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The Dynamics of the Treatment-enhancement Distinction: ADHD as a Case Study 治疗-强化区别的动态:ADHD个案研究
Q4 Arts and Humanities Pub Date : 2007-01-02 DOI: 10.21825/philosophica.82183
M. Schermer
A central issue in the ethical debate on psychopharmacological enhancers concerns the distinction between therapy and enhancement. Although from a theoretical point of view it is difficult to make a clear-cut distinction between treatment (of disease) on the one hand, and enhancement (of normal functioning) on the other, in medical practice and policy debates the counter-positioning of therapy to enhancement is clearly at work. Especially pharmaceutical companies have an interest in occupying the ‘grey area’ between normal and abnorm al, treatment and enhancement. This article discusses the dynamics of the treatment-enhancement distinction, and argues that practices that could be labelled ‘enhancement’ can also be understood in terms of medicalisation and ‘d isease mongering’. The argument is supported by results from a qualitative empirical study into the experiences and opinions of adults diagnosed with Attention Deficit Hyperactivity Disorder (ADH D). Patients are ambivalent about how to understand ADH D: as a disease, a disorder or a normal variation. Intervention with psychopharmacological means can a lso be understood in d ifferent ways . From an insider perspective it is conceived of as a ‘norm alising’ of functioning, w hereas from an outsider perspective it can be understood as med icalisation of underperformance, or indeed as performance enhancement. This draws attention to new moral issues which are important but under-recognised in the enhancement debate, and which are related to medicalisation.
关于精神药理学增强剂的伦理辩论的一个中心问题是治疗和增强之间的区别。虽然从理论的角度来看,很难明确区分治疗(疾病)与增强(正常功能)之间的区别,但在医疗实践和政策辩论中,治疗与增强的对立定位显然在起作用。制药公司尤其有兴趣占领正常与异常、治疗与增强之间的“灰色地带”。本文讨论了治疗-强化区别的动态,并认为可以贴上“强化”标签的做法也可以从医学化和“疾病贩卖”的角度来理解。这一观点得到了一项定性实证研究结果的支持,该研究对被诊断为注意力缺陷多动障碍(adhd)的成年人的经历和观点进行了研究。患者对如何理解注意力缺陷多动障碍是一种疾病、一种障碍还是一种正常变异存在矛盾。用精神药理学手段进行干预也可以从不同的角度来理解。从内部人士的角度来看,它被认为是功能的“规范”,而从外部人士的角度来看,它可以被理解为表现不佳的医学化,或者实际上是表现的增强。这引起了人们对新的道德问题的关注,这些问题很重要,但在增强辩论中没有得到充分认识,并且与医疗化有关。
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引用次数: 7
The Rationale of Variation in Methodological and Evidential Pluralism 方法论和证据多元论中变异的基本原理
Q4 Arts and Humanities Pub Date : 2006-01-02 DOI: 10.21825/philosophica.82199
F. Russo
Causal analysis in the social sciences takes advantage of a variety of methods and of a multi-fold source of information and evidence. The first developments of quantitative causal analysis in the social sciences are due to Quetelet (1869) and Durkheim (1895 and 1897) in demography and sociology respectively. Significant improvements are due to Blalock (1964) and Duncan (1975). Since then causal analysis has shown noteworthy progress in the formal methods of analysis, e.g., structural equation models, covariance structure models, multilevel models, and contingency tables. By means of these different methodologies, social scientists try to infer causal relations between variables of interest with reasonable confidence. Data comes from a variety of different sources: surveys, census, experiments, interviews, etc. Analogously, evidence of causal relations can come from different sources: previous studies, background knowledge, knowledge of mechanisms or of probabilistic relations, etc. This pluralistic methodology and source of information raises the question of whether we should accordingly have a pluralistic metaphysics and epistemology. This paper focuses on epistemology and argues that a pluralistic methodology and evidence do not entail a pluralistic epistemology. It will be shown that causal models employ a single rationale of testing, based on the notion of variation. This view of causality profoundly breaks down with the received view, an heritage of Hume, that sees in regularity and/or invariance the key notions for causality. For instance, the rationale of variation clearly emerges in the interpretation of structural equation models: given a system of equations, parameters quantify the variation of the dependent variable due to the variation in the independent variable(s). Regularity and invariance thus become constraints to impose on the variation in order ensure that the model correctly specify the data generating process and that it does not confuse accidental and spurious relations with causal ones. Further, I argue that this monistic epistemology is also involved in alternative philosophical theories of causation, for instance, in probabilistic theories of causality, mechanist and counterfactual accounts, agency-manipulability theories and in the epistemic theory. The philosophical gain in adopting the rationale of variation is at least threefold. First, causality is not merely lodged in a psychological habit of observing regular successions of events. Agreed, we do experience such regular sequences but it is not because of regularity that we interpret them causally. Instead, this is because certain variational relations hold. Second, causality is not reduced to statistics either. Further, to claim that variation is a precondition for regularity and invariance has the advantage of not confusing the rationale of causality with the conditions that allow to interpret variations causally. Third, the adoption of the rationale of variation
社会科学中的因果分析利用了多种方法和多重信息和证据来源。社会科学中定量因果分析的第一次发展要归功于人口学中的奎特莱(1869)和社会学中的迪尔凯姆(1895和1897)。重要的改进是由于Blalock(1964)和Duncan(1975)。此后,因果分析在结构方程模型、协方差结构模型、多层模型、列联表等形式化分析方法上取得了显著进展。通过这些不同的方法,社会科学家试图以合理的信心推断感兴趣的变量之间的因果关系。数据来自各种不同的来源:调查、人口普查、实验、访谈等。类似地,因果关系的证据可以来自不同的来源:以前的研究、背景知识、机制或概率关系的知识等。这种多元化的方法论和信息来源提出了一个问题,即我们是否应该相应地拥有多元化的形而上学和认识论。本文着重于认识论,并认为多元的方法论和证据并不意味着多元的认识论。它将表明,因果模型采用单一的基本原理的测试,基于变异的概念。这种因果关系的观点与休谟的传统观点截然不同,休谟认为规律和/或不变性是因果关系的关键概念。例如,变异的基本原理清晰地出现在结构方程模型的解释中:给定一个方程系统,参数量化因变量由于自变量的变异而产生的变异。因此,规律性和不变性成为对变化施加的约束,以确保模型正确地指定数据生成过程,并且不会将偶然和虚假的关系与因果关系混淆。此外,我认为这种一元论的认识论也涉及到因果关系的其他哲学理论,例如,在因果关系的概率理论,机械论和反事实的叙述,能动性理论和认识论中。采用变异理论的哲学收益至少有三方面。第一,因果关系不只是存在于观察事件有规律连续的心理习惯中。同意,我们确实经历过这种规律的序列,但这并不是因为规律,我们解释它们的因果关系。相反,这是因为某些变分关系成立。其次,因果关系也不能简化为统计数据。此外,声称变异是规律性和不变性的先决条件,其优点是不会混淆因果关系的基本原理与允许因果关系解释变异的条件。第三,采用变异的基本原理避免了混淆(1)因果关系是什么(形而上学)与用于检验的概念(认识论)和(2)与强加于变异上的条件(例如不变性)来解释它的因果关系(方法论)。
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引用次数: 17
A Defence of Quasi-reductionism in the Epistemology of Testimony 证言认识论中的准还原论辩护
Q4 Arts and Humanities Pub Date : 2006-01-02 DOI: 10.21825/philosophica.82189
D. Pritchard
Two key intuitions regarding knowledge are explored: that knowledge is a kind of cognitive achievement and that knowledge excludes luck. It is claimed that a proper understanding of how these intuitions should inform our conception of knowledge leads to some surprising results, not just as regards the theory of knowledge more generally but also as regards the epistemology of testimonial belief. In particular, it is argued that this conception of knowledge motivates a new kind of proposalquasi-reductionismthat can accommodate the motivations behind both reductionist and anti-reductionist accounts of the epistemology of testimony. 0. Here are two intuitions that many have regarding knowledge, and which inform much of our theorising about knowledge. The firstwhat I will call the achievement intuitionis that knowledge is a cognitive achievement of some sort. The secondwhat I will call the antiluck intuitionis that knowledge is incompatible with luck. It is tempting to think that these intuitions are just two sides of the same coin, or at least that once the intuitions are suitably fleshed out then we will come to see that the one intuition is simply an entailment of the other. For example, one might hold that achievements by their nature exclude luck in the relevant way and thus that the anti-luck intuition is simply a consequence of the achievement intuition. As I will show, however, this natural way of thinking about these two intuitions is mistaken, and this has important ramifications not only for our understanding of knowledge but also for our understanding of specifically testimonial knowledge. Indeed, I will claim that the intuition that knowledge is a type of cognitive achievement, while containing (like all intuitions) an important truth, is in fact wrong. As we will see, gaining an understanding of how these intuitions should inform our conception of knowledge will lead us to adopt a very
本文探讨了关于知识的两个关键直觉:知识是一种认知成就,知识排除运气。有人声称,对这些直觉应该如何告知我们的知识概念的正确理解会导致一些令人惊讶的结果,不仅是在更普遍的知识理论方面,而且在证言信仰的认识论方面。特别是,有人认为这种知识概念激发了一种新的提议准还原论,它可以容纳还原论和反还原论证词认识论背后的动机。0. 以下是许多人对知识的两种直觉,它们在很大程度上影响了我们对知识的理论化。第一个我称之为成就直觉知识是某种认知成就。第二个我称之为反运气直觉知识与运气是不相容的。我们很容易认为这些直觉是同一枚硬币的两面,或者至少一旦这些直觉得到适当充实,我们就会看到,一种直觉只是另一种直觉的必然结果。例如,有人可能会认为,成就本身就排除了运气,因此反运气直觉只是成就直觉的结果。然而,正如我将要展示的那样,这种对这两种直觉的自然思考方式是错误的,这不仅对我们对知识的理解,而且对我们对具体证言知识的理解都有重要的影响。事实上,我要说,那种认为知识是一种认知成就的直觉,虽然(像所有的直觉一样)包含了一个重要的真理,但实际上是错误的。正如我们将看到的,理解这些直觉应该如何告知我们的知识概念,将引导我们采取一种非常
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引用次数: 11
Mechanisms and Counterfactuals: a Different Glimpse of the (Secret?) Connexion 机制与反事实:对(秘密?)的不同一瞥联系
Q4 Arts and Humanities Pub Date : 2006-01-02 DOI: 10.21825/philosophica.82196
Raffaella Campaner
Ever since Wesley Salmon’s theory, the mechanical approach to causality has found an increasing number of supporters who have developed it in different directions. Mechanical views such as those advanced by Stuart Glennan, Jim Bogen and Peter Machamer, Lindley Darden and Carl Craver have met with broad consensus in recent years. This paper analyses the main features of these mechanical positions and some of the major problems they still face, referring to the latest debate on mechanisms, causal explanation and the relationship between mechanisms and counterfactuals. I shall claim that the mechanical approach can be recognised as having a fundamental explanatory power, whereas the counterfactual approach, recently developed mainly by Jim Woodw ard and essentially linked to the notion of intervention, has an important heuristic role. Claiming that mechanisms are by no means to be seen as parasitic on counterfactuals or less fundamental than them – as it has been recently suggested –, and that yet counterfactuals can play a part in a conceptual analysis of causation, I shall look for hin ts in support of the peaceful coexistence of the two. 1. The causal structure of the world: processes and interactions, entities and activities In the last couple of decades philosophy of science has seen the elaboration of several mechanical accounts. While terminology and emphasis differ, all the theories overlap in believing that mechanisms are complex systems present in nature. Wesley Salmon’s philosophical work is unanimously regarded as the compulsory locus for anyone interested in the notion of mechanism since the eighties. As is well-known, Salmon has developed a “process theory” of causation, centred on the notions of causal process, causal RAFAELLA CAMPAN ER 16 1 Apart from Craver (2001:69-70). production and causal propagation. In short, causal processes are defined as spatio-temporally continuous processes which exhibit consistency of structure over time, and are capable of transmitting a modification of their structure from the point at which it is performed onwards, without additional interventions. The production of causal influence is accounted for by appealing to causal forks, characterised in statistical terms. Once produced, causal influence is propagated continuously through processes. Interacting processes constitute a mechanical, objective and probabilistic network, underlying phenomena and responsible for their occurrence. Salmon’s conception of causality goes hand in hand with his theory of causal explanation, which comprises two levels: we first need to identify the properties which are statistically relevant with respect to the occurrence of the event to be explained; we then account for them in terms of the net of causal processes underlying the event. A further distinction Salmon makes, not recalled by later authors, is that between etiological and constitutive causation. When we aim at explaining a given event E, we may look at E as occu
马查默、达顿和克拉弗在过去六年中撰写的文章(部分是联合撰写的,部分是单独撰写的)将机制作为实体呈现出来
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引用次数: 9
Testimony as Evidence 作为证据的证词
Q4 Arts and Humanities Pub Date : 2006-01-02 DOI: 10.21825/philosophica.82190
Sanford C. Goldberg
Regarding testimony as evidence fails to predict the sort of epistemic support testimony provides for testimonial belief. As a result, testimony-based belief should not be assimilated into the category of ep istemically inferen tial, evidence-based belief. 1. Reasons, Evidence, and Inference Holmes is trying to determine who committed the murder. His evidence consists of E1, E2, and E3. It occurs to him that he would have these pieces of evidence only if Mustard did it. He concludes that Mustard committed the murder. Here, the basis of Holmes’ conclusion is (a) his belief that his evidence consists of E1, E2, and E3, (b) his belief that he would have these pieces of evidence only if Mustard committed the murder, (c) whatever it is that supports these beliefs, and (d) whatever it is that bears on Holmes’ entitlement to draw the relevant inference from (a) and (b) to the conclusion that Mustard committed the murder. Smith is suffering from some condition that she would like diagnosed. The doctor notes the manifesting symptoms, S1, S2, and S3. On the basis of observing these symptoms, and having good reason to think that a patient manifests S1, S2, and S3 only if she is suffering from disease D, the doctor diagnoses Smith as suffering from D. Here, the basis of the doctor’s diagnosis is (e) his belief that Smith manifests S1, S2, and S3, (f) his belief that one manifests S1, S2, and S3 only if one is suffering from disease D, (g) whatever it is that supports these beliefs, and (h) whatever it is that bears on the doctor’s entitlement to draw the SANFORD C. GOLDBERG 30 relevant inference from (e) and (f) to the conclusion that Smith suffers from D. My description of these two cases is meant to bring out what I regard as an obvious parallel – one that goes to the heart of the epistemic account of inferential, evidence-based belief. In both case, the materials relevant to an epistemic assessment of the conclusion/diagnosis are the same. They consist of (i) the belief(s) that constitute(s) the subject’s evidence, (ii) the belief(s) that constitute(s) the generalization that links this evidence to the target conclusion/diagnosis, (iii) the epistemic support for all of these beliefs, and (iv) the subject’s entitlement to make the transition from these beliefs to the target conclusion/diagnosis itself. If the evidence-involving inference through which the subject acquired the belief is the only source of support for the belief in question, then (i)(iv) are the only materials that are relevant to the epistemic assessment of the belief: these exhaust the belief’s epistemic support. I will call beliefs of this sort Evidence-based beliefs, or E-beliefs for short. E-beliefs are only as epistemically good as the evidence on which they are based, the generalization(s) applied to that evidence, and the subject-drawn inference(s) to the E-belief itself. We can capture the foregoing idea in terms of the notion of supervenience, as follows: (Spv) The epistemic goodne
将证词视为证据并不能预测证词为证词信仰提供的那种认识论支持。因此,以证言为基础的信仰不应被同化为系统推理、循证信仰的范畴。1. 理由、证据和推论福尔摩斯试图确定是谁犯了谋杀罪。他的证据包括E1, E2和E3。他突然想到,只有芥末做了这件事,他才会有这些证据。他断定马斯塔德是凶手。在这里,福尔摩斯结论的基础是(a)他相信他的证据由E1, E2和E3组成,(b)他相信只有当Mustard犯下谋杀罪时他才会有这些证据,(c)支持这些信念的任何东西,以及(d)任何与福尔摩斯有权从(a)和(b)得出Mustard犯下谋杀罪的结论相关的推论有关的东西。史密斯患有某种疾病,她希望得到诊断。医生记录了S1、S2和S3的明显症状。的基础上,观察这些症状,并有充分的理由认为,病人表现S1, S2和S3只有她是患有疾病D,史密斯医生诊断为患有D,医生的诊断是的基础(e)他相信史密斯体现S1, S2和S3 (f)他相信一个体现S1, S2和S3只有一个是患有疾病D (g)支持这些信仰,不管它是什么以及(h)医生有权从(e)和(f)中得出SANFORD C. GOLDBERG 30的相关推论,从而得出史密斯患有d的结论。我对这两个案例的描述是为了提出一个我认为显而易见的相似之处——它触及了推理、循证信仰的认识论的核心。在这两种情况下,与结论/诊断的认知评估相关的材料是相同的。它们包括(i)构成主体证据的信念,(ii)构成将这些证据与目标结论/诊断联系起来的概括的信念,(iii)对所有这些信念的认知支持,以及(iv)主体从这些信念过渡到目标结论/诊断本身的权利。如果主体通过涉及证据的推理获得信念是支持所讨论的信念的唯一来源,那么(i)和(iv)是与信念的认知评估相关的唯一材料:这些耗尽了信念的认知支持。我把这种信念称为基于证据的信念,简称e信念。电子信念只有在它们所基于的证据、应用于该证据的概括以及主体对电子信念本身的推断的认识论上是正确的。我们可以根据监督的概念来捕捉上述概念,如下:(Spv)电子信仰的认知良善监督于考虑(i)-(iv)。根据(Spv),就(i)-(iv)而言,不可能有两个相同的e信念,但它们所享有的认知支持的数量不同。也许更深层的考虑会让人产生怀疑(Spv)。这样的怀疑将基于这样的想法,即可能有两个主体,就(i)-(iv)而言是相同的,但由于他们各自的e信仰所享有的认知善,由于“外部”因素,他们无可指责地无知。这个问题很棘手;最终的判决将取决于相关的认知善的概念以及格蒂埃案例的性质。我将在下面简要地回到这些话题。然而,在这里,我建议通过条件化(Spv)来规避这个问题,如下所示:证词作为证据31这是一种信念,即证据E1, E2和E3只有在Mustard犯下罪行时才能获得。2见G oldberg (2007b),我在其中讨论了推理信仰的认识论
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引用次数: 3
Introduction to the Epistemology of Testimony 证言认识论导论
Q4 Arts and Humanities Pub Date : 2006-01-02 DOI: 10.21825/philosophica.82188
D. O’Brien
Spoken and written testimony pervades much of our life. I hear the announcement that the train is delayed, I read that Philip Roth has published another novel, and one’s partner can tell you that she loves you. A good deal of our knowledge would appear to be testimonial knowledge – perhaps most. Curiously, though, until fairly recently philosophers did not often concern themselves with this way of acquiring knowledge, and it was thought that one should be suspicious of beliefs acquired in this way. To know something one must be able to reason it through for oneself, or perceive it oneself, and not just acquire it secondhand from someone else. Here is Locke expressing this “individualist” approach to knowledge.
口头和书面的证词在我们的生活中无处不在。我听到广播说火车晚点了,我读到菲利普·罗斯(Philip Roth)又出版了一部小说,你的伴侣会对你说她爱你。我们的许多知识似乎都是证言性的知识——也许是大多数。然而,奇怪的是,直到最近,哲学家们才经常关心这种获取知识的方式,人们认为人们应该对以这种方式获得的信仰持怀疑态度。要了解一件事,一个人必须能够自己推理,或者自己感知,而不仅仅是从别人那里二手地获得它。这里是洛克表达这种“个人主义”的知识方法。
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引用次数: 3
Causal Pluralism versus Epistemic Causality 因果多元论与认知因果论
Q4 Arts and Humanities Pub Date : 2006-01-02 DOI: 10.21825/philosophica.82198
Jon Williamson
It is tempting to analyse causality in terms of just one of the indicators of causal relationships, e.g., mechanisms, probabilistic dependencies or independencies, counterfactual conditionals or agency considerations. While such an analysis will surely shed light on some aspect of our concept of cause, it will fail to capture the whole, rather multifarious, notion. So one might instead plump for pluralism: a different analysis for a different occasion. But we do not seem to have lots of different concepts of cause - just one eclectic notion. The resolution of this conundrum, I think, requires us to accept that our causal beliefs are generated by a wide variety of indicators, but to deny that this variety of indicators yields a variety of concepts of cause. This focus on the relation between evidence and causal beliefs leads to what I call *epistemic* causality. Under this view, certain causal beliefs are appropriate or rational on the basis of observed evidence; our notion of cause can be understood purely in terms of these rational beliefs. Causality, then, is a feature of our epistemic representation of the world, rather than of the world itself. This yields one, multifaceted notion of cause.
人们很容易根据因果关系的一个指标来分析因果关系,例如,机制、概率依赖性或独立性、反事实条件或代理考虑。这样的分析固然可以说明原因概念的某些方面,但却不能说明原因概念的全貌。因此,人们可能转而支持多元主义:针对不同场合进行不同的分析。但是我们似乎没有很多不同的原因概念——只有一个折衷的概念。我认为,要解决这个难题,需要我们接受我们的因果信念是由各种各样的指标产生的,但要否认这些指标产生了各种各样的原因概念。这种对证据和因果信念之间关系的关注导致了我所说的“认知”因果关系。在这种观点下,根据观察到的证据,某些因果信念是适当的或合理的;我们的原因概念可以纯粹从这些理性信念的角度来理解。因此,因果关系是我们对世界的认知表征的一个特征,而不是世界本身的特征。这就产生了一个多方面的原因概念。
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引用次数: 53
Causal Pluralism and Scientific Knowledge: an Underexposed Problem 因果多元主义与科学知识:一个未被充分揭示的问题
Q4 Arts and Humanities Pub Date : 2006-01-02 DOI: 10.21825/philosophica.82200
Leen De Vreese
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引用次数: 0
Testimony, Engineered Knowledge and Internalism 证言、工程知识和内部主义
Q4 Arts and Humanities Pub Date : 2006-01-02 DOI: 10.21825/philosophica.82191
D. O’Brien
Testimonial knowledge sometimes depends on internalist epistemic conditions, those that thinkers are able to reflect upon. In the testimony literature the only internalist conditions that are considered are those concerning a hearer’s knowledge of a speaker’s reliability. I argue, however, that the relevant sense of “internal” should not be seen as referring to just the hearer’s point of view, but rather to the points of view of both the hearer and the speaker. There are certain cases of testimonial knowledge transmission that depend on the speaker’s knowledge of his audience. These include cases of “engineered knowledge” in which a speaker deviously manipulates a hearer’s beliefs. Such knowledge is therefore internalist because it depends on factors that are internal to the point of view of the speaker, and not merely on externalist factors such as the reliability of the speakers’ and hearers’
证言性知识有时依赖于内部主义的认知条件,即思想家能够反思的条件。在证词文献中,唯一被考虑的内部条件是关于听者对说话人可靠性的认识。然而,我认为,“内部”的相关含义不应被视为仅指听者的观点,而应被视为听者和说话者的观点。在某些情况下,证词知识的传播取决于说话者对听众的了解程度。这包括“工程知识”的案例,在这种情况下,说话者迂回地操纵听者的信念。因此,这种知识是内部主义的,因为它取决于说话者观点的内部因素,而不仅仅是外部因素,如说话者和听者的可信度。
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引用次数: 0
Pluralism in the Philosophy of Causation: Desideratum or Not? 因果哲学中的多元主义:是否可取?
Q4 Arts and Humanities Pub Date : 2006-01-02 DOI: 10.21825/philosophica.82195
Leen De Vreese
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引用次数: 3
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