Philosophy Department publications

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Death-row organ donation, revisited
(Wiley, 2023) Hansman, Laura; Reis-Dennis, Samuel
In 2011, bioethicists turned their attention to the question of whether prisoners on death row ought to be allowed to be organ donors. The discussion began with a provocative anti-procurement article by Arthur Caplan and prompted responses from an impressive lineup of commentators. In the 10 years since, the situation for death-row inmates seeking to donate has hardly changed: U.S. prison authorities consistently refuse to allow death-row procurement. We believe that it is time to revisit the issue. While Caplan's commentators rebutted his narrow contention that organ procurement would undermine the goals of deterrence and retribution, none of them attempted to make a positive, nonconsequentialist case for organ donation as a right of death-row inmates. That is the task we take up in this paper. After sketching and briefly defending a theory of punishment, we show how denial of organ donation is inconsistent with punishment's basic logic.
Against neuroclassicism: On the perils of armchair neuroscience
(Wiley, 2022) Morgan, Alex
Neuroclassicism is the view that cognition is explained by “classical” computing mechanisms in the nervous system that exhibit a clear demarcation between processing machinery and read–write memory. The psychologist C. R. Gallistel has mounted a sophisticated defense of neuroclassicism by drawing from ethology and computability theory to argue that animal brains necessarily contain read–write memory mechanisms. This argument threatens to undermine the “connectionist” orthodoxy in contemporary neuroscience, which does not seem to recognize any such mechanisms. In this paper I argue that the neuroclassicist critique rests on a misunderstanding of how computability theory constrains theorizing about natural computing mechanisms.
The Intentional Structure of Moods
(Michigan Publishing, 2019) Kriegel, Uriah
Moods are sometimes claimed to constitute an exception to the rule that mental phenomena are intentional (in the sense of representing something). In reaction, some philosophers have argued that moods are in fact intentional, but exhibit a special and unusual kind of intentionality: They represent the world as a whole, or everything indiscriminately, rather than some more specific object(s). In this paper, I present a problem for extant versions of this idea, then propose a revision that solves the problem but also entrains an important change in our understanding of the nature of moods—and indeed of the nature of mind. What emerges is an intentionalist account that emphasizes the role of attitude rather than content in determining the character of moods.
The Causal Map and Moral Psychology
(Oxford University Press, 2017) Schroeder, Timothy
Some philosophers hold that the neuroscience of action is, in practice or in principle, incapable of touching debates in action theory and moral psychology. The role of desires in action, the existence of basic actions, and the like are topics that (they hold) must be sorted out by philosophers alone: at least at present, and perhaps by the very nature of the questions. This paper examines both philosophical and empirical arguments against the relevance of neuroscience to such questions and argues that neither succeeds. In practice, there is already a stable body of findings from neuroanatomy and neurophysiology that warrants attention. And as a matter of principle, the ‘causal map’ of action production derivable from these findings requires the study of action theorists and moral psychologists because every such philosopher has commitments (sometimes, deeply implicit) to the shape of this causal map: commitments that might be in conflict with reality.
Do Surgical Trials Meet the Scientific Standards for Clinical Trials?
(Elsevier, 2012) Wenner, Danielle M.; Brody, Baruch A.; Jarman, Anna F.; Kolman, Jacob M.; Wray, Nelda P.; Ashton, Carol M.
Unlike medications, the dissemination of surgical procedures into practice is not regulated. Before marketing, pharmaceutical products are required to be shown safe and efficacious in comparative clinical trials that use bias-reducing strategies designed to reduce the distortion of estimates of treatment effect by predispositions toward the investigational intervention or control. Unless an investigational device is involved, the corresponding process for surgical innovations is usually unregulated and therefore may not be based on adequate evidence. Given these differences, we sought to evaluate the state of clinical research on invasive procedures. We conducted a systematic review of publications from 1999 through 2008, which reported the results of studies evaluating the effects of invasive therapeutic procedures, focusing on trials that appeared to influence practice. Our objective was to determine what proportion of studies evaluating surgical procedures use a comparative clinical trial design and methods to control bias. This article reports our results and raises concerns about the methodologic, and therefore the ethical, quality of clinical research used to justify the implementation of surgical procedures into practice.
Doubly distributing special obligations: what professional practice can learn from parenting
(BMJ Publishing Group Ltd?& Institute of Medical Ethics, 2016) Tilburt, Jon; Brody, Baruch A.
A traditional ethic of medicine asserts that physicians have special obligations to individual patients with whom they have a clinical relationship. Contemporary trends in US healthcare financing like bundled payments seem to threaten traditional conceptions of special obligations of individual physicians to individual patients because their population-based focus sets a tone that seems to emphasise responsibilities for groups of patients by groups of physicians in an organisation. Prior to undertaking a cogent debate about the fate and normative weight of special obligations and a traditional ethic for contemporary healthcare, we need a deeper examination of what the traditional ethic of special obligations really means. Here we offer a conception of ‘doubly distributed’ special obligations. Physicians and similarly minded healing professionals abiding by a traditional ethic have always spread their devotion and attention across multiple patients and have shared responsibilities with physician and non-physician colleagues in much the same way devoted parents have frequently distributed their special obligations across multiple children and across multiple parents. By taking up the extended analogy of parent we argue that doubly distributing special obligations need not contradict the possibility of special obligations in restructured collective forms of healthcare delivery and financing.
Expecting the Unexpected
(Res Philosophica, 2015) Dougherty, Tom; Horowitz, Sophie; Sliwa, Paulina
In an influential paper, L. A. Paul argues that one cannot rationally decide whether to have children. In particular, she argues that such a decision is intractable for standard decision theory. Paul’s central argument in this paper rests on the claim that becoming a parent is “epistemically transformative”—prior to becoming a parent, it is impossible to know what being a parent is like. Paul argues that because parenting is epistemically transformative, one cannot estimate the values of the various outcomes of a decision whether to become a parent. In response, we argue that it is possible to estimate the value of epistemically transformative experiences. Therefore, there is no special difficulty involved in deciding whether to undergo epistemically transformative experiences. Insofar as major life decisions do pose a challenge to decision theory, we suggest that this is because they often involve separate, familiar problems.
Respecting all the evidence
(Springer, 2015) Sliwa, Paulina; Horowitz, Sophie
Plausibly, you should believe what your total evidence supports. But cases of misleading higher-order evidence—evidence about what your evidence supports—present a challenge to this thought. In such cases, taking both first-order and higher-order evidence at face value leads to a seemingly irrational incoherence between one’s first-order and higher-order attitudes: you will believe P, but also believe that your evidence doesn’t support P. To avoid sanctioning tension between epistemic levels, some authors have abandoned the thought that both first-order and higher-order evidence have rational bearing. This sacrifice is both costly and unnecessary. We propose a principle, Evidential Calibration, which requires rational agents to accommodate first-order evidence correctly, while allowing rational uncertainty about what to believe. At the same time, it rules out irrational tensions between epistemic levels. We show that while there are serious problems for some views on which we can rationally believe, “P, but my evidence doesn’t support P”, Evidential Calibration avoids these problems. An important upshot of our discussion is a new way to think about the relationship between epistemic levels: why first-order and higher-order attitudes should generally be aligned, and why it is sometimes—though not always—problematic when they diverge.
Philosophy of stem cell biology- an introduction
(John Wiley & Sons Ltd, 2013) Fagan, Melinda Bonnie
This review surveys three central issues in philosophy of stem cell biology: the nature of stem cells, stem cell experiments, and explanations of stem cell capacities. First, I argue that the fundamental question “what is a stem cell?” has no single substantive answer. Instead, the core idea is explicated via an abstract model, which accounts for many features of stem cell experiments. The second part of this essay examines several of these features: uncertainty, model organisms, and manipulability. The results shed light on the form of our emerging knowledge of stem cells: mechanistic explanations. The third part of the essay sketches some key features of these explanations, which are constructed by a collaborative experimenting community.
The Value of Achievements
(John Wiley & Sons Ltd, 2013) Bradford, Gwen
This article gives an account of what makes achievements valuable. Although the natural thought is that achievements are valuable because of the product, such as a cure for cancer or a work of art, I argue that the value of the product of an achievement is not sufficient to account for its overall value. Rather, I argue that achievements are valuable in virtue of their difficulty. I propose a new perfectionist theory of value that acknowledges the will as a characteristic human capacity, and thus holds that the exercise of the will, and therefore difficulty, is intrinsically valuable.
Beyond the Principles of Bioethics: Facing the Consequences of Fundamental Moral Disagreement
(Universidade Federal de Santa Catarina, 2012-06) Engelhardt, H. Tristram Jr.
Given intractable secular moral pluralism, the force and significance of the four principles (autonomy, beneficence, non-maleficence, and justice) of Tom Beauchamp and James Childress must be critically re-considered. This essay examines the history of the articulation of these four principles of bioethics, showing why initially there was an illusion of a common morality that led many to hold that the principles could give guidance across cultures. But there is no one sense of the content or the theoretical justification of these principles. In addition, a wide range of secular moral and bioethical choices has been demoralized into lifestyle choices; the force of the secular moral point of view has also been deflated, thus compounding moral pluralism. It is the political generation of the principles that provides a common morality in the sense of an established morality. The principles are best understood as embedded not in a common morality, sensu stricto, but in that morality that is established at law and public policy in a particular polity. Although moral pluralism is substantive and intractable at the level of moral content, in a particular polity a particular morality and a particular bioethics can be established, regarding which health care ethics consultants can be experts. Public morality and bioethics are at their roots a political reality.
Fair Equality of Opportunity Critically Reexamined: The Family and the Sustainability of Health Care Systems
(Oxford University Press, 2012) Engelhardt, H. Tristram Jr.
A complex interaction of ideological, financial, social, and moral factors makes the financial sustainability of health care systems a challenge across the world. One difficulty is that some of the moral commitments of some health care systems collide with reality. In particular, commitments to equality in access to health care and to fair equality of opportunity undergird an unachievable promise, namely, to provide all with the best of basic health care. In addition, commitments to fair equality of opportunity are in tension with the existence of families, because families are aimed at advantaging their own members in preference to others. Because the social-democratic state is committed to fair equality of opportunity, it offers a web of publicly funded entitlements that make it easier for persons to exit the family and to have children outside of marriage. In the United States, in 2008, 41% of children were born outside of wedlock, whereas, in 1940, the percentage was only 3.8%, and in 1960, 5%, with the further consequence that the social and financial capital generated through families, which aids in supporting health care in families, is diminished. In order to explore the challenge of creating a sustainable health care system that also supports the traditional family, the claims made for fair equality of opportunity in health care are critically reconsidered. This is done by engaging the expository device of John Rawls's original position, but with a thin theory of the good that is substantively different from that of Rawls, one that supports a health care system built around significant copayments, financial counseling, and compulsory savings, with a special focus on enhancing the financial and social capital of the family. This radical recasting of Rawls, which draws inspiration from Singapore, is undertaken as a heuristic to aid in articulating an approach to health care allocation that can lead past the difficulties of social-democratic policy.
Are Surgical Trials with Negative Results Being Interpreted Correctly?
(Elsevier, 2013) Brody, Baruch A.; Ashton, Carol M.; Liu, Dandan; Xiong, Youxin; Yao, Xuan; Wray, Nelda P.
BACKGROUND: Many published accounts of clinical trials report no differences between the treatment arms, while being underpowered to find differences. This study determined how the authors of these reports interpreted their findings. STUDY DESIGN: We examined 54 reports of surgical trials chosen randomly from a database of 110 influential trials conducted in 2008. Seven that reported having adequate statistical power (b 0.9) were excluded from further analysis, as were the 32 that reported significant differences between the treatment arms. We examined the remaining 15 to see whether the authors interpreted their negative findings appropriately. Appropriate interpretations discussed the lack of power and/or called for larger studies. RESULTS: Three of the 7 trials that did not report an a priori power calculation offered inappropriate interpretations, as did 3 of the 8 trials that reported an a priori power < 0.90. However, we examined only a modest number of trial reports from 1 year. CONCLUSIONS: Negative findings in underpowered trials were often interpreted as showing the equivalence of the treatment arms with no discussion of the issue of being underpowered. This may lead clinicians to accept new treatments that have not been validated.

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