This paper explores how transformative experience generates decision-making problems of particular seriousness in medical settings. Potentially transformative experiences are especially likely to be encountered in medicine, and the associated decisions are confronted jointly by patients and clinicians in the context of an imbalance of power and expertise. However in such scenarios the principle of informed consent, which plays a central role in guiding clinicians, is unequal to the task. We detail how the principle’s assumptions about autonomy, rationality and information handle (...) transformative experiences poorly, appealing to several difficult cases for medical decision-making to illustrate the resulting problem, and we consider how the existing literature on complications with consent fails to offer a resolution. We argue that recognition of the problem has a role to play in achieving a more effective response to transformative decisions. In Sect. 1 we introduce several representative cases of challenging patient decision-making that clinicians might face. In Sect. 2 we detail how transformative experience has been analysed in the recent literature, before outlining in Sect. 3 the theoretical basis of the principle of informed consent, which plays a central role in how clinicians are expected to support decision-making. In Sect. 4, having laid the groundwork for a clear description, we return to the cases given in Sect. 1 to confirm how their transformative nature presents a problem: either clinicians treat the decisions faced by these patients as ‘normal’, encouraging them to focus on information provision that patients may be unable to act on, or they treat them as transformative, in which case they lack the resources to recognise whether they are helping patients make (subjectively) good decisions. In Sect. 5 we argue that the existing literature does not offer any escape from this problem. We close in Sect. 6 by noting the significant impact that appreciating the problem of transformative experience could have on supporting transformative decisions in medicine and briefly suggesting how we might aim to develop new approaches to dealing with these. (shrink)

Much contemporary ontological inquiry takes place within the so-called ‘Quinean tradition’ but, given that some aspects of Quine’s project have been widely abandoned even by those who consider themselves Quineans, it is unclear what this amounts to. Fortunately recent work in metaontology has produced two relevant results here: a clearer characterisation of the metaontology uniting the aforementioned Quineans, most notably undertaken by Peter van Inwagen, and a raft of criticisms of that metaontology. In this paper I critique van Inwagen’s Quinean (...) metaontology, finding that certain challenges, supplemented by pressure to reflect more closely Quine’s work, should drive Quineans to adopt a stronger metaontology incorporating more of Quine’s radical views. I conclude that while van Inwagen’s Quineanism is problematic there are prospects for a viable, more wholeheartedly Quinean, metaontology. (shrink)

Much recent work in metaontology challenges the so-called ‘Quinean tradition’ in metaphysics. Especially prominently, Amie Thomasson argues for a highly permissive ontology over ontologies which eliminate many entities. I am concerned with disputing not her ontological claim, but the methodology behind her rejection of eliminativism – I focus on ordinary objects. Thomasson thinks that by endorsing the Quinean criterion of ontological commitment eliminativism goes wrong; a theory eschewing quantification over a kind may nonetheless be committed to its existence. I argue (...) that, contrary to Thomasson's claims, we should retain the Quinean criterion. Her arguments show that many eliminativist positions are flawed, but their flaws lie elsewhere: the Quinean criterion is innocent. Showing why reveals the importance of pragmatism in ontology. In §1 I compare Thomasson's account and the eliminativist views to which it stands in opposition. In §2 I re-construct Thomasson's reasons for rejecting the Quinean criterion. In §3 I defend the Quinean criterion, showing that the eliminativists’ flaws are not consequences of applying the Quinean criterion, before explaining the criterion's importance when properly understood. I conclude that Thomasson, though right to criticise the methodology of ordinary-object eliminativists, is wrong to identify the Quinean criterion as the source of their mistake. (shrink)

Several recent discussions of metaphysics disavow existence-questions, claiming that they are metaphysically uninteresting because trivially settled in the affirmative by Moorean facts. This is often given as a reason to focus metaphysical debate instead on questions of grounding. I argue that the strategy employed to undermine existence-questions fails against its usual target: Quineanism. The Quinean can protest that the formulation given of their position is a straw man: properly understood, as a project of explication, Quinean metaphysics does not counsel us (...) to choose between obvious ordinary-language claims and absurd revisionist claims, even if appeal to Moorean facts is permitted. (shrink)

Alongside the direct parallels and contrasts between traditional narrative fiction and games, there lie certain partial analogies that provide their own insights. This article begins by examining a direct parallel between narrative fiction and games—the role of fictional reliefs and reality checks in shaping aesthetic engagement—before arguing that from this a partial analogy can be developed stemming from a feature that distinguishes most games from most traditional fictions: the presence of rules. The relation between rules and fiction in games has (...) heretofore been acknowledged but not examined in detail, giving an impression of a tension that is constant. However, the paired concepts of formal reliefs and representation checks, once introduced, allow us to explain how rules and fiction interact to alter the ways in which players engage with games in a dynamic but limited way. (shrink)

W. V. Quine stands out as one of the foremost figures of twentieth-century analytic philosophy. This chapter aims to show that a significant part of his work’s enduring value lies in its contribution to metametaphysics, which will include showing how some more contentious aspects of Quine’s thought can be seen as indispensable to it; we will problematise the widespread belief that one can isolate basic elements of Quine’s metametaphysics without eroding their warrant. -/- §1 introduces the broad context. §2 examines (...) Quine’s most clearly metametaphysical work (and the desired backdrop for many analytic philosophers): ‘On what there is’. Finding the story incomplete here, we explore other elements of Quine’s corpus in turn. §3 analyses the nascent naturalism evident in ‘Two dogmas of empiricism’, §4 explores how the principle of charity becomes significant in Word & Object, and §5 shows how the eponymous principle of ‘Ontological relativity’ aims to defuse the puzzles of indeterminacy. In the process we will see how Quine’s concerns stemming from naturalism in general, and from the problems of indeterminacy in particular, make it hard to separate the basic picture from his more controversial fullblown approach – hard, that is, to avoid ontological relativity. This is bad news for those wishing to use Quine as a neutral backdrop to analytic metaphysical debate, but good news for those who value the distinctive philosophical tradition within which Quine’s work is a key development. (shrink)