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Personalised medicine (PM) has been discussed as a medical paradigm shift that will improve health while reducing inefficiency and waste. At the same time, it raises new practical, regulatory, and ethical challenges. In this paper, we... more
Personalised medicine (PM) has been discussed as a medical paradigm shift that will improve health while reducing inefficiency and waste. At the same time, it raises new practical, regulatory, and ethical challenges. In this paper, we examine PM strategies epistemologically in order to develop capacities to address these chal-lenges, focusing on a recently proposed strategy for developing patient-specific models from induced pluripotent stem cells (iPSCs) so as to make individualised treatment predictions. We compare this strategy to two main PM strategies—strati-fied medicine and computational models. Drawing on epistemological work in the philosophy of medicine, we explain why these two methods, while powerful, are neither truly personalised nor, epistemologically speaking, novel strategies. Both are forms of correlational black box. We then argue that the iPSC models would count as a new kind of black box. They would not rely entirely on mechanistic knowledge, and they would utilise correlational evidence in a different way from other strate-gies—a way that would enable personalised predictions. In arguing that the iPSC models would present a novel method of gaining evidence for clinical practice, we provide an epistemic analysis that can help to inform the practical, regulatory, and ethical challenges of developing an iPSC system.
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Surgery is an important part of contemporary health care, but currently much of surgery lacks a strong evidence base. Uptake of evidence-based medicine (EBM) methods within surgical research and among practitioners has been slow compared... more
Surgery is an important part of contemporary health care, but currently much of surgery lacks a strong evidence base. Uptake of evidence-based medicine (EBM) methods within surgical research and among practitioners has been slow compared with other areas of medicine. Although this is often viewed as arising from practical and cultural barriers, it also reflects a lack of epistemic fit between EBM research methods and surgical practice. In this paper we discuss some epistemic challenges in surgery relating to this lack of fit, and investigate how resources from feminist epistemology can help to characterize them. We point to ways in which these epistemic challenges may be addressed by gathering and disseminating evidence about what works in surgery using methods that are contextual, pluralistic, and sensitive to hierarchies.
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Many health care systems include programs that allow patients in exceptional circumstances to access medical interventions of as yet unproven benefit. In this article we consider the ethical justifications for—and demands on—these special... more
Many health care systems include programs that allow patients in exceptional circumstances to access medical interventions of as yet unproven benefit. In this article we consider the ethical justifications for—and demands on—these special access programs (SAPs). SAPs have a compassionate basis: They give patients with limited options the opportunity to try interventions that are not yet approved by standard regulatory processes. But while they signal that health care systems can and will respond to individual suffering, SAPs have several disadvantages, including the potential to undermine regulatory and knowledge-generation structures that constitute significant public goods. The “balance” between these considerations depends in part on how broadly SAPs are used, but also on whether SAPs can be made to contribute to the generation of knowledge about the effects of health interventions. We argue that patients should usually be required to contribute outcome data while using SAPs.
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Recent evidence from the neurosciences and cognitive sciences provides some support for a narrative theory of self-understanding. However, it also suggests that narrative self-understanding is unlikely to be accurate, and challenges its... more
Recent evidence from the neurosciences and cognitive sciences provides some support for a narrative theory of self-understanding. However, it also suggests that narrative self-understanding is unlikely to be accurate, and challenges its claims to truth. This article examines a range of this empirical evidence, explaining how it supports a narrative theory of self-understanding while raising questions of these narrative’s accuracy and veridicality. I argue that this evidence does not provide sufficient reason to dismiss the possibility of truth in narrative self-understanding. Challenges to the possibility of attaining true, accurate self-knowledge through a self-narrative have previously been made on the basis of the epistemological features of narrative. I show how the empirical evidence is consistent with the epistemological concerns, and provide three ways to defend the notion of narrative truth. I also aim to show that neuroethical discussions of self-understanding would benefit from further engagement with the philosophical literature on narrative truth.
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'Contract cheating' has recently emerged as a form of academic dishonesty. It involves students contracting out their coursework to writers in order to submit the purchased assignments as their own work, usually via the internet. This... more
'Contract cheating' has recently emerged as a form of academic dishonesty. It involves students contracting out their coursework to writers in order to submit the purchased assignments as their own work, usually via the internet. This form of cheating involves epistemic and ethical problems that are continuous with older forms of cheating, but which it also casts in a new form. It is a concern to educators because it is very difficult to detect, because it is arguably more fraudulent than some other forms of plagiarism, and because it appears to be connected to a range of systemic problems within modern higher education. This paper provides an overview of the information and literature thus far available on the topic, including its definition, the problems it involves, its causal factors, and the ways in which educators might respond. We argue that while contract cheating is a concern, some of the suggested responses are themselves problematic, and that best practice responses to the issue should avoid moral panic and remain focussed on supporting honest students and good academic practice.
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Neil Levy argues that while addicts who believe they are not addicts are self-deceived, addicts who believe they are addicts are just as self-deceived. Such persons accept a false belief that their addictive behaviour involves a loss of... more
Neil Levy argues that while addicts who believe they are not addicts are self-deceived, addicts who believe they are addicts are just as self-deceived. Such persons accept a false belief that their addictive behaviour involves a loss of control. This paper examines two implications of Levy's discussion: that accurate self-knowledge may be particularly difficult for addicts; and that an addict's self-deceived belief that they cannot control themselves may aid their attempts at self-control. I argue that the self-deceived beliefs of addicts in denial and of self-described addicts differ in kind. Unlike the self-deception of an addict in denial, that of the self-described addict allows them to acknowledge their behaviour. As such, it may aid an addict to develop more self-control. A paradoxical implication is that this self-deception may allow an addict more self-knowledge.
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