Children ranging from 3 to 5 years were introduced to two anthropomorphic robots that provided them with information about unfamiliar animals. Children treated the robots as interlocutors. They supplied information to the robots and retained what the robots told them. Children also treated the robots as informants from whom they could seek information. Consistent with studies of children's early sensitivity to an interlocutor's non-verbal signals, children were especially attentive and receptive to whichever robot displayed the greater non-verbal contingency. Such selective (...) information seeking is consistent with recent findings showing that although young children learn from others, they are selective with respect to the informants that they question or endorse. (shrink)
Two of the most influential theories about scientific inference are inference to the best explanation and Bayesianism. How are they related? Bas van Fraassen has claimed that IBE and Bayesianism are incompatible rival theories, as any probabilistic version of IBE would violate Bayesian conditionalization. In response, several authors have defended the view that IBE is compatible with Bayesian updating. They claim that the explanatory considerations in IBE are taken into account by the Bayesian because the Bayesian either does or should (...) make use of them in assigning probabilities to hypotheses. I argue that van Fraassen has not succeeded in establishing that IBE and Bayesianism are incompatible, but that the existing compatibilist response is also not satisfactory. I suggest that a more promising approach to the problem is to investigate whether explanatory considerations are taken into account by a Bayesian who assigns priors and likelihoods on his or her own terms. In this case, IBE would emerge from the Bayesian account, rather than being used to constrain priors and likelihoods. I provide a detailed discussion of the case of how the Copernican and Ptolemaic theories explain retrograde motion, and suggest that one of the key explanatory considerations is the extent to which the explanation a theory provides depends on its core elements rather than on auxiliary hypotheses. I then suggest that this type of consideration is reflected in the Bayesian likelihood, given priors that a Bayesian might be inclined to adopt even without explicit guidance by IBE. The aim is to show that IBE and Bayesianism may be compatible, not because they can be amalgamated, but rather because they capture substantially similar epistemic considerations. 1 Introduction2 Preliminaries3 Inference to the Best Explanation4 Bayesianism5 The Incompatibilist View : Inference to the Best Explanation Contradicts Bayesianism5. 1 Criticism of the incompatibilist view6 Constraint - Based Compatibilism6. 1 Criticism of constraint - based compatibilism7 Emergent Compatibilism7. 1 Analysis of inference to the best explanation7. 1. 1 Inference to the best explanation on specific hypotheses7. 1. 2 Inference to the best explanation on general theories7. 1. 3 Copernicus versus Ptolemy7. 1. 4 Explanatory virtues7. 1. 5 Summary7. 2 Bayesian account8 Conclusion. (shrink)
Hierarchical Bayesian models (HBMs) provide an account of Bayesian inference in a hierarchically structured hypothesis space. Scientific theories are plausibly regarded as organized into hierarchies in many cases, with higher levels sometimes called ‘paradigms’ and lower levels encoding more specific or concrete hypotheses. Therefore, HBMs provide a useful model for scientific theory change, showing how higher‐level theory change may be driven by the impact of evidence on lower levels. HBMs capture features described in the Kuhnian tradition, particularly the idea that (...) higher‐level theories guide learning at lower levels. In addition, they help resolve certain issues for Bayesians, such as scientific preference for simplicity and the problem of new theories. *Received July 2009; revised October 2009. †To contact the authors, please write to: Leah Henderson, Massachusetts Institute of Technology, 77 Massachusetts Avenue, 32D‐808, Cambridge, MA 02139; e‐mail: lhenders@mit.edu. (shrink)
The vast majority of health research resources are used to study conditions that affect a small, advantaged portion of the global population. This distribution has been widely criticized as inequitable and threatens to exacerbate health disparities. However, there has been little systematic work on what individual health research funders ought to do in response. In this article, we analyze the general and special duties of research funders to the different populations that might benefit from health research. We assess how these (...) duties apply to governmental, multilateral, nonprofit, and for-profit organizations. We thereby derive a framework for how different types of funders should take the beneficiaries of research into account when they allocate scarce research resources. (shrink)
_K. al-Manām_ by Ibn Abī al-Dunyā is a compendium of 350 Muslim dream narratives in Arabic. The English introduction examines the function of dreams in classical Arabic literature with a focus on dreams as a means of edification.
These essays engage Jin Y. Park’s recent translation of the work of Kim Iryŏp, a Buddhist nun and public intellectual in early twentieth-century Korea. Park’s translation of Iryŏp’s Reflections of a Zen Buddhist Nun was the subject of two book panels at recent conferences: the first a plenary session at the annual meeting of the Society for Asian and Comparative Philosophy and the second at the Eastern Division of the American Philosophical Association on a group program session sponsored by the (...) International Society for Buddhist Philosophy. This exchange also includes a response from Park. (shrink)
The no miracles argument is one of the main arguments for scientific realism. Recently it has been alleged that the no miracles argument is fundamentally flawed because it commits the base rate fallacy. The allegation is based on the idea that the appeal of the no miracles argument arises from inappropriate neglect of the base rate of approximate truth among the relevant population of theories. However, the base rate fallacy allegation relies on an assumption of random sampling of individuals from (...) the population which cannot be made in the case of the no miracles argument. Therefore the base rate fallacy objection to the no miracles argument fails. I distinguish between a “local” and a “global” form of the no miracles argument. The base rate fallacy objection has been leveled at the local version. I argue that the global argument plays a key role in supporting a base-rate-fallacy-free formulation of the local version of the argument. (shrink)
Patient-reported outcome measures (PROMs) are increasingly used to assess multiple facets of healthcare, including effectiveness, side effects of treatment, symptoms, health care needs, quality of care, and the evaluation of health care options. There are thousands of these measures and yet there is very little discussion of their theoretical underpinnings. In her 2008 Presidential address to the Society for Quality of Life Research (ISOQoL), Professor Donna Lamping challenged researchers to grapple with the theoretical issues that arise from these measures. In (...) this paper, I attempt to do so by arguing for an analogy between PROMs and Hans-Georg Gadamer’s logic of question and answer. While researchers readily admit that the constructs involved in PROMs are imperfectly understood and lack a gold standard, they often ignore the consequences of this fact. Gadamer’s work on questions and their importance to philosophical hermeneutics helps to show that the questions researchers ask about such constructs are also imperfectly understood. I argue that these questions should not be standardized, and I instead propose a theoretical framework that understands PROMs as posing genuine questions to respondents—questions that are open to reinterpretation. (shrink)
BackgroundFunctional neurodiagnostics could allow researchers and clinicians to distinguish more accurately between the unresponsive wakefulness syndrome and the minimally conscious state. It remains unclear how it informs surrogate decision-making.ObjectiveTo explore how the next of kin of patients with disorders of consciousness interpret the results of a functional neurodiagnostics measure and how/why their interpretations influence their attitudes towards medical decisions.Methods and SampleWe conducted problem-centered interviews with seven next of kin of patients with DOC who had undergone a functional HD-EEG examination at (...) a neurological rehabilitation center in Germany. The examination included an auditory oddball paradigm and a motor imagery task to detect hidden awareness. We analyzed the interview transcripts using structuring qualitative content analysis.ResultsRegardless of the diagnostic results, all participants were optimistic of the patients’ meaningful recovery. We hypothesize, that participants deal with the results of examinations according to their belief system. Thus, an unfavorable evaluation of the patient’s state had the potential to destabilize the participant’s belief system. To re-stabilize or to prevent the destabilization of their belief system, participants used different strategies. Participants accepted a “positive” HD-EEG result since it stabilized their belief system.ConclusionWe hypothesize, that a group of next of kin of patients with DOC deals with functional neurodiagnostics results on the basis of the result’s value and their high hope that the patient will recover meaningfully. A psychological mechanism seems to moderate the impact of functional neurodiagnostics on surrogate treatment decisions. (shrink)
ABSTRACTCrying is often considered to be a positive experience that benefits the crier, yet there is little empirical evidence to support this. Indeed, it seems that people hold a range of appraisals about their crying, and these are likely to influence the effects of crying on their emotional state. This paper reports on the development and psychometric validation of the Beliefs about Crying Scale, a new measure assessing beliefs about whether crying leads to positive or negative emotional outcomes in individual (...) and interpersonal contexts. Using 40 preliminary items drawn from a qualitative study, an exploratory factor analysis with 202 participants yielded three subscales: Helpful Beliefs, Unhelpful-Individual Beliefs, and Unhelpful-Social Beliefs, explaining 60% of the variance in the data. Confirmatory factor analysis on the 14-item scale with 210 participants showed a good fit to the three factors. The subscales showed differential... (shrink)
One of the main features of the contemporary environmental crisis is that no one has a clear picture of what is taking place. Environmental problems are real enough but they bring home the inadequacy of our knowledge. How does the natural world relate to the social world? Why do we continue to have such a poor understanding? How can ecological knowledge be made to relate to our understanding of human society? Reconstructing Nature argues that the division of labor is a (...) key but neglected factor underlying people's inability to adequately understand and relate to the natural world. The argument extends Marx's theory of alienation to account for inadequate knowledge and therefore inadequate concern for nature. Using recent developments in "critical realist" philosophy, the book aims to find ways of reorganizing knowledge in the light of ecological consciousness. It also corrects the emphasis of much environmental literature by focusing on production rather than consumption. (shrink)
Does the Buddhist doctrine of no-self imply, simply put, no-other? Does this doctrine necessarily come into conflict with an ethics premised on the alterity of the other? This article explores these questions by situating Emmanuel Levinas’s ethics in the context of contemporary Japanese philosophy. The work of twentieth-century Japanese philosopher Watsuji Tetsurō provides a starting point from which to consider the ethics of the self-other relation in light of the Buddhist notion of emptiness. The philosophy of thirteenth-century Zen Master Dōgen (...) casts doubt on Watsuji’s commitment to reciprocal self-other relationality, showing that the idea of self-emptiness disrupts any conventional understanding of reciprocity and promotes instead other-oriented compassion. Despite interesting similarities between the ethics of alterity and Buddhist compassion, a Buddhist-influenced understanding of alterity differs from Levinas on important points, by making possible the claim that all others—human, animal, plant, and mineral—are ethical others. (shrink)
Philosophers and others have questioned whether or not expertise in morality is possible. This debate is not only theoretical, but also affects the perceived legitimacy of clinical ethicists. One argument against moral expertise is that in a pluralistic society with competing moral theories no one can claim expertise regarding what another ought morally to do. There are simply too many reasonable moral values and intuitions that affect theory choice and its application; expertise is epistemically uniform. In this article, we discuss (...) how similar concerns have recently threatened to undermine expertise in medicine and science. In contrast, we argue that the application of values is needed to exercise medical, scientific, and moral expertise. As long as these values are made explicit, worries about a pretense to authority in the context of a liberal democracy are ill-conceived. In conclusion, we argue for an expertise that is epistemically diverse. (shrink)
Shenker has claimed that Von Neumann's argument for identifying the quantum mechanical entropy with the Von Neumann entropy, S() = – ktr( log ), is invalid. Her claim rests on a misunderstanding of the idea of a quantum mechanical pure state. I demonstrate this, and provide a further explanation of Von Neumann's argument.
Health-related quality of life measures aim to assess patients’ subjective experience in order to gauge an increasingly wide variety of health care issues such as patient needs; satisfaction; side effects; quality of care; disease progression and cost effectiveness. Their popularity is undoubtedly due to a larger initiative to provide patient-centered care. The use of patient perspectives to guide health care improvements and spending is rooted in the idea that we must respect patients as self-determining agents. In this paper I look (...) at the two main orientations to quality of life measurement: standardized and individualized measures. I argue that while these measures are attempts to provide for patient self-determination, they both fail to do so. In their place I suggest a new approach which overcomes their respective difficulties: a dialogic approach. (shrink)
It is commonly thought that there is some tension between the second law of thermodynam- ics and the time reversal invariance of the microdynamics. Recently, however, Jos Uffink has argued that the origin of time reversal non-invariance in thermodynamics is not in the second law. Uffink argues that the relationship between the second law and time reversal invariance depends on the formulation of the second law. He claims that a recent version of the second law due to Lieb and Yngvason (...) allows irreversible processes, yet is time reversal invariant. In this paper, I attempt to spell out the traditional argument for incompatibility between the second law and time reversal invariant dynamics, making the assumptions on which it depends explicit. I argue that this argument does not vary with different versions of the second law and can be formulated for Lieb and Yngvason's version as for other versions. Uffink's argument regarding time reversal invariance in Lieb and Yngvason is based on a certain symmetry of some of their axioms. However, these axioms do not constitute the full expression of the second law in their system. (shrink)
Since the 1970’s epidemiological measures focusing on “health-related quality of life” or simply “quality of life” have figured increasingly as endpoints in clinical trials. Before the 1970’s these measures were known, generically, as performance measures or health status measures. Relabeled as “quality of life measures” they were first used in cancer trials. In the early 2000’s they were relabeled again as “patient-reported outcome measures” or PROMs, in their service to the FDA to support drug labeling claims. To the limited degree (...) that the philosophical literature addresses these measures, it tends to associate them with two major theories of well-being: subjective well-being and the capabilities approach. In this paper, I argue that philosophers ought to treat quality of life measures/PROMs as a distinct from these theories. I argue that quality of life/PROMs serve healthcare as vehicles for patient-centered care and this has important consequences for how we theorize these measures. To this end, two requirements set them apart from measures of subjective well-being and the capabilities approach: quality of life/PROMs need to be patient-directed and inclusive. (shrink)
Background In 2001 a report on the provision of clinical ethics support in UK healthcare institutions identified 20 clinical ethics committees. Since then there has been no systematic evaluation or documentation of their work at a national level. Recent national surveys of clinical ethics services in other countries have identified wide variation in practice and scope of activities. Objective To describe the current provision of ethics support in the UK and its development since 2001. Method A postal/electronic questionnaire survey administered (...) to the chairs of all 82 clinical ethics services registered with the UK Clinical Ethics Network in July 2010. Results Response rate was 62% with the majority of responding services situated in acute trusts. All services included a clinical ethics committee with one service also having a clinical ethicist. Lay members were present in 72% of responding committees. Individual case consultation has increased since 2001 with 29% of chairs spending more than 50% of their time on this. Access to and involvement in the process of case consultation is less for patients and families than for clinical staff. There is wide variation in committee processes and levels of institutional support. Over half of the responding committees undertook some form of evaluation. Conclusion Clinical ethics services in the UK are increasing as is their involvement in case consultation. However, the significant variation in committee processes suggests that further qualitative research is needed to understand how these committees function and the role they play in their institution. (shrink)
Failings in patient care and quality in NHS Trusts have become a recurring theme over the past few years. In this paper, we examine the Care Quality Commission’s Guidance about Compliance: Essential Standards of Quality and Safety and ask how NHS Trusts might be better supported in fulfilling the regulations specified therein. We argue that clinical ethics committees (CECs) have a role to play in this regard. We make this argument by attending to the many ethical elements that are highlighted (...) in the Commission’s Regulations and by providing practical examples of how CECs can (and in some case already do) provide ethics support to health professionals and trusts. Although CECs have been traditionally associated with case consultation, i.e., discrete problems caused by individual circumstances, in the previous 10 years the literature suggests that clinical ethics services have become more integrated into the life of the health care organization and are increasing construed as proactive agents of systematic change. We provide evidence from a recent survey of UK clinical ethics services that this trend is present in the UK. (shrink)
While influential works have been devoted to comparative studies of various Asian philosophies and continental philosophers such as Nietzsche, Heidegger, Merleau-Ponty, and Derrida, this collection is the first to fully treat the increased interest in intercultural and interdisciplinary studies related to the work of Emmanuel Levinas in such a context. Levinas and Asian Thought seeks to discover common ground between Levinas’s ethical project and various religious and philosophical traditions of Asia such as Mahāyāna Buddhism, Theravādic Buddhism, Vedism, Confucianism, Daoism, and (...) Islam. -/- In these 13 essays, contributors draw on resources as diverse as the self-sacrificial ethic of bushidō, Islamic jurisprudence, and contemporary research in cognitive science. The essays are organized around three primary themes of enduring ethical, political, and religious importance. The first set of essays considers a dialogue between Levinasian and Asian accounts of the self, others, and the intersubjective relationship. Through a conversation with a variety of non-Western traditions, the second group of essays addresses the question of Levinas’s extreme portrayal of the self’s responsibility to the other and its potential limits. Finally, the collection ends with essays that utilize Asian thought and culture to consider ways in which Levinas’s ethics of alterity might be put into practice in the sphere of politics, social norms, and institutions. -/- Levinas and Asian Thought is not only a comprehensive attempt to bring Levinas into conversation with the philosophies of Asia, but it also represents a focused effort to recognize, address, and overcome Levinas’s own Eurocentrism. Overall, the thoughtful investigations collected here chart new territory, pushing Levinas’s practice of philosophy outside its familiar European and Jewish contexts, expanding our understanding of key Levinasian terms, thus furthering the thinking necessary for ethics as first philosophy. This volume will be of interest to a wide range of scholars and students, as it builds connections among Levinas studies, Asian philosophy, comparative philosophy, continental philosophy, and ethics. (shrink)
Patient-reported outcomes are increasingly used as dependent variables in studies regarding the effectiveness of clinical interventions. But patient-reported outcome measures (PROMs) do not provide intuitively meaningful data. For instance, it is not clear what a five point increase or decrease on a particular scale signifies. Establishing ‘interpretability’ involves making changes in outcomes meaningful. Attempts to interpret PROMs have led to the development of methods for identifying a minimum important difference (MID). In this paper, however, I draw on Charles Taylor’s distinction (...) between weak and strong evaluations to suggest that identifying a MID, specifically, a MID that uses a patient-reported reference group, may not provide an adequate interpretation of these measures. Moreover, I argue that the difficulty with interpreting these measures is tied to a larger problem concerning their validity. If researchers wish to interpret PROMs, they may first need to know more about the constructs they attempt to measure, namely, quality of life. (shrink)
In the classic study Little science, big science (New York: Columbia University Press, 1963), Derek Price traces the historical shift from what he calls little science?exemplified by early?modern ?invisible colleges? of scientific amateurs and enthusiasts engaged in small?scale, informal interactions and personal correspondence?to 20th?century big science, dominated by professional scientists and wealthy institutions, where scientific information (primarily in print form and its analogues) was mass?produced, marketed and circulated on a global scale. This article considers whether the growing use of more (...) participatory, interactive ?Web 2.0? technologies and social media in science today (e.g. wikis, blogs, tagging and bookmarking, conferencing, etc.) may signal a revival of little science modes of communication that contrast with big science conventions that continue to dominate research policy, scientific institutions, and the publishing industry. A brief historical review of responses to the scientific ?information explosion? since the early 1900s is presented, with a particular focus on the idealization of large?scale, automated information systems and the privileging of formal (document?producing) over informal (interpersonal) modes of scientific communication. Alternative frameworks for scientific communication that incorporate both documents and interaction are used to examine contemporary examples of so?called Science 2.0 and citizen science projects to determine whether such projects indicate the emergence of new modes of communication in science that bridge the immediacy and involvement of invisible colleges and the rigor of peer?reviewed publishing. The implications for traditional documentary forms such as the journal article are also discussed. (shrink)
There has been much philosophical interest regarding the ‘hierarchy of evidence’ used to determine which study designs are of most value for reporting on questions of effectiveness, prognosis, and so on. There has been much less philosophical interest in the choice of outcome measures with which the results of, say, an RCT or a cohort study are presented. In this paper, we examine the FDA’s recently published guidelines for assessing the psychometric adequacy of patient-reported outcome measures. We focus on their (...) recommendations for demonstrating content validity and also for how researchers should weigh up the sum of psychometric evidence when choosing these measures. We argue that questions regarding judgment and understanding meaning of these measures should play a more central role in determining their adequacy. (shrink)
In When Clinical Trials Compete: Prioritizing Study Recruitment, Gelinas et al tackle an important issue—study non-completion—and draw conclusions with which we largely agree. Most importantly, we accept that setting priorities among competing research studies is necessary and should be informed by ethical analysis. We disagree with the conclusion of Gelinas et al that this priority setting should take place at the level of the individual research institution. At a minimum, they should consider other actors who might be better suited for (...) this role instead of—or alongside—the institutions that host research. Our view is motivated by three main considerations. First, research institutions have significant latitude to promote their own interests, and there is reason to suspect that their interests do not closely align with the interests of the public. Thus, asking research institutions to set research priorities may result in the selection of studies with suboptimal social value. Second, a large proportion of clinical trials recruits participants at multiple institutions.1 If each institution sets its own priorities, we can expect discrepancies between the priorities set by partner institutions. These discrepancies may delay and discourage collaborative research projects. Finally, we suspect that a great deal of recruitment competition occurs between, rather than within, research institutions. Setting priorities only at …. (shrink)
Quality improvement mechanisms increasingly use outcome measures to evaluate health care providers. This move toward outcome measures is a radical departure from the traditional focus on process measures. More radical still is the proposal to shift from relatively simple and proximal measures of outcome, such as mortality, to complex outcomes, such as quality of life. While the practical, scientific, and ethical issues associated with the use of outcomes such as mortality and morbidity to compare health care providers have been well (...) rehearsed, the specific concerns associated with the use of quality of life measures in quality of care research have received little attention. As with much research on quality of life there is a tendency to assume that the disadvantages are outweighed by the general virtue of “listening” to patients. In this paper we disagree with this assumption and argue that quality of life is a process, not an outcome. (shrink)
ABSTRACTTwelve years ago the British media got wind of a London gynecologist who performed an elective reduction on a twin pregnancy reducing it to a singleton. Perhaps not surprisingly, opinion on the moral status of twin reductions was divided. But in the last few years new evidence regarding the medical risks of twin pregnancies has emerged, suggesting that twin reductions are relevantly similar to the reductions performed on high‐end multi‐fetal pregnancies. This evidence has appeared to resolve the moral debate.In this (...) paper I look at the role of clinical evidence in medical ethics. In particular I examine the role of clinical evidence in determining what counts as a significant harm or risk. First, I challenge the extent to which these empirical claims are descriptive, suggesting instead that the evidence is to some degree normative in character. Second, I question whether such empirical claims should count as evidence for what are essentially difficult ethical decisions – a role they appear to play in the case of elective reductions. I will argue that they should not, primarily because the value‐laden nature of this evidence conceals much of what is ethically at stake. It is important to recognize that empirical evidence cannot be a substitute for ethical deliberation. (shrink)
Whoever writes in blood and aphorisms does not want to be read, but rather to be learned by heart.Here's what is necessary: one blow with a club, one scar; one slap on the face, a handful of blood. Your reading of what other people write should be just like this. Don't be lax!In several recent articles, Leigh Kathryn Jenco questions the use of Eurocentric methodologies in conducting cross-cultural research within and about Chinese traditions.3 As she says, "postcolonial and 'non-Western' societies (...) can be positioned as particularly challenging case studies, offering 'alternative' views of self, culture, and society. However, their rich traditions of historical, political, and literary scholarship can play no role in... (shrink)