Involving patients in decisions on primary prevention can be questioned from an ethical perspective, due to a tension between health promotion activities and patient autonomy. A nurse-led intervention for prevention of cardiovascular diseases, including counselling (risk communication, and elements of shared decision-making and motivational interviewing) and supportive tools such as a decision aid, was implemented in primary care. The aim of this study was to evaluate the nurse-led intervention from an ethical perspective by exploring in detail the experiences of patients (...) with the intervention, and their views on the role of both the nurse and patient. The study had a qualitative design. 18 patients who had received the intervention participated. Data were gathered by in-depth interviews. The interviews were analysed using directed content analysis. The findings revealed that patients perceived the consultations not as an infringement on their autonomy, but as supportive to risk reduction efforts they tried but found hard to realise. They specifically emphasised the role of the nurse, and appreciated the nurse's realistic advice, encouragement, and help in understanding. Patients' views on and experiences with risk management are in line with notions of relational autonomy, caring cooperation and communicative action found in the literature. We conclude that patients define the relationship with the nurse as shared work in the process of developing a healthier lifestyle. (shrink)

Marie van Loon | : In this paper, I argue that Alfred Mele’s conception of self-deception is such that it always fulfils the reasons-responsiveness condition for doxastic responsibility. This is because self-deceptive mechanisms of belief formation are such that the kind of beliefs they bring about are the kind of beliefs that fulfil the criteria for doxastic responsibility from epistemic reasons responsiveness. I explain why in this paper. Mele describes the relation of the subject to the evidence as a (...) biased relation. The subject does not simply believe on the basis of evidence, but on the basis of manipulated evidence. Mele puts forward four ways in which the subject does this. The subject could misinterpret positively or negatively, selectively focus, or gather evidence. Through these ways of manipulation, the evidence is framed such that the final product constitutes evidence on the basis of which the subject may believe a proposition that fits that subject’s desire that P. Whichever form of manipulation the subject uses, the evidence against P must be neutralized in one way or another. Successful neutralization of the evidence requires the ability to recognize what the evidence supports and the ability to react to it. These abilities consist precisely in the two parts of the reasons-responsiveness condition, reasons receptivity and reasons reactivity. In that sense, self-deceptive beliefs always fulfil the reasons-responsiveness condition for doxastic responsibility. However, given that reasons responsiveness is only a necessary condition for doxastic responsibility, this does not mean that self-deceived subjects are always responsible for their belief. | : Dans cet article, je soutiens que la conception d’auto-illusion chez Alfred Mele remplit toujours l’une des conditions de la responsabilité doxastique, à savoir la « sensibilité aux raisons ». Il en est ainsi car les mécanismes d’auto-illusion dans la formation de croyances produisent des types de croyances qui remplissent les critères pour la responsabilité doxastique quant à la sensibilité aux raisons épistémiques. J’explique pourquoi dans cet article. Mele décrit la relation du sujet à la preuve comme biaisée. Le sujet ne croit pas seulement sur la base de preuves, mais de preuves manipulées. Mele avance quatre façons qu’a le sujet de faire ceci. Le sujet peut mal interpréter positivement ou négativement, focaliser de façon sélective, ou accumuler des preuves. Par ces formes de manipulations, la preuve est formulée de sorte qu’elle produise un fondement pour la croyance en une proposition qui s’accorde avec le désir du sujet que P. Peu importe la forme de manipulation qu’emploie le sujet, la preuve contre P doit être neutralisée d’une façon ou d’une autre. Une neutralisation réussie de la preuve requiert la capacité de reconnaître ce que soutient la preuve et la capacité d’y réagir. Ces capacités consistent précisément en ces deux parties de la condition de la sensibilité aux raisons, soit la réceptivité et la réactivité aux raisons. En ce sens, les croyances d’auto-illusion remplissent toujours la condition de la sensibilité aux raisons pour la responsabilité doxastique. Toutefois, étant donné que la sensibilité aux raisons n’est une condition nécessaire que pour la responsabilité doxastique, cela ne veut pas dire que les sujets souffrant d’auto-illusion sont toujours responsables de leurs croyances. (shrink)

Ulrich Beck's best selling Risk Society established risk on the sociological agenda. It brought together a wide range of issues centering on environmental, health and personal risk, provided a rallying ground for researchers and activists in a variety of social movements and acted as a reference point for state and local policies in risk management. The Risk Society and Beyond charts the progress of Beck's ideas and traces their evolution. It demonstrates why the issues raised by Beck reverberate widely throughout (...) social theory and covers the new risks that Beck did not foresee, associated with the emergence of new technologies, genetic and cybernetic. The book is unique because it offers both an introduction to the main arguments in Risk Society and develops a range of critical discussions of aspects of this and other works of Beck. (shrink)

This paper aims to show that the development of Feyerabend’s philosophical ideas in the 1950s and 1960s largely took place in the context of debates on quantum mechanics. In particular, he developed his influential arguments for pluralism in science in discussions with the quantum physicist David Bohm, who had developed an alternative approach to quantum physics which (in Feyerabend’s perception) was met with a dogmatic dismissal by some of the leading quantum physicists. I argue that Feyerabend’s arguments for theoretical pluralism (...) and for challenging established theories were connected to his objections to the dogmatism and conservatism he observed in quantum physics. However, as Feyerabend gained insight into the physical details and historical complexities which led to the development of quantum mechanics, he gradually became more modest in his criticisms. His writings on quantum mechanics especially engaged with Niels Bohr; initially, he was critical of Bohr’s work in quantum mechanics, but in the late 1960s, he completely withdrew his criticism and even praised Bohr as a model scientist. He became convinced that however puzzling quantum mechanics seemed, it was methodologically unobjectionable – and this was crucial for his move towards ‘anarchism’ in philosophy of science. (shrink)

When David Bohm published his alternative theory of quantum mechanics in 1952, it was not received well; a recurring criticism was that it formed a reactionary attempt to return to classical physics. In response, Bohm emphasized the progressiveness of his approach, and even turned the accusation of classicality around by arguing that he wanted to move beyond classical elements still inherent in orthodox quantum mechanics. In later years, he moved more and more towards speculative and mystical directions. This paper aims (...) to explain this discrepancy between the ways in which Bohm’s work on quantum mechanics has been received and the way in which Bohm himself presented it. I reject the idea that Bohm’s early work can be described as mechanist, determinist, and realist, in contrast to his later writings, and argue that there is in fact a strong continuity between his work on quantum mechanics from the early 1950s and his later, more speculative writings. In particular, I argue that Bohm was never strongly committed to determinism and was a realist in some ways but not in others. A closer look at Bohm’s philosophical commitments highlights the ways in which his theory of quantum mechanics is non-classical and does not offer a way to avoid all ‘quantum weirdness’. (shrink)

Bohr’s work in quantum mechanics posed a challenge to philosophers of science, who struggled with the question of whether and to what degree his theories and methods could be considered rational. This paper focuses on Popper, Feyerabend, Lakatos and Kuhn, all of whom recognized some irrational, dogmatic, paradoxical or even inconsistent features in Bohr’s work. Popper, Feyerabend, and Lakatos expressed strong criticism of Bohr’s approach to quantum physics, while Kuhn argued that such criticism was unlikely to be fruitful: progress in (...) science is generally not made through philosophical reflection. Feyerabend’s criticism of Bohr gradually weakened, as he gained a more detailed understanding of the development of Bohr’s views on quantum mechanics, and this went together with an increasingly critical view of normative philosophy of science and was instrumental to his conversion to ‘anarchism’. This paper aims to show that quantum mechanics played a central role in their debates and disagreements on the rationality of science and the possibility of a normative philosophy of science. (shrink)

Bohr’s work in quantum mechanics posed a challenge to philosophers of science, who struggled with the question of whether and to what degree his theories and methods could be considered rational. This paper focuses on Popper, Feyerabend, Lakatos and Kuhn, all of whom recognized some irrational, dogmatic, paradoxical or even inconsistent features in Bohr’s work. Popper, Feyerabend, and Lakatos expressed strong criticism of Bohr’s approach to quantum physics, while Kuhn argued that such criticism was unlikely to be fruitful: progress in (...) science is generally not made through philosophical reflection. Feyerabend’s criticism of Bohr gradually weakened, as he gained a more detailed understanding of the development of Bohr’s views on quantum mechanics, and this went together with an increasingly critical view of normative philosophy of science and was instrumental to his conversion to ‘anarchism’. This paper aims to show that quantum mechanics played a central role in their debates and disagreements on the rationality of science and the possibility of a normative philosophy of science. (shrink)

Bohm’s interpretation of quantum mechanics has generally been received as an attempt to restore the determinism of classical physics. However, although this interpretation, as Bohm initially proposed it in 1952, does indeed have the feature of being deterministic, for Bohm this was never the main point. In fact, in other publications and in correspondence from this period, he argued that the assumption that nature is deterministic is unjustified and should be abandoned. Whereas it has been argued before that Bohm’s commitment (...) to determinism was connected to his interest in Marxism, I argue for the opposite: Bohm found resources in Marxist philosophy for developing a nondeterministic notion of causality, which is based on the idea of infinite complexity and an infinite number of levels of nature. From ca. 1954 onwards, Bohm’s conception of causality further weakened, as he developed the idea of a dialectical relation between causality and chance. (shrink)

In this paper I examine the foundations of Laplace's famous statement of determinism in 1814, and argue that rather than derived from his mechanics, this statement is based on general philosophical principles, namely the principle of sufficient reason and the law of continuity. It is usually supposed that Laplace's statement is based on the fact that each system in classical mechanics has an equation of motion which has a unique solution. But Laplace never proved this result, and in fact he (...) could not have proven it, since it depends on a theorem about uniqueness of solutions to differential equations that was only developed later on. I show that the idea that is at the basis of Laplace's determinism was in fact widespread in enlightenment France, and is ultimately based on a re-interpretation of Leibnizian metaphysics, specifically the principle of sufficient reason and the law of continuity. Since the law of continuity also lies at the basis of the application of differential calculus in physics, one can say that Laplace's determinism and the idea that systems in physics can be described by differential equations with unique solutions have a common foundation. (shrink)

The reversibility problem (better known as the reversibility objection) is usually taken to be an internal problem in the kinetic theory of gases, namely the problem of how to account for the second law of thermodynamics within this theory. Historically, it is seen as an objection that was raised against Boltzmann's kinetic theory of gases, which led Boltzmann to a statistical approach to the kinetic theory, culminating in the development of statistical mechanics. In this paper, I show that in the (...) late nineteenth century, the reversibility problem had a much broader significance - it was widely discussed and certainly not only as an objection to Boltzmann's kinetic theory of gases. In this period, there was a conflict between mechanism and irreversibility in physics which was tied up with central issues in philosophy of science such as materialism, empiricism and the need for mechanistic foundations of physical theories, as well as with concerns about the heat death of the universe. I discuss how this conflict was handled by the major physicists of the period, such as Maxwell, Kelvin, Duhem, Poincaré, Mach and Planck, as well as by a number of lesser-known authors. (shrink)

This special issue arises from the observation that an exploration of the role of non-evidential considerations in epistemology through a broader lens is missing from the current landscape of philosophical research. The present collection of contributions fills this research gap by bringing together three central and much-discussed epistemological topics for which non-evidential considerations become relevant.

It is widely believed that implicit bias is common and that it contributes, in part, to the perpetuation of systemic injustice. Hence, the existence of implicit bias raises the question: can individuals be blameworthy for their implicit bias? Here, I consider what it is about implicit bias that renders agents blameworthy. I defend the claim that, when individuals omit to engage in activities that could prevent the influence of implicit bias on their behavior, they may be blamed for their implicit (...) bias. The plausibility of my proposal depends on whether individuals are able to engage freely in such activities and on whether there exists an obligation not to be biased (broadly put). I will answer positively to the former question and open the way for an answer to the latter, and tougher, question. (shrink)

According to a popular view, excuses undermine blameworthiness. At the same time, philosophers commonly accept that blameworthiness is composed of two necessary conditions: a moral objectionability condition and a responsibility condition. For excuses to do their job, they must undermine at least one of these conditions. In this paper, I conclude that excuses do neither. By inference to the best explanation, I propose a view that reconciles this conclusion with the function of excuses.

Network is a device for organizing and conceptualizing non-linear complexity. Networks defy narrative, chronology and thus also genealogy because they entail a multiplicity of traces. Networks problematize boundaries and centrality but intensify our ability to think in terms of flows and simultaneity. As a concept, network has been highly conducive to theorizing phenomena and processes such as globalization, digital media (Internet), speed, symbiosis and complexity. This in turn enables us to rethink what constitutes the foundations of intelligence, knowledge and even (...) life itself. One particularly useful application of network as a concept is the notion of the gift, which is often seen as the archetypical figure for understanding the nature of economics and social relationships. (shrink)

Health care organizations are constantly seeking ways to improve quality of care and one of the often-posed solutions to deliver ‘good care’ is reflexivity. Several authors stress that enhancing the organizations’ and caregivers’ reflexivity allows for more situated, and therefore better care. Within quality improvement initiatives, devices that guarantee quality are also seen as key to the delivery of good care. These devices do not solely aim at standardizing work practices, but are also of importance in facilitating reflexivity. In this (...) article, we study how quality improvement devices position the relationship between situated reflection and standardization of work processes. By exploring the work of Michel Callon, Michael Lynch, and Lucy Suchman on reflexivity in work practices, we study the development and introduction of the Care Living Plan. This device aimed to transform care organizations of older people from their orientation towards the system of care into organizations that take a client-centred approach. Our analysis of the construction of specific forms of reflexivity in quality devices indicates that the question of reflexivity does not need to be opposed to standardization and needs to be addressed not only at the level of where reflexivity is organizationally situated and who gets to do the reflecting, but also on the content of reflexivity, such as what are the issues that care workers can and cannot reflect upon. In this paper we point out the theoretical importance of a more detailed empirical study of the framing of reflexivity in care practices. (shrink)

This article deals with the birth of `the virus' as an object of technoscientific analysis. The aim is to discuss the process of objectification of pathogen virulence in virological and medical discourses. Through a short excursion into the history of modern virology, it will be argued that far from being a matter of fact, pathogen virulence had to be `produced', for example in petri-dishes, test-kits and hyper-real signification-practices. The now commonly accepted objective status of `the virus' has been an accomplishment (...) of a complex ensemble of actors. Indeed, this illustrates why objectification rather than objectivity has become the main focus of science and technology studies. The objectification of `the' virus was by no means a smooth process. It involved more than five decades of highly speculative and fragmented research projects before it became actualized as a separate discipline under the heading of virology. The specific objectification of viruses took place through an inter-disciplinary de-differentiation of research questions, methodologies, techniques and technologies. The main argument of this article is that viruses only became intelligible after the establishment of a virology-assemblage. Its inauguration in the early 1950s was radical and sudden because only then could the various substrands of virological technoscience affect each other through deliberate enrolment, and engender a universal intelligibility. (shrink)

BackgroundRadiotherapy is an essential component of cancer treatment, yet many countries do not have adequate capacity to serve all patients who would benefit from it. Allocation systems are needed to guide patient prioritization for radiotherapy in resource-limited contexts. These systems should be informed by allocation principles deemed relevant to stakeholders. This study explores the ethical dilemmas and views of decision-makers engaged in real-world prioritization of scarce radiotherapy resources at a cancer center in Rwanda in order to identify relevant principles.MethodsSemi-structured interviews (...) were conducted with a purposive sample of 22 oncology clinicians, program leaders, and clinical advisors. Interviews explored the factors considered by decision-makers when prioritizing patients for radiotherapy. The framework method of thematic analysis was used to characterize these factors. Bioethical analysis was then applied to determine their underlying normative principles.ResultsParticipants considered both clinical and non-clinical factors relevant to patient prioritization for radiotherapy. They widely agreed that disease curability should be the primary overarching driver of prioritization, with the goal of saving the most lives. However, they described tension between curability and competing factors including age, palliative benefit, and waiting time. They were divided about the role that non-clinical factors such as social value should play, and agreed that poverty should not be a barrier.ConclusionsMultiple competing principles create tension with the agreed upon overarching goal of maximizing lives saved, including another utilitarian approach of maximizing life-years saved as well as non-utilitarian principles, such as egalitarianism, prioritarianism, and deontology. Clinical guidelines for patient prioritization for radiotherapy can combine multiple principles into a single allocation system to a significant extent. However, conflicting views about the role that social factors should play, and the dynamic nature of resource availability, highlight the need for ongoing work to evaluate and refine priority setting systems based on stakeholder views. (shrink)

In this article, we analyse the tensions associated with the emergence of microorganism-based agricultural inputs in two Latin American countries, Brazil and Mexico. More specifically, we examine the ways in which these technologies, which are based on the use of living organisms, leave public microbiology research laboratories and are further developed by manufacturers or farmers. To this end, we draw on the concept of the ‘laboratorisation’ of society, part of the actor-network theory. We show that the emergence of these technologies (...) is currently facing a number of challenges, due to the risks associated with their biological nature and the difficulty involved in establishing production processes as reliable as those used in reference laboratories. Whether produced by companies or on farms, the quality and safety of the practices and of these products are the subject of debate, as well as the focus of scientific, economic and political scrutiny. These microbiological inputs are evidence for the transformation of the relationship between science, industry, users and politics that is taking place around the emergence of alternatives to synthetic chemical inputs in agriculture, and more broadly, about the use of microbiological resources in agriculture. (shrink)

Peter van Inwagen, author of the classic book An Essay on Free Will, has established himself over the last forty years as a leading figure in the philosophical debate about the problem of free will. This volume presents eleven influential essays from throughout his career, as well as two new and previously unpublished essays, 'The Problem of Fr** W*ll' and 'Ability'. The essays include discussions of determinism, moral responsibility, 'Frankfurt counterexamples', the meaning of 'the ability to do otherwise', and the (...) very definition of free will, as well as critiques of writings on the topic by Daniel Dennett and David Lewis. An introduction by the author discusses the history of his thinking about free will. The volume will be a valuable resource for those looking to engage with van Inwagen's significant contributions to this perennially important topic. (shrink)

A great deal of philosophy of mind in the modern era has been driven by an intense aversion to Cartesian dualism. In the 1950s, materialists claimed to have succeeded once and for all in exorcising the Cartesian ghost by identifying the mind with the brain. In subsequent decades, cognitive science put scientific meat on this metaphysical skeleton by explicating mental processes as digital computation implemented in the brain's hardware.

During the period 1860-1880, a number of physicists and mathematicians, including Maxwell, Stewart, Cournot and Boussinesq, used theories formulated in terms of physics to argue that the mind, the soul or a vital principle could have an impact on the body. This paper shows that what was primarily at stake for these authors was a concern about the irreducibility of life and the mind to physics, and that their theories can be regarded primarily as reactions to the law of conservation (...) of energy, which was used among others by Helmholtz and Du Bois-Reymond as an argument against the possibility of vital and mental causes in physiology. In light of this development, Maxwell, Stewart, Cournot and Boussinesq showed that it was still possible to argue for the irreducibility of life and the mind to physics, through an appeal to instability or indeterminism in physics: if the body is an unstable or physically indeterministic system, an immaterial principle can act through triggering or directing motions in the body, without violating the laws of physics. (shrink)

The development of rigorous foundations of differential calculus in the course of the nineteenth century led to concerns among physicists about its applicability in physics. Through this development, differential calculus was made independent of empirical and intuitive notions of continuity, and based instead on strictly mathematical conditions of continuity. However, for Boltzmann and Poincaré, the applicability of mathematics in physics depended on whether there is a basis in physics, intuition or experience for the fundamental axioms of mathematics—and this meant that (...) to determine the status of differential equations in physics, they had to consider whether there was a justification for these mathematical continuity conditions in physics. For this reason, their ideas about continuity and discreteness in nature were entangled with epistemology and philosophy of mathematics. They reached opposite conclusions: Poincaré argued that physicists must work with a continuous representation of nature, and thus with differential equations, while Boltzmann argued that physicists must ultimately take nature to be discrete. (shrink)