Jonathan Dowell

This paper addresses two related questions. First, what is involved in giving a distinctively realist and naturalist construal of an area of discourse, that is, in so much as stating a distinctively realist and naturalist position about, for example, content or value? I defend a condition that guarantees the realism and naturalism of any position satisfying it, at least in the case of positions on content, but perhaps in other cases as well. Second, what sorts of considerations render a distinctively realist and naturalist position more plausible than its irrealist and non-naturalist rivals? The answer here focuses again on theories of content and is wholly negative. I argue that the standard array of arguments offered in support of realist and naturalist theories in fact provide equal support for a host of irrealist and non-naturalist ones. Taken together, these considerations reveal an important gap in the recent philosophical literature on content. The challenge to proponents of putatively realist and naturalist theories is to insure that those theories so much as state distinctively realist and naturalist positions and then to identify arguments that support what is distinctively realist and naturalist about them.

Recent challenges to Kratzer’s canonical contextualist semantics for modal expressions are united by a shared methodological practice: Each requires the assessment of the truth or warrant of a sentence in a scenario. The default evidential status accorded these judgments is a constraining one: It is assumed that, to be plausible, a semantic hypothesis must vindicate the reported judgments. Fully assessing the extent to which these cases do generate data that puts pressure on the canonical semantics, then, requires an understanding of this methodological practice. Here I argue that not all assessments are fit to play this evidential role. To play it, we need reason to think that speakers’ assessments can be reasonably expected to be reliable. Minimally, having such grounds requires that assessments are given against the background of non-defectively characterized points of evaluation. Assessing MacFarlane’s central challenge case to contextualism about deontic modals in light of this constraint shows that his judgments do not have the needed evidential significance. In addition, new experimental data shows that once the needed scenario is characterized non-defectively, none of the resulting range of cases provides data that cannot be accommodated by a Kratzer-style contextualism.

On elective students may not always be clear about safeguarding themselves and others. It is important that placements are safe, and ethically grounded. A concern for medical schools is equipping their students for exposure to and response to uncomfortable and/or unfamiliar requests in locations away from home, where their comfort and safety, or that of the patient, may be compromised. This can require legal, ethical, and/or moral reasoning on the part of the student. The goal of this article is to establish what students actually encounter on elective, to inform better preparing students for safe and ethical medical placements. We discuss the implications of our findings, which are arguably applicable to other areas of graduate training, e.g. first medical roles post-qualification. An anonymised survey exploring clinical and ethical dilemmas on elective was issued across 3 years of returning final year elective medical students. Questions included the prevalence and type of potentially unsafe scenarios encountered, barriers to saying ‘no’ in unsafe situations, perceived differences between resource poor and developed world settings and the degree to which students refused or consented to participation in events outside of the ‘norms’ of their own training experience. Three hundred seventy-nine students participated. 45% were asked to do something “not permissible” at home. 27% were asked to do something they felt “uncomfortable” with, often an invasive clinical task. Half asked to do something not usually permissible were “comfortable”. 48% felt it more acceptable to bypass guidelines in developing settings. 27% refused an offer outside their experience. Of interest are reasons for “going along with” uncomfortable invitations, e.g. “emergency”, self-belief in ‘capability’ and being ‘more qualified’ than host-personnel. This “best pair of hands available” merits scrutiny. Adverse scenarios were not exclusive to developing settings. We discuss preparing students for decision-making in new contexts, and address whether ‘home’ processes are too inflexible to prepare students for ‘real’ medical life? Ethical decision-making and communicating reluctance should be included in elective preparation.