This paper critically examines the extent to which health promoting wearable technologies can provide people with greater autonomy over their health. These devices are frequently presented as a means of expanding the possibilities people have for making healthier decisions and living healthier lives. We accept that by collecting, monitoring, analysing and displaying biomedical data, and by helping to underpin motivation, wearable technologies can support autonomy over health. However, we argue that their contribution in this regard is limited and that—even with (...) respect to their ‘autonomy enhancing’ potential—these devices may deliver costs as well as benefits. We proceed by rehearsing the distinction that can be drawn between procedural autonomy and substantive-relational autonomy. While the information provided by wearable technologies may support deliberation and decision-making, in isolation these technologies do little to provide substantive opportunities to act and achieve better health. As a consequence, wearable technologies risk generating burdens of anxiety and stigma for their users and reproducing existing health inequalities. We then reexamine the extent to which wearable technologies actually support autonomous deliberation. We argue that wearable technologies that subject their users to biomedical and consumerist epistemologies, norms and values also risk undermining processes of genuinely autonomous deliberation. (shrink)

Psychological externalism is the thesis that the contents of many of a person's propositional mental states are determined in part by relations he bears to his natural and social environment. This thesis has recently been thrust into prominence in the philosophy of mind by a series of thought experiments due to Hilary Putnam and Tyler Burge. Externalism is a metaphysical thesis, but in this work I investigate its implications for the epistemology of the mental. I am primarily concerned with the (...) question whether externalism undermines the idea that a person typically knows the contents of her own thoughts, beliefs, and other propositional attitudes directly and authoritatively. I criticize arguments that have been advanced on behalf of a positive answer to this question, and argue that they rest on a faulty conception of the nature of first person authority, one which likens our access to our own minds to perception. An account of the basis of first person authority is sketched that locates our epistemic right to our self-ascriptions of propositional attitude not in our ability to discriminate among the various thought contents we might be thinking, but rather in our ability to express our thoughts, and to think with them in accordance with the norms of rationality. I consider also the question whether first person authority and externalism jointly make possible a refutation of certain forms of global skepticism, as has been famously argued by Putnam. I argue that Putnam's attempted refutation fails, because the crucial externalist claims that drive it are not knowable a priori. (shrink)

There are various reasons why efforts to promote “support for self-management” have rarely delivered the kinds of sustainable improvements in healthcare experiences, health and wellbeing that policy leaders internationally have hoped for. This paper explains how the basis of failure is in some respects built into the ideas that underpin many of these efforts. When support for self-management is narrowly oriented towards educating and motivating patients to adopt the behaviours recommended for disease control, it implicitly reflects and perpetuates limited and (...) somewhat instrumental views of patients. It tends to: restrict the pursuit of respectful and enabling ‘partnership working’; run the risk of undermining patients’ self-evaluative attitudes ; limit recognition of the supportive value of clinician-patient relationships; and obscure the practical and ethical tensions that clinicians face in the delivery of support for self-management. We suggest that a focus on enabling people to live well with their long-term conditions is a promising starting point for a more adequate conception of support for self-management. We then outline the theoretical advantages that a capabilities approach to thinking about living well can bring to the development of an account of support for self-management, explaining, for example, how it can accommodate the range of what matters to people for living well, help keep the importance of disease control in perspective, recognize social influences on people’s values, behaviours and wellbeing, and illuminate more of the rich potential and practical and ethical challenges of supporting self-management in practice. (shrink)

Attention to individual choice is a valuable dimension of public health policy; however, the creation of effective public health programmes requires policy makers to address the material and social structures that determine a person’s chance of actually achieving a good state of health. This statement summarizes a well understood and widely held view within public health practice. In this article, we (i) argue that advocates for public health can and should defend this emphasis on ‘structures’ by reference to citizen autonomy (...) and not simply by emphasizing concern for counter-balancing values such as ‘population health’ or ‘fairness’, (ii) map and critically explore the contrasting conceptions of autonomy that feature in such debates, with particular attention to conceptions of autonomy that might feature in the defence of an emphasis on structures. We draw on (i) a relational conception of autonomy and (ii) the distinction that can be made between autonomous deliberation and autonomous action to suggest that offering people the opportunity to make choices about their health without also supporting their capability to achieve the object of these choices falls short of what is often considered to be morally and politically important about promoting autonomy in relation to health. (shrink)

Chapter One THE PROBLEM OF BEING IN THE METAPHYSICS TO determine whether the notion of Being in Alexander of Hales is Aristotelian or Platonic, a recent historian seeks his criterion in "the gradual separation of the Aristotelian ...

I. An approach to the question of teleology in nature for Aristotle requires first of all a sufficiently clear understanding of the terms involved. In regard to the notion of teleology itself, there can hardly be any pertinent difficulty. The term is a modern one, and is quite definitely fixed in meaning by contemporary use. It seems to have been coined in eighteenth-century philosophical Latin to denote the study of final causes in nature. It became readily accepted in modern philosophical (...) vocabulary. Against this historical background it is commonly understood today to focus on “purposive or goal-directed activity.” In application to nature it assumes that purposive activity is present and asks how the activity is to be identified and described. The initial problem, accordingly, will lie not with the notion of teleology but rather with the other term, ‘nature’. (shrink)

My primary goal in this paper is to focus attention on a certain conception of internal access, on the Cartesian conception that a rational subject's capacity to determine sameness and difference in explicit propositional attitudes is independent of knowledge of the external world. This conception of introspection plays a crucial, if unacknowledged, role in numerous arguments and theoretical positions. In particular, it plays a large role in motivating psychological internalism. I argue in favor of rejecting this epistemology and the internalism (...) it supports. (shrink)

Bioethics is a diverse field that accommodates a broad range of perspectives and disciplines. The recent explosion of literature on methods in interdisciplinary and empirical ethics might appear, however, to overshadow the fact that ‘bioethics’ has long been an interdisciplinary field. The Interdisciplinary and Empirical Ethics Network (IEEN) was established, with funding from the Wellcome Trust, to facilitate critical and constructive discussion around the nature of this disciplinary diversity and shift focus away from the ‘empirical turn’, towards the ongoing development (...) of bioethics as an evolving field of interdisciplinary study. In April 2012 the IEEN organized a workshop at the Centre for Public Policy Research, King's College London, dedicated to discussing the relationship between aims and methods in interdisciplinary and empirical bioethics. This paper reports on that first meeting. (shrink)

In this paper we contribute to “sociology in bioethics” and help clarify the range of ways sociological work can contribute to ethics scholarship. We do this using a case study of an innovative neurotechnology, functional magnetic resonance imaging, and its use to attempt to diagnose and communicate with severely brain-injured patients. We compare empirical data from interviews with relatives of patients who have a severe brain injury with perspectives from mainstream bioethics scholars. We use the notion of an “ethical landscape” (...) as an analogy for the different ethical positions subjects can take—whereby a person’s position relative to the landscape makes a difference to the way they experience and interact with it. We show that, in comparison to studying abstract ethics “from above” the ethical landscape, which involves universal generalizations and global judgements, studying ethics empirically “from the ground,” within the ethical landscape foregrounds a more plural and differentiated picture. We argue it is important not to treat empirical ethics as secondary to abstract ethics, to treat on-the-ground perspectives as useful only insofar as they can inform ethics from above. Rather, empirical perspectives can illuminate the plural vantage points in ethical judgments, highlight the “lived” nature of ethical reasoning, and point to all ethical vantage points as being significant. This is of epistemic importance to normative ethics, since researchers who pay attention to the various positions in and trajectories through the ethical landscape are unlikely to think about ethics in terms of abstract agency—as can happen with top-down ethics—or to elide agency with the agency of policymakers. Moreover, empirical perspectives may have transformative implications for people on the ground, especially where focus on the potential harms and benefits they face brings their experiences and interests to the forefront of ethical and policy discussion. (shrink)

Does the act of creation show itself anywhere within the creation? A common contemporary ontology tends to see two possibilities for those who want to defend a notion of creation. The first is to argue that an original set of materials was brought into existence out of nothing by divine action a long time ago. The second, in the tradition of Paley, posits a specific divine action that oversees the development of some of the materials into entities with an end-directedness. (...) Much contemporary energy focuses on the second possibility. The argument of the paper is that the ontology behind both of these possibilities, which limits itself to the notions of a creation of materials and the building of some of the materials into end-directed entities, conceals rather than reveals the idea of creation. The paper tries to show how an Aristotelian sense of nature, with its recognition of internal teleology and original spontaneity, offers a better starting point for coming up against the mystery of divine creative activity. (shrink)

The relation between imagery and philosophy in the poem of Parmenides has occasioned much discussion in recent years. One item of particular import has been the direction taken by the journey that was so inspiringly pictured in the opening section. Is the travel upwards? Or is it downwards? Or is it rather cross-country, either aloft, or on the earth’s surface, or in the depths of the nether world? Further, if there is cross travel on any of these three levels, is (...) the direction from east to west, or from west to east? (shrink)

At a conference on ‘Leisure in Canada,’ held more than a decade ago at Montmorency in Quebec, a participant observed that ‘practically all writers on the subject take Aristotle as the point of departure in discussing leisure but seldom seem to move from that point.’ At first sight this statement may seem surprising. How is it to be understood? Certainly recent writers on leisure do in fact list Aristotle's conception as one of the significant positions on it.

There is a growing acceptance of the idea that the explanatory states of folk psychology do not supervene on the physical. Even Fodor (1987) seems to grant as much. He argues, however, that this cannot be true of theoretical psychology. Since theoretical psychology offers causal explanations, its explanatory states must be taxonomized in such a way as to supervene on the physical. I use this concession to invert his argument and cast doubt on the received model of folk psychological explanation (...) as causal explanation by intentionally individuated states. This in turn undermines the central model of cognitive theory--causal explanation by representational states. (shrink)

FIVE 'WAYS' TO PROVE THAT GOD EXISTS ARE OFFERED IN AQUINAS' "SUMMA OF THEOLOGY," ALL TAKEN FROM HISTORICALLY TRACEABLE SOURCES IN WHICH THEY DID NOT REACH THE CONCLUSION ENVISAGED BY HIM. 'WAYS' UP TO ELEVEN IN NUMBER ARE IN FACT USED IN HIS WORKS. ALL FUNCTION IN A STRICTLY METAPHYSICAL--NOT COSMOLOGICAL OR TELEOLOGICAL--FRAMEWORK THAT WAS DEVELOPED EARLY IN HIS CAREER. THE ANSELMIAN AND OTHER ARGUMENTS THAT CANNOT FIT INTO THAT FRAMEWORK ARE REJECTED OR LEFT UNNOTICED, WHILE THOSE THAT DO FIT (...) IN ARE ACCEPTED IN LINE WITH THE CONVENIENCE OF THE MOMENT. ACCORDINGLY THE NUMBER AND ORDER OF THE 'FIVE WAYS' MEAN NO MORE THAN A MOMENTARY CONVENIENCE OF THIS TYPE. (shrink)

This paper considers proposals for developing ‘co-productive’ medical partnerships, within the UK National Health Service (NHS), concentrating in particular on the potential problem involved in combining professional and lay conceptions of health. Much of the literature that advocates the introduction of co-productive healthcare partnerships assumes that medical professionals and patients share, or can easily come to share, a common set of beliefs about what is valuable with regard to health interventions and outcomes. However, a substantial literature documents the contestability of (...) the concept of health, particular across professional and lay divides. We suggest that this potential disagreement ought to be taken seriously, and suggest that the prospect of a co-productive NHS in which patients and professionals act in partnership is threatened by the existence of unresolved epistemic differences. We suggest that part of the solution may lie in re-framing this potential disagreement in the terms provided by Engel’s bio-psycho-social account of health, and demonstrate how support for this account can be grounded upon a critical realist foundation. What we call a ‘stratified conception of health’ reveals the potential complementarity between health beliefs which may have at first seemed to be essentially contradictory. We consider some of the practical implications this idea has for conceiving and creating co-productive medical partnerships. (shrink)

DIFFICULTIES about existence have plagued Western thought since the time of Parmenides. The Eleatic sage had concentrated on what was most obvious and most incontrovertible to him, namely, that something exists. He made that tenet the way and the test of truth. From it he drew consequences that succeeding Greek thinkers from Empedocles to Plotinus accepted in part and rejected in part, intrigued by much of what he had stated but repelled by seeming enormities in some of his conclusions. Later, (...) the patristic acceptation of being as the most appropriate name for God gave additional complication to the issue. In modern times the Kantian and linguistic approaches have raised the questions how existence is a predicate and whether there is a concept of it, and if so, what kind of a concept. On the other hand, the impact of Heidegger has inspired renewed and often enthusiastic absorption in the important role played by existence in philosophical thought, and current contacts with Hindu philosophies are furthering this interest. (shrink)

These substances have been considered in recent times, as in traditional interpretation, to be identical with the immobile Movers of the Physics. Both Physics and Metaphysics refer to the same separate substances. On the other hand, the immobile Movers of the Physics have been identified with the immanent souls of the Heavens, and so sharply distinguished from the separate substances of the Metaphysics. Then in the opposite extreme, the Movers of the Metaphysics have been completely identified with the celestial souls. (...) Or again, the first only of the Movers has been declared separate, and the others identified with the different sphere-souls, among which is the first Mover of the Physics. In still another interpretation the first Mover alone is separate, but the other immobile Movers are held to be the divine thoughts, identical with the first Mover. Even the first Mover has been interpreted as a thought in the mind of some other Being, as merely an ideal or standard of goodness which does not imply--though it need not exclude--any corresponding existent reality in the Aristotelian universe. (shrink)

Explanation of cognition as a special way of being appears in Aristotle without traceable ancestry. Earlier, in Parmenides and in Empedocles, the notion that cognition is somehow equated with the physical constitution of the knower at any given moment had been put forward. But the now rather enigmatic fragments of those thinkers fail to show how this notion foreshadowed any new kind of being over and above the physical. In fact, would it not seem incongruous to use the term “being” (...) for something proposed by them in terms of change? ·. (shrink)

The opening chapter of the Categories fails to reveal whether it is introducing a grammatical, a logical, or a metaphysical treatise. It deals with equivocals and univocals and ends with a definition of paronyms. The definition of paronyms is given in purely grammatical terms. Paronyms derive their name from an identical source with a difference only in case ending, as bravery and the brave, grammar and the grammarian. The second chapter, however, proceeds to state that an expression can be either (...) complex or simple--complex like "a man runs," or simple like "man" or "runs." Then it immediately passes over to beings. Of the things that are, it states, some are asserted of a subject, but are not in any subject. The example given is that "man" is asserted of a particular man. To supply for Aristotle a current instance of what is here meant, one might use the sentence "Bertrand Russell is a man." This type of statement, to take the Aristotelian text literally, is dealing with beings and is asserting something of a subject. What is asserted, "man," is not in any subject even though it is asserted of a subject. In other words, the logically proper name "Bertrand Russell" denotes a substance and not an accident. (shrink)

In this volume, John R. Catan has gathered together 18 major essays by the well-known aristotelian scholar Joseph Owens that have influenced current opinion on the philosopher.

With its probative force drawn solely from premises accessible to the human mind's own inherent powers, Christian philosophy probes the divinely re- vealed truths under their naturally knowable aspects. From the apologetic or defensive angle, this type of philosophy is needed to meet rational queries- one's own or those of others-arising from religious doctrines, for instance from the tenets of creation, divine providence, immortality of the spiritual soul, or human destiny. On the positive side, Christian philosophy deepens the attraction of (...) revealed doctrines in a way comparable to the enhancement given them by architecture, music, art and poetry in actual Christian life. (shrink)