Self-tracking devices point to a future in which individuals will be more involved in the management of their health and will generate data that will benefit clinical decision making and research. They have thus attracted enthusiasm from medical and public health professionals as key players in the move toward participatory and personalized healthcare. Critics, however, have begun to articulate a number of broader societal and ethical concerns regarding self-tracking, foregrounding their disciplining, and disempowering effects. This paper has two aims: first, (...) to analyze some of the key promises and concerns that inform this polarized debate. I argue that far from being solely about health outcomes, this debate is very much about fundamental values that are at stake in the move toward personalized healthcare, namely, the values of autonomy, solidarity, and authenticity. The second aim is to provide a framework within which an alternative approach to self-tracking for health can be developed. I suggest that a practice-based approach, which studies how values are enacted in specific practices, can open the way for a new set of theoretical questions. In the last part of the paper, I sketch out how this can work by describing various enactments of autonomy, solidarity, and authenticity among self-trackers in the Quantified Self community. These examples show that shifting attention to practices can render visible alternative and sometimes unexpected enactments of values. Insofar as these may challenge both the promises and concerns in the debate on self-tracking for health, they can lay the groundwork for new conceptual interventions in future research. (shrink)

Since the outbreak of COVID-19, governments have turned their attention to digital contact tracing. In many countries, public debate has focused on the risks this technology poses to privacy, with advocates and experts sounding alarm bells about surveillance and mission creep reminiscent of the post 9/11 era. Yet, when Apple and Google launched their contact tracing API in April 2020, some of the world’s leading privacy experts applauded this initiative for its privacy-preserving technical specifications. In an interesting twist, the tech (...) giants came to be portrayed as greater champions of privacy than some democratic governments. This article proposes to view the Apple/Google API in terms of a broader phenomenon whereby tech corporations are encroaching into ever new spheres of social life. From this perspective, the advantage these actors have accrued in the sphere of the production of digital goods provides them with access to the spheres of health and medicine, and more worrisome, to the sphere of politics. These sphere transgressions raise numerous risks that are not captured by the focus on privacy harms. Namely, a crowding out of essential spherical expertise, new dependencies on corporate actors for the delivery of essential, public goods, the shaping of public policy by non-representative, private actors and ultimately, the accumulation of decision-making power across multiple spheres. While privacy is certainly an important value, its centrality in the debate on digital contact tracing may blind us to these broader societal harms and unwittingly pave the way for ever more sphere transgressions. (shrink)

The datafication and digitalization of health and medicine has engendered a proliferation of new collaborations between public health institutions and data corporations like Google, Apple, Microsoft and Amazon. Critical perspectives on these new partnerships tend to frame them as an instance of market transgressions by tech giants into the sphere of health and medicine, in line with a “hostile worlds” doctrine that upholds that the borders between market and non-market spheres should be carefully policed. This article seeks to outline the (...) limitations of this common framing for critically understanding the phenomenon of the Googlization of health. In particular, the mobilization of a diversity of non-market value statements in the justification work carried out by actors involved in the Googlization of health indicates the co-presence of additional worlds or spheres in this context, which are not captured by the market vs. non-market dichotomy. It then advances an alternative framework, based on a multiple-sphere ontology that draws on Boltanski and Thevenot’s orders of worth and Michael Walzer’s theory of justice, which I call a normative pragmatics of justice. This framework addresses both the normative deficit in Boltanski and Thevenot’s work and provides an important emphasis on the empirical workings of justice. Finally, I discuss why this framework is better equipped to identify and to address the many risks raised by the Googlization of health and possibly other dimensions of the digitalization and datafication of society. (shrink)

The paper argues that knowledge is not closed under logical inference. The argument proceeds from the openness of evidential support and the dependence of empirical knowledge on evidence, to the conclusion that knowledge is open. Without attempting to provide a full-fledged theory of evidence, we show that on the modest assumption that evidence cannot support both a proposition and its negation, or, alternatively, that information that reduces the probability of a proposition cannot constitute evidence for its truth, the relation of (...) evidential support is not closed under known entailment. Therefore the evidence-for relation is deductively open regardless of whether evidence is probabilistic or not. Given even a weak dependence of empirical knowledge on evidence, we argue that empirical knowledge is also open. On this basis, we also respond to the strongest argument in support of knowledge closure. Finally, we present a number of significant benefits of our position, namely, offering a unified explanation for a range of epistemological puzzles. (shrink)

Informed consent is an essential step in helping patients be aware of consequences of their treatment decisions. With surgery, it is vitally important for patients to understand the risks and benefits of the procedure and decide accordingly. We explored whether a written IC form was provided to patients; whether they read and signed it; whether they communicated orally with the physician; whether these communications influenced patient decisions. Adult postsurgical patients in nine general hospitals of Italy’s Campania Region were interviewed via (...) a structured questionnaire between the second and seventh day after the surgery at the end of the first surgical follow up visit. Physicians who were independent from the surgical team administered the questionnaire. The written IC form was given to 84.5% of those interviewed. All recipients of the form signed it, either personally or through a delegate; however, 13.9% did not know/remember having done so; 51.8% said that they read it thoroughly. Of those who reported to have read it, 90.9% judged it to be clear. Of those receiving the written consent form, 52.0% had gotten it the day before the surgery at the earliest 41.1% received it some hours or immediately before the procedure. The written IC form was explained to 65.6% of the patients, and 93.9% of them received further oral information that deemed understandable. Most attention was given to the diagnosis and the type of surgical procedure, which was communicated respectively to 92.8 and 88.2% of the patients. Almost one in two patients believed that the information provided some emotional relief, while 23.2% experienced increased anxiety. Younger patients and patients with higher levels of education were more likely to read the written IC form. The written IC form is not sufficient in assuring patients and making them fully aware of choices they made for their health; pre-operative information that was delivered orally better served the patients’ needs. To improve the quality of communication we suggest enhancing physicians’ communication skills and for them to use structured conversation to ensure that individuals are completely informed before undergoing their procedures. (shrink)

The idea that knowledge can be extended by inference from what is known seems highly plausible. Yet, as shown by familiar preface paradox and lottery-type cases, the possibility of aggregating uncertainty casts doubt on its tenability. We show that these considerations go much further than previously recognized and significantly restrict the kinds of closure ordinary theories of knowledge can endorse. Meeting the challenge of uncertainty aggregation requires either the restriction of knowledge-extending inferences to single premises, or eliminating epistemic uncertainty in (...) known premises. The first strategy, while effective, retains little of the original idea—conclusions even of modus ponens inferences from known premises are not always known. We then look at the second strategy, inspecting the most elaborate and promising attempt to secure the epistemic role of basic inferences, namely Timothy Williamson’s safety theory of knowledge. We argue that while it indeed has the merit of allowing basic inferences such as modus ponens to extend knowledge, Williamson’s theory faces formidable difficulties. These difficulties, moreover, arise from the very feature responsible for its virtue- the infallibilism of knowledge. (shrink)

Harman and Lewis credit Kripke with having formulated a puzzle that seems to show that knowledge entails dogmatism. The puzzle is widely regarded as having been solved. In this paper we argue that this standard solution, in its various versions, addresses only a limited aspect of the puzzle and holds no promise of fully resolving it. Analyzing this failure and the proper rendering of the puzzle, it is suggested that it poses a significant challenge for the defense of epistemic closure.

There are few indulgences academics can crave more than to have their work considered and addressed by leading researchers in their field. We have been fortunate to have two outstanding philosophers from whose work we have learned a great deal give ours their thoughtful attention. Grappling with Stephen Yablo’s, and Juan Comesaña’s comments and criticisms has helped us gain a better understanding of our ideas as well as their shortcomings. We are extremely grateful to them for the attentiveness and seriousness (...) with which they have considered our arguments and to philosophical studies for giving us this opportunity. Given the substantive difference between the two response papers, there is not much beyond sincere gratitude that we can covey to them jointly. We will therefore address them in turn. (shrink)

Societies evolve practices that reflect social norms of appropriateness in social interaction, for example when and to what extent one should respect the boundaries of another person’s private sphere. One such practice is what the sociologist Erving Goffman called civil inattention—the social norm of showing a proper amount of indifference to others—which functions as an almost unnoticed yet highly potent privacy-preserving mechanism. These practices can be disrupted by technologies that afford new forms of intrusions. In this paper, we show how (...) new networked technologies, such as facial recognition, challenge our ability to practice civil inattention. We argue for the need to revitalise, in academic and policy debates, the role of civil inattention and related practices in regulating behaviour in public space. Our analysis highlights the relational nature of privacy and the importance of social norms in accomplishing and preserving it. While our analysis goes some way in supporting current calls to ban FR technology, we also suggest that, pending a ban and in light of the power of norms to limit what is otherwise technically possible, cultivating new practices of civil inattention may help address the challenges raised by FR and other forms of digital surveillance in public. (shrink)

A correction to this paper has been published: https://doi.org/10.1007/s11019-021-10018-3.

Intersexual infants and infants with other genital abnormalities often receive genital surgery for sex assignment or for normalizing purposes. The wisdom and beneficence of these practices have been questioned by intersexual individuals, support groups, some doctors, and the media. Because the practices have been developed without long-term studies to evaluate them, pediatric urologists and parents of such children must face decisions with very little guidance from empirical support. In the face of ignorance about what is really the best medical response (...) to intersexuality or genital abnormalities, some have argued for a moratorium on infant genital surgery until empirical studies are available. The urgent need for retrospective studies is now being recognized in medical journals. Because genital surgery may be appropriate and beneficent in some of these conditions, or in some degrees of these conditions, but not in others, retrospective studies must be devised to examine the degree of success of surgery for each of these conditions, or levels thereof. (shrink)

It is often argued that courts avoid foreign laws because they prefer local law. It would make sense if they did—after all, foreign law can be hard to understand and complicated to employ, and it is also... foreign. Aiming to investigate this assumption through a qualitative analysis of all available cases on one question and comparing the findings with the approach towards local matrimonial property cases in Israel, this Article finds something rather different. At least as regards Israeli judges discussing (...) matrimonial property, it appears that sometimes judges do not prefer the lex fori but something else. The Article discusses one case that reveals what could be described as a judicial mutiny, where judges chose to apply neither foreign law nor local law per se. In the case of matrimonial property, a particular legal norm seems particularly close to the judges’ hearts. So much so that despite legislative intervention designed to change the judicially-shaped law, the courts continue to apply their own, judicially created law. (shrink)

Communication is an integral part of nursing practice—with patients and their relatives, other nurses and members of the healthcare team, and ancillary staff. Through interaction with the ‘other’, language and silence creates and recreates social realities. Acceptance, rejection or modification of social realities depends on what is expressed and by whom. Narratives that are offered can tell of some experiences and not others. Some nurses choose to be silent while others are silenced. In nursing situations recognising and allowing silence to (...) speak is a challenging but uniquely personal experience that embraces reflection in and on experiences, practice and self as a person and a professional. If enabled and truly heard, silence can speak more loudly than the hubbub of daily practice, allowing us to collectively question and challenge inherent assumptions and biases as professionals, and as a profession. Through a microcosm of Newly Graduated Nurses' lived experiences of nursing situations and expressions of silence individuals' discomfort and private efforts to ascribe meaning to experiences are reflected on. Returning to silence is to return to a constant process of professional transformation that can enable ways of knowing and being that can reform our profession from within and enable us to cast off shackles that bind us to a shameful cultural underbelly. (shrink)

Almaatouq et al.'s prescription for more integrative experimental designs is welcome but does not address an equally important problem: Lack of adequate theories. We highlight two features theories ought to satisfy: “Well-specified” and “grounded.” We discuss the importance of these features, some positive exemplars, and the complementarity between the target article's prescriptions and improved theorizing.

Processing the various features from different feature maps and modalities in coherent ways requires a dedicated integration mechanism . Many authors have related feature binding to conscious awareness but little is known about how tight this relationship really is. We presented subjects with asynchronous audiovisual stimuli and tested whether the two features were integrated. The results show that binding took place up to 350 ms feature-onset asynchronies, suggesting that integration covers a relatively wide temporal window. We also asked subjects to (...) explicitly judge whether the two features would belong to the same or to the different events. Unsurprisingly, synchrony judgments decreased with increasing asynchrony. Most importantly, feature binding was entirely unaffected by conscious experience: features were bound whether they were experienced as occurring together or as belonging to a separate events, suggesting that the conscious experience of unity is not a prerequisite for, or a direct consequence of binding. (shrink)

In many ways set theory lies at the heart of modern mathematics, and it does powerful work both philosophical and mathematical – as a foundation for the subject. However, certain philosophical problems raise serious doubts about our acceptance of the axioms of set theory. In a detailed and original reassessment of these axioms, Sharon Berry uses a potentialist approach to develop a unified determinate conception of set-theoretic truth that vindicates many of our intuitive expectations regarding set theory. Berry further (...) defends her approach against a number of possible objections, and she shows how a notion of logical possibility that is useful in formulating Potentialist set theory connects in important ways with philosophy of language, metametaphysics and philosophy of science. Her book will appeal to readers with interests in the philosophy of set theory, modal logic, and the role of mathematics in the sciences. (shrink)

This study proposes that Moses’ agape and storge love of his people was the motivation for his adoption of fatherly leadership style. The study relies on a direct reading of Hebrew language version of the relevant books of the Old Testament. We provide examples that anchor Moses fatherly leadership style in biblical texts, and reference it to modern leadership thoughts and practical wisdom. Moses’ traits, such as humility, gratitude, forgiveness, and altruism, and his unparalleled grit provided him with the capabilities (...) required to perform as a father leader. This leadership style is characterized by availability (awareness), building community, commitment to the growth of people, disciplining, foresight, healing, involvement, listening, persuasion, providing, relinquishing control, role modeling, showing empathy, stewardship (serving), supporting, and teaching. We provide leaders with a list of fatherly leadership behaviors that lacks the authoritarian component of eastern paternalistic leadership style, and that may be well practiced in the health care, social work, education, sport management and other people service industries. (shrink)

The Mesillas Yesharim / Path of the Just was the masterpiece of Rabbi Moshe Chaim Luzzatto, the great mystic, philosopher, sage, and saint. For centuries, this classic text for better living has been every man's primer for ideal life. Wherever there were Jews there was a well-thumbed Mesillas Yesharim. In this book, Rabbi Twerski applies the text and themes of Mesillas Yesharim to the everyday challenges of the 90s. He shows us how we can succeed in the quest for (...) a better life and in bettering ourselves. (shrink)

This book describes Carmeli's cosmological general and special relativity theory, along with Einstein's general and special relativity. These theories are discussed in the context of Moshe Carmeli's original research, in which velocity is introduced as an additional independent dimension. Four- and five-dimensional spaces are considered, and the five-dimensional braneworld theory is presented. The Tully-Fisher law is obtained directly from the theory, and thus it is found that there is no necessity to assume the existence of dark matter in the (...) halo of galaxies, nor in galaxy clusters.The book gives the derivation of the Lorentz transformation, which is used in both Einstein's special relativity and Carmeli's cosmological special relativity theory. The text also provides the mathematical theory of curved space?time geometry, which is necessary to describe both Einstein's general relativity and Carmeli's cosmological general relativity. A comparison between the dynamical and kinematic aspects of the expansion of the universe is made. Comparison is also made between the Friedmann-Robertson-Walker theory and the Carmeli theory. And neither is it necessary to assume the existence of dark matter to correctly describe the expansion of the cosmos. (shrink)

The literature on conscientious objection in medicine presents two key problems that remain unresolved: Which conscientious objections in medicine are justified, if it is not feasible for individual medical practitioners to conclusively demonstrate the genuineness or reasonableness of their objections? How does one respect both medical practitioners’ claims of conscience and patients’ interests, without leaving practitioners complicit in perceived or actual wrongdoing? My aim in this paper is to offer a new framework for conscientious objections in medicine, which, by bringing (...) medical professionals’ conscientious objection into the public realm, solves the justification and complicity problems. In particular, I will argue that: an “Uber Conscientious Objection in Medicine Committee” —which includes representatives from the medical community and from other professions, as well as from various religions and from the patient population—should assess various well-known conscientious objections in medicine in terms of public reason and decide which conscientious objections should be permitted, without hearing out individual conscientious objectors; medical practitioners should advertise their conscientious objections, ahead of time, in an online database that would be easily accessible to the public, without being required, in most cases, to refer patients to non-objecting practitioners. (shrink)

In Science as Social Knowledge, Helen Longino offers a contextual analysis of evidential relevance. She claims that this "contextual empiricism" reconciles the objectivity of science with the claim that science is socially constructed. I argue that while her account does offer key insights into the role that values play in science, her claim that science is nonetheless objective is problematic.

Answers to the questions of what justifies conscientious objection in medicine in general and which specific objections should be respected have proven to be elusive. In this paper, I develop a new framework for conscientious objection in medicine that is based on the idea that conscience can express true moral claims. I draw on one of the historical roots, found in Adam Smith’s impartial spectator account, of the idea that an agent’s conscience can determine the correct moral norms, even if (...) the agent’s society has endorsed different norms. In particular, I argue that when a medical professional is reasoning from the standpoint of an impartial spectator, his or her claims of conscience are true, or at least approximate moral truth to the greatest degree possible for creatures like us, and should thus be respected. In addition to providing a justification for conscientious objection in medicine by appealing to the potential truth of the objection, the account advances the debate regarding the integrity and toleration justifications for conscientious objection, since the standard of the impartial spectator specifies the boundaries of legitimate appeals to moral integrity and toleration. The impartial spectator also provides a standpoint of shared deliberation and public reasons, from which a conscientious objector can make their case in terms that other people who adopt this standpoint can and should accept, thus offering a standard fitting to liberal democracies. (shrink)

First Published in 1999. Routledge is an imprint of Taylor & Francis, an informa company.

I offer a novel two-stage reconstruction of Hume’s general-point-of-view account, modeled in part on his qualified-judges account in ‘Of the Standard of Taste.’ In particular, I argue that the general point of view needs to be jointly constructed by spectators who have sympathized with (at least some of) the agents in (at least some of) the actor’s circles of influence. The upshot of the account is two-fold. First, Hume’s later thought developed in such a way that it can rectify the (...) problems inherent in his Treatise account of the general point of view. Second, the proposed account provides the grounds for an adequate and well-motivated modest ideal observer theory of the standard of virtue. (shrink)

In this book Sharon Krause argues that moral and political deliberation must incorporate passions, even as she insists on the value of impartiality.

Two problems seem to plague Adam Smith’s account of sympathy and approbation in The Theory of Moral Sentiments (TMS). First, Smith’s account of sympathy at the beginning of TMS appears to be inconsistent with the account of sympathy at the end of TMS. In particular, it seems that Smith did not appreciate the distinction between ‘self-oriented sympathy’ and ‘other-oriented sympathy’, that is, between imagining being oneself in the actor’s situation and imagining being the actor in the actor’s situation. Second, Smith’s (...) account of approbation, according to which a sentiment of approval arises when there is recognition of concordance between the spectator’s sympathetic passion and the actor’s original passion, seems to face the following problem: since the spectator attains both his own sympathetic passion and the actor’s original passion by sympathizing with the actor, the sympathetic passion of the spectator and the original passion of the actor will necessarily be identical. Therefore, Smith’s account of approbation requires that the spectator utilize both self-oriented and other-oriented sympathy (‘the double-sympathy model of approbation’). I offer a novel developmental account of sympathy in TMS that renders Smith’s account of sympathy consistent and allows for the utilization of the double-sympathy model of approbation. (shrink)

Physicians frequently ask whether they should give patients what they want, usually when there are considerations pointing against doing so, such as medicine’s values and physicians’ obligations. It has been argued that the source of medicine’s values and physicians’ obligations lies in what has been dubbed “the internal morality of medicine”: medicine is a practice with an end and norms that are definitive of this practice and that determine what physicians ought to do qua physicians. In this paper, I defend (...) the claim that medicine requires a morality that is internal to its practice, while rejecting the prevalent characterization of this morality and offering an alternative one. My approach to the internal morality of medicine is constructivist in nature: the norms of medicine are constructed by medical professionals, other professionals, and patients, given medicine’s end of “benefitting patients in need of prima facie medical treatment and care.” I make the case that patients should be involved in the construction of medicine’s morality not only because they have knowledge that is relevant to the internal morality of medicine—namely, their own values and preferences—but also because medicine is an inherently relational enterprise: in medicine the relationship between physician and patient is a constitutive component of the craft itself. The framework I propose provides an authoritative morality for medicine, while allowing for the incorporation, into that very morality, of qualified deference to patient values. (shrink)