How Doctors Think defines the nature and importance of clinical judgment. Although physicians make use of science, this book argues that medicine is not itself a science but rather an interpretive practice that relies on clinical reasoning. A physician looks at the patient's history along with the presenting physical signs and symptoms and juxtaposes these with clinical experience and empirical studies to construct a tentative account of the illness. How Doctors Think is divided into four parts. Part one introduces the (...) concept of medicine as a practice rather than a science; part two discusses the idea of causation; part three delves into the process of forming clinical judgment; and part four considers clinical judgment within the uncertain nature of medicine itself. In How Doctors Think, Montgomery contends that assuming medicine is strictly a science can have adverse side effects, and suggests reducing these by recognizing the vital role of clinical judgment. (shrink)
We wish to describe and acknowledge the exceptional contributions to medical ethics, both in the UK and internationally, made by Edward Shotter1 who died at home on 3 July 2019. He was founder of the London Medical Group2 3 and instigator of similar student-led medical ethics groups throughout the UK; founder of the Institute of Medical Ethics4 and founder of the Journal of Medical Ethics. Ted Shotter transformed the study of medical ethics in the UK in the interests of patients (...) and professionals alike. In 1963, he established the pioneering ‘Medical Group’ model, an innovative bottom-up method whereby students in the health professions could gain a grounding in ethics that had previously been denied to the profession.5 It was with these Medical Groups that many of the leading figures in contemporary UK medical ethics and law began their careers in the subject including Sir Kenneth Calman, Sir Ian Kennedy, Professor Margaret Brazier OBE, Professor John Harris and Professor Sir Jonathan Montgomery to name but …. (shrink)
Despite medicine's achievements, medical errors and the difficulty of reproducing research prove medicine is far from perfect. This book provides a critical and historical analysis of medical reasoning that recognizes the constant need for certainty despite the enormous variety of disease, illness, symptoms, and behavior in patients. According to Erwin Montgomery, Jr., medicine depends on logic, balancing utility with certainty, and anticipating errors in judgment.
Most ?theories of consciousness? are based on vague speculations about the properties of conscious experience. We aim to provide a more solid basis for a science of consciousness. We argue that a theory of consciousness should provide an account of the very processes that allow us to acquire and use information about our own mental states ? the processes underlying introspection. This can be achieved through the construction of information processing models that can account for ?Type-C? processes. Type-C processes can (...) be specified experimentally by identifying paradigms in which awareness of the stimulus is necessary for an intentional action. The Shallice (1988b) framework is put forward as providing an initial account of Type-C processes, which can relate perceptual consciousness to consciously performed actions. Further, we suggest that this framework may be refined through the investigation of the functions of prefrontal cortex. The formulation of our approach requires us to consider fundamental conceptual and methodological issues associated with consciousness. The most significant of these issues concerns the scientific use of introspective evidence. We outline and justify a conservative methodological approach to the use of introspective evidence, with attention to the difficulties historically associated with its use in psychology. (shrink)
Cognitive science has wholeheartedly embraced functional brain imaging, but introspective data are still eschewed to the extent that it runs against standard practice to engage in the systematic collection of introspective reports. However, in the case of executive processes associated with prefrontal cortex, imaging has made limited progress, whereas introspective methods have considerable unfulfilled potential. We argue for a re-evaluation of the standard ‘cognitive mapping’ paradigm, emphasizing the use of retrospective reports alongside behavioural and brain imaging techniques. Using all three (...) sources of evidence can compensate for their individual limitations, and so triangulate on higher cognitive processes. (shrink)
Cognitive science is shamelessly materialistic. It maintains that human beings are nothing more than complex physical systems, ultimately and completely explicable in mechanistic terms. But this conception of humanity does not ?t well with common sense. To think of the creatures we spend much of our day loving, hating, admiring, resenting, comparing ourselves to, trying to understand, blaming, and thanking -- to think of them as mere mechanisms seems at best counterintuitive and unhelpful. More often it may strike us as (...) ludicrous, or even abhorrent. We are. (shrink)
One of the best gimmicks on the cognitive science conference circuit is the demonstration of inattentional blindness. Many readers of this journal must have already been exposed to it. For the rest we will briefly describe a striking and popular demonstration. It typically evolves during a conference talk, where the presenter provides the audience with a stimulus in the form of a small video clip of six people, three in white, three in black, who pass two basket balls around. The (...) instruction is to count the number of passes made by the players in white. When the movie is over, the presenter asks for a response, someone provides it, and he then goes on to elicit a report: 'Did anyone notice something strange during the film?' Usually, only those who have seen the film before have, but they are not allowed to answer. The film is then replayed, but this time, the audience is instructed to look out for anything unusual. Muted, surprised laughter goes through the auditorium when someone dressed as a gorilla enters into the scene of kids playing, confronts the spectators, bangs his chest, and slowly walks out again. It seems incredible that it went unnoticed the first time around, and yet those who have been exposed to the experiment before can testify that the gorilla was indeed there in both showings of the film. (shrink)
Wegner's thesis that the experience of will is an illusion is not just wrong, it is an impediment to progress in psychology. We discuss two readings of Wegner's thesis and find that neither can motivate his larger conclusion. Wegner thinks science requires us to dismiss our experiences. Its real promise is to help us to make better sense of them.
I sketch an explanatory framework that fits a variety of contemporary research programs in cognitive science. I then investigate the scope and the implications of this framework. The framework emphasizes (a) the explanatory role played by the semantic content of cognitive representations, and (b) the important mechanistic, non-intentional dimension of cognitive explanations. I show how both of these features are present simultaneously in certain varieties of cognitive explanation. I also consider the explanatory role played by grounded representational content, that is, (...) content evaluated by appeal to its truth, falsity, accuracy, inaccuracy and other relational properties. (shrink)
This paper argues that ross's theory is an unsatisfactory compromise between moore's ideal utilitarianism and prichard's intuitionism. by including an 'optimific' principle, ross is exposed like moore to such difficulties as having to grant that we never know our duty and that logically we have a duty to pursue our own pleasure. in addition, this paper attributes to moore's influence ross's very inadequate treatment of justice; difficulties in his basic distinction of prima facie versus actual duties; and his unsatisfactory treatments (...) of the deontological/teleological issue. (shrink)
With some regularity, cognitive scientists seem to introduce cognitive values into their explanations. After identifying examples of this practice, I sketch an account of psychological explanation that, under certain conditions, legitimizes value-laden cognitive explanations in which evaluative claims appear in the explanandum. I then present and discuss two applications of the proposed account in order to show its viability and explore its consequences.
I offer support for the view that physicalist theories of cognition don't reduce to neurophysiological theories. On my view, the mind-brain relationship is to be explained in terms of evolutionary forces, some of which tug in the direction of a reductionistic mind-brain relationship, and some of which which tug in the opposite direction. This theory of forces makes possible an anti-reductionist account of the cognitive mind-brain relationship which avoids psychophysical anomalism. This theory thus also responds to the complaint which arguably (...) lies behind the Churchlands' strongest criticisms of anti-reductionism — namely the complaint that anti-reductionists fail to supply principled explanations for the character of the mind-brain relationship. While lending support to anti-reductionism, the view defended here also insures a permanent place for mind-brain reduction as an explanatory ideal analogous to Newtonian inertial motion or Aristotelian natural motion. (shrink)
Bering contends that belief in the afterlife is explained by the simulation constraint hypothesis: the claim that we cannot imagine what it is like to be dead. This explanation suffers from some difficulties. First, it implies the existence of a corresponding belief in the “beforelife.” Second, a simpler explanation will suffice. Rather than appeal to constraints on our thoughts about death, we suggest that belief in the afterlife can be better explained by the lack of such constraints.
Those who are optimistic about the prospects of a science of consciousness, and those who believe that it lies beyond the reach of standard scientific methods, have something in common: both groups view consciousness as posing a special challenge for science. In this paper, we take a close look at the nature of this challenge. We show that popular conceptions of the problem of consciousness, epitomized by David Chalmers’ formulation of the ‘hard problem’, can be best explained as a cognitive (...) illusion, which arises as a by-product of our cognitive architecture. We present evidence from numerous sources to support our claim that we have a specialized system for thinking about phenomenal states, and that an inhibitory relationship exists between this system and the system we use to think about physical mechanisms. Even though the ‘hard problem’ is an illusion, unfortunately it appears that our cognitive architecture forces a closely related problem upon us. The ‘genuine problem’ of consciousness shares many features with the hard problem, and it also represents a special challenge for psychology. Nonetheless, researchers should be careful not to mistake the hard problem for the genuine problem, since the strategies appropriate for dealing with these problems differ in important respects. (shrink)
A critical survey of recent work on the ontological status of colors supports the conclusion that, while some accounts of color can plausibly be dismissed, no single account can yet be endorsed. Among the remaining options are certain forms of color realism according which familiar colors are instantiated by objects in our extra-cranial visual environment. Also still an option is color anti-realism, the view that familiar colors are, at best, biologically adaptive fictions, instantiated nowhere.I argue that there is simply no (...) fact of the matter as to which of these remaining options is correct. I blame this indeterminacy on the fact that color vision exhibits several of the hallmarks of a modular input system, as described by Jerry Fodor in The Modularity of Mind. (shrink)
In a recent article in Philosophy Professor Knox makes a plea for a philosophic treatment of economic activity by way of contrast to either the specialized study of economic history or of economic science. The conclusion which was reached was embodied in the statement that “the historical and scientific methods of the study of economic activity leave incompletely satisfied the curiosity of students , and reach results which need special interpretation before they can be useful to politicians, let alone to (...) business men” . Each of these methods is said to involve unreal abstractions which detract from the usefulness of the study. A philosophic. (shrink)