Objective The objective of this article is to provide an ethical analysis of a high-risk, advanced treatment case where the patient received transcatheter aortic valve insertion, for aortic valve stenosis. Particular emphasis will be placed upon the significance of evidence and the implications for priority setting. Method One paradigmatic case involving a TAVI patient from a large university hospital in Norway is described and analysed. The method used was ethical case analysis modified after Kymlicka by Miljeteig et al. Perioperative mortality (...) risk was estimated using the Euroscore risk-logarithm and the Society of Thoracic Surgeons’ risk model, STS. These predict the risk of operative mortality and morbidity associated with adult cardiac surgery. GRADE, the Grading of Recommendations Assessment, Development and Evaluation, was used to evaluate the evidence. Results In the case analysis, we found that it would be ethically justifiable not to recommend TAVI treatment for this patient. Although the patient had a severe condition in need of treatment, the expected improvement was marginal, the quality of evidence was low and the opportunity costs for other patients and society were higher than usually deemed appropriate. Conclusions Decision-making in the absence of high quality evidence from randomized trials is a complex process involving difficult ethical judgments. Novel high-risk devices often enter the European market with limited clinical evidence. Transparency and improved clinical evaluation are required so patient safety is not jeopardized. We argue that implementation of high risk, high cost interventions should be better regulated at a national level. Background All clinical decisions imply priority setting and therefore indirectly affect other patients and other patient groups. The use of expensive, innovative health technologies has an affect on individual patients as well as on other patient groups competing for the same resources. (shrink)

In this article, we report the findings from a qualitative study that explored how relatives of terminally ill, alert and competent intensive care patients perceived their involvement in the end-of-life decision-making process. Eleven family members of six deceased patients were interviewed. Our findings reveal that relatives narrate about a strong intertwinement with the patient. They experienced the patients’ personal individuality as a fragile achievement. Therefore, they viewed their presence as crucial with their primary role to support and protect the patient, (...) thereby safeguarding his values and interests. However, their inclusion in decision making varied from active participation in the decision-making process to acceptance of the physicians’ decision or just receiving information. We conclude that models of informed shared decision making should be utilised and optimised in intensive care, where nurses and physicians work with both the patient and his or her family and regard the family as partners in the process. (shrink)

Background How often does refractory suffering, which is suffering due to symptoms that cannot be adequately controlled, occur at the end of life in modern palliative care? What are the causes of such refractory suffering? Should euthanasia be offered for refractory suffering at the end of life? We sought to shed light on these questions through interviews with palliative care specialists. Methods Semi-structured interviews with six nurses and six doctors working in palliative care in five Norwegian hospitals. Transcripts were analysed (...) with systematic text condensation, a qualitative analysis framework. Results Informants find that refractory suffering is rare, and that with palliative sedation satisfactory symptom control can nearly always be achieved at the end of life. However, the process of reaching adequate symptom control can be protracted, and there can be significant suffering in the meantime. Both somatic, psychological, social and existential factors can contribute to refractory suffering and potentiate each other. However, informants also place significant weight on factors pertaining to the organization of palliative care services as contributing to insufficient symptom control. Conclusions If refractory suffering is indeed rare, then this arguably weakens a common prima facie argument for the legalization of assisted dying. However, the process of reaching adequate symptom control can be protracted and involve significant suffering. The experiences of palliative care clinicians constitute important empirical premises for the assisted dying debate. The study points to several areas in which palliative care can be improved. (shrink)

The aim of this paper is to diagnose the so-called two envelopes paradox. Many writers have claimed that there is something genuinely paradoxical in the situation with the two envelopes, and some writers are now developing non-standards theories of expected utility. I claim that there is no paradox for expected utility theory as I understand that theory, and that contrary claims are confused. Expected utility theory is completely unaffected by the two-envelope paradox.

Myths of the Self is a departure from the standard fare of postmodern thought. In a unique and brilliant turn, Smith argues that the best way of dealing with the topic of the self is a synthesis of a narrative theory of identity, using Ricoeur as a source, along with the constructive "postmodern" metaphysics of Alfred North Whitehead. The resulting synthesis is a new and potentially invigorating spin on the genesis of postmodern thought.

This book is a meticulous study of Aristotle's phronesis and its applications to the fields of personal development or character formation and of ethical ...

In standard decision theory, the probability function ought to be updated in light of evidence, but the utility function generally stays fixed. However, there is nothing in the formal theory that prevents one from instead updating the utility function, while keeping the probability function fixed. Moreover, there are good arguments for updating the utilities and not just the probabilities. Hence, the first puzzle is whether there is anything that justifies updating beliefs, but not desires, in light of evidence. The paper (...) argues that there is not, but that this raises a second puzzle. (shrink)

This volume deals with the transformation of unchurched religious creativity in the late modern West.

Bayesian inference is limited in scope because it cannot be applied in idealized contexts where none of the hypotheses under consideration is true and because it is committed to always using the likelihood as a measure of evidential favouring, even when that is inappropriate. The purpose of this article is to study inductive inference in a very general setting where finding the truth is not necessarily the goal and where the measure of evidential favouring is not necessarily the likelihood. I (...) use an accuracy argument to argue for probabilism and I develop a new kind of argument to argue for two general updating rules, both of which are reasonable in different contexts. One of the updating rules has standard Bayesian updating, Bissiri et al.’s general Bayesian updating, Douven’s IBE-based updating, and Vassend’s ]) quasi-Bayesian updating as special cases. The other updating rule is novel. (shrink)

Scientists often study hypotheses that they know to be false. This creates an interpretive problem for Bayesians because the probability assigned to a hypothesis is typically interpreted as the probability that the hypothesis is true. I argue that solving the interpretive problem requires coming up with a new semantics for Bayesian inference. I present and contrast two new semantic frameworks, and I argue that both of them support the claim that there is pervasive pragmatic encroachment on whether a given Bayesian (...) probability assignment is rational. (shrink)

Charles Stein discovered a paradox in 1955 that many statisticians think is of fundamental importance. Here we explore its philosophical implications. We outline the nature of Stein’s result and of subsequent work on shrinkage estimators; then we describe how these results are related to Bayesianism and to model selection criteria like AIC. We also discuss their bearing on scientific realism and instrumentalism. We argue that results concerning shrinkage estimators underwrite a surprising form of holistic pragmatism.

The role of narrativity in the constitution of personal identity, a widely discussed topic in recent philosophy, is also an important issue in Robert Musil’s novel “The Man without Qualities.” Apart from a theoretical passage, where the coherence established by life-narratives is explicitly rejected as an illusion, the novel displays various instances of reflection in which characters seek to articulate their identity by narrating parts of their lives. Not all of these self-narratives are presented as flawed; rather, by highlighting the (...) differences between various instances of self-reflection, the novel suggests that a life-narrative has to meet certain standards in order to further self-understanding. The essay seeks to identify these standards by analysing two examples of self-reflection rendered in Musil’s novel. Furthermore, it briefly compares the novel’s dealing with the issue of narrativity and personal identity with recent philosophical approaches, in particular with Charles Taylor’s view that in order to have an identity, human beings have to understand their lives in the form of a narrative that determines their place relative to the good. (shrink)

I argue that information is a goal-relative concept for Bayesians. More precisely, I argue that how much information is provided by a piece of evidence depends on whether the goal is to learn the truth or to rank actions by their expected utility, and that different confirmation measures should therefore be used in different contexts. I then show how information measures may reasonably be derived from confirmation measures, and I show how to derive goal-relative non-informative and informative priors given background (...) information. Finally, I argue that my arguments have important implications for both objective and subjective Bayesianism. In particular, the Uniqueness Thesis is either false or must be modified. Moreover, objective Bayesians must concede that pragmatic factors systematically influence which priors are rational, and subjective Bayesians must concede that pragmatic factors sometimes partly determine which prior distribution most accurately represents an agent’s epistemic state. (shrink)

According to a widespread but implicit thesis in Bayesian confirmation theory, two confirmation measures are considered equivalent if they are ordinally equivalent—call this the “ordinal equivalence thesis” (OET). I argue that adopting OET has significant costs. First, adopting OET renders one incapable of determining whether a piece of evidence substantially favors one hypothesis over another. Second, OET must be rejected if merely ordinal conclusions are to be drawn from the expected value of a confirmation measure. Furthermore, several arguments and applications (...) of confirmation measures given in the literature already rely on a rejection of OET. I also contrast OET with stronger equivalence theses and show that they do not have the same costs as OET. On the other hand, adopting a thesis stronger than OET has costs of its own, since a rejection of OET ostensibly implies that people’s epistemic states have a very fine-grained quantitative structure. However, I suggest that the normative upshot of the paper in fact has a conditional form, and that other Bayesian norms can also fruitfully be construed as having a similar conditional form. (shrink)

Jan-Olav Henriksen reconstructs and analyzes Christianity as a cluster of practices that manifest a distinct historically and contextually shaped mode of being in the world. Henriksen suggests that these practices imply a complicated relationship between the tradition in which they originate, the community that emerges from and is constituted by that tradition, and the individuals who appropriate the tradition that these communities mediate through their practices. Thus, to think of Christianity simply in terms of belief is misleading and represents (...) an underdetermination of its distinct character. Henriksen further argues this relationship needs to be described primarily as practices aimed at orientation and transformation. His analysis points to Christianity's similarity to other religions in regard to the functional or pragmatic dimensions it displays. Examining facets such as prayer, the use of scripture, preaching and doctrine, Henriksen emphasizes that the element that makes a practice distinctively Christian is how it relates to and is informed by the Jesus story. (shrink)

The original article, which first appeared in Norwegian, is a detailed study of anamnesis or recollection in Plato and Aristotle. It discusses, first, how recollection is relevant for the understanding of central aspects of the philosophy of Aristotle, and then discusses how the “regained” Platonic-Aristotelian concept of anamnesis can be related to current methodological challenges in modern social research. After having received feedback on the original article from David Bloch, who has recently translated and commented the Aristotelian text “On memory (...) and recollection”, I have decided to rewrite it in English and publish it here. (shrink)

The article discusses relationships and contexts for "reason", "knowledge", and virtue in Aristotle, based on and elaborating some results from Eikeland. It positions Eikeland in relation to Moss but with a side view to Cammick, Kristjansson, and Taylor. These all seem to disagree among themselves but still agree partly in different ways with Eikeland. The text focuses on two questions: 1) the role or tasks of "reason", "knowledge", and "virtue" respectively in setting the end or goal for ethical deliberation, and (...) more generally, 2) the role of dialogue or dialectics in Aristotle's philosophy, including its role concerning question one. The author argues that phrónêsis needs to be interpreted in the context of the totality of Aristotle's philosophy, and explains how this totality is fundamentally dialectical. (shrink)

This volume comprises systematic as well as historical essays, including contributions intended to give comprehensive overviews of such areas as genetic phenomenology, transcendental phenomenology, philosophy and history of logic and mathematics, Kant, hermeneutics, Hegel, and philosophy of language. The book is addressed to phenomenologists, particularly those who are interested in some or all of the areas mentioned. In his introduction Joseph J. Kockelmans indicates that these diverse areas enter into dialogue in the work of Thomas M. Seebohm, whom the editors (...) and authors wish to honor, and the systematic papers mirror the state of the art of research in the above-mentioned disciplines. (shrink)

This paper defends moral realism against Sharon Street’s “Darwinian Dilemma for Realist Theories of Value” (this journal, 2006). I argue by separation of cases: From the assumption that a certain normative claim is true, I argue that the first horn of the dilemma is tenable for realists. Then, from the assumption that the same normative claim is false, I argue that the second horn is tenable. Either way, then, the Darwinian dilemma does not add anything to realists’ epistemic worries.

Hinge epistemology and Bayesianism are two prominent approaches in contemporary epistemology, but the relationship between these approaches has not been systematically studied. This paper formalizes the central commitments of hinge epistemology in a Bayesian framework and argues for the following two theses: (1) many of the types of claims that are treated as paradigmatic hinges in the hinge epistemology literature, such as the claim that there exists an external world of physical objects, are not capable of enabling rational inquiry, even (...) though this is typically regarded as a central property of hinges; (2) the standard Bayesian story of how rational inquiry proceeds is incorrect or at best incomplete. (shrink)

This paper analyses and criticizes S. Kripke's celebrated argument against materialist identity?theories. While criticisms of Kripke in the literature attack one or more of his premisses, an attempt is made here to show that Kripke's conclusion is unjustified even if his premisses are accepted. Kripke's premisses have sufficient independent plausibility to make this strategy interesting. Having stated Kripke's argument, it is pointed out that Kripke must assume that the contents of the Cartesian intuitions are clear and of a kind suited (...) for the type of explanation he favours, while his own result concerning contents in epistemic contexts is precisely that this might not be so when objects or events we thought distinct happen to be identical. The point is that only by assuming that the identity?theory is false, can Kripke maintain that the Cartesian intuitions express contents which can be explained in his favoured way. But such an assumption is clearly illegitimate when the aim is to establish that the identity?theory is false. Kripke cannot conclude that the identity?theory is false because no explanation of epistemic possibilities is produced, since by his own standards no such explanation can be produced if the identity?theory is true. (shrink)

In this paper I discuss Fred Dretske's account of knowledge critically, and try to bring out how his account of informational content leads to cases of extreme epistemic good luck in his treatment of knowledge. My main interest, however, is to establish that the cases of epistemic luck arise because Dretske's account of knowledge in a fundamental way fails to take into account the role our actual recognitional capacities and powers of discrimination play in perceptually based knowledge. This result is, (...) I believe, new. The paper has three sections. In Section 1 I give a short exposition of Dretske's theory, and make some necessary qualifications about how it is to be understood. In Section 2 I discuss in greater detail how the theory actually works, and provide some examples I think are very troublesome for Dretske. In Section 3 I argue that these cases establish my main claim. I also show that there are cases of epistemic bad luck due to Dretske's account of how information causes belief. (shrink)

It is often thought that the main significant difference between evidential decision theory and causal decision theory is that they recommend different acts in Newcomb-style examples (broadly construed) where acts and states are correlated in peculiar ways. However, this paper presents a class of non-Newcombian examples that evidential decision theory cannot adequately model whereas causal decision theory can. Briefly, the examples involve situations where it is clearly best to perform an act that will not influence the desired outcome. On evidential (...) decision theory—but not causal decision theory—this situation turns out to be impossible: acts that an agent does not think influence the desired outcome are never optimal. Typically, sophisticated versions of evidential decision theory emulate causal decision theoretic reasoning by (implicitly) conditioning on causal confounders, but in the kind of example considered here, this trick does not work. The upshot is that there is more to causal reasoning than has so far been appreciated. (shrink)

According to a widespread but implicit thesis in Bayesian confirmation theory, two confirmation measures are considered equivalent if they are ordinally equivalent—call this the “ordinal equivalence thesis”. I argue that adopting OET has significant costs. First, adopting OET renders one incapable of determining whether a piece of evidence substantially favors one hypothesis over another. Second, OET must be rejected if merely ordinal conclusions are to be drawn from the expected value of a confirmation measure. Furthermore, several arguments and applications of (...) confirmation measures given in the literature already rely on a rejection of OET. I also contrast OET with stronger equivalence theses and show that they do not have the same costs as OET. On the other hand, adopting a thesis stronger than OET has costs of its own, since a rejection of OET ostensibly implies that people’s epistemic states have a very fine-grained quantitative structure. However, I suggest that the normative upshot of the paper in fact has a conditional form, and that other Bayesian norms can also fruitfully be construed as having a similar conditional form. (shrink)

Stanley Stevens draws a useful distinction among ordinal scales, interval scales, and ratio scales. Most recent discussions of confirmation measures have proceeded on the ordinal level of analysis. In this article, I give a more quantitative analysis. In particular, I show that the requirement that our desired confirmation measure be at least an interval measure naturally yields necessary conditions that jointly entail the log-likelihood measure. Thus, I conclude that the log-likelihood measure is the only good candidate interval measure.

One of the main goals of Bayesian epistemology is to justify the rational norms credence functions ought to obey. Accuracy arguments attempt to justify these norms from the assumption that the source of value for credences relevant to their epistemic status is their accuracy. This assumption and some standard decision-theoretic principles are used to argue for norms like Probabilism, the thesis that an agent’s credence function is rational only if it obeys the probability axioms. We introduce an example that shows (...) that the accuracy arguments for Probabilism given by Joyce and Pettigrew fail, and that Probabilism in fact turns out to be false given Pettigrew’s way of conceiving of the goal of having accurate credences. Finally, we use our discussion of Pettigrew’s framework to draw an important general lesson about normative theorizing that relies on the positing of ideal agents. (shrink)

Bayesianism and likelihoodism are two of the most important frameworks philosophers of science use to analyse scientific methodology. However, both frameworks face a serious objection: much scientific inquiry takes place in highly idealized frameworks where all the hypotheses are known to be false. Yet, both Bayesianism and likelihoodism seem to be based on the assumption that the goal of scientific inquiry is always truth rather than closeness to the truth. Here, I argue in favour of a verisimilitude framework for inductive (...) inference. In the verisimilitude framework, scientific inquiry is conceived of, in part, as a process where inference methods ought to be calibrated to appropriate measures of closeness to the truth. To illustrate the verisimilitude framework, I offer a reconstruction of parsimony evaluations of scientific theories, and I give a reconstruction and extended analysis of the use of parsimony inference in phylogenetics. By recasting phylogenetic inference in the verisimilitude framework, it becomes possible to both raise and address objections to phylogenetic methods that rely on parsimony. 1Introduction2Problems with the Law of Likelihood3Introducing Verisimilitude-Based Inference4Examples of Verisimilitude-Based Inference Procedures4.1Parsimony inference over theories4.2Parsimony inference in phylogenetics5Conclusion. (shrink)

I argue that information is a goal-relative concept for Bayesians. More precisely, I argue that how much information is provided by a piece of evidence depends on whether the goal is to learn the truth or to rank actions by their expected utility, and that different confirmation measures should therefore be used in different contexts. I then show how information measures may reasonably be derived from confirmation measures, and I show how to derive goal-relative non-informative and informative priors given background (...) information. Finally, I argue that my arguments have important implications for both objective and subjective Bayesianism. In particular, the Uniqueness Thesis is either false or must be modified. Moreover, objective Bayesians must concede that pragmatic factors systematically influence which priors are rational, and subjective Bayesians must concede that pragmatic factors sometimes partly determine which prior distribution most accurately represents an agent's epistemic state. (shrink)