Hastings Center Report, Volume 52, Issue S1, Page S72-S78, March‐April 2022.

In this issue of The Journal of Clinical Ethics, we offer a variety of perspectives on the moral and medical responsibilities of professionals with regard to a woman’s choice of where she will birth her baby. The articles in this special issue focus on place of birth, but they have larger resonance for clinicians whose decisions about providing the best possible care require them to sort through evidence, consider their own possible biases and the limitations of their training, and balance (...) the wishes of their patients with the demands of colleagues, hospitals, and insurers. The articles published in this special issue of The Journal of Clinical Ethics will help those who wrestle with such dilemmas in everyday clinical decision making. (shrink)

Evidence-based medicine (EBM), by its ability to decrease irrational variations in health care, was expected to improve healthcare quality and outcomes. The utility of EBM principles evolved from individual clinical decision-making to wider foundational clinical practice guideline applications, cost containment measures, and clinical quality performance measures. At this evolutionary juncture one can ask the following questions. Given the time-limited exigencies of daily clinical practice, is it tenable for clinicians to follow guidelines? Whose or what interests are served by applying performance (...) assessments? Does such application improve medical care quality? What happens when the best interests of vested parties conflict? Mindful of the constellation of socially and clinically relevant variables influencing health outcomes, is it fair to apply evidence-based performance assessment tools to judge the merits of clinical decision-making? Finally, is it fair and just to incentivize clinicians in ways that might sway clinical judgment? To address these questions, we consider various clinical applications of performance assessment strategies, examining what performance measures purport to measure, how they are measured and whether such applications demonstrably improve quality. With attention to the merits and frailties associated with such applications, we devise and defend criteria that distinguish between justice-sustaining and justice-threatening performance-based clinical protocols. (shrink)

Contends that psychologists can contribute to the debate on the nature of science. The author suggests that the work of individual scientists can best be understood as a joint product of intellectual background and willingness to adopt a position with respect to important elements of that context.

Introduction to the Institutional Logics Perspective -- Precursors to the Institutional Logics Perspective -- Defining the Inter-institutional System -- The Emergence, Stability and Change of the Inter-institutional System -- Micro-Foundations of Institutional Logics -- The Dynamics of Organizational Practices and Identities -- The Emergence and Evolution of Field-Level Logics -- Implications for Future Research.

The ways in which knowledge relates to power have been much discussed in radical education theory. New emphasis on the role of gender and the growing debate about subjectivity have deepened the discussion, while making it more complex. In Getting Smart , Patti Lather makes use of her unique integration of feminism and postmodernism into critical education theory to address some of the most vital questions facing education researchers and teachers.

Background Informed consent is one of the key principles of conducting research involving humans. When research participants give consent, they perform an act in which they utter, write or otherwise provide an authorisation to somebody to do something. This paper proposes a new understanding of the informed consent as a compositional act. This conceptualisation departs from a modular conceptualisation of informed consent procedures. Methods This paper is a conceptual analysis that explores what consent is and what it does or does (...) not do. It presents a framework that explores the basic elements of consent and breaks it down into its component parts. It analyses the consent act by first identifying its basic elements, namely: a) data subjects or legal representative that provides the authorisation of consent; b) a specific thing that is being consented to; and c) specific agent(s) to whom the consent is given. Results This paper presents a framework that explores the basic elements of consent and breaks it down into its component parts. It goes beyond only providing choices to potential research participants; it explains the rationale of those choices or consenting acts that are taking place when speaking or writing an authorisation to do something to somebody. Conclusions We argue that by clearly differentiating the goals, the procedures of implementation, and what is being done or undone when one consent, one can better face the challenges of contemporary data-intensive biomedical research, particularly regarding the retention and use of data. Conceptualising consent as a compositional act enhances more efficient communication and accountability and, therefore, could enable more trustworthy acts of consent in biomedical science. (shrink)

In Frege's Conception of Logic Patricia A. Blanchette explores the relationship between Gottlob Frege's understanding of conceptual analysis and his understanding of logic.

In this innovative study Patricia Kitcher argues that we can only understand the deduction of the categories in Kant's Critique of Pure Reason in terms of his attempt to fathom the psychological prerequisites of thought. Thus a consideration of his conception of psychology is essential to an understanding of his philosophy. Kitcher specifically considers Kant's claims about the unity of the thinking self; the spatial forms of human perceptions; the relations among mental states necessary for them to have content; (...) the relations between perceptions and judgment; and the limits of philosophical insight into psychological processes. (shrink)

We propose that people typically reason about realistic situations using neither content-free syntactic inference rules nor representations of specific experiences. Rather, people reason using knowledge structures that we term pragmatic reasoning schemas, which are generalized sets of rules defined in relation to classes of goals. Three experiments examined the impact of a “permission schema” on deductive reasoning. Experiment 1 demonstrated that by evoking the permission schema it is possible to facilitate performance in Wason's selection paradigm for subjects who have had (...) no experience with the specific content of the problems. Experiment 2 showed that a selection problem worded in terms of an abstract permission elicited better performance than one worded in terms of a concrete but arbitrary situation, providing evidence for an abstract permission schema that is free of domain-specific content. Experiment 3 provided evidence that evocation of a permission schema affects not only tasks requiring procedural knowledge, but also a linguistic rephrasing task requiring declarative knowledge. In particular, statements in the form if p then q were rephrased into the form p only if q with greater frequency for permission than for arbitrary statements, and rephrasings of permission statements produced a pattern of introduction of modals totally unlike that observed for arbitrary conditional statements. Other pragmatic schemas, such as “causal” and “evidence” schemas can account for both linguistic and reasoning phenomena that alternative hypotheses fail to explain. (shrink)

Husserl’s writings on sociality have received increasing attention in recent years. Despite this growing interest, Husserl’s reflections on the specific role of communication remain underexplored. In this paper, we aim to fill this gap by reconstructing the various ways in which Husserl draws systematic connections between communication and communalization. As will become clear, Husserl’s analysis converges with much more recent ideas defended by Margaret Gilbert and Naomi Eilan.

Introduction : schizoanalysis, digital screens and new brain circuits -- Schizoid minds, delirium cinema and powers of machines of the invisible -- Illusionary perception and powers of the false -- Surveillance screens and powers of affect -- Signs of time : meta/physics of the brain-screen -- Degrees of belief : epistemology of probabilities -- Powers of creation : aesthetics of material-force -- The open archive : cinema as world-memory -- Divine in(ter)vention : micropolitics and resistance -- Logistics of perception 2.0 (...) : multiple screens as affective weapons -- Conclusion : the neuro-image : brain-screens from the future. (shrink)

Overview -- Locke's internal sense and Kant's changing views -- Personal identity amd its problems -- Rationalist metaphysics of mind -- Consciousness, self-consciousness, and cognition -- Strands of Argument in the Duisburg Nachlass -- A transcendental deduction for a priori concepts -- Synthesis : why and how? -- Arguing for apperception -- The power of apperception -- "I-think" as the destroyer of rational psychology -- Is Kant's theory consistent? -- The normativity objection -- Is Kant's thinker (as such) a free (...) and responsible agent? -- Kant our contemporary. (shrink)

'During the course of the seventeenth century, within the scholastic tradition itself, commentaries on Aristotle's natural philosophical works increasingly gave way to textbooks and compendia organized along thematic lines' (Dear 1985, 161).

This paper focuses on the cognitive/computational and evolutionary levels. It describes three proposals to make cognition computationally tractable, namely: Resource Rationality, the Adaptive Toolbox and Massive Modularity. While each of these proposals appeals to evolutionary considerations to dissolve the intractability of cognition, Rich, Blokpoel, de Haan, and van Rooij argue that, in each case, the intractability challenge is not resolved, but just relocated to the level of evolution.

How do people imagine the possibilities in which an assertion would be true and the possibilities in which it would be false? We argue that the mental representation of the meanings of connectives, such as "and", "or", and "if", specify how to construct the true possibilities for simple assertions containing just a single connective. It follows that the false possibilities are constructed by inference from the true possibilities. We report converging evidence supporting this account from four experiments in which the (...) participants had to list the true and the false possibilities for various sorts of assertion. Their systematic errors, response times, and think-aloud protocols corroborated the theory's predictions. Not even true possibilities are immediately available for complex assertions containing two or more different connectives. The task of listing the true possibilities then becomes difficult, and the task of listing the false possibilities almost impossible. (shrink)

This paper focuses on the cognitive/computational and evolutionary levels. It describes three proposals to make cognition computationally tractable, namely: Resource Rationality, the Adaptive Toolbox and Massive Modularity. While each of these proposals appeals to evolutionary considerations to dissolve the intractability of cognition, Rich, Blokpoel, de Haan, and van Rooij argue that, in each case, the intractability challenge is not resolved, but just relocated to the level of evolution.

David Marr's theory of vision has been widely cited by philosophers and psychologists. I have three projects in this paper. First, I try to offer a perspicuous characterization of Marr's theory. Next, I consider the implications of Marr's work for some currently popular philosophies of psychology, specifically, the "hegemony of neurophysiology view", the theories of Jerry Fodor, Daniel Dennett, and Stephen Stich, and the view that perception is permeated by belief. In the last section, I consider what the phenomenon of (...) vision must be like for Marr's project to succeed. (shrink)

An imperfect duty such as the duty to aid those in need is supposed to leave leeway for choice as to how to satisfy it, but if our reason for a certain way of satisfying it is our strongest, that leeway would seem to be eliminated. This paper defends a conception of practical reasons designed to preserve it, without slighting the binding force of moral requirements, though it allows us to discount certain moral reasons. Only reasons that offer criticism of (...) alternatives can yield requirements, but our reasons for particular ways of satisfying imperfect duties merely count in favor of the acts in question. When the state is authorized to take over charitable obligations, it should not be seen as enforcing fulfillment of our imperfect duties, but rather as forcing us to help fulfill collective duties that may be substantially modified by transfer to the state, replacing imperfect duties with perfect. Besides the cost to us in freedom of choice there is a moral cost to replacing the virtuous motives of charity with those that tend to accompany paying taxes. However, a compensating feature of state involvement is the fact that its more precise demands come with limits. (shrink)

This book explores Gilles Deleuze's contribution to film theory. According to Deleuze, we have come to live in a universe that could be described as metacinematic. His conception of images implies a new kind of camera consciousness, one that determines our perceptions and sense of selves: aspects of our subjectivities are formed in, for instance, action-images, affection-images and time-images. We live in a matrix of visual culture that is always moving and changing. Each image is always connected to an assemblage (...) of affects and forces. This book presents a model, as well as many concrete examples, of how to work with Deleuze in film theory. It asks questions about the universe as metacinema, subjectivity, violence, feminism, monstrosity, and music. Among the contemporary films it discusses within a Deleuzian framework are Strange Days, Fight Club, and Dancer in the Dark. (shrink)

There are two prominent viewpoints regarding the nature of rationality and how it should be evaluated in situations of interest: the traditional axiomatic approach and the newer ecological rationality. An obstacle to comparing and evaluating these seemingly opposite approaches is that they employ different language and formalisms, ask different questions, and are at different stages of development. I adapt a formal framework known as SCOP to address this problem by providing a comprehensive common framework in which both approaches may be (...) defined and compared. The main result is that the axiomatic and ecological approaches are in far greater agreement on fundamental issues than has been appreciated; this is supported by a pair of theorems to the effect that they will make accordant rationality judgements when forced to evaluate the same situation. I conclude that ecological rationality has some subtle advantages, but that we should move past the issues currently dominating the discussion of rationality. (shrink)

A dialogue between virtue and care ethics is formed as a step towards meeting Pellegrino's challenge to create a more comprehensive moral philosophy. It is also a dialogue between nursing and medicine since each practice draws on the Greek Virtue Tradition and the Judeo-Christian Tradition of care differently. In the Greek Virtue Tradition, the point of scrutiny lies in the inner character of the actor, whereas in the Judeo-Christian Tradition the focus is relational, i.e. how virtues are lived out in (...) specific relationships, particularly unequal relationships where vulnerability of one of the members is an issue. In a care ethic relational qualities such as attunement rather than inner qualities are the point of scrutiny. A dialogue between these two traditions makes it possible to consider the relational virtues and skills of openness and responsiveness that are required for a respectful meeting of the other. (shrink)

Sarah Moss’ thesis that we have probabilistic knowledge is from some perspectives unsurprising and from other perspectives hard to make sense of. The thesis is potentially transformative, but not yet elaborated in sufficient detail for epistemologists. This paper interprets Mossean probabilistic knowledge in a suitably-modified Kripke framework, thus filling in key details. It argues that probabilistic knowledge looks natural and plausible when so interpreted, and shows how the most pressing challenges to the thesis can be overcome. Most importantly, probabilistic knowledge (...) can satisfy factivity in the framework, though we are not forced to accept a specific account of probabilistic “facts”. The framework also reflects Moss’ claim that old-fashioned propositional knowledge is just a limiting case of probabilistic knowledge, and all knowledge is fundamentally probabilistic. Finally, Moss endorses a failure of contraposition: for example, p implies probably p, but not probably p does not imply not p. The framework makes clear the sense in which the valid inferences regarding probably p are as Moss claims. (shrink)

Interweaves elements of Kristevan and Heideggerian thought in order to reconstruct a linguistically embedded, existentially and affectively rich, dialectical model of willed self-regulation.