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The concept of a reason is now central to many areas of contemporary philosophy. Key theses in ethics, epistemology, political philosophy, philosophy of action, and the philosophy of the emotions, among others, have come to be framed in terms of reasons. And yet, despite their centrality, theorists seem to take inconsistent things for granted about how reasons work, what kinds of things can be reasons, what reasons favor, and more. Somehow reasons have come to be both indispensable and impenetrable. -/- (...) The Fundamentals of Reasons offers a comprehensive introduction to the philosophy of reasons. Focusing on the twin roles of reasons in explanation and deliberation, the book not only emphasizes what has made reasons central across philosophy but it also explores why philosophers have such incompatible pictures about what reasons are and how they work. Working from the inside out, Howard and Schroeder identify contentious assumptions about not only the internal structure of reasons but also their relationship to other important concepts, and then show how these contentious assumptions shape the many downstream applications of reasons in ethics, epistemology, political philosophy, and beyond. -/- This mildly opinionated exploration of key questions about the significance and nature of reasons helps the reader to navigate this important part of the philosophical landscape and to get clearer about why reasons seem important and what their import, ultimately, is. (shrink)

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The normative notion of fittingness figures saliently in the work of a number of ethical theorists writing in the late nineteenth and mid-twentieth centuries and has in recent years regained prominence, occupying an important place in the theoretical tool kits of a range of contemporary writers. Yet the notion remains strikingly undertheorized. This article offers a (partial) remedy. I proceed by canvassing a number of attempts to analyze the fittingness relation in other terms, arguing that none is fully adequate. In (...) explaining why various analyses of fittingness fail, I draw into relief certain of the relation’s constitutive features and spotlight some of its interesting and important connections to various other properties. Along the way, I highlight the relation’s relevance to a number of ongoing debates in normative and metanormative philosophy. I conclude by indicating some directions for further research. (shrink)

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Many authors, including Derek Parfit, T. M. Scanlon, and Mark Schroeder, favor a “reasons-first” ontology of normativity, which treats reasons as normatively fundamental. Others, most famously G. E. Moore, favor a “value-first” ontology, which treats value or goodness as normatively fundamental. Chapter 10 argues that both the reasons-first and value-first ontologies should be rejected because neither can account for all of the normative reasons that, intuitively, there are. It advances an ontology of normativity, originally suggested by Franz Brentano and A. (...) C. Ewing, according to which fittingness is normatively fundamental. The normative relation of fittingness is the relation in which a response stands to an object when the object merits—or is worthy of—that response. The author argues that his “fittingness-first” ontology is no less parsimonious than either the reasons- or the value-first ontology, but it can plausibly accommodate the existence of all the normative reasons there are. It therefore provides a superior ontology of normativity. (shrink)

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Artificial intelligence (AI) systems have demonstrated impressive performance across a variety of clinical tasks. However, notoriously, sometimes these systems are 'black boxes'. The initial response in the literature was a demand for 'explainable AI'. However, recently, several authors have suggested that making AI more explainable or 'interpretable' is likely to be at the cost of the accuracy of these systems and that prioritising interpretability in medical AI may constitute a 'lethal prejudice'. In this paper, we defend the value of interpretability (...) in the context of the use of AI in medicine. Clinicians may prefer interpretable systems over more accurate black boxes, which in turn is sufficient to give designers of AI reason to prefer more interpretable systems in order to ensure that AI is adopted and its benefits realised. Moreover, clinicians may be justified in this preference. Achieving the downstream benefits from AI is critically dependent on how the outputs of these systems are interpreted by physicians and patients. A preference for the use of highly accurate black box AI systems, over less accurate but more interpretable systems , may itself constitute a form of lethal prejudice that may diminish the benefits of AI to - and perhaps even harm - patients. (shrink)

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I propose and defend a novel view called “de se consequentialism,” which is noteworthy for two reasons. First, it demonstrates—contra Doug Portmore, Mark Schroeder, Campbell Brown, and Michael Smith, among others—that agent-neutral consequentialism is consistent with agent-centered constraints. Second, it clarifies the nature of agent-centered constraints, thereby meriting attention from even dedicated nonconsequentialists. Scrutiny reveals that moral theories in general, whether consequentialist or not, incorporate constraints by assessing states in a first-personal guise. Consequently, de se consequentialism enacts constraints through the (...) very same feature that nonconsequentialist theories do. (shrink)

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Recently, bioethicists and the UNCRPD have advocated for supported medical decision-making on behalf of patients with intellectual disabilities. But what does supported decision-making really entail? One compelling framework is Anita Silvers and Leslie Francis’ mental prosthesis account, which envisions supported decision-making as a process in which trustees act as mere appendages for the patient’s will; the trustee provides the cognitive tools the patient requires to realize her conception of her own good. We argue that supported decision-making would be better understood (...) as a collaborative process, giving patients with intellectual disabilities the opportunity to make decisions in a respectful relationship with trusted others. We offer an alternative account of supported decision-making where the primary constraint is to protect the patient from domination by the trustee. This is advantageous in its preservation of the prospects for genuine collaboration, for the mental prosthesis approach ultimately reinforces a problematic ideal of isolated patient self-determination. (shrink)

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This paper is about how epistemic and practical reasons for belief can be compared against one another when they conflict. It provides a model for determining what one ought to believe, all-things-considered, when there are conflicting epistemic and practical reasons. The model is meant to supplement a form of pluralism about doxastic normativity that I call ‘Inclusivism’. According to Inclusivism, both epistemic and practical considerations can provide genuine normative reasons for belief, and both types of consideration can contribute to metaphysically (...) determining what beliefs one ought, all-things-considered, to have. (shrink)

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What is commonly known as the Copenhagen interpretation of quantum mechanics, regarded as representing a unitary Copenhagen point of view, differs significantly from Bohr's complementarity interpretation, which does not employ wave packet collapse in its account of measurement and does not accord the subjective observer any privileged role in measurement. It is argued that the Copenhagen interpretation is an invention of the mid‐1950s, for which Heisenberg is chiefly responsible, various other physicists and philosophers, including Bohm, Feyerabend, Hanson, and Popper, having (...) further promoted the invention in the service of their own philosophical agendas. (shrink)

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This paper addresses a recent puzzle in the ethics of emotions concerning the fitting duration of emotions. On the one hand, many of our emotions tend to fade with time and can seem to do so fittingly. Think of attitudes like anger, grief, and regret. On the other hand, it's difficult to see how it could be fitting for these feelings to fade since the facts that make them fitting can seem to persist. This is the puzzle in brief; that (...) of explaining how certain feelings can fittingly fade with time. This paper argues that this puzzle has no general solution: in a wide range of true‐to‐life cases our fitting feelings remain fitting forever, until the day that we die. I conclude by exploring the normative significance of this result and its implications for the ethics of attitudes more generally. (shrink)

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I defend the widely-held view that morally worthy action need not be motivated by a desire to promote rightness as such. Some have recently come to reject this view, arguing that desires for rightness as such are necessary for avoiding a certain kind of luck thought incompatible with morally worthy action. I show that those who defend desires for rightness as such on the basis of this argument misunderstand the relationship between moral worth and the kind of luck that their (...) argument employs. Consequently, the argument provides no reason to doubt the popular view that a desire for rightness as such is no part of virtue. I conclude by suggesting that a family of worries about merely accidentally right action presuppose one side of the recent debate about objectivism and perspectivism about moral rightness. (shrink)

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This paper considers the responsibilities of the FDA with regard to disseminating information about the benefits and harms of e-cigarettes. Tobacco harm reduction advocates claim that the FDA has been overcautious and has violated ethical obligations by failing to clearly communicate to the public that e-cigarettes are far less harmful than cigarettes. We argue, by contrast, that the FDA’s obligations in this arena are more complex than they may appear at first blush. Though the FDA is accountable for informing the (...) public about the health risks and benefits of products it regulates, it also has other roles that inform when and how it should disseminate information. In addition to being a knowledge purveyor, it is also a knowledge producer, an advisor to the public, and a practical agent shaping the material conditions in which people make health-related choices. In our view, those other roles call for caution in the way the FDA interprets and communicates the available evidence. (shrink)

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While it is tempting to suppose that an act has moral worth just when and because it is motivated by sufficient moral reasons, philosophers have, largely, come to doubt this analysis. Doubt is rooted in two claims. The first is that some facts can motivate a given act in multiple ways, not all of which are consistent with moral worth. The second is the orthodox view that normative reasons are facts. I defend the tempting analysis by proposing and defending a (...) heterodox account of both normative and motivating reasons that is inspired by Donald Davidson’s primary reasons. We should adopt the heterodox view, I argue, because it addresses an overlooked but fatal defect in the orthodox conception of reasons, of which challenges to the tempting analysis are a special case. (shrink)

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Inflicting harm is generally preferable to inflicting death. If you must choose between the two, you should generally choose to harm. But prenatal harm seems different. If a mother must choose between harming her fetus or aborting it, she may choose either, at least in many cases. So it seems that prenatal harm is particularly objectionable, sometimes on a par with death. This paper offers an explanation of why prenatal harm seems particularly objectionable by drawing an analogy to the all-or-nothing (...) problem. It then argues that this analogy offers independent support for the ‘voluntarist’ view that at least some parental role obligations are grounded in the choice to be a parent. (shrink)

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The chapter introduces and characterizes the notion of fittingness. It charts the history of the relation and its relevance to contemporary debates in normative and metanormative philosophy and proceeds to survey issues to do with fittingness covered in the volume’s chapters, including the nature and epistemology of fittingness, the relations between fittingness and reasons, the normativity of fittingness, fittingness and value theory, and the role of fittingness in theorizing about responsibility. The chapter concludes with a brief discussion of issues to (...) do with fittingness that aren’t covered extensively by the volume’s chapters in order to indicate avenues for further research. (shrink)

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While intimately familiar, gender eludes theorizing. We argue that well-known challenges to gender’s analysis originate in a subtle ambiguity: questions about gender sometimes express questions about gender categories themselves (e.g., womanhood, manhood, and so on), while at other times expressing questions about what makes someone a member of these categories. Distinguishing these questions accentuates gender’s connections to morality, making a novel “antirealist” view of gender, or as we call it, “unrealist” view, especially natural. Gender’s relations to identity, sex, and social (...) position are illuminated along the way. Taking cues from both historical and contemporary debates in metaethics about the roles that attitudes can play in metaphysical and semantic analysis, we introduce and begin developing a comprehensive non-ameliorative framework for explicating gender’s nature and our thought and talk about it. In a slogan, on the view we defend, you belong to the gender category to which you intrinsically desire to belong. (shrink)

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I argue that Davidson's conception of motivating reasons as belief-desire pairs suggests a model of normative reasons for action that is superior to the orthodox conception according to which normative reasons are propositions, facts, or the truth-makers of such facts.

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more on the history of the Vienna Circle and its allies, see Coffa 1991; Friedman 1983; Hailer 1982, 1985; Kraft 1950; and Proust 1986, 1989). Without question, however, the crucial, formative, early intellectual experience of at least Schlick, Reichenbach, and Carnap, the experience that did most to give form and content to their emergent philosophies of science, was their engagement with relativity theory. Thus, after a few early writings on more general philosophical themes, Schlick first caught the attention of a (...) broader philosophical public with his 1915 essay, "Die philosophische Bedeutung des.. (shrink)

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Philosophy &Public Affairs, Volume 47, Issue 2, Page 208-254, Spring 2019.

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— Niels Bohr, 19231 “There must be quite definite and clear grounds, why you repeatedly declare that one must interpret observations classically, which lie absolute ly in thei r essenc e. . . . It must belong to your deepest conviction—and I cannot understand on what you base it.”.

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Throughout his career, Derek Parfit made the bold suggestion, at various times under the heading of the "Normativity Objection," that anyone in possession of normative concepts is in a position to know, on the basis of their competence with such concepts alone, that reductive realism in ethics is not even possible. Despite the prominent role that the Normativity Objection plays in Parfit's non-reductive account of the nature of normativity, when the objection hasn't been ignored, it's been criticized and even derided. (...) We argue that the exclusively negative attention that the objection has received has been a mistake. On our reading, Parfit's Normativity Objection poses a serious threat to reductivism, as it exposes the uneasy relationship between our a priori knowledge of a range of distinctly normative truths and the typical package of semantic commitments that reductivists have embraced since the Kripkean revolution. (shrink)

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Recent years have seen a substantial increase in alternative agrifood initiatives that attempt to use the market to curtail the negative social and environmental effects of production and trade in a globalized food system. These alternatives pose a challenge to capital accumulation and the externalization of environmental costs by large agribusiness, trading and retail firms. Yet the success of these alternatives also makes them an inviting target for corporate participation. This article examines these dynamics through a case study of the (...) two most significant such food system alternatives—organics and fair trade—focusing on corporate involvement in establishing and renegotiating the standards undergirding these initiatives. We compare the development of and contestation over the standards for both certified organic and certified fair trade, with particular attention to the U.S. context. We provide a brief history of their parallel processes of rapid growth and market mainstreaming. We examine claims of cooptation by movement participants, as well as the divergences and similarities between the organic and fair trade cases. Analyzing these two cases provides useful insights into the strategic approaches that corporate firms have deployed to further capital accumulation and to defuse threats to their profit margins and to status quo production, pricing, labor, trading and retailing practices. It can also offer valuable lessons regarding the most effective means of responding to such counter-reforms and of protecting or reasserting the more transformative elements at the heart of these alternative systems. (shrink)

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‘‘Undone science’’ refers to areas of research that are left unfunded, incomplete, or generally ignored but that social movements or civil society organizations often identify as worthy of more research. This study mobilizes four recent studies to further elaborate the concept of undone science as it relates to the political construction of research agendas. Using these cases, we develop the argument that undone science is part of a broader politics of knowledge, wherein multiple and competing groups struggle over the construction (...) and implementation of alternative research agendas. Overall, the study demonstrates the analytic potential of the concept of undone science to deepen understanding of the systematic nonproduction of knowledge in the institutional matrix of state, industry, and social movements that is characteristic of recent calls for a ‘‘new political sociology of science.’’. (shrink)

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Skepticism about the ‘wrong kind’ of reasons—the view that wrong-kind reasons are reasons to want and bring about certain attitudes, but not reasons for those attitudes—is more often assumed than argued for. Jonathan Way sets out to remedy this: he argues that skeptics about, but not defenders of, wrong-kind reasons can explain a distinctive pattern of transmission among such reasons and claims that this fact lends significant support to the skeptical view. I argue that Way's positive case for wrong-kind reason (...) skepticism fails. I conclude with an account of what's needed to resolve the debate between wrong-kind reason skeptics and defenders. (shrink)

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Many contemporary act consequentialists define facts about what we should do in terms of facts about what we should prefer. They claim that we should perform an action if and only if we should prefer its outcome to the outcome of any available alternative. Some of these theorists claim they can accommodate deontic constraints, such as a constraint against killing the innocent. I argue that they can’t. If there’s a constraint against killing, then when we can prevent five killings only (...) by killing one, we shouldn’t kill—but we should prefer the outcome where we do. (shrink)

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Some have attempted to explain why it appears that action based on deferential moral belief lacks moral worth by appealing to claims about an attitude that is difficult to acquire through testimony, which theorists have called “moral understanding”. I argue that this state is at least partly non-cognitive. I begin by employing case-driven judgments to undermine the assumption that I argue is responsible for the strangeness of deferential moral belief: the assumption that if an agent knows that some fact gives (...) them a moral reason to act in some way, then they’re in a position to act that way for the moral reason given by that fact. I then argue that cases from non-moral epistemology concerning properly-based belief give us independent reason to reject this assumption and conclude by sketching a Davidson-inspired account of normative reasons that explains why acting for moral reasons requires the right non-cognitive state, which is worth calling a kind of moral understanding. (shrink)

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Artificial intelligence (AI) systems have demonstrated impressive performance across a variety of clinical tasks. However, notoriously, sometimes these systems are “black boxes.” The initial response in the literature was a demand for “explainable AI.” However, recently, several authors have suggested that making AI more explainable or “interpretable” is likely to be at the cost of the accuracy of these systems and that prioritizing interpretability in medical AI may constitute a “lethal prejudice.” In this paper, we defend the value of interpretability (...) in the context of the use of AI in medicine. Clinicians may prefer interpretable systems over more accurate black boxes, which in turn is sufficient to give designers of AI reason to prefer more interpretable systems in order to ensure that AI is adopted and its benefits realized. Moreover, clinicians may be justified in this preference. Achieving the downstream benefits from AI is critically dependent on how the outputs of these systems are interpreted by physicians and patients. A preference for the use of highly accurate black box AI systems, over less accurate but more interpretable systems, may itself constitute a form of lethal prejudice that may diminish the benefits of AI to—and perhaps even harm—patients. (shrink)

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When people are making certain medical decisions – especially potentially transformative ones – the specter of regret may color their choices. In this paper, I ask: can predicting that we will regret a decision in the future serve any justificatory role in our present decision-making? And if so, what role? While there are many pitfalls to such reasoning, I ultimately conclude that considering future retrospective emotions like regret in our decisionmaking can be both rational and authentic. Rather than indicating that (...) one is about to make a mistake or that there is some underlying value that one already cares about but is overlooking, the prediction that one will regret a decision in the future makes one confront how her present values and priorities may change as a result of her choice in ways she cannot presently anticipate. (shrink)

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Based upon the proceedings of the First International Conference on the History of General Relativity, held at Boston University's Osgood Hill Conference Center, North Andover, Massachusetts, 8-11 May 1986, this volume brings together essays by twelve prominent historians and philosophers of science and physicists. The topics range from the development of general relativity (John Norton, John Stachel) and its early reception (Carlo Cattani, Michelangelo De Maria, Anne Kox), through attempts to understand the physical implications of the theory (Jean Eisenstaedt, Peter (...) Havas) and to quantize it (Peter G. Bergmann), to elaborations of the theory into a unified theory of electromagnetism and gravitation (Vladimir P. Vizgin, Michel Biezunski), and considerations of its cosmological extensions (Pierre Kerszberg, George F.R. Ellis). This is the first volume to survey many of the most important questions in the history of general relativity, with many of the contributions drawing upon such original resources as the Einstein Archive. It is hoped that it will stimulate much-needed further research in this hitherto neglected area. (shrink)

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Next SectionThis article argues against two dominant accounts of the nature of nostalgia. These views assume that nostalgia depends, in some way, on comparing a present situation with a past one. However, neither does justice to the full range of recognizably nostalgic experiences available to us – in particular, ‘Proustian’ nostalgia directed at involuntary autobiographical memories. Therefore, the accounts in question fail. I conclude by considering an evaluative puzzle raised by Proustian nostalgia when it is directed at memories that the (...) nostalgist herself regards as non-veridical. (shrink)

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This volume explores the usefulness of the notion of fittingness in investigating a range of normative matters. Topics include the nature and epistemology of fittingness, the relation between fittingness and reasons, the normativity of fittingness, fittingness and value theory, and the role of fittingness in theorizing about responsibility.

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Recently, there has been an upsurge of attention focused on bias and its impact on specialized artificial intelligence applications. Allegations of racism and sexism have permeated the conversation as stories surface about search engines delivering job postings for well-paying technical jobs to men and not women, or providing arrest mugshots when keywords such as “black teenagers” are entered. Learning algorithms are evolving; they are often created from parsing through large datasets of online information while having truth labels bestowed on them (...) by crowd-sourced masses. These specialized AI algorithms have been liberated from the minds of researchers and startups, and released onto the public. Yet intelligent though they may be, these algorithms maintain some of the same biases that permeate society. They find patterns within datasets that reflect implicit biases and, in so doing, emphasize and reinforce these biases as global truth. This paper describes specific examples of how bias has infused itself into current AI and robotic systems, and how it may affect the future design of such systems. More specifically, we draw attention to how bias may affect the functioning of a robot peacekeeper, a self-driving car, and a medical robot. We conclude with an overview of measures that could be taken to mitigate or halt bias from permeating robotic technology. (shrink)

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In The Minority Body, Elizabeth Barnes rejects prevailing social constructionist accounts of disability for two reasons. First, because they understand disability in terms of oppressive social responses to bodily impairment, they cannot make sense of disability pride. Second, they maintain a problematic distinction between impairment and disability. In response to these challenges, this paper defends a version of the social model of disability, which we call the Social Exclusion Model. On our account, to be disabled is to be in a (...) bodily or psychological state that is represented as an impairment in the prevailing ideology of one’s society, and to be excluded from valuable activities on the basis of this representation. While this model refers to a distinction between disability and impairment, it makes no presuppositions about which bodies function ‘normally’ and which do not. It is the ideology of impairment rather than impairment itself that does any work to determine whether a person is disabled. We argue that this model answers some of the important objections that Barnes raises against prevailing social constructionist accounts of disability, and that it’s focus on the oppressive social positioning of disabled people gives it explanatory power that Barnes’s own account lacks. (shrink)

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This is a critical notice of Conor McHugh and Jonathan Way's <i>Getting Things Right<\i> (2022, OUP).

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Philosophers have recently come to focus on explaining the phenomenon of ​bad beliefs,​ beliefs that are apparently true and well-evidenced but nevertheless objectionable. Despite this recent focus, a consensus is already forming around a particular explanation of these beliefs’ badness called ​moral encroachment​, according to which, roughly, the moral stakes engendered by bad beliefs make them particularly difficult to justify. This paper advances an alternative account not just of bad beliefs but of bad attitudes more generally according to which bad (...) beliefs’ badness originates not in a failure of sufficient evidence but in a failure to respond adequately to reasons. I motivate this alternative account through an analogy to recent discussions of moral worth centered on the well-known grocer case from Kant’s ​Groundwork​, and by showing that this analogy permits the proposed account to generalize to bad attitudes beyond belief. The paper concludes by contrasting the implications of moral encroachment and of the proposed account for bad attitudes’ blameworthiness. (shrink)

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Pierre Duhem's often unrecognized influence on twentieth-century philosophy of science is illustrated by an analysis of his significant if also largely unrecognized influence on Albert Einstein. Einstein's first acquaintance with Duhem's La Théorie physique, son objet et sa structure around 1909 is strongly suggested by his close personal and professional relationship with Duhem's German translator, Friedrich Adler. The central role of a Duhemian holistic, underdeterminationist variety of conventionalism in Einstein's thought is examined at length, with special emphasis on Einstein's deployment (...) of Duhemian arguments in his debates with neo-Kantian interpreters of relativity and in his critique of the empiricist doctrines of theory testing advanced by Schlick, Reichenbach, and Carnap. Most striking is Einstein's 1949 criticism of the verificationist conception of meaning from a holistic point of view, anticipating by two years the rather similar, but more famous criticism advanced independently by Quine in Two Dogmas of Empiricism. (shrink)

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The wrong kind of reason (WKR) problem is a problem for attempts to analyze normative properties using only facts about the balance of normative reasons, a style of analysis on which the ‘Reasons First’ programme depends. I argue that this problem cannot be solved if the orthodox view of reasons is true --- that is, if each normative reason is numerically identical with some fact, proposition, or state-of-affairs. That’s because solving the WKR problem requires completely distinguishing between the right- and (...) wrong-kind reasons for an attitude. I argue that some facts give both right- and wrong-kind reasons for an attitude. Consequently, no such distinction between the two types of reasons is complete if reasons are facts or the like. I conclude by suggesting that reasons and facts are related by constitution, not identity. (shrink)

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I investigate the normative status of an unexamined category of emotions: ‘lyrical’ emotions about the transience of things. Lyrical emotions are often accused of sentimentality—a charge that expresses the idea that they are unfitting responses to their objects. However, when we test the merits of that charge using the standard model of emotion evaluation, a surprising problem emerges: it turns out that we cannot make normative distinctions between episodes of such feelings. Instead, it seems that lyrical emotions are always fitting. (...) Although this claim is counterintuitive, the price of denying it is to hold that such emotions are never fitting—an equally strange result. If this is correct, then the commonplace discourse of sentimentality surrounding lyrical emotions lacks normative moorings. (shrink)

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The increasing use of opioid treatment agreements has prompted debate within the medical community about ethical challenges with respect to their implementation. The focus of debate is usually on the efficacy of OTAs at reducing opioid misuse, how OTAs may undermine trust between physicians and patients and the potential coercive nature of requiring patients to sign such agreements as a condition for receiving pain care. An important consideration missing from these conversations is the potential for racial bias in the current (...) way that OTAs are incorporated into clinical practice and in the amount of physician discretion that current opioid guidelines support. While the use of OTAs has become mandatory in some states for certain classes of patients, physicians are still afforded great leeway in how these OTAs are implemented in clinical practice and how their terms should be enforced. This paper uses the guidelines provided for OTA implementation by the states of Indiana and Pennsylvania as case studies in order to argue that giving physicians certain kinds of discretion may exacerbate racial health disparities. This problem cannot simply be addressed by minimising physician discretion in general, but rather by providing mechanisms to hold physicians accountable for how they treat patients on long-term opioid therapy to ensure that such treatment is equitable. There are no data in this work. (shrink)

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The 2006 outbreak of E. coli O157:H7, traced to bagged spinach from California, illustrates a number of contradictions. The solutions sought by many politicians and popular food analysts have been to create a centralized federal agency and a uniform set of production standards modeled after those of the animal industry. Such an approach would disproportionately harm smaller-scale producers, whose operations were not responsible for the epidemic, as well as reduce the agroecological diversity that is essential for maintaining healthy human beings (...) and ecosystems. Why should responses that only reinforce the problem be proffered? We use the framework of accumulation and legitimation to suggest corporate and government motives for concealing underlying problems and reinforcing powerful ideologies of individualism, scientism, and centralizing authority. Food safety (or the illusion of safety) is being positioned to secure capital rather than public welfare. We propose implementing the principle of subsidiarity as a more democratic and decentralized alternative. Because full implementation of this principle will be resisted by powerful interests, some promising intermediate steps include peer production or mass collaboration as currently applied to disease prevention and surveillance, as well as studying nascent movements resisting current food safety regulations. (shrink)

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Background: Current practice frequently fails to provide care consistent with the preferences of decisionally-incapacitated patients. It also imposes significant emotional burden on their surrogates. Algorithmic-based patient preference predictors (PPPs) have been proposed as a possible way to address these two concerns. While previous research found that patients strongly support the use of PPPs, the views of surrogates are unknown. The present study thus assessed the views of experienced surrogates regarding the possible use of PPPs as a means to help make (...) treatment decisions for decisionally-incapacitated patients. -/- Methods: This qualitative study used semi-structured interviews to determine the views of experienced surrogates [n=26] who were identified from two academic medical centers and two community hospitals. The primary outcomes were respondents’ overall level of support for the idea of using PPPs and the themes related to their views on how a PPP should be used, if at all, in practice. -/- Results: Overall, 21 participants supported the idea of using PPPs. The remaining five indicated that they would not use a PPP because they made decisions based on the patient’s best interests, not based on substituted judgment. Major themes which emerged were that surrogates, not the patient’s preferences, should determine how treatment decisions are made, and concern that PPPs might be used to deny expensive care or be biased against minority groups. -/- Conclusions: Surrogates, like patients, strongly support the idea of using PPPs to help make treatment decisions for decisionally-incapacitated patients. These findings provide support for developing a PPP and assessing it in practice. At the same time, patients and surrogates disagree over whose preferences should determine how treatment decisions are made, including whether to use a PPP. These findings reveal a fundamental disagreement regarding the guiding principles for surrogate decision-making. Future research is needed to assess this disagreement and consider ways to address it. (shrink)

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