Doug Hardman

There is increasing evidence for the use of open-label placebo (OLP) as an effective and safe treatment for a range of chronic conditions. OLP is generally conceived as an ethical alternative to classic placebo treatment because patients know that they are taking a placebo and are hence not deceived. However, despite its potential benefits and lack of side effects, the paradoxical nature of OLP may make it difficult to propose as a treatment option in clinical practice. To mitigate this issue, we propose a practical way for clinicians and patients to conceive of OLP in clinical practice: namely, as a worthwhile wager.

Bioethics seems preoccupied with establishing, debating, promoting and sometimes debunking principles. While these tasks trade on the status of the word ‘principle’ in our ordinary language, scant attention is paid to the way principles operate in language. In this paper, we explore how principles relate to rules and practices so as to better understand their logic. We argue that principles gain their sense and power from the practices which give them sense. While general principles can be, and are, establishable in abstraction from specific practices, as they are in principlist bioethics, such principles are impotent as moral guides to action. We show that the purchase any principle has as a moral guide to action emerges from its indexical properties as a principle which has sense in a specific practice. The meaning of any principle is internal to the practice and context in which it is invoked and, therefore, principles are not kinds of master rule which dictate moral judgement in new contexts but rather chameleon-like rules which change with the contexture in which they are invoked.

1 Context The idea for the current issue of _Philosophia Scientiæ_ emerged from discussions which took place in the Manchester Ethnomethodology Reading Group. This reading group has its origins in Wes Sharrock’s weekly discussion groups, which have taken place in Manchester (UK) since the early 1970s. As the global Covid-19 pandemic hit in early 2020, the reading group moved online, facilitated by Phil Hutchinson and Alex Holder. Being an online reading group opened up participation to people beyond Northwest UK and within weeks the group became global, with the membership including participants logging on from Canada, Czech Republic, Finland, France, Germany, Greece, Hong Kong, Japan, Macau, New Zealand, Spain, Sweden, and the USA. While the name of the group might indicate an exclusive focus on ethnomethodology, following the naming conventions for academic discussion groups, the name really fails to indicate both the heterogeneity of the group’s reading materials, the interests of t...

Wayfinding is generally understood as the process of purposefully navigating to distant and non-visible destinations. Within this broad framework, uninformed searching entails finding one’s way to a target destination, in an unfamiliar environment, with no knowledge of its location. Although a variety of search strategies have been previously reported, this research was largely conducted in the laboratory or virtual environments using simplistic and often non-realistic situations, raising questions about its ecological validity. In this study, we explored how extant findings on searching translate to a real-world environment, using a phenomenologically informed experiment. Our findings demonstrate a previously undescribed complex and dynamic interplay of different search strategies. Importantly, our results reveal that: (i) the presence of other people is importantly entangled with the process of searching; and (ii) people frequently probe and switch between search strategies based on local environmental characteristics. Together, our results reveal that search behaviour is critically dependent on environmental features and that searching in complex real-world settings should not be conceptualised as depending on a simple singular strategy. This raises questions about the dominance of laboratory-based experiments and their narrow cognitivist framework, highlighting the value of studying wayfinding in the real world.

In this essay, I consider whether it makes sense to say that our cognitive capacities—remembering, imagining, intending, hoping, expecting and so on—manifest as inner, subpersonal processes. Given whether something makes sense is a grammatical rather than theoretical or empirical issue, it cannot be explained but can only be better understood by describing and reflecting on situations in which it arises. As such, I approach this issue using the descriptive method of O.K. Bouwsma, which is a development of Wittgenstein's latter methodological approach of conceptually clarifying our bounds of sense. In the course of my investigation, I come to the realisation that cognitive capacities do not, as much psychology and cognitive science imply, make sense as inner, subpersonal processes. Instead, they make sense as personal capacities, which manifest in many ways of acting.

InWhere the Ethical Action Is,we argued that medical and ethical modes of thought are not different in kind but different aspects of a situation. One of the consequences of this argument is that the requirement for or benefits of normative moral theorising in bioethics is undercut. In response, Wagner has argued that normative moral theories should be reconceived as models. Wagner’s argument seems to be that once reconceived as models, the rationale for moral theorising, undercut by our arguments inWhere the Ethical Action Is,will be re-established because we will see those moral-theories-now-rebranded-as-models as serving a role akin to the role models serve in some of the natural sciences. In this response to Wagner, we provide two arguments against Wagner’s proposal. We call these arguments the Turner-Cicourel Challenge and the Question Begging Challenge.

In my recent article,Pretending to care, I argue that a better understanding of non-doxastic attitudes could improve our understanding of deception in clinical practice. In an insightful and well-argued response, Colgrove highlights three problems with my account. For the sake of brevity, in this reply I focus on the first: that my definition of deception is implausible because it does not involve intention. Although I concede that my initial broad definition needs modification, I argue that it should not be modified by involving intention but by involving responsibility.

On one hand, it is commonly accepted that clinicians should not deceive their patients, yet on the other there are many instances in which deception could be in a patient’s best interest. In this paper, I propose that this conflict is in part driven by a narrow conception of deception as contingent on belief. I argue that we cannot equate non-deceptive care solely with introducing or sustaining a patient’s true belief about their condition or treatment, because there are many instances of clinical care which are non-doxastic and non-deceptive. Inasmuch as this is true, better understanding of non-doxastic attitudes, such as hope and pretence, could improve our understanding of deception in clinical practice.

In our article, Where the ethical action is, we argue that medical and ethical modes of thought are not different in kind but merely different aspects of a clinical situation. In response, Emmerich argues that in so doing, we neglect several important features of healthcare and medical education. Although we applaud the spirit of Emmerich’s response, we argue that his critique is an attempt at a general defence of the value of bioethical expertise in clinical practice, rather than a specific critique of our account.

The placebo effect is now generally defined widely as an individual’s response to the psychosocial context of a clinical treatment, as distinct from the treatment’s characteristic physiological effects. Some researchers, however, argue that such a wide definition leads to confusion and misleading implications. In response, they propose a narrow definition restricted to the therapeutic effects of deliberate placebo treatments. Within the framework of modern medicine, such a scope currently leaves one viable placebo treatment paradigm: the non-deceptive and non-concealed administration of “placebo pills” or open-label placebo (OLP) treatment. In this paper, I consider how the placebo effect occurs in OLP. I argue that a traditional, belief-based account of OLP is paradoxical. Instead, I propose an account based on the non-doxastic attitude of pretence, understood within a fictionalist framework.

The extended mind thesis states that the mind is not brain-bound but extends into the physical world. The philosophical debate around the thesis has mostly focused on extension towards epistemic artefacts, treating the phenomenon as a special capacity of the human organism to recruit external physical resources to solve individual tasks. This paper argues that if the mind extends to artefacts in the pursuit of individual tasks, it extends to other humans in the pursuit of collective tasks. Mind extension to other humans corresponds essentially to the ‘we-mode’ of cognition, the unique power of human minds to be jointly directed at goals, intentions, states of affairs, or values (which, importantly, differs from having a ‘group mind’). Because the capacity for collective intentionality holds evolutionary and developmental primacy over human-epistemic artefacts relations, the extended mind should not be seen as a special phenomenon, but as a central aspect of the human condition. The original extended mind thesis carried important implications for how the cognitive sciences should proceed. In a version of the thesis that accommodates collective intentionality, these implications would go far deeper than originally assumed.