David De Bruijn

There are ethical dilemmas faced by clinicians when responding to using unregistered medical devices, such as innovative internet technologies for managing type 1 diabetes mellitus. This chronic disease significantly impacts patients' health, requiring intensive daily activities like blood glucose monitoring, insulin injections, and specific dietary recommendations. Recent technological advances, including continuous glucose monitors and insulin pumps, have been shown to improve glycemic control. Di-it Yourself Artificial Pancreas Systems are emerging open-source automated delivery methods initiated by the diabetes community, although they are not clinically evaluated and present a liability challenge for healthcare providers. To use them or not? Should parents and healthcare providers use such technology that helps, but is not proven? Having all of that in mind, we argue that the World Health Organization's (WHO) definition of health is outdated, advocating for the “Extended Health Hypothesis”. This hypothesis claims that health extends beyond traditional biological boundaries to include essential functional structures like diabetes-related technology, making technology a part of a patient's health. This view aligns with the “Extended Mind Hypothesis,” suggesting that health should include elements beyond organic material if they are vital to a patient's functions. In the commentary, we highlight that both naturalist and normative conceptions of health support the extended health hypothesis, emphasizing that human health is not confined to organic material. This perspective raises critical questions about whether devices like insulin pumps and continuous glucose monitors are integral to a patient's health and whether their malfunction constitutes a form of disease. Devices are considered integral to health, there is no ethical dilemma in using unregistered medical devices for managing type 1 diabetes. Finally, we call for reevaluating the definitions of health and patients, particularly for children with type 1 diabetes using advanced technologies. It asserts that the optimal use of such devices represents a new form of health, creating a health-device symbiosis that should be evaluated with the child's best interests in mind.

In recent work, Scott Soames (2010, 2013, 2015, 2019) and Peter Hanks (2011, 2013, 2015) have developed a theory of propositions on which these are constituted by complexes of intellectual acts. In this article, I adapt this type of theory to provide an account of perceptual content. After introducing terminology in section 1, I detail the approach proffered by Soames and Hanks in section 2, focusing on Hanks’s version. In section 3, I introduce a problem that these theories face, namely, how to account for the unity among the relevant intellectual acts. Section 4 provides an answer to this problem of unity, while section 5 explicates the relation to Soames and Hanks. In section 6, I extend the model to a theory of the unity of experiential consciousness. Finally, in section 7, I apply the preceding considerations to debates about the nature of perceptual representation. The upshot will be that experiential unity is not simply a phenomenal feature of consciousness, but central to an account of the role perceptual representation plays in perceptual cognition.

Epistemological disjunctivists hold that perceiving subjects have “reflective access” to factive perceptual support for belief. However, little has been done to elaborate the intended notion of reflection, or introspective awareness more generally. Moreover, critics have pointed out that the disjunctivist conception of “reflective access” can seem vulnerable to varieties of Williamson’s anti-luminosity argument. In this paper I defend disjunctivism from this charge, arguing that it holds the resources for a potent defense of the claim that knowledge of perceptual states is luminous. Indeed, I argue that appreciating the relation between disjunctivism and luminosity sheds critical light on how the disjunctivist conceives of perceptual support for belief.

Negative disjunctivists like Mike Martin and Bill Fish understand hallucinations in purely epistemic terms, and do not attribute phenomenal character to these visual misfires. However, the approaches by Martin and Fish are importantly different, and there has been little systematic work on how negative disjunctivism is motivated. In this paper, I argue for a version of negative disjunctivism that centers on the idea that perception involves the exercise of a fallible self-conscious capacity. I claim that this at once explains hallucinations in purely negative terms that are close to Martin’s approach, while at the same time providing negative disjunctivism with an explanatory basis that Fish attempts to provide and Martin’s view lacks.

Epistemological disjunctivists make two strong claims about perceptual experience's epistemic value: experience guarantees the knowledgeable character of perceptual beliefs; experience's epistemic value is “reflectively accessible”. In this paper I develop a form of disjunctivism grounded in a presentational view of experience, on which the epistemic benefits of experience consist in the way perception presents the subject with aspects of her environment. I show that presentational disjunctivism has both dialectical and philosophically fundamental advantages over more traditional expositions. Dialectically, presentational disjunctivism resolves a puzzle disjunctivists face in their posture vis-à-vis skeptical scenarios. More systematically, presentational disjunctivism provides an especially compelling view of disjunctivism as an internalist view of perceptual consciousness by explaining the way perceptual presence manifests the subject's rationality in a distinct way.

According to epistemological disjunctivism (ED), ordinary perceptual experience ensures an opportunity for perceptual knowledge. In recent years, two distinct models of this idea have been developed. For Duncan Pritchard (Epistemological disjunctivism, 2012, Oxford University Press; Epistemic angst: Radical skepticism and the groundlessness of our believing, 2012, Princeton University Press), perception provides distinctly powerful reasons for belief. By contrast, Clayton Littlejohn (Journal of Philosophical Research, 41, 201; Knowledge first, 2017, Oxford University Press; Normativity: Epistemic and practical, 2018, Oxford University Press) and Alan Millar (The nature and value of knowledge: Three investigations, 2010, Oxford University Press; Philosophical Issues, 21, 332) argue for a version of ED in terms of a “knowledge first” program, on which perception directly provides knowledge, without relying on antecedent reasons or justification. Specifically, both Littlejohn and Millar argue that “reasons first” ED faces a problematic regress. In this article, I defend “reasons first” ED by arguing that experience provides a type of reason that escapes the regress. I also argue that reasons are a fundamental aspect of ED, especially in its anti-skeptical stance.