Philosophical discussions on causal inference in medicine are stuck in dyadic camps, each defending one kind of evidence or method rather than another as best support for causal hypotheses. Whereas Evidence Based Medicine advocates the use of Randomised Controlled Trials and systematic reviews of RCTs as gold standard, philosophers of science emphasise the importance of mechanisms and their distinctive informational contribution to causal inference and assessment. Some have suggested the adoption of a pluralistic approach to causal inference, and an inductive (...) rather than hypothetico-deductive inferential paradigm. However, these proposals deliver no clear guidelines about how such plurality of evidence sources should jointly justify hypotheses of causal associations. We here develop such guidelines by first giving a philosophical analysis of the underpinnings of Hill’s viewpoints on causality. We then put forward an evidence-amalgamation framework adopting a Bayesian net approach to model causal inference in pharmacology for the assessment of harms. Our framework accommodates a number of intuitions already expressed in the literature concerning the EBM vs. pluralist debate on causal inference, evidence hierarchies, causal holism, relevance, and reliability. (shrink)

It is widely assumed that severe mental disabilities prevent relevant deliberative capacities from developing or persisting. Accordingly, excluding many people with mental disabilities from discourse practices seems justified. Against this common assumption I wish to show that the general exclusion is not justified and amounts to a form of epistemic injustice, as theorised by Miranda Fricker. The received norm of capable deliberators is connected to a specific model of deliberation. I introduce an alternative model of deliberation, which I dub the (...) joint effort model. According to this model, people with minority minds (as I call them) add valuable cognitive diversity to the process of deliberation, which is a relevant element of epistemic improvement. In this part of the argument I rely on empirically informed theoretical work by Hélène Landemore. I scrutinise the minimal requirements of capable deliberators from the perspective of a joint effort model of deliberation, and I highlight specific beneficial contributions people with minority minds can make to discourse practices. I will argue that people with minority minds can be presumptively deemed capable deliberators and that therefore their general exclusion is unjustified. (shrink)

This chapter introduces the main findings of the medical research on psychopathy as well as the most significant threads of the philosophical debates surrounding psychopathy. It also introduces the articles collected in this volume. The introduction focuses on issues in moral psychology and metaethics, such as moral motivation, moral responsibility, and moral understanding. It shows the difficulty in conceptualising psychopathy and in using psychopathy as a test case for philosophical theories.

This is the first wide-ranging, multi-authored handbook in the field of philosophy of medicine, covering the underlying conceptual issues of many important social, political and ethical issues in health care. It introduces and develops over 70 topics, concepts, and issues in the field. It is written by distinguished specialists from multiple disciplines, including philosophy, health sciences, nursing, sociology, political theory, and medicine. Many difficult social and ethical issues in health care are based on conceptual problems, most prominently on the definitions (...) of health and disease, or on epistemological issues regarding causality or diagnosis. Philosophy is the discipline that deals with such conceptual, metaphysical, epistemological, methodological, and axiological matters. This handbook covers all the central concepts in medicine, such as ageing, death, disease, mental disorder, and well-being. It is an invaluable source for laypeople, academics with an interest in medicine, and health care specialists who want be informed and up to date with the relevant discussions. The text also advances these debates and will set the agenda for years to come. (shrink)

The concept of mental disorder is often defined by reference to the notion of mental dysfunction, which is in line with how the concept of disease in somatic medicine is often defined. However, the notions of mental function and dysfunction seem to suffer from some problems that do not affect models of physiological function. Functions in general have a teleological structure; they are effects of traits that are supposed to have a particular purpose, such that, for example, the heart serves (...) the goal of pumping blood. But can we single out mental functions in the same way? Can we identify mental functions scientifically, for instance, by applying evolutionary theory? Or are models of mental functions necessarily value-laden? I want to identify several philosophical problems regarding the notion of mental function and dysfunction and point out some possible solutions. As long as these questions remain unanswered, definitions of mental disorder that rest upon the concept of mental dysfunction will lack a secure foundation. (shrink)

The paper defends the World Health Organisation (WHO) definition of health against widespread criticism. The common objections are due to a possible misinterpretation of the word complete in the descriptor of health as ‘complete physical, mental and social well-being’. Complete here does not necessarily refer to perfect well-being but can alternatively mean exhaustive well-being, that is, containing all its constitutive features. In line with the alternative reading, I argue that the WHO definition puts forward a holistic account, not a notion (...) of perfect health. I use historical and analytical evidence to defend this interpretation. In the second part of the paper, I further investigate the two different notions of health (holistic health and perfect health). I argue that both ideas are relevant but that the holistic interpretation is more adept for political aims. (shrink)

This article sketches an idealized strategy for the identification of neural correlates of consciousness. The proposed strategy is based on a state space approach originating from the analysis of dynamical systems. The article then focuses on one constituent of consciousness, phenomenal awareness. Several rudimentary requirements for the identification of neural correlates of phenomenal awareness are suggested. These requirements are related to empirical data on selective attention, on completely intrinsic selection and on globally unconscious states. As an example, neuroscientific findings on (...) synchronized γ activity are categorized according to these requirements. (shrink)

In this paper, I discuss several arguments against non‐therapeutic mutilation. Interventions into bodily integrity, which do not serve a therapeutic purpose and are not regarded as aesthetically acceptable by the majority, e.g. tongue splitting, branding and flesh stapling, are now practised, but, however, are still seen as a kind of ‘aberration’ that ought not to be allowed. I reject several arguments for a possible ban on these body modifications. I find the common pathologisation of body modifications, Kant's argument of duties (...) to oneself and the objection from irrationality all wanting. In conclusion, I see no convincing support for prohibition of voluntary mutilations. (shrink)

The interdisciplinary contributions of this edition promote the development of a new "philosophical psychopathology".

According to the objective Bayesian approach to inductive logic, premisses inductively entail a conclusion just when every probability function with maximal entropy, from all those that satisfy the premisses, satisfies the conclusion. When premisses and conclusion are constraints on probabilities of sentences of a first-order predicate language, however, it is by no means obvious how to determine these maximal entropy functions. This paper makes progress on the problem in the following ways. Firstly, we introduce the concept of a limit in (...) entropy and show that, if the set of probability functions satisfying the premisses contains a limit in entropy, then this limit point is unique and is the maximal entropy probability function. Next, we turn to the special case in which the premisses are categorical sentences of the logical language. We show that if the uniform probability function gives the premisses positive probability, then the maximal entropy function can be found by simply conditionalising this uniform prior on the premisses. We generalise our results to demonstrate agreement between the maximal entropy approach and Jeffrey conditionalisation in the case in which there is a single premiss that specifies the probability of a sentence of the language. We show that, after learning such a premiss, certain inferences are preserved, namely inferences to inductive tautologies. Finally, we consider potential pathologies of the approach: we explore the extent to which the maximal entropy approach is invariant under permutations of the constants of the language, and we discuss some cases in which there is no maximal entropy probability function. (shrink)

ABSTRACT In this paper, I discuss several arguments against non‐therapeutic mutilation. Interventions into bodily integrity, which do not serve a therapeutic purpose and are not regarded as aesthetically acceptable by the majority, e.g. tongue splitting, branding and flesh stapling, are now practised, but, however, are still seen as a kind of ‘aberration’ that ought not to be allowed. I reject several arguments for a possible ban on these body modifications. I find the common pathologisation of body modifications, Kant's argument of (...) duties to oneself and the objection from irrationality all wanting. In conclusion, I see no convincing support for prohibition of voluntary mutilations. (shrink)

TugendethikenTugend, Tugendethik sind normative Theorien des richtigen und guten Handelns, die den zentralen Gesichtspunkt der ethischen Bewertung in der handelnden Person, genauer in ihrer charakterlichen und motivationalen Verfassung sehen. Eine Tugend ist eine charakterlich gefestigte Haltung von Menschen, die sie das Richtige und Gute aus eigener Überzeugung erkennen und erstreben lässt. Als Tugenden gelten dabei nicht nur die im engen Sinne moralischen Tugenden wie Gerechtigkeit oder Aufrichtigkeit,WahrhaftigkeitAufrichtigkeitAufrichtigkeit, sondern sie umfassen beispielsweise auch selbstbezogene und intellektuelle Vortrefflichkeiten wie Besonnenheit oder WeisheitWeisheit, die (...) beide lange Zeit zu den Kardinaltugenden gehörten. (shrink)

We study questionnaire responses to situations in which sacrificing one life may save many other lives. We demonstrate gender differences in moral judgments: males are more supportive of the sacrifice than females. We investigate a source of the endorsement of the sacrifice: antisocial preferences. First, we measure individual proneness to spiteful behavior, using an experimental game with monetary stakes. We demonstrate that spitefulness can be sizable—a fifth of our participants behave spitefully—but it is not associated with gender. Second, we find (...) that gender is consistently associated with responses even when we account for individual differences in the propensity to spitefulness. (shrink)

Augmented Reality (AR) is commonly defined as a digital layer of information viewed on top of the physical world through a smartphone, tablet or eyewear. Increasingly, this understanding of AR is shifting to a dynamic framework of ‘smart things’, including wearable technology, sensors and artificial intelligence (AI), with the ability to intercede in key moments and to deliver contextual and meaningful experiences. The things that come into context are the logical next steps in an evolutionary development towards computers that are (...) better able to show empathy in relation to people: even more human-oriented, anticipative and ubiquitous. Thus, this outsourcing of meaning to empathic technologies points to one of the fundamental questions concerning the relation of human and technology – the nature of the trust that users place in technology. (shrink)

Freitag (2015) and Schramm (2014) have proposed different, although converging, solutions of Goodman’s New Riddle of Induction. Answering their proposals, Dorst (2016 and 2018) has used the fictitious character of a ‘grue-speaker’ as his principal device for criticizing counterfactual-based treatments of the Riddle. In this paper, I argue that Dorst’s arguments fail: On the observation of no other than green emeralds, the ‘grue-speaker’ cannot use the symmetry between the ‘green’- and ‘grue’-languages for claiming ‘grue’- instead of ‘green’-evidence, and the counterfactuals (...) involved (explicitly by Schramm and implicitly by Freitag) remain unaffected by Dorst’s proposal for how to evaluate them. (shrink)

Journal of Social Philosophy, EarlyView.

In this paper, I want to scrutinise the value of utilising the concept of disease for a theory of distributive justice in health care. Although many people believe that the presence of a disease-related condition is a prerequisite of a justified claim on health care resources, the impact of the philosophical debate on the concept of disease is still relatively minor. This is surprising, because how we conceive of disease determines the amount of justified claims on health care resources. Therefore, (...) the severity of scarcity depends on our interpretation of the concept of disease. I want to defend a specific combination of a theory of disease with a theory of distributive justice. A naturalist account of disease, together with sufficientarianism, is able to perform a gate-keeping function regarding entitlements to medical treatment. Although this combination cannot solve all problems of justice in health care, it may inform rationing decisions as well. (shrink)

Ageing is often deemed bad for people and something that ought to be eliminated. An important aspect of this normative aspect of ageing is whether ageing, i.e., senescence, is a disease. In this essay, I defend a theory of disease that concludes that ageing is not a disease, based on an account of natural function. I also criticize other arguments that lead to the same conclusion. It is important to be clear about valid reasons in this debate, since the failure (...) of bad analyses is exploited by proponents of the view that ageing is indeed a disease. Finally, I argue that there could be other reasons for attempting to eradicate senescence, which have to do with an evaluative assessment of ageing in relation to the good life. I touch on some reasons why ageing might be good for people and conclude that we cannot justify generalized statements in this regard. (shrink)

In 2012, the symposium "Christopher Boorse and the Philosophy of Medicine" was held at the University of Hamburg. The initial ideas presented at this event, which celebrated Chris's contribution to the development of what is now a vibrant area of research, especially to the theory of disease, form the core of the papers published in this issue. Similarly to what Robert Nozick once said about John Rawls's work, it can be demanded that philosophers of medicine must now either work within (...) Boorse's theory or explain why not. It is simply the main contender in the so-called naturalist camp of contributions to the theory of disease. All of the papers in this issue address his approach in some respect, and all of them are friendly toward his theory up to a point. In this brief introduction, I try to extract common threads. In doing so, I focus on three issues that have the capacity to determine future debates. The first is the methodology of developing a theory of disease, especially what conceptual analysis amounts to and what it may achieve. The second is the issue of value-ladenness of the concepts of health and disease, a topic that has been at the forefront of the philosophical debate, but which -- to my mind -- has often been misunderstood. The third issue is the problem of the unity of medical terminology. We can ask whether there is only one core medical concept, be it "disease," "pathology," "disorder," "malady," or something else. Alternatively, we might propose different concepts for different purposes. (shrink)

The paper contrasts Lennart Nordenfelt’s normative theory of health with the naturalists’ point of view, especially in the version developed by Christopher Boorse. In the first part it defends Boorse’s analysis of disease against the charge that it falls short of its own standards by not being descriptive. The second part of the paper sets out to analyse the positive concept of health and introduces a distinction between a positive definition of health (‘health’ is not defined as absence of disease (...) but in positive terms) and a positive conception of health (health is seen as an ideal). An objection against Nordenfelt’s account is developed by making use of a specific example of an ambitious athlete. It is stated that Nordenfelt’s conceptualisation includes too many phenomena under the umbrella of ill health. An ideal conception of health like Nordenfelt’s is in danger of supporting medicalization. In conclusion, although Nordenfelt’s theory is not altogether rejected and even seen in congruence with Boorse’s account, it is claimed that the naturalistic framework should obtain conceptual priority. (shrink)

If a patient complies voluntarily with a certain proposal, we generally regard the treatment as legitimate. But a competent patient may also assent to a certain treatment only because he was compelled to do so. Influences on the formation of his decision may render his choice contrary to his will. It is my aim to focus on these particular forms of coercion which are often neglected in discussions of informed consent.

Misunderstanding other people can be interpreted as the result of an insufficient performance of people’s skills to understand other persons and their experiences. But what does understand mean in these contexts? And what are the relevant skills that need to be engaged to successfully understand other people? I argue that understanding other people is a form of recognition of the epistemic validity of another person’s perspective. I claim that minimal understanding does not require an endorsement of another person’s perspective. This (...) makes the avoidance of lack of understanding a feasible achievement in almost all cases, though it often requires effort in the interactive process of understanding. I specifically analyse the epistemic and normative roles of empathy in this process. In pursuing this aim, I also defend empathy against recent philosophical arguments that point at moral dangers of empathic processes. (shrink)

Decision-making capacity or mental competence is one of the most intensively discussed concepts in contemporary bioethics and medical ethics. In this paper I argue that anorexia nervosa, an eating disorder primarily afflicting adolescent girls and young women, seriously challenges what I label the traditional account of decision-making capacity. In light of these results, it may in addition be necessary to rethink a certain popular type of paternalistic argumentation that grounds the justification of compulsory treatment, for example of anorexic persons who (...) refuse treatment, on a lack of decision-making capacity. (shrink)

Nudges are means to influence the will formation of people to make specific choices more likely. My focus is on nudges that are supposed to improve the health condition of individuals and populations over and above the direct prevention of disease. I point out epistemic and moral problems with these types of nudges, which lead to my conclusion that health-enhancing nudges fail. They fail because we cannot know which choices enhance individual health—properly understood in a holistic way—and because health-enhancing nudges (...) are often themselves bad for our health. They can be bad for our health because they assume inferior agency in their targets and accordingly regularly lead to appropriate resentment and anger—strong emotions which go along with an increased risk of health impairments. Briefly, health-enhancing nudges fail because they are based on persistent ignorance and on a presumptuous attitude. (shrink)

In this paper I show that Rawls’s contract apparatus in A Theory of Justice depends on a particular presumption that is in conflict with the goal of conserving environmental resources. He presumes that parties in the original position want as many resources as possible. I challenge Rawls’s approach by introducing a rational alternative to maximising. The strategy of satisficing merely goes for what is good enough. However, it seems that under conditions of scarcity Rawls’s maximising strategy is the only rational (...) alternative. I therefore scrutinise the common account of scarcity. I distinguish between absolute and relative scarcity in order to show that scarcity is influenced by our decisions. If we would not accept the claim to as much as possible without further legitimisation, like Rawls does, then scarcity might not be as severe a problem. Finally, I reject Rawls’s proposed solution for dealing with problems of sustainability, namely his idea of the just savings principle. I conclude that Rawlsian Justice as Fairness is bad for the environment. (shrink)

Extant literature on Goodman’s ‘New Riddle of Induction’ deals mainly with two versions. I consider both of them, starting from the (‘epistemic’) version of Goodman’s classic of 1954. It turns out that it belongs to the realm of applications of inductive logic, and that it can be resolved by admitting only significant evidence (as I call it) for confirmations of hypotheses. Sect. 1 prepares some ground for the argument. As much of it depends on the notion of evidential significance, this (...) concept is defined and its introduction motivated. Further, I introduce and explain the distinction between support and confirmation: put in a slogan, ‘confirmation is support by significant evidence’. The second section deals with the Riddle itself. I demonstrate that, given the provisions of the first section, not ‘anything confirms anything’: significant green-evidence confirms only green-hypotheses (and no grue-hypotheses), and significant grue-evidence confirms only grue-hypotheses (and no green-hypotheses), whichever terms we use for expressing these evidences or hypotheses. The third section rounds off my treatment. First I show that Frank Jackson’s use of his counterfactual condition is unsuccessful. Further, I argue that no unwanted consequences result, if one starts from the other, ‘objective’, definition of ‘grue’, as it constitutes no more than a mere fact of logic that cannot do any harm. Finally, I present a grue-case involving both kinds of definition, where the exclusive confirmation of either the green- or the grue-hypothesis is shown. (shrink)

Mit dem Ausdruck ‚sympathy‘ bezeichnet Mill die menschliche Fähigkeit, zu fühlen, was andere fühlen; oder allgemeiner, Zugang zum subjektiven Erleben Anderer zu erlangen. Sowohl Einfühlung als auch Mitfühlen sind in dieser Idee integriert. Für Mill ist ‚sympathy‘ eine wesentliche Voraussetzung der menschlichen Moralität. Allerdings gilt es, ‚sympathy‘ zur Fähigkeit auszubilden, genuin moralische Empfindungen zu zeigen. Erst dann sind stabile Moraldispositionen zu erwarten und damit letztlich die Realisierbarkeit des utilitaristischen Moralprinzips ermöglicht.

Palabras pronunciadas por Jürgen Habermas en el Memorial a Richard Rorty con motivo de su fallecimiento, ceremonia que tuvo lugar en la Universidad de Stanford el día 2 de noviembre de 2007.

The chemist Max von Pettenkofer studied with Justus von Liebig, and after leaving Giessen in 1844 did not immediately find an academic position. During the period 1844/1845 he wrote a cycle of 16 Chemical Sonnets, but published them only in 1886. The Sonnets have with few exceptions a historiographical character. We present a translation of the Sonette into Portuguese as well as commentaries about their content and their philosophical significance. We also comment rather briefly on Pettenkofer’s career as an empirical (...) chemist and later as a somewhat heterodox hygienist. (shrink)