Stephen Napier

The prevailing orthodoxy for competency assessment is to test for the presence of certain abilities. This article argues that the presence of certain abilities is not enough when a patient refuses a life-sustaining/lifesaving measure that promises to work and does not present obviously onerous burdens. In such cases, we need to know whether the patient has rendered a competent refusal of such measures. Whereas the former refers us to test for certain abilities, the latter refers us to assess the quality of one’s judgment. Although such a thesis has been entertained previously (for example, Freedman), I reformulate the argument by applying two well-accepted epistemological criteria for justified belief. I argue that a competent refusal of such measures requires that the judgment be based on reasons. This basing condition turns on (or kicks in) in what I refer to as high-stakes contexts—contexts in which the patient’s life will end by respecting the refusal, and, by not respecting it, the patient undergoes a lifesaving and minimally burdensome treatment.

There is debate among virtue epistemologists concerning what is the nature of an intellectual virtue. Linda Zagzebski in Virtues of the Mind , for instance, argues that an intellectual virtue has both a success and motivational component. Furthermore, Zagzebski defines knowledge with reference to acts of intellectual virtue. An agent S knows p iff S performs an act of intellectual virtue in forming the belief that p. This means that Zagzebski is committed to the counter-intuitive claim that low-grade knowledge requires the agent to be epistemically motivated to form such low-grade beliefs. In this project I look at empirical research in cognitive psychology which suggests that epistemic motivations are involved in low-grade processing. Research on the role of attention in vision and memory suggests that attentional focus is necessary in order to have low-grade knowledge. And research on the relationship between motivation and attentional processing suggests that motivation informs attentional operations. The next step in the argument aims to show that such motivations are epistemic in that they are motivations to attain a cognitive state whose value is alethically related. Thus, one's epistemic motivations are necessary for low-grade knowledge. The second half of my project turns to higher-grade knowledge, i.e., testimony. It is here that I apply Zagzebski's account of knowledge to testimony. I do this to give a heretofore counterexample free definition of testimonial knowledge. Altogether, the project shows how Zagzebski's theory can account for the major modes by which we acquire empirical knowledge.