A growing body of research has demonstrated significant heterogeneity of hospital ethics committee (HEC) size, membership and training requirements, length of appointment, institutional support, clinical and policy roles, and predictors of self identified success. Because these studies have focused on HECs at a single point in time, however, little is known about how the composition of HECs changes over time and what impact these changes have on committee utilization. The current study presents 20 years of data on the evolution of (...) the Massachusetts General Hospital HEC. Between 1993 and 2012, the average number of committee members per year was 38 ± 3 and the average length of membership was 4.8 ± 0.4 years. During that time, the committee performed 934 consults, averaging 47 ± 3 per year. Attendance rates fell from 61.5 to 23.8 % over the study period and were inversely correlated with the total number of members. Between 1993 and 2012, the committee saw substantial growth in the diversity of the professional backgrounds of its members. Multivariate analysis, however, suggests that substantial changes in committee composition did not impact its utilization and that other factors are more likely to explain fluctuations in consultation volume. (shrink)
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)
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)
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.
Timothy Williamson has famously argued that the principle should be rejected. We analyze Williamson's argument and show that its key premise is ambiguous, and that when it is properly stated this premise no longer supports the argument against. After canvassing possible objections to our argument, we reflect upon some conclusions that suggest significant epistemological ramifications pertaining to the acquisition of knowledge from prior knowledge by deduction.
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)
Experimentation in Technological Wisdom: Can the Political be Kept off the Practice Ground?Gert GoeminneCentre Leo Apostel, Vrije Universiteit Brussel, BelgiumCentre for Sustainable Development, Ghent University, Belgiume-mail: firstname.lastname@example.orgA Welcome VoiceI met Michel Puech for the first time in 2008 at a workshop entitled ‘Artificial Environments.’ In an interdisciplinary Science and Technology Studies spirit, this 2-day event at Roskilde University gathered philosophers and sociologists of science and technology, as well as architecture theorists. Being rather new to the STS-field at that point, I (...) had read the main authors of the Anglo-Saxon tradition, including Andrew Pickering and Peter‐Paul Verbeek, who were present at the workshop. And sure, I had acquainted myself with the work of the French masters such as Bruno Latour, Gilbert Simondon and Bernard Stiegler. I had never heard of the French philosopher of technology Michel Puech, though. But there he was, startin .. (shrink)
Kamphof offers an illuminating depiction of the technological mediation of morality. Her case serves as the basis for a plea for modesty up and against the somewhat heroic conceptualizations of techno-moral change to date—less logos, less autos, more practice, more relationality. Rather than a displacement of these conceptualizations, I question whether Kamphof’s art of living offers only a different perspective: in scale, and in unit of analysis. As a supplement and not an alternative, this modest art has nonetheless audacious implications (...) for the ethics of surveillance. (shrink)