Background Regionalised models of health care delivery have important implications for people with disabilities and chronic illnesses yet the ethical issues surrounding disability and regionalisation have not yet been explored. Although there is ethics-related research into disability and chronic illness, studies of regionalisation experiences, and research directed at improving health systems for these patient populations, to our knowledge these streams of research have not been brought together. Using the Canadian province of Ontario as a case study, we address this gap (...) by examining the ethics of regionalisation and the implications for people with disabilities and chronic illnesses. The critical success factors we provide have broad applicability for guiding and/or evaluating new and existing regionalised health care strategies. Discussion Ontario is in the process of implementing fourteen Local Health Integration Networks (LHINs). The implementation of the LHINs provides a rare opportunity to address systematically the unmet diverse care needs of people with disabilities and chronic illnesses. The core of this paper provides a series of composite case vignettes illustrating integration opportunities relevant to these populations, namely: (i) rehabilitation and services for people with disabilities; (ii) chronic illness and cancer care; (iii) senior's health; (iv) community support services; (v) children's health; (vi) health promotion; and (vii) mental health and addiction services. For each vignette, we interpret the governing principles developed by the LHINs – equitable access based on patient need, preserving patient choice, responsiveness to local population health needs, shared accountability and patient-centred care – and describe how they apply. We then offer critical success factors to guide the LHINs in upholding these principles in response to the needs of people with disabilities and chronic illnesses. Summary This paper aims to bridge an important gap in the literature by examining the ethics of a new regionalisation strategy with a focus on the implications for people with disabilities and chronic illnesses across multiple sites of care. While Ontario is used as a case study to contextualize our discussion, the issues we identify, the ethical principles we apply, and the critical success factors we provide have broader applicability for guiding and evaluating the development of – or revisions to – a regionalised health care strategy. (shrink)

Three experiments investigated reasoners' beliefs about causal powers; that is, their beliefs about the capacity of a putative cause to produce a given effect. Covariation-based theories (e.g., Cheng, 1997; Kelley, 1973; Novick & Cheng, 2004) posit that beliefs in causal power are represented in terms of the degree of covariation between the cause and its effect; covariation is defined in terms of the degree to which the effect occurs in the presence of the cause, and fails tooccur in the absence (...) of the cause. To test the degree to which beliefs incausal power are reflected in beliefs about covariation information, participants in three experiments rated their beliefs that putative causes have the capacity to produce a given effect (i.e., possess the causal power to produce an effect) as well as their beliefs regarding the degree to which the putative cause and effectcovary. A strong positive correlation was discovered between participants' beliefs in causal power and their beliefs that the effect occurs in the presence of the cause. However, no direct relationship was found between participants' beliefs in causal power and their belief that the effect will fail tooccur in the absence of the cause. These findings were replicated using bothwithin- (Experiments 1 and 3) and between-subject designs (Experiment 2). In Experiment 3, we extended these analyses to measures of familiarity, imageability, and detailedness of the representation. We found that participants' beliefs in causal power were strongly associated with familiarity, and imageability, but not the perceived detailedness of the cause and effect relationship. These data provide support for a multidimensional account of causal knowledge whereby people's representations of causation include, but are not limited to, the covariation, familiarity, and imageability of cause and effect relationships. (shrink)

We tested the hypothesis that choices determined by Type 1 processes are compelling because they are fluent, and for this reason they are less subject to analytic thinking than other answers. A total of 104 participants completed a modified version of Wason's selection task wherein they made decisions about one card at a time using a two-response paradigm. In this paradigm participants gave a fast, intuitive response, rated their feeling of rightness for that response, and were then allowed free time (...) to reconsider their answers. As we predicted, answers consistent with a matching heuristic were made more quickly than other answers, were given higher FOR ratings, and received less subsequent analysis as measured by rethinking time and the probability of changing answers. These data suggest that reasoning biases may be compelling because they are fluently generated; this is turn creates a strong FOR, which acts as a signal that further analysis is not necessary. (shrink)

In two experiments we tested the hypothesis that the mechanisms that produce belief bias generalise across reasoning tasks. In formal reasoning (i.e., syllogisms) judgements of validity are influenced by actual validity, believability of the conclusions, and an interaction between the two. Although apparently analogous effects of belief and argument strength have been observed in informal reasoning, the design of those studies does not permit an analysis of the interaction effect. In the present studies we redesigned two informal reasoning tasks: the (...) Argument Evaluation Task (AET) and a Law of Large Numbers (LLN) task in order to test the similarity of the phenomena concerned. Our findings provide little support for the idea that belief bias on formal and informal reasoning is a unitary phenomenon. First, there was no correlation across individuals in the extent of belief bias shown on the three tasks. Second, evidence for belief by strength interaction was observed only on AET and under conditions not required for the comparable finding on syllogistic reasoning. Finally, we found that while conclusion believability strongly influenced assessments of arguments strength, it had a relatively weak influence on the verbal justifications offered on the two informal reasoning tasks. (shrink)

This paper reports a literature review on the topic of ethical issues in in-depth interviews. The review returned three types of article: general discussion, issues in particular studies, and studies of interview-based research ethics. Whilst many of the issues discussed in these articles are generic to research ethics, such as confidentiality, they often had particular manifestations in this type of research. For example, privacy was a significant problem as interviews sometimes probe unexpected areas. For similar reasons, it is difficult to (...) give full information of the nature of a particular interview at the outset, hence informed consent is problematic. Where a pair is interviewed (such as carer and cared-for) there are major difficulties in maintaining confidentiality and protecting privacy. The potential for interviews to harm participants emotionally is noted in some papers, although this is often set against potential therapeutic benefit. As well as these generic issues, there are some ethical issues fairly specific to in-depth interviews. The problem of dual role is noted in many papers. It can take many forms: an interviewer might be nurse and researcher, scientist and counsellor, or reporter and evangelist. There are other specific issues such as taking sides in an interview, and protecting vulnerable groups. Little specific study of the ethics of in-depth interviews has taken place. However, that which has shows some important findings. For example, one study shows participants are not averse to discussing painful issues provided they feel the study is worthwhile. Some papers make recommendations for researchers. One such is that they should consider using a model of continuous (or process) consent rather than viewing consent as occurring once, at signature, prior to the interview. However, there is a need for further study of this area, both philosophical and empirical. (shrink)

Until quite recently, mind-body dualism has been regarded with deep suspicion by both philosophers and scientists. This has largely been due to the widespread identification of dualism in general with one particular version of it: the interactionist substance dualism of Réné Descartes. This traditional form of dualism has, ever since its first formulation in the seventeenth century, attracted numerous philosophical objections and is now almost universally rejected in scientific circles as empirically inadequate. During the last few years, however, renewed attention (...) has begun to be paid to the dualistic point of view, as a result of increasing discontent with the prevailing materialism and reductionism of contemporary scientific and philosophical thought. Awareness has grown that dualism need not be restricted to its traditional form and that other varieties of dualism are not subject to the difficulties commonly raised against Descartes' own version of it. -/- Interest in these alternative versions of dualism is growing fast today, because it seems that they are capable of capturing deep-seated philosophical intuitions, while also being fully consistent with the methodological assumptions and empirical findings of modern scientific work on the human mind and brain. The object of this book is to provide philosophers, scientists, their students, and the wider general public with an up-to-date overview of current developments in dualistic conceptions of the mind in contemporary philosophy and science. (shrink)

1 Evidence-based policy requires researchers to provide the answers to ecological questions that are of interest to policy makers. To find out what those questions are in the UK, representatives from 28 organizations involved in policy, together with scientists from 10 academic institutions, were asked to generate a list of questions from their organizations. 2 During a 2-day workshop the initial list of 1003 questions generated from consulting at least 654 policy makers and academics was used as a basis for (...) generating a short list of 100 questions of significant policy relevance. Short-listing was decided on the basis of the preferences of the representatives from the policy-led organizations. 3 The areas covered included most major issues of environmental concern in the UK, including agriculture, marine fisheries, climate change, ecosystem function and land management. 4 The most striking outcome was the preference for general questions rather than narrow ones. The reason is that policy is driven by broad issues rather than specific ones. In contrast, scientists are frequently best equipped to answer specific questions. This means that it may be necessary to extract the underpinning specific question before researchers can proceed. 5 Synthesis and applications. Greater communication between policy makers and scientists is required in order to ensure that applied ecologists are dealing with issues in a way that can feed into policy. It is particularly important that applied ecologists emphasize the generic value of their work wherever possible. (shrink)

Environmental changes can bear upon the environmental virtues, having effects not only on the conditions of their application but also altering the concepts themselves. I argue that impending radical changes in global climate will likely precipitate significant changes in the dominate world culture of consumerism and then consider how these changes could alter the moral landscape, particularly culturally thick conceptions of the environmental virtues. According to Jonathan Lear, as the last principal chief of the Crow Nation, Plenty Coups exhibited (...) the virtue of “radical hope,” a novel form of courage appropriate to a culture in crisis. I explore what radical hope may look like today, arguing how it should broadly affect our environmental character and that a framework for future environmental virtues will involve a diminished place for valuing naturalness as autonomy from human interference. (shrink)

Color relationalism is the view that colors are constituted in terms of relations between subjects and objects. The most historically important form of color relationalism is the classic dispositionalist view according to which, for example red is the disposition to look red to standard observers in standard conditions (mutatis mutandis for other colors).1 However, it has become increasingly apparent in recent years that a commitment to the relationality of colors bears interest that goes beyond dispositionalism (Cohen, 2004; Matthen, 1999, 2001, (...) 2005; Thompson, 1995). Accordingly, it is an important project for those interested in the metaphysics of color to sort through and assess different forms of color relationalism. There is, however, a powerful and general cluster of objections that has been thought by many to amount to a decisive refutation of any and all forms of color relationalism. Although this idea has been developed in a number of ways, the basic thought is that relationalism — qua theory of color — is at odds with the manifest evidence of color phenomenology, and that this clash between theory and data should be resolved by giving up the theory. (shrink)

Is the brain really a computer? In particular, is our intelligence a computational achievement: is it because our brains are computers that we get on in the world as well as we do? In this paper I will evaluate an ambitious new argument to the contrary, developed in Landgrebe and Smith (2021a, 2022). Landgrebe and Smith begin with the fact that many dynamical systems in the world are difficult or impossible to model accurately (inter alia, because it is intractable to (...) find exact solutions to the differential equations that describe them—meaning we have to approximate—but at the same time they are such that small differences in starting conditions lead to big differences in final conditions, thwarting accurate approximation). Yet we manage to survive and thrive in a world full of such systems. Landgrebe and Smith argue from these premises that it is not because our brains are computers that we get on as well as we do: instead it is because of the various ways that we dynamically couple with such systems, these couplings themselves impossible to model well enough to emulate in silico. Landgrebe and Smith thus defend a dynamical systems model in the lineage of Gibson (1979), Van Gelder (1995), and Thompson (2007), though their focus is on decisively refuting the computationalist alternatives rather than developing the positive account. Here I will defend the claim that human intelligence is genuinely computational (and that whole brain emulation and others forms of AGI may be possible) against this argument. (shrink)

Book review of Jonathan Lear's study of Hans Loewald's views about the nature of therapeutic action in psychoanalysis.

In both editions of the Critique of Pure Reason, and in the Prolegomena, the table of the logical functions of the understanding in judgments lists under “quantity of judgments”: universal, particular, and singular; and the table of categories lists under “categories of quantity”: unity, plurality, and totality. As Kant regarded the forms of judgments as giving “the clue” to the derivation of categories and held that the two lists are “in complete agreement”, one would conclude from the tables that the (...) category of unity is derived from the universal form of judgment and the category of totality from the singular form. But this view of the derivations seems wrong. As a universal judgment pertains to all objects of a given sort and a singular judgment pertains to but one object, one would expect unity to be derived from the singular and totality from the universal form of judgment. That this second view of the derivations is what Kant really intended seems confirmed by the fact that at several places in his writings, including a passage in the Critique and one in the Prolegomena, when he is speaking of quantitative determinations, he explicitly associates the singular judgment with unity. But if this second view is what he intended, one wonders why he failed to correct the order in the tables in the Prolegomena and in the second edition of the Critique. Is this failure merely, as Jonathan Bennett has suggested, “a slip”? (shrink)

Photography matters, writes Jerry Thompson, because of how it works -- not only as an artistic medium but also as a way of knowing. It matters because how we understand what photography is and how it works tell us something about how we understand anything. With these provocative observations, Thompson begins a wide-ranging and lucid meditation on why photography is unique among the picture-making arts. Thompson, a working photographer for forty years, constructs an argument that moves with (...) natural logic from Thomas Pynchon to Jonathan Swift to Plato to Emily Dickinson to detailed readings of photographs by Eugène Atget, Garry Winogrand, Marcia Due, Walker Evans, and Robert Frank. He questions Susan Sontag's assertion in On Photography that "nobody" can any longer imagine literate, authoritative, or transcendent photographs. He considers the money-fueled expansion of the market for photography, and he compares ambitious "meant-for-the-wall" photographs with smaller, quieter works. Forcefully and persuasively, Thompson argues for photography as a medium concerned with understanding the world we live in -- a medium whose business is not constructing fantasies pleasing to the eye or imagination but describing the world in the toughest and deepest way. (shrink)

Color relationalism is the view that colors are constituted in terms of relations between subjects and objects. The most historically important form of color relationalism is the classic dispositionalist view according to which, for example red is the disposition to look red to standard observers in standard conditions (mutatis mutandis for other colors).1 However, it has become increasingly apparent in recent years that a commitment to the relationality of colors bears interest that goes beyond dispositionalism (Cohen, 2004; Matthen, 1999, 2001, (...) 2005; Thompson, 1995). Accordingly, it is an important project for those interested in the metaphysics of color to sort through and assess different forms of color relationalism. There is, however, a powerful and general cluster of objections that has been thought by many to amount to a decisive refutation of any and all forms of color relationalism. Although this idea has been developed in a number of ways, the basic thought is that relationalism — qua theory of color — is at odds with the manifest evidence of color phenomenology, and that this clash between theory and data should be resolved by giving up the theory. (shrink)

Perry Anderson, Edward Palmer Thompson, David Harvey, Moishe Postone, Derek Sayer, Simon Clarke, Robert Brenner, Ellen Meiksins Wood et David McNally : neuf penseurs importants dont l'influence grandissante marque un renouveau de l'apport de l'oeuvre de Marx et de ses successeurs au champ des sciences sociales. Chaque chapitre décrit le parcours intellectuel de l'une de ces figures et analyse sa contribution à une pensée en mouvement, offrant ainsi pour la première fois au public francophone un tour d'horizon des différentes (...) formes du marxisme anglo-saxon contemporain. Hétérogène, ce courant de pensée résolument antidogmatique est traversé de tendances communes telles la critique du réductionnisme économique et une sensibilité accrue aux processus historiques des rapports de domination. Historiens, sociologues, politologues, géographes ou philosophes, les auteurs ici réunis ont chacun à leur manière contribué au vaste chantier théorique de la pensée marxiste et du matérialisme historique, qui continue de s'étendre, un siècle et demi après sa fondation. (shrink)

This essay is the journal editor's introduction to part 3 of an ongoing symposium on quietism. With reference to writings of James Joyce, Francis Picabia, J. M. Coetzee, Charles Taylor, Alasdair MacIntyre, Elaine Pagels, and Karen King—and with extended reference to Jonathan Lear's study of “cultural devastation,” Radical Hope—Jeffrey Perl explores the possibility that the fear of anomie (“anomiphobia”) is misplaced. He argues that, in comparison with the violence and narrowness of any given social order, anomie may well be (...) preferable, and, in any case, may be no more than another name for quietism. (shrink)

Much of the extant discussion focuses on the question of whether contextualism resolves skeptical paradoxes. Understandably. Yet there has been less discussion as to the internal structure of contextualist theories. Regrettably. Here, for instance, are two questions that could stand further discussion: (i) what is the linguistic basis for contextualism and (ii) what is the parameter that shifts with context?

I begin by expressing my sincere thanks to my critics for taking time from their own impressive projects in epistemology to consider mine. Often, in reading their criticisms, I had the feeling of having received more help than I really wanted! But the truth of the matter is that we learn best by making mistakes, and I appreciate the conscientious attention to my work that my critics have shown.

Davidson's account of weakness of will dependsupon a parallel that he draws between practicaland theoretical reasoning. I argue that theparallel generates a misleading picture oftheoretical reasoning. Once the misleadingpicture is corrected, I conclude that theattempt to model akratic belief on Davidson'saccount of akratic action cannot work. Thearguments that deny the possibility of akraticbelief also undermine, more generally, variousattempts to assimilate theoretical to practicalreasoning.

What kind of knowledge is medical knowledge? Can medicine be explained scientifically? Is disease a scientific concept, or do explanations of disease depend on values? What is ‘evidence-based’ medicine? Are advances in neuroscience bringing us closer to a scientific understanding of the mind? The nature of medicine raises fundamental questions about explanation, causation, knowledge and ontology – questions that are central to philosophy as well as medicine. In this book Paul R. Thompson and Ross E. G. Upshur introduce the (...) fundamental issues in philosophy of medicine for those coming to the subject for the first time. They introduce and explain the following key topics: Understanding the physician-patient relationship: the phenomenology of the medical encounter. Models and theories in biology and medicine: what role do theories play in medicine? Are they similar to scientific theories? Randomised controlled trials: can scientific experiments be replicated in clinical medicine? What are the philosophical criticisms levelled at RCTs? The concept of evidence in medical research: what do we mean by ‘Evidence-based medicine?’ Should all medicine be based on evidence? Causation in medicine What do advances in neuroscience reveal about the relationship between mind and body? Defining health and disease: are explanations of disease objective or do they depend on values? Evolutionary medicine: what is the role of evolutionary biology in understanding medicine? Is it relevant? Extensive use of empirical examples and case studies is made throughout the book. These include debates about smoking and cancer, the use of placebos in randomised controlled trials and controversies about research into the causes of HIV and autism. This is an indispendable introduction to those teaching philosophy of medicine and philosophy of science. (shrink)

Climate change adaptation is largely a local matter, and adaptation planning can benefit from local climate change projections. Such projections are typically generated by accepting climate model outputs in a relatively uncritical way. We argue, based on the IPCC’s treatment of model outputs from the CMIP5 ensemble, that this approach is unwarranted and that subjective expert judgment should play a central role in the provision of local climate change projections intended to support decision-making.

"--Daniel Callahan, cofounder of the Hastings Center "Doctors and people who have no choice but to trust doctors--which means all of us--need to read this book.

"To some people, life is very simple . . . no shadings and grays, all blacks and whites. . . . Now, others of us find that good, bad, right, wrong, are many-sided, complex things. We try to see every side; but the more we see, the less sure we are." —Sir John Talbot, The Wolf Man (Universal Pictures, 1941).

In this essay, I consider the ontological status of spacetime from the points of view of the standard tensor formalism and three alternatives: twistor theory, Einstein algebras, and geometric algebra. I briefly review how classical field theories can be formulated in each of these formalisms, and indicate how this suggests a structural realist interpretation of spacetime.

The rapid development in healthcare technologies in recent years has resulted in the need for health services, whether publicly funded or insurance based, to identify means to maximise the benefits and provide equitable distribution of limited resources. This has resulted in the need for rationing decisions, and there has been considerable debate regarding the substantive and procedural ethical principles that promote distributive justice when making such decisions. In this paper, I argue that while the scientifically rigorous approaches of evidence-based healthcare (...) are claimed as aspects of procedural justice that legitimise such guidance, there are biases and distortions in all aspects of the process that may lead to epistemic injustices. Regardless of adherence to principles of distributive justice in the decision-making process, evidential failings may undermine the fairness and legitimacy of such decisions. In particular, I identify epistemic exclusion that denies certain patient and professional groups the opportunity to contribute to the epistemic endeavour. This occurs at all stages of the process, from the generation, analysis and reporting of the underlying evidence, through the interpretation of such evidence, to the decision-making that determines access to healthcare resources. I further argue that this is compounded by processes which confer unwarranted epistemic privilege on experts in relation to explicit or implicit value judgements, which are not within their remit. I suggest a number of areas in which changes to the processes for developing, regulating, reporting and evaluating evidence may improve the legitimacy of such processes. (shrink)

A critique of conversational epistemic contextualism focusing initially on why pragmatic encroachment for knowledge is to be avoided. The data for pragmatic encroachment by way of greater costs of error and the complementary means to raise standards of introducing counter-possibilities are argued to be accountable for by prudence, fallibility and pragmatics. This theme is sharpened by a contrast in recommendations: holding a number of factors constant, when allegedly higher standards for knowing hold, invariantists still recommend assertion (action), while contextualists do (...) not. Given the knowledge norm of assertion, if one recommendation is preferable to the other, the result favors the preferred recommendation's account of knowledge. In the final section, I offer a unification of these criticisms centering on the contextualist use of 'epistemic position'. Their use imposes on threshold notions of justification, warrant, or knowledge tests that are suitable only to unlimited comparative or scalar notions like confidence or certainty and places them at one with an important strand of sceptical reasoning. (shrink)

Probably the most successful scientific theory ever created, quantum theory has profoundly changed our view of the world and extended the limits of our knowledge, impacting both the theoretical interpretation of a tremendous range of phenomena and the practical development of a host of technological breakthroughs. Yet for all its success, quantum theory remains utterly baffling. Quantum Reality: Theory and Philosophy cuts through much of the confusion to provide readers with an exploration of quantum theory that is as authoritatively comprehensive (...) as it is intriguingly comprehensible. Requiring no more than school level physics and mathematics background, this volume requires only an interest in understanding how quantum theory came to be and the myriad ways it both explains how our universe functions and extends the reach of human knowledge. Written by well-known physics author and teacher Dr. Jonathan Allday, this highly engaging work: Presents a thorough grounding in the theoretical machinery of quantum physics Offers a whistle-stop tour through the early part of the 20th century when the founding fathers of quantum theory forever altered the frontiers of human thought Provides an example-filled interpretation of the theory, its applications, and its pinnacle in quantum field theory (QFT), so crucial in shaping ideas about the nature of reality Separates fact from speculation regarding quantum physics’ ability to provide a starting point for philosophical queries into ultimate understanding and the limits of science The world beneath the one that we experience with our senses is profoundly mysterious, and while we may never completely unravel that mystery, quantum theory allows us to come closer than ever to understanding where the science leaves off and the mystery begins. Quantum Reality: Theory and Philosophy makes that understanding accessible to anyone possessing a quest for knowledge and a sense of awe. (shrink)

There is overwhelming evidence that the opioid crisis—which has cost hundreds of thousands of lives and trillions of dollars (and counting)—has been created or exacerbated by webs of influence woven by several pharmaceutical companies. These webs involve health professionals, patient advocacy groups, medical professional societies, research universities, teaching hospitals, public health agencies, policymakers, and legislators. Opioid companies built these webs as part of corporate strategies of influence that were designed to expand the opioid market from cancer patients to larger groups (...) of patients with acute or chronic pain, to increase dosage as well as opioid use, to downplay the risks of addiction and abuse, and to characterize physicians’ concerns about the addiction and abuse risks as “opiophobia.” In the face of these pervasive strategies, conflict of interest policies have proven insufficient for addressing corporate influence in medical practice, medical research, and public health policy. Governments, the academy, and civil society need to develop counterstrategies to insulate themselves from corporate influence and to preserve their integrity and public trust. These strategies require a paradigm shift—from partnerships with the private sector, which are ordinarily vehicles for corporate influence, to a norm of separation. (shrink)