role of abstraction and idealization in scientific models. We challenge each of these assumptions to reframe the debates over Bayesian modelling in cognitive science. (shrink)

This unpublished article was written around 2009 for a journal special issue of a journal which never materialized. In 2018, the article was rewritten and published in the Oxford Handbook of Philosophy and Disability. It can be found on PhilPapers as Drayson and Clark (2018), 'Cognitive Disability and the Embodied, Extended Mind'.

Daniel Dennett's distinction between personal and subpersonal explanations was fundamental in establishing the philosophical foundations of cognitive science. Since it was first introduced in 1969, the personal/subpersonal distinction has been adapted to fit different approaches to the mind. In one example of this, the ‘Pittsburgh school’ of philosophers attempted to map Dennett's distinction onto their own distinction between the ‘space of reasons’ and the ‘space of causes’. A second example can be found in much contemporary philosophy of psychology, where Dennett's (...) distinction has been presumed to be equivalent to Stephen Stich's distinction between doxastic and subdoxastic states. Both these interpretations of the personal/subpersonal distinction, and also Dennett's own philosophical views of the mind, go beyond the personal/subpersonal distinction itself. They each involve supplementing the distinction between personal and subpersonal explanations with metaphysical claims about the relationship between the two kinds of explanation and the entities they posit. (shrink)

Modular approaches to the architecture of the mind claim that some mental mechanisms, such as sensory input processes, operate in special-purpose subsystems that are functionally independent from the rest of the mind. This assumption of modularity seems to be in tension with recent claims that the mind has a predictive architecture. Predictive approaches propose that both sensory processing and higher-level processing are part of the same Bayesian information-processing hierarchy, with no clear boundary between perception and cognition. Furthermore, it is not (...) clear how any part of the predictive architecture could be functionally independent, given that each level of the hierarchy is influenced by the level above. Both the assumption of continuity across the predictive architecture and the seeming non-isolability of parts of the predictive architecture seem to be at odds with the modular approach. I explore and ultimately reject the predictive approach’s apparent commitments to continuity and non-isolation. I argue that predictive architectures can be modular architectures, and that we should in fact expect predictive architectures to exhibit some form of modularity. (shrink)

Predictive approaches to the mind claim that perception, cognition, and action can be understood in terms of a single framework: a hierarchy of Bayesian models employing the computational strategy of predictive coding. Proponents of this view disagree, however, over the extent to which perception is direct on the predictive approach. I argue that we can resolve these disagreements by identifying three distinct notions of perceptual directness: psychological, metaphysical, and epistemological. I propose that perception is plausibly construed as psychologically indirect on (...) the predictive approach, in the sense of being constructivist or inferential. It would be wrong to conclude from this, however, that perception is therefore indirect in a metaphysical or epistemological sense on the predictive approach. In the metaphysical case, claims about the inferential properties of constructivist perceptual mechanisms are consistent with both direct and indirect solutions to the metaphysical problem of perception (e.g. naïve realism, representationalism, sense datum theory). In the epistemological case, claims about the inferential properties of constructivist perceptual mechanisms are consistent with both direct and indirect approaches to the justification of perceptual belief. In this paper, I demonstrate how proponents of the predictive approach have conflated these distinct notions of perceptual directness and indirectness, and I propose alternative strategies for developing the philosophical consequences of the approach. (shrink)

Many models of cognitive ability and disability rely on the idea of cognition as abstract reasoning processes implemented in the brain. Research in cognitive science, however, emphasizes the way that our cognitive skills are embodied in our more basic capacities for sensing and moving, and the way that tools in the external environment can extend the cognitive abilities of our brains. This chapter addresses the implications of research in embodied cognition and extended cognition for how we think about cognitive impairment (...) and rehabilitation, how cognitive reserve mitigates neural impairment, and the distinction between medical and social models of disability. (shrink)

How does the philosophical debate between naive realism and intentionalism relate to the psychological debate between ecological theories and constructivist theories? The participants in each debate take themselves to be doing something distinctive, but I show that characterizing the distinction is difficult: the theories in both debates use inference to the best explanation to draw contingent conclusions about the constitutive nature of perception. I argue that both debates concern the metaphysics of perception, and that philosophers of perception are wrong to (...) think that constructivist and ecological theories are engaged in a distinct and non-metaphysical task. (shrink)

Intellectualism is the claim that practical knowledge or ‘know-how’ is a kind of propositional knowledge. The debate over Intellectualism has appealed to two different kinds of evidence, semantic and scientific. This paper concerns the relationship between Intellectualist arguments based on truth-conditional semantics of practical knowledge ascriptions, and anti-Intellectualist arguments based on cognitive science and propositional representation. The first half of the paper argues that the anti-Intellectualist argument from cognitive science rests on a naturalistic approach to metaphysics: its proponents assume that (...) findings from cognitive science provide evidence about the nature of mental states. We demonstrate that this fact has been overlooked in the ensuing debate, resulting in inconsistency and confusion. Defenders of the semantic approach to Intellectualism engage with the argument from cognitive science in a way that implicitly endorses this naturalistic metaphysics, and even rely on it to claim that cognitive science support Intellectualism. In the course of their arguments, however, they also reject that scientific findings can have metaphysical import. We argue that this situation is preventing productive debate about Intellectualism, which would benefit from both sides being more transparent about their metaphilosophical assumptions. (shrink)

The past twenty years have seen an increase in the importance of the body in psychology, neuroscience, and philosophy of mind. This 'embodied' trend challenges the orthodox view in cognitive science in several ways: it downplays the traditional 'mind-as-computer' approach and emphasizes the role of interactions between the brain, body, and environment. In this article, I review recent work in the area of embodied cognitive science and explore the approaches each takes to the ideas of consciousness, computation and representation. Finally, (...) I look at the current relationship between orthodox cognitive science and the study of mental disorder, and consider the implications that the embodied trend could have for issues in psychopathology. (shrink)

This paper explores the relationship between several ideas about the mind and cognition. The hypothesis of extended cognition claims that cognitive processes can and do extend outside the head, that elements of the world around us can actually become parts of our cognitive systems. It has recently been suggested that the hypothesis of extended cognition is entailed by one of the foremost philosophical positions on the nature of the mind: functionalism, the thesis that mental states are defined by their functional (...) relations rather than by their physical constituents. Furthermore, it has been claimed that functionalism entails a version of extended cognition which is sufficiently radical as to be obviously false. I survey the debate and propose several ways of avoiding this conclusion, emphasizing the importance of distinguishing the hypothesis of extended cognition from the related notion of the extended mind. (shrink)

The neural vehicles of mental representation play an explanatory role in cognitive psychology that their realizers do not. In this paper, I argue that the individuation of realizers as vehicles of representation restricts the sorts of explanations in which they can participate. I illustrate this with reference to Rupert’s (2011) claim that representational vehicles can play an explanatory role in psychology in virtue of their quantity or proportion. I propose that such quantity-based explanatory claims can apply only to realizers and (...) not to vehicles, in virtue of the particular causal role that vehicles play in psychological explanations. (shrink)

In some situations, we attribute intentional mental states to a person despite their inability to articulate the contents in question: these are implicit mental states. Attributions of implicit mental states raise certain philosophical challenges related to rationality, concept possession, and privileged access. In the philosophical literature, there are two distinct strategies for addressing these challenges, depending on whether the content attributions are personal-level or subpersonal-level. This paper explores the difference between personal-level and subpersonal-level approaches to implicit mental state attribution and (...) investigates the relationship between the two approaches. It concludes by highlighting the methodological and metaphilosophical commitments which can result in different perspectives on the relative priority of personal-level and subpersonal-level theories. (shrink)

Explanations in psychology are described as personal when they attribute psychological phenomena to the person, as when we attribute beliefs and thought processes to each other, for example. By contrast, explanations in psychology are described as subpersonal when they attribute psychological phenomena below the level of the person, as occurs when scientists describe parts of the brain as representing or evaluating, for example. The practice of subpersonal psychology raises a number of philosophical issues: whether it is acceptable to attribute psychological (...) phenomena to parts of persons, for example, and whether such attributions can yield any explanatory benefit. Even those who endorse subpersonal psychology do not necessarily agree on what this entails: there are several distinct ways of understanding the relationship between subpersonal psychology and personal psychology, which depend in part on how the ontological commitments of subpersonal explanations are understood. (shrink)

Carrie Figdor argues for literalism, a semantic claim about psychological predicates, on the basis of a scientific claim about the nature of psychological properties. I argue that her scientific claim is based on controversial interpretations of scientific modelling, and that even if it were correct it would not justify her claims that psychological predicates are undergoing radical conceptual change.

Detecting conscious awareness in a patient emerging from a coma state is problematic, because our standard attributions of conscious awareness rely on interpreting bodily movement as intentional action. Where there is an absence of intentional bodily action, as in the vegetative state, can we reliably assume that there is an absence of conscious awareness? Recent neuroimaging work suggests that we can attribute conscious awareness to some patients in a vegetative state by interpreting their brain activity as intentional mental action. I (...) suggest that this change of focus, from the interpretation of motor behaviour as intentional bodily action to the interpretation of neural activity as intentional mental action, raises philosophical issues that affect the interpretation of the neuroimaging data. (shrink)

Contemporary scientific and philosophical literature on perception often focuses on the relationship between perception and action, emphasizing the ways in which perception can be understood as geared towards action or ‘action-oriented’. In this paper I provide a framework within which to classify approaches to action-oriented perception, and I highlight important differences between the distinct approaches. I show how talk of perception as action-oriented can be applied to the evolutionary history of perception, neural or psychological perceptual mechanisms, the semantic content or (...) phenomenal character of perceptual states, or to the metaphysical nature of perception. I argue that there are no straightforward inferences from one kind of action-oriented perception to another. Using this framework and its insights, I then explore the notion of action-oriented perceptual representation which plays a key role in some approaches to embodied cognitive science. I argue that the concept of action-oriented representation proposed by Clark and Wheeler is less straightforward than it might seem, because it seems to require both that the mechanisms of perceptual representation are action-oriented and that the content of these perceptual representations are action-oriented. Given that neither of these claims can be derived from the other, proponents of action-oriented representation owe us separate justification for each claim. I will argue that such justifications are not forthcoming in the literature, and that attempts to reconstruct them run into trouble: the sorts of arguments offered for the representational mechanisms being action-oriented seem to undermine the sorts of arguments offered for the representational content being action-oriented, and vice-versa. (shrink)

A primer on the philosophical issues relating to phenomenal consciousness, part of a collection of new papers by scientists and philosophers on the constitution of consciousness.

Neurath (1932) suggests that in our quest for scientific knowledge “we are like sailors who have to rebuild their ship on the open sea, without ever being able to dismantle it in dry-dock and reconstruct it from its best components”. Neurath's boat features in discussions of various philosophical ideas, including the debate with foundationalism and coherentism about justification, the ethics literature on reflective equilibrium, and naturalistic approaches to metaphilosophy.

In Thinking and Perceiving, Stokes challenges “the pernicious cognitive effects assumption”: the assumption that it would be epistemically problematic if our thoughts were to directly influence our perceptual experience. In doing so, Stokes takes himself to be supplementing the epistemological claims of philosophers like Siegel and Lyons with descriptive claims about human psychology. I argue that his conclusions are more radical than they first appear, to the extent that Stokes’s project is at odds with the standard epistemological discussions of cognitive (...) penetration. (shrink)

In Pieces of Mind: The Proper Domain of Psychological Predicates (Oxford UP, 2018), I argue that psychological predicates used to ascribe cognitive capacities to many nonhuman biological species should be interpreted literally with the same reference for humans and nonhumans alike. In this Mind & Language book symposium, I respond to comments and criticisms by Zoe Drayson, Edouard Machery, and Eric Schwitzgebel, and conclude that the Literalist position is still the best interpretation of these uses.

Many philosophers subscribe to the view that philosophy is a priori and in the business of discovering necessary truths from the armchair. This paper sets out to empirically test this picture. If this were the case, we would expect to see this reflected in philosophical practice. In particular, we would expect philosophers to advance mostly deductive, rather than inductive, arguments. The paper shows that the percentage of philosophy articles advancing deductive arguments is higher than those advancing inductive arguments, which is (...) what we would expect from the vantage point of the armchair philosophy picture. The results also show, however, that the percentages of articles advancing deductive arguments and those advancing inductive arguments are converging over time and that the difference between inductive and deductive ratios is declining over time. This trend suggests that deductive arguments are gradually losing their status as the dominant form of argumentation in philosophy. (shrink)

Perception provides us with access to the external world, but that access is shaped by our own experiential histories. Through perceptual learning, we can enhance our capacities for perceptual discrimination, categorization, and attention to salient properties. We can also encode harmful biases and stereotypes. This article reviews interdisciplinary research on perceptual learning, with an emphasis on the implications for our rational and normative theorizing. Perceptual learning raises the possibility that our inquiries into topics such as epistemic justification, aesthetic criticism, and (...) moral knowledge should include not only an examination of cognition but also of perception. (shrink)

According to a traditional picture, perception and belief have starkly different epistemic roles. Beliefs have epistemic statuses as justified or unjustified, depending on how they are formed and maintained. In contrast, perceptions are “unjustified justifiers.” Core cognition is a set of mental systems that stand at the border of perception and belief, and has been extensively studied in developmental psychology. Core cognition's borderline states do not fit neatly into the traditional epistemic picture. What is the epistemic role of these states? (...) Focusing on the core object system, the author argues that core object representations have epistemic statuses like beliefs do, despite their many prototypically perceptual features. First, the author argues that it is a sufficient condition on a mental state's having an epistemic status as justified or unjustified that the state is based on reasons. Then the author argues that core object representations are based on reasons, through an examination of both experimental results and key markers of the basing relation. The scope of mental states that are subject to epistemic evaluation as justified or unjustified is not restricted to beliefs. (shrink)

The concept of ecofascism describes the distortion of ecology for the purpose of gaining greater and wider audience, popularising ideologies and fulfilling xenophobic and nationalistic goals by regimes such as the far-right agenda and the radical ecological groups. This study investigates the issue of ecofascism in Europe, using the example of Greece, by examining the views of the citizens of Greece on the links between the political parties and ecology and environment. A survey of 600 people was conducted in Greece, (...) using questionnaires on ecofascism, politics and ecological issues. The survey showed that the sample has, in general, humanistic, democratic and quite left-wing ideals. However, some of the respondents indicated nationalistic, even fascist, trends. Because the current socio-economic and political conditions in Europe can fuel an outbreak of fascism, we should be very cautious about these findings, due to the growing impact of far-right ideas on society. Some aspects of the ecofascist rhetoric still continue to mislead, revealing the sly and worrying penetration of fascism in Greek society on the pretext of the protection of the Greek environment. (shrink)

Perceptual experiences are not immediately responsive to reasons. You see a stick submerged in a glass of water as bent no matter how much you know about light refraction. Due to this isolation from reasons, perception is traditionally considered outside the scope of epistemic evaluability as justified or unjustified. Is perception really as independent from reasons as visual illusions make it out to be? I argue no, drawing on psychological evidence from perceptual learning. The flexibility of perceptual learning is a (...) way of responding to new epistemic reasons. The resulting perceptual experiences are epistemically evaluable as justified or unjustified. (shrink)

A novel problem or task may seem difficult at first, but with enough practice, it can become easy and routine. Practice and the process of learning is often accompanied by some mild cognitive uneas...

Our perceptual systems are not stagnant but can learn from experience. Why is this so? That is, what is the function of perceptual learning? I consider two answers to this question: The Offloading View, which says that the function of perceptual learning is to offload tasks from cognition onto perception, thereby freeing up cognitive resources (Connolly, 2019) and the Perceptual View, which says that the function of perceptual learning is to improve the functioning of perception. I argue that the Perceptual (...) View better explains data from infants and animals, and better accounts for learned tasks that only perception could perform. (shrink)

A unique concept: 40 extraordinary people give answers to 10 searching questions about their beliefs. In our current age of uncertainty and turmoil, this is a book to give insight for life's journey and to encourage readers to confront the same questions themselves. "My suggestion or advice is very simple; that is, to have a sincere heart." - The Dalai Lama What Has Life Taught You? features the answers given by 40 outstanding people to 10 profound questions about life, the (...) mind and the spirit. Author Zoë Sallis has a passion for stirring up debate on philosophical and ethical questions and journeyed all over the globe to ask well-known figures of widely varying beliefs the same 10 questions. Interviewees include: Nelson Mandela His Holiness the Dalai Lama Neale Donald Walsch Anjelica Huston Jack Nicholson Sophia Loren Teale Swan Richard Dawkins David Lynch Gore Vidal And more... The questions range from "What is your concept of God?" and "Do you think this life is all there is, or do you believe in an afterlife?" to "What has life taught you so far?" and "How do you find peace within yourself?" Socrates thought the unexamined life was not worth living, and perhaps that is why he roamed the streets of Athens accosting people and asking them their thoughts and beliefs. By sharing the wisdom of these truly inspiring people, the book hopes to provoke debate and encourage readers to examine what they have learned on their life journey so far and share their own insights with others. (shrink)

What kinds of mental states can be based on epistemic reasons? The standard answer is only beliefs. I argue that perceptual states can also be based on reasons, as the result of crossmodal interactions. A perceptual state from one modality can provide a reason on which an experience in another modality is based. My argument identifies key markers of the basing relation and locates them in the crossmodal Marimba Illusion (Schutz & Kubovy 2009). The subject’s auditory experience of musical tone (...) duration is based on the reason provided by her visual representation of the length of the musician’s gesture and other stored perceptual principles. (shrink)

Do epistemic and aesthetic values ever conflict? The answer might appear to be no, given that background knowledge generally enhances aesthetic experience, and aesthetic experience in turn generates new knowledge. As Keats writes, ‘Beauty is truth, truth beauty’ (Keats, 1996). Contra this line of thought, I argue that epistemic and aesthetic values can conflict when we over-rely on aesthetically enhancing background beliefs. The true and the beautiful can pull in different directions, forcing us to choose between flavours of normativity.

Language provides rich social information about its speakers. For instance, adults and children make inferences about a speaker's social identity, geographic origins, and group membership based on her language and accent. Although infants prefer speakers of familiar languages, little is known about the developmental origins of humans’ sensitivity to language as marker of social identity. We investigated whether 9-month-olds use the language a person speaks as an indicator of that person's likely social relationships. Infants were familiarized with videos of two (...) people who spoke the same or different languages, and then viewed test videos of those two individuals affiliating or disengaging. Results suggest that infants expected two people who spoke the same language to be more likely to affiliate than two people who spoke different languages. Thus, infants view language as a meaningful social marker and use language to make inferences about third-party social relationships. (shrink)

Is there a parallel between climate change and our body’s temperature or non-compliance and failure to act on global warming? This paper proposes a model which describes the human body as part of N...

Recognizing and aligning individuals’ unique adaptive beliefs or “priors” through cooperative communication is critical to establishing a therapeutic relationship and alliance. Using active inference, we present an empirical integrative account of the biobehavioral mechanisms that underwrite therapeutic relationships. A significant mode of establishing cooperative alliances—and potential synchrony relationships—is through ostensive cues generated by repetitive coupling during dynamic touch. Established models speak to the unique role of affectionate touch in developing communication, interpersonal interactions, and a wide variety of therapeutic benefits for (...) patients of all ages; both neurophysiologically and behaviorally. The purpose of this article is to argue for the importance of therapeutic touch in establishing a therapeutic alliance and, ultimately, synchrony between practitioner and patient. We briefly overview the importance and role of therapeutic alliance in prosocial and clinical interactions. We then discuss how cooperative communication and mental state alignment—in intentional communication—are accomplished using active inference. We argue that alignment through active inference facilitates synchrony and communication. The ensuing account is extended to include the role of tactile afferents in realizing the beneficial effect of therapeutic synchrony. We conclude by proposing a method for synchronizing the effects of touch using the concept of active inference. (shrink)

We provide a novel articulation of the epistemic peril of p-hacking using three resources from philosophy: predictivism, Bayesian confirmation theory, and model selection theory. We defend a nuanced position on p-hacking: p-hacking is sometimes, but not always, epistemically pernicious. Our argument requires a novel understanding of Bayesianism, since a standard criticism of Bayesian confirmation theory is that it cannot represent the influence of biased methods. We then turn to pre-analysis plans, a methodological device used to mitigate p-hacking. Some say that (...) pre-analysis plans are epistemically meritorious while others deny this, and in practice pre-analysis plans are often violated. We resolve this debate with a modest defence of pre-analysis plans. Further, we argue that pre-analysis plans can be epistemically relevant even if the plan is not strictly followed—and suggest that allowing for flexible pre-analysis plans may be the best available policy option. (shrink)

The “received wisdom” in contemporary analytic philosophy is that intuition talk is a fairly recent phenomenon, dating back to the 1960s. In this paper, we set out to test two interpretations of this “received wisdom.” The first is that intuition talk is just talk, without any methodological significance. The second is that intuition talk is methodologically significant; it shows that analytic philosophers appeal to intuition. We present empirical and contextual evidence, systematically mined from the JSTOR corpus and HathiTrust’s Digital Library, (...) which provide some empirical support for the second rather than the first hypothesis. Our data also suggest that appealing to intuition is a much older philosophical methodology than the “received wisdom” alleges. We then discuss the implications of our findings for the contemporary debate over philosophical methodology. (shrink)

Introduction to Special Issue of Review of Philosophy and Psychology. Overview of the central issues in cognitive architecture, epistemology, and ethics surrounding cognitive penetrability. Special issue includes papers by philosophers and psychologists: Gary Lupyan, Fiona Macpherson, Reginald Adams, Anya Farennikova, Jona Vance, Francisco Marchi, Robert Cowan.

As many studies around the theme of ‘too much medicine’ attest, investigations are being ordered with increasing frequency; similarly the threshold for providing treatment has lowered. Our contention is that trust is a significant factor in influencing this, and that understanding the relationship between trust and investigations and treatments will help clinicians and policymakers ensure ethical decisions are more consistently made. Drawing on the philosophical literature, we investigate the nature of trust in the patient–doctor relationship, arguing that at its core (...) it involves a transfer of discretion. We show that there is substantial empirical support for the idea that more trust will reduce the problem of too much medicine. We then investigate ways in which trust can be built, concentrating on issues of questioning, of acknowledging uncertainty and of shouldering responsibility for it. We argue that offering investigations or treatments as a way of generating trust may itself be an untrustworthy way of proceeding, and that healthcare systems should provide the institutional support for facilitating continuity, questioning and the entrusting of uncertainty. (shrink)

This paper investigates the relationship between economic theory and theories of justice in the design of public policy. In particular, it focuses on the role of mechanism design in policy contexts beset with issues of social, racial and distributive justice. Economists’ involvement in redesigning Boston’s algorithm for allocating K-12 students to public schools serves as an instructive case study. The paper draws on the distinction betweenideal theoryandnon-ideal theoryin political philosophy and the concept ofperformativityin economic sociology to argue that mechanism design (...) can enact elaborate ideal theories of justice. Anormative gapthus emerges between the goals of the policymakers and the objectives of economic designs. As a result, mechanism design may obstruct stakeholders’ avenues for normative criticism of public policies, and serve as a technology of depoliticization. (shrink)

Christopher Hill's book Perceptual experience argues for a representational theory of mind that is grounded in empirical psychology. I focus here on three aspects of Hill's picture: The objects of visual awareness, the perception/cognition border, and the epistemic role of perceptual experience. I introduce challenges to Hill's account and consider ways these challenges may be overcome.

To practise ‘fairly and justly’ a clinician must balance the needs of both the many and the few: the individual patient in front of them, and the many unseen patients in the waiting room, and in the county. They must consider the immediate clinical needs of those in the present, and how their actions will impact on future patients. The good medical practice guidance ‘Make the care of your patient your first concern’ provides no guidance on how doctors should act (...) when they care for multiple patients with conflicting needs. Moreover, conflicting needs extend far past simply those between different patients. At an organisational level, financial obligations must be balanced with clinical ones; the system must support those who work within it in a variety of roles; and, finally, in order for a healthcare service to be sustainable, the demands of current and future generations must be balanced.The central problem, we propose, is that there is no shared philosophical framework on which the provision of care or the development of health policy is based, nor is there a practical, fair and transparent process to ensure that the service is equipped to deal justly with new challenges as they emerge. Many philosophers have grappled with constructing a set of principles which would lead to a ‘good’ society which is just to different users; prominent among them is Rawls.Four important principles can be derived using a Rawlsian approach: equity of access, distributive justice, sustainability and openness. However, Rawls’ approach is sometimes considered too abstract to be applied readily to policymaking; it does not provide clear guidance for how individuals working within existing institutions can enact the principles of justice. We therefore combine the principles derived from Rawls with Scanlonian contractualism: by demanding that decisions are made in a way which cannot be ‘reasonably rejected’ by different stakeholders, we ensure that conflicting needs are considered robustly.We demonstrate how embedding this framework would ensure just policies and fair practice. We illustrate this by using examples of how it would help prevent injustice among different socioeconomic groups, prevent intergenerational injustice and prevent injustice in a crisis, for example, as we respond to new challenges such as COVID-19.Attempts to help individual doctors practise fairly and justly throughout their professional lives are best focused at an institutional or systemic level. We propose a practical framework: combining Scanlonian contractualism with a Rawlsian approach. Adopting this framework would equip the workforce and population to contribute to fair policymaking, and would ultimately result in a healthcare system whose practice and policies—at their core—were just. (shrink)

Chapter 8 argues against the view that the moral rightness of an act is not a reason to perform it, and our reasons are instead the features that make the act right. Philosophers typically defend this view by noting that it seems redundant to take rightness to be an additional reason, once it has been acknowledged that the right-making features are already reasons. The author shows that this argument dramatically overgeneralizes, ruling out all cases in which two or more reasons (...) are arranged in relationships of metaphysical constitution. She then proposes an alternative way of thinking about these metaphysical hierarchies: Rather than assuming that at most one of the facts in each hierarchy is the “real” reason, bearing all the normative weight, it should be accepted that these facts can all be genuine reasons, whose normative weight is shared in virtue of the metaphysical relationships between them. Some tests are offered that can be used to determine which facts occur in metaphysical hierarchies with shared weight, and it is argued that the fact that an act is morally right passes the tests. The author then explains what she takes to be some kernels of truth underlying the redundancy argument, arguing that these phenomena are pragmatic, not metaphysical. (shrink)