The articles in this volume offer a fresh perspective on the important role of the concept of law (lex) in the moral and political philosophy of the 'School of Salamanca'.

Most phase III clinical trials today are explanatory. Because explanatory, or efficacy, trials test hypotheses under “ideal” conditions, they are not well suited to providing guidance on decisions made in most clinical care contexts. Pragmatic trials, which test hypotheses under “usual” conditions, are often better suited to this task. Yet, pragmatic, or effectiveness, trials are infrequently carried out. This mismatch between the design of clinical trials and the needs of health care professionals is frustrating for everyone involved, and explains some (...) of the challenges inherent in attempts to enhance knowledge translation and encourage evidence-based practice. The situation is more than simply frustrating, however; it is potentially unethical. Clinical trials must be socially valuable in order to (1) warrant the risks they impose on human research subjects and (2) fairly and efficiently assess new clinical interventions. Most bioethicists would agree that trials that have no social value, for instance, because their results do not have the potential to advance clinical care, should not be performed. What is less widely appreciated is that given limited research resources, trials that are more socially valuable should be preferred to trials that are less socially valuable when all else is equal. With respect to clinical trial design, I argue that while explanatory trials often have some social value, many have less social value than their pragmatic counterparts. On the basis of this general ethical assessment, I provide a preliminary defense of the position that clinical researchers should aim to conduct pragmatic trials, that is, that researchers face a burden of justification related to any idealizing elements added to trial designs. (shrink)

In this volume Donald Munro, author of important studies on early and contemporary China, provides a critical analysis of the doctrines of the Sung Neo-Confucian philosopher Chu Hsi (1130-1200). For nearly six centuries Confucian orthodoxy was based on Chu Hsi's commentaries on Confucian classics. These commentaries were the core of the curriculum studied by candidates for the civil service in China until 1905 and provided guidelines both for personal behavior and for official policy. Munro finds the key to (...) the complexities of Chu Hsi's thought in his mode of discourse: the structural images of family, stream of water, mirror, body, plant, and ruler. Furthermore, he discloses the basic framework of Chu Hsi's ethics and the theory of human nature that is provided by these illustrative images. As revealed by Munro, Chu Hsi's thought is polarized between family duty and a broader altruism and between obedience to external authority and self-discovery of moral truth. To understand these tensions moves us toward clarifying the meaning of each idea in the sets. The interplay of these ideas, selectively emphasized over time by later Confucians, is a background for explaining modern Chinese thought. In it, among other things, Confucianism and Marxism-Leninism co-exist. Originally published in 1988. The Princeton Legacy Library uses the latest print-on-demand technology to again make available previously out-of-print books from the distinguished backlist of Princeton University Press. These editions preserve the original texts of these important books while presenting them in durable paperback and hardcover editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905. (shrink)

Recently, a view I refer to as “hypothetical continuism” has garnered some favour among philosophers, based largely on empirical research showing substantial neurocognitive overlaps between episodic memory and imagination. According to this view, episodically remembering past events is the same kind of cognitive process as sensorily imagining future and counterfactual events. In this paper, I first argue that hypothetical continuism is false, on the basis of substantive epistemic asymmetries between episodic memory and the relevant kinds of imagination. However, I then (...) propose and defend an alternative form of continuism, according to which episodic memory is continuous with a capacity I call “actuality-oriented imagination.” Because of the deep epistemic affinities between episodic memory and actuality-oriented imagination, it makes sense to think of them as cognitive processes of the same kind. (shrink)

Proponents of evidence-based medicine have recently suggested a “4S” approach to clinical decision making in which physicians are advised to rely on increasingly abstract summaries of the available research evidence. This retreat from the original data of medical research is ill-advised: it extends an unjustified evidence hierarchy, overestimates the role of computer systems, divides communities, discards evidence, ignores contexts, and devalues broad critical evaluation. I draw upon feminist social epistemology to evaluate the 4S approach to EBM and to suggest means (...) for improving the evidence base of medical research and practice. (shrink)

In Science as Social Knowledge in 1990 and The Fate of Knowledge in 2002, Helen Longino develops an epistemological theory known as Critical Contextual Empiricism (CCE). Knowledge production, she argues, is an active, value-laden practice, evidence is context dependent and relies on background assumptions, and science is a social inquiry that, under certain conditions, produces social knowledge with contextual objectivity. While Longino’s work has been generally well-received, there have been a number of criticisms of CCE raised in the philosophical literature (...) in recent years. In this paper I outline the key elements of Longino’s theory and propose modifications to the four norms offered by the account. The version of CCE I defend, which draws on lessons learned by medical researchers in recent years, gives principles of epistemic diversity a central role and also provides greater specification of three of the four norms. Further, it offers additional resources for defending CCE against Alvin Goldman’s suggestion that there is a need for a “healthy dogmatism” in science, as well as a concern about “manufactured uncertainty” arising out of recent work by David Michaels. Finally, the modified version proposed here is also well positioned to respond (negatively) to a suggestion from Kristen Intemann that CCE needs to be adapted to incorporate a central insight from feminist standpoint theory. In light of the variety of social pressures influencing contemporary scientific research, and the role of science in shaping public policy, I argue that a rigorous social epistemology such as CCE is indispensable for understanding and assessing contemporary scientific practice. (shrink)

The volume of clinical research is increasing exponentially—far beyond our ability to process and absorb the results. Given this situation, it may be beneficial to consider reducing the flow at its source. In what follows, I will motivate and critically evaluate the following proposal: researchers should conduct fewer clinical trials. More specifically, I c onsider whether researchers should be permitted to conduct only clinical research of very high quality and, in turn, whether research ethics committees should prohibit all other, lower-quality (...) research, even when it might appear to meet some minimal ethical standard. Following a close analysis of the social-value requirement of ethical clinical research, I argue that this proposal is defensible. The problem identified in this paper has two parts, quantity and quality, and some clarification is needed about the latter because “quality” is a highly contested term in the medical literature. When some scholars advocate for high-quality trials, they mean large-scale, simple, explanatory randomized controlled trials. Others, including myself, have defended a different characterization of high-quality research that tends more toward pragmatic trial design and the use of methods other than RCTs. Pragmatic trials aim to provide evidence that directly supports clinical decision-making in “usual” care settings. Unlike explanatory trials, which aim to abstract away from particular settings and patients, in the hopes of creating ideal conditions for the success of an intervention, pragmatic trials deliberately pursue knowledge of high applicability, through the use of representative subjects, clinically important questions, flexible treatment protocols, patient-oriented outcome measures, and so on. I see applicability as a marker of high-quality research. The context in which research is meant to be applied should be the context in which new interventions are evaluated. (shrink)

Volume 20, Issue 2, February 2020, Page 25-27.

There’s a certain pleasure in fantasizing about possessing knowledge, especially possessing secret knowledge to which outsiders don’t have access. Such fantasies are typically a source of innocent entertainment. However, under the right conditions, fantasies of knowledge can become epistemically dangerous, because they can generate illusions of genuine knowledge. I argue that this phenomenon helps to explain why some people join and eventually adopt the beliefs of epistemic communities who endorse seemingly bizarre, outlandish claims, such as extreme cults and online conspiracy (...) theory groups. It can be difficult to grasp how members of such groups come to believe the theories they endorse. I argue that one route to such beliefs is via deep absorption in fantasies of knowledge, which can lead entire groups to become collectively detached from reality. (shrink)

A simple transposition in the text would, I venture to suggest, remove one or two of the many difficulties of this obscure chapter.

Some incredibly far-fetched conspiracy theories circulate online these days. For most of us, clear evidence would be required before we’d believe these extraordinary theories. Yet, conspiracists often cite evidence that seems transparently very weak. This is puzzling, since conspiracists often aren’t irrational people who are incapable of rationally processing evidence. I argue that existing accounts of conspiracist belief formation don’t fully address this puzzle. Then, drawing on both philosophical and empirical considerations, I propose a new explanation that appeals to the (...) role of the imagination in conspiracist belief formation. I argue that conspiracists first become imaginatively absorbed in conspiracist narratives, where this helps to explain how they process their evidence. From there, we can better understand why they find this evidence so compelling, as well as the psychological role it plays in their belief forming processes. This account also has practical implications for combatting the spread of online conspiracy theories. (shrink)

Clinical research has at least three problematic features: it tends to be redundant, secretive, and isolated.1 Research with these features not only wastes resources and causes harm, it also fails to meet a basic ethical requirement of research: scientific validity. As bioethicists, we should be asking why, if research with these three features is ethically unjustified, it has been so routinely approved by research ethics committees over the past half century. In what follows, I provide one answer to this question. (...) The first section of this paper outlines empirical evidence for the redundant, secretive, and isolated nature of much contemporary clinical research. Next, I argue that a lack of clarity .. (shrink)

In their paper, “Think Pragmatically: Investigators’ Obligations to Patient-Subjects When Research is Embedded in Care,” Stephanie Morain and Emily Largent (2023) argue that investigators, and poss...

It has long been recognized that we have a great deal of freedom to imagine what we choose. This paper explores a thesis—what we call “intentionalism (about the imagination)”—that provides a way of making this evident (if vague) truism precise. According to intentionalism, the contents of your imaginings are simply determined by whatever contents you intend to imagine. Thus, for example, when you visualize a building and intend it to be of King’s College rather than a replica of the college (...) you have imagined the former rather than the latter because you intended to imagine King’s College. This is so even if the visual image you conjure up equally resembles either. This paper proposes two kinds of counterexamples to intentionalism and discusses their significance. In particular, it sketches a positive account of how many sensory imaginings get to be about what they are about, which explains how the causal history of our mental imagery can prevent us from succeeding in imagining what we intended. (shrink)

It now seems technically feasible to culture human embryos beyond the “fourteen‐day limit,” which has the potential to increase scientific understanding of human development and perhaps improve infertility treatments. The fourteen‐day limit was adopted as a compromise but subsequently has been considered an ethical line. Does it remain relevant in light of technological advances permitting embryo maturation beyond it? Should it be changed and, if so, how and why? What justifications would be necessary to expand the limit, particularly given that (...) doing so would violate some people's moral commitments regarding human embryos? Robust stakeholder engagement preceded adoption of the fourteen‐day limit and should arguably be part of efforts to reassess it. Such engagement could also consider the need for enhanced oversight of human embryo research. In the meantime, developing and implementing reliable oversight systems should help foster high‐quality research and public confidence in it. (shrink)

Body care is considered a key aspect of nursing and imperative for the health, wellbeing, and dignity of older people. In Scandinavian countries, body care as a professional practice has undergone considerable changes, bringing new understandings, values, and dilemmas into nursing. A systematic mapping review was conducted with the aims of identifying and mapping international nursing research on body care of older people in different institutionalized settings in the healthcare system and to critically discuss the dominant assumptions within the research (...) by adapting a problematization approach. Most identified papers reported on empirical research with a biomedical approach focusing on outcome and effectiveness. Conceptual papers, papers with a focus on the perspectives of the older people, or contextual and material aspects were lacking. The research field is dominated by four dominant assumptions: Body care as an evidence‐based practice, body care as a relational ethical practice, the body as a body‐object and a body‐subject, the objects in the body care practices as nonrelational materialities. Given the complexities of professional body care practices, there is a need for other research designs and theoretical perspectives within nursing that expand our understanding of body care taking into consideration the multiple social and material realities. (shrink)

This paper investigates a capacity I call actuality-oriented imagining, by which we use sensory imagination in a way that's directed at representing the actual world. I argue that this kind of imagining is distinct from other, similar mental states in virtue of its distinctive content determination and success conditions. Actuality-oriented imagining is thus a distinctive cognitive capacity in its own right. Thinking about this capacity reveals that we should resist an intuitive tendency to think of the imagination’s primary function or (...) default mode as representing the non-actual or the fictional. Instead, the imagination is a cognitive faculty that often puts us in touch with the way things are in reality. (shrink)

David Kaplan’s analysis of the factors that determine what words someone has used in a given utterance requires that a speaker can only use a word through producing an utterance performed with a particular, related intention directed at speaking that word. This account, or any that requires a speaker to have an intention to utter a specific word, proves inconsistent with models of speech planning in psycholinguistics as informed by data on slips-of-the-tongue. Kaplan explicitly aims to formulate a theory of (...) words that elides the details of the processes responsible for speech planning and production. Though it may superficially seem that the picture of speech planning and production offered by psycholinguistics can add no insight into our analysis—on closer inspection—we find a rich body of empirical data that should be integrated into any viable account of what words someone has used in a given utterance. (shrink)

Internet trolling involves making assertions with the aim of provoking emotionally heated responses, all while pretending to be a sincere interlocutor. In this paper, I give an account of some of the epistemic and psychological dimensions of trolling, with the goal of better understanding why certain kinds of trolling can be dangerous. I first analyze how trolls eschew the epistemic norms of assertion, thus covertly violating their conversation partners’ normative expectations. Then, drawing on literature on the “explore/exploit trade-off,” I argue (...) that trolling is a kind of exploratory behaviour. Specifically, it involves exploring the consequences of violating an interlocutor’s expectation that one will follow the epistemic norms of assertion. To defend this account, I argue that it explains various facts about trolls and the kind of pleasure they get from their activities. My account provides a deeper understanding of why trolling can be dangerous: namely, it explains why certain trolling behaviours contribute to radicalizing people into extremist or hateful ideologies, as well as why online platforms where trolls run amok gradually become polluted with extreme, hateful speech. (shrink)

We often turn to comforting stories to distract ourselves from emotionally painful truths. This paper explores a dark side of this tendency. I argue that the way false conspiracy theories are disseminated often involves packaging them as part of narratives that offer comforting alternatives to ugly truths. Furthermore, I argue that the way these narratives arouse and resolve our emotions can be part of what causes people to believe conspiracy theories. This account helps to bring out some general implications about (...) the power of narratives for misleading people into believing misinformation: I argue that narratives can cause intuitive judgements of truth that are especially difficult to dispel through critical reflection. I also sketch some practical implications for how the media can better frame their reports about both conspiracy theories and factual narratives. (shrink)

Mental imagery often occurs during testimonial belief transmission: a testifier often episodically remembers or imagines a scene while describing it, while a listener often imagines that scene as it’s described to her. I argue that getting clear on imagery’s psychological roles in testimonial belief transmission has implications for some fundamental issues in the epistemology of testimony. I first appeal to imagery cases to argue against a widespread “internalist” approach to the epistemology of testimony. I then appeal to the same sort (...) of case to argue for an alternative, externalist view. (shrink)

People frequently report that, at times, their thought has a vocal character. Thinking commonly appears to be accompanied or constituted by silently ‘talking’ to oneself in inner speech. In this paper, we explore the specifically epistemic role of inner speech in conscious reasoning. A plausible position—but one I argue is ultimately wrong—is that inner speech plays asolelyfacilitative role that is exhausted by (i) serving as the vehicle of representation for conscious reasoning, and/or (ii) allowing one to focus on certain types (...) of objects or relations, e.g., causal relations, abstracta, counterfactuals, etc., or to consciously entertain structured propositional contents that it would be hard (or impossible) to focus on or entertain with representations in other (e.g., imagistic) formats. According to this position, inner speech doesn't figure as a justificatory element in our reasoning or as the partial epistemic basis of our conclusions—it merely facilitates reasoning through (i) and/or (ii). In contrast to the view that inner speech is amerefacilitator, I establish that (outside of potentially playing roles (i) and/or (ii)) the language we use itself serves as a crucial source of information in reasoning. In other words, we reason from propositions about the language we use in inner speech as opposed to exclusively reasoning from the semantic contents of the speech. My conclusion follows from how we use language as a cognitive tool to keep track of information, e.g., the contents of premises, lemmas, previous reasoning results, etc., in reasoning. (shrink)

Evidentialism as an account of theoretical rationality is a popular and well-defended position. However, recently, it's been argued that misleading higher-order evidence (HOE) – that is, evidence about one's evidence or about one's cognitive functioning – poses a problem for evidentialism. Roughly, the problem is that, in certain cases of misleading HOE, it appears evidentialism entails that it is rational to adopt a belief in an akratic conjunction – a proposition of the form “p, but my evidence doesn't support p” (...) – despite it being the case that believing an akratic conjunction appears to be clearly irrational. In this paper, I diffuse the problem for evidentialism using the distinction between propositional and doxastic rationality. I argue that, although it can be propositionally rational to believe an akratic conjunction (according to evidentialism), one cannot inferentially base an akratic belief in one's evidence, and, thus, one cannot doxastically rationally possess an akratic belief. In addition, I address the worry that my solution to the puzzle commits evidentialists to the possibility of epistemic circumstances in which a proposition, p, is propositionally rational to believe (namely, an akratic conjunction), yet one cannot, in principle, (doxastically) rationally believe p. As I demonstrate, cases of misleading HOE are not the only types of cases that force evidentialists to accept that propositional rationality does not entail the possibility of doxastic rationality. There are no new problems raised by misleading HOE that weren't already present in cases involving purely first-order evidence. (shrink)

Japanese edition of Flock of watchbirds. The masterpiece of Munro Leaf is finally republished! This is a book of what are bad behaviors: deceit, lazy, greedy... A child learns what behaviors are acceptable through these hilarious pictures of children in daily life. In Japanese. Annotation copyright Tsai Fong Books, Inc. Distributed by Tsai Fong Books, Inc.

BackgroundIn 2004, patient advocate groups were major players in helping pass and implement significant public policy and funding initiatives in stem cells and regenerative medicine. In the following years, advocates were also actively engaged in Washington DC, encouraging policy makers to broaden embryonic stem cell research funding, which was ultimately passed after President Barack Obama came into office. Many advocates did this because they were told stem cell research would lead to cures. After waiting more than 10 years, many of (...) these same patients are now approaching clinics around the world offering experimental stem cell-based interventions instead of waiting for scientists in the US to complete clinical trials. How did the same groups who were once the strongest supporters of stem cell research become stem cell tourists? And how can scientists, clinicians, and regulators work to bring stem cell patients back home to the US and into the clinical trial process?DiscussionIn this paper, we argue that the continued marketing and use of experimental stem cell-based interventions is problematic and unsustainable. Central problems include the lack of patient protection, US liability standards, regulation of clinical sites, and clinician licensing. These interventions have insufficient evidence of safety and efficacy; patients may be wasting money and time, and they may be forgoing other opportunities for an intervention that has not been shown to be safe and effective. Current practices do not contribute to scientific progress because the data from the procedures are unsuitable for follow-up research to measure outcomes. In addition, there is no assurance for patients that they are receiving the interventions promised or of what dosage they are receiving. Furthermore, there is inconsistent or non-existent follow-up care. Public policy should be developed to correct the current situation.ConclusionThe current landscape of stem cell tourism should prompt a re-evaluation of current approaches to study cell-based interventions with respect to the design, initiation, and conduct of US clinical trials. Stakeholders, including scientists, clinicians, regulators and patient advocates, need to work together to find a compromise to keep patients in the US and within the clinical trial process. Using HIV/AIDS and breast cancer advocate cases as examples, we identify key priorities and goals for this policy effort. (shrink)

The history of the vivisection debate is a case study in the use of vilification not unlike its rhetorical use by adversaries in the pro-life/pro-choice controversy. According to Vanderford, vilification in that debate serves a number of functions: to identify adversaries as ; to cast opponents in an exclusively negative light; to attribute diabolical motives to one's adversaries; and to magnify the opposition's power as an enemy capable of doing great evil. In the vivisection debate, both sides have attempted to (...) delegitimize each other by one or more of these means. On the antivivisection side, Samuel Johnson in 1758 produced the fiercest attack up to that time on and When the antivivisectionist movement peaked in England in the 1870s, the animal experimentalists began to organize in earnest to fend off the charge that vivisection was both cruel and useless. By the turn of the century an American neurologist, Charles Loomis Dana, identified a way to discredit the mainly female antiscience in the antivivisection movement by inventing the disease to describe one of the diseases affecting mainly women who, having no children or a useful occupation, joined animal protection societies and campaigned against vivisection. Zoophil-psychosis, it was claimed, was a form of mental illness, an incurable insanity that afflicted the hysterical opponents of vivisection. (shrink)

Amending and Defending Critical Contextual Empiricism: Lessons from Medical Research In Science as Social Knowledge (1990) and The Fate of Knowledge (2002), Helen Longino develops a social epistemological theory known as Critical Contextual Empiricism (CCE). While Longino’s work has been generally well-received, there have been a number of criticisms of CCE raised in the philosophical literature in recent years. In this paper I outline the key elements of Longino’s theory and propose several modifications to the four norms offered by the (...) account. The revisions I propose are shaped by a number of developments in the medical context in recent years. The modified norms, which determined whether a particular community produces objective knowledge, are thus: 1. Avenues for Criticism – there must be recognized avenues for criticism, and these avenues must be publicly accessible and require transparent disclosure of all relevant information (including competing interests) from those who present their ideas. It must also be a community requirement that all members present their ideas for critical scrutiny if they wish them to be recognized as knowledge. 2. Responsiveness to Criticism – the community must be responsive to criticism. 3. Shared Public Standards – there must be some shared standards that determine community membership. Outsiders to a particular community are welcome to engage in critical debates as long as they share at least one of the community standards with the target community. 4. Cultivation of Diverse Perspectives – communities must cultivate diverse perspectives, that is, the perspectives of those who express strong dissent. The version of CCE I defend gives the principle of diversity a more central role than the original and provides greater specification of two of the other norms in light of challenges faced by medical researchers in recent years. The medical context provides us with a number of cautionary tales in which knowledge production that appears to meet the original four norms has been seriously compromised by particular social interests. The proposed modifications attempt to address these ‘loopholes’ in a way that is not ad hoc. I argue that the modifications I suggest are in line with the underlying assumptions and goals of CCE. The modified version of CCE also offers resources for defending CCE against the criticisms leveled against it by Miriam Solomon & Alan Richardson, Alvin Goldman and Philip Kitcher as well as one general concern arising out of a recent work by David Michaels. I provide responses to these criticisms in the final section of the paper. Throughout the paper I connect the theoretical work done in social epistemology to the real practice of knowledge-production as is occurs in the medical context. In light of the variety of social pressures influencing contemporary scientific research, and the role of science in shaping public policy, I argue that a rigorous social epistemology such as CCE is indispensable for understanding and assessing contemporary scientific practice. (shrink)

It now seems technically feasible to culture human embryos beyond the “fourteen‐day limit,” which has the potential to increase scientific understanding of human development and perhaps improve infertility treatments. The fourteen‐day limit was adopted as a compromise but subsequently has been considered an ethical line. Does it remain relevant in light of technological advances permitting embryo maturation beyond it? Should it be changed and, if so, how and why? What justifications would be necessary to expand the limit, particularly given that (...) doing so would violate some people's moral commitments regarding human embryos? Robust stakeholder engagement preceded adoption of the fourteen‐day limit and should arguably be part of efforts to reassess it. Such engagement could also consider the need for enhanced oversight of human embryo research. In the meantime, developing and implementing reliable oversight systems should help foster high‐quality research and public confidence in it. (shrink)

`Being sensitive' in nursing was explored using Schwartz-Barcott and Kim's hybrid model of concept development, producing a tentative definition of the concept. Three phases were employed: theoretical, empirical/fieldwork and analytical. An exploration of the literature identified where the common idea of `being sensitive' as a nurse was embedded and demonstrated that a theoretical development of this fundamental aspect of nursing was absent. The empirical phase was conducted using semistructured interviews with nine expert palliative care and cancer nurses. This method was (...) particularly useful for the exploration of this concept because of its firm grounding in practical example. A definition of what the concept `being sensitive' means in nursing, and subsequent clarification of `being insensitive', have been posed from the research process undertaken. The essential nature of this concept being integral to nursing practice is emphasized. Potential implications for the development of nursing practice through teaching of this concept were identified. (shrink)

After Hegel's death, with the crisis of idealism and the triumphs of science, philosophy began to suffer an identity crisis, the legacy of which characterises 20th century epistemology. Against this background, the positions interpreted and compared in this study are distinguished by their innovative approaches to a solution: the rehabilitation, re-establishment and interdisciplinary expansion of epistemology, the reclaiming of its role of justifying orientation in everyday life and knowledge instead of its development as a narrow and specialised academic discipline. These (...) approaches provide a common reminder and challenge to contemporary philosophy not to bury the problematic dimensions of epistemology, including the means of justifcation. (shrink)