Coos Engelsma

During the last decades, shared decision making (SDM) has become a very popular model for the physician-patient relationship. SDM can refer to a process (making a decision in a shared way) and a product (making a shared decision). In the literature, by far most attention is devoted to the process. In this paper, I investigate the product, wondering what is involved by a medical decision being shared. I argue that the degree to which a decision to implement a medical alternative is shared should be determined by taking into account six considerations: (i) how the physician and the patient rank that alternative, (ii) the individual preference scores the physician and the patient (would) assign to that alternative, (iii) the similarity of the preference scores, (iv) the similarity of the rankings, (v) the total concession size, and (vi) the similarity of the concession sizes. I explain why shared medical decisions are valuable, and sketch implications of the analysis for the physician-patient relationship.

According to Peter Klein, foundationalism fails because it allows a vicious form of arbitrariness. The present article critically discusses his concept of arbitrariness. It argues that the condition Klein takes to be necessary and sufficient for an epistemic item to be arbitrary is neither necessary nor sufficient. It also argues that Klein's concept of arbitrariness is not a concept of something that is obviously vicious. Even if Klein succeeds in establishing that foundationalism allows what he regards as arbitrariness, this does not yet mean that he confronts it with a sound objection.

This paper evaluates Peter Klein’s objection to foundationalism. According to Klein, foundationalism fails because it allows arbitrariness “at the base.” I first explain that this objection can be interpreted in two ways: either as targeting dialectical foundationalism or as targeting epistemic foundationalism. I then clarify Klein’s concept of arbitrariness. An assertion or belief is assumed to be arbitrary if and only if it lacks a reason that is “objectively and subjectively available.” Drawing on this notion, I evaluate Klein’s objection. I first argue that his objection construed as targeting dialectical foundationalism fails, since nothing prevents dialectical foundationalism from ruling out arbitrary assertions. I then argue that the objection seen as targeting epistemic foundationalism cannot be disqualified in the way some foundationalists believe. However, I show that also the objection so construed does not succeed, since epistemic foundationalism need not countenance arbitrary beliefs