Rani Anjum

We claim that if a complete philosophy of evidence-based practice is intended, then attention to the nature of causation in health science is necessary. We identify how health science currently conceptualises causation by the way it prioritises some research methods over others. We then show how the current understanding of what causation is serves to constrain scientific progress. An alternative account of causation is offered. This is one of dispositionalism. We claim that by understanding causation from a dispositionalist stance, many of the processes within an evidence-based practice framework are better accounted for. Further, some of the problems associated with the health research, e.g. external validity of causal findings, dissolve.

Evidence based medicine (EBM) is under critical debate, and person centered healthcare (PCH) has been proposed as an improvement. But is PCH offered as a supplement or as a replacement of EBM? Prima facie PCH only concerns the practice of medicine, while the contended features of EBM also include methods and medical model. I here argue that there are good philosophical reasons to see PCH as a radical alternative to the existing medical paradigm of EBM, since the two seem committed to conflicting ontologies. This paper aims to make explicit some of the most fundamental assumptions that motivate EBM and PCH, respectively, in order to show that the choice between them ultimately comes down to ontological preference. While EBM has a solid foundation in positivism, or what I here call Humeanism, PCH is more consistent with causal dispositionalism. I conclude that if there is a paradigmatic revolution on the way in medicine, it is first of all one of ontology.

There are a number of dispositionalist solutions to the free will problem based on freedom consisting in the agent's exercise of a power. But if a subject a is free when they exercise their power P, there is an objection to be overcome from the possibility of power implantation. A brainwasher, rather than directly manipulating a subject's movements, can instead implant in them a desire, to be understood as a disposition to act, and allow the subject to exercise such a power. It seems that, according to the dispositionalist theory of freedom, such an agent would still count as acting freely. There is a strong non-consent intuition that a is not free in such a case because they did not consent to having the power P—the desire in question. Filling out this intuition is not straightforward. But it can be done in terms of the exercise of P being regulated by higher-order powers of self-reflection. Such regulation is what allows an agent to either take ownership of a power or to reject it

Medically unexplained symptoms (MUS) remain recalcitrant to the medical profession, proving less suitable for homogenic treatment with respect to their aetiology, taxonomy and diagnosis. While the majority of existing medical research methods are designed for large scale population data and sufficiently homogenous groups, MUS are characterised by their heterogenic and complex nature. As a result, MUS seem to resist medical scrutiny in a way that other conditions do not. This paper approaches the problem of MUS from a philosophical point of view. The aim is to first consider the epistemological problem of MUS in a wider ontological and phenomenological context, particularly in relation to causation. Second, the paper links current medical practice to certain ontological assumptions. Finally, the outlines of an alternative ontology of causation are offered which place characteristic features of MUS, such as genuine complexity, context-sensitivity, holism and medical uniqueness at the centre of any causal set-up, and not only for MUS. This alternative ontology provides a framework in which to better understand complex medical conditions in relation to both their nature and their associated research activity

A standard way of representing causation is with neuron diagrams. This has become popular since the influential work of David Lewis. But it should not be assumed that such representations are metaphysically neutral and amenable to any theory of causation. On the contrary, this way of representing causation already makes several Humean assumptions about what causation is, and which suit Lewis’s programme of Humean Supervenience. An alternative of a vector diagram is better suited for a powers ontology. Causation should be understood as connecting property types and tokens where there are dispositions towards some properties rather than others. Such a model illustrates how an effect is typically polygenous: caused by many powers acting with each other, and sometimes against each other. It models causation as a tendency towards an effect which can be counteracted. The model can represent cases of causal complexity, interference, over-determination and causation of absence (equilibrium).

Grice argues that indicative conditionals ‘if p then q’ have conventional, truth conditional meaning according to the material conditional ‘p  q’. In order to explain away the known paradoxes with this interpretation, he distinguishes between truth conditions and assertion conditions, attempting to demonstrate that the assumed connection between ‘p’ and ‘q’ (the Indirectness Condition) is a conversational implicature; hence a matter only relevant for the assertion conditions of a conditional. This paper argues that Grice fails to demonstrate i) that the Indirectness Condition is cancellable, hence a conversational implicature, ii) that the Indirectness Condition is not part of the conventional, truth-relevant meaning of ‘if’, and accordingly, iii) semantic or logical equivalence between indicative and material conditionals.

In an explanation ‘y because x’, because can be used to express an explanatory relation between an explanandum ‘y’ and an explanans ‘x’. But because can also be used to express the speaker’s reason for uttering ‘y’. This difference will be elucidated by connecting it with the distinction between the at-issue dimension and the speaker dimension of meaning. There are also internal relations between if and because that can help us find and analyse different uses of because, and thus also different types of explanatory relations.

Hume thought that if you believed in powers, you believed in necessary connections in nature. He was then able to argue that there were none such because anything could follow anything else. But Hume wrong-footed his opponents. A power does not necessitate its manifestations: rather, it disposes towards them in a way that is less than necessary but more than purely contingent. -/- In this paper a dispositional theory of causation is offered. Causes dispose towards their effects and often produce them. But a set of causes, even though they may succeed in producing an effect, cannot necessitate it since the effect could have been counteracted by some additional power. This would require a separation of our concepts of causal production and causal necessitation. The most conspicuous cases of causation are those where powers accumulate and pass a requisite threshold for an effect to occur. -/- We develop a model for representing powers as constituent vectors within an n-dimensional quality space, where composition of causes appears as vector addition. Even our resultant vector, however, has to be understood as having dispositional force only. This model throws new light on causal modality and cases of prevention, causation by absence and probabilistic causation

[EN]Most theories of causation assume that it must involve some kind of necessity, or that the cause must be entirely sufficient for the effect. Others have already suggested that it should be possible to get a theory of causation from a theory of powers or dispositions. Such a project is far from complete but even here we find that the key point in a dispositional theory of causation has been lacking. This paper attempts to establish some of the most important principles of such a theory and in so doing turn the existing discussion in a new direction. [ES]La mayoría de las teorías de causación asumen que debe envolverse algún tipo de necesidad, o que la causa debe ser enteramente suficiente para el efecto. Otros ya han sugerido que debería de ser posible obtener una teoría de causación a partir de una teoría de poderes o disposiciones. Un proyecto tal está muy lejos de estar completo, pero incluso aquí encontramos que ha faltado el punto clave en una teoría dispositiva de causación. Este escrito intenta establecer algunos de los principios más importantes de una teoría tal, y al hacerlo inclina la discusión existente en una nueva dirección.