Rajeev Dutta

I argue that true informed consent is impossible to obtain for certain medical procedures in which epistemic transformation occurs. Cases in which undergoing a procedure itself provides new experiential information, that is, phenomenal knowledge (what I call “knowledge-what-it’s-like”), true informed consent for that procedure cannot be attained from knowing facts about the procedure (“knowledge-that”) alone. If epistemically transformative medical procedures indeed undermine informed consent as I argue they do, I suggest that there are important implications for the decision-making of patients considering these procedures (e.g., chemotherapy, invasive surgeries, cochlear implants, gender-affirming procedures). Rather than solely communicating biological, clinical, and epidemiological facts about procedures, clinicians should supplement pre-procedure counseling with previous patient testimonials or even virtual/augmented reality to compensate (albeit partially) for the “knowledge-what-it’s-like” that is absent prior to undergoing epistemically transformative medical procedures. Although these interventions may not (accurately) convey what it is like to undergo the procedure, they address the traditionally under-explored experiential aspect of medical treatments in medical decision-making from the patient’s perspective.

I argue that generic generalizations expressed in language (hereafter “generics”) are not to blame in cases of prejudicial reasoning and treatment that involve them. I introduce four cases in which generics based plausibly on genetic associations (i.e., “genetic generics,” which are prima facie most susceptible to essentialism in that they suggest an inherent cause of a property or effect) serve as motivation for prejudicial behavior. I then argue for three claims. First, I argue that generics do not rationally license corresponding essentialist beliefs. Second, I argue that we ought to mediate cognitive biases and heuristics like essentialism (i.e., revise unjustified false beliefs that arise from essentialism). Third, I argue that genetic generics, even if true, don’t account for the (problematic) actions in the cases that seem to be motivated by them. In other words, I vindicate generics by granting that even if seemingly problematic generics turn out to be true, prejudicial treatment does not correctly follow from or depend upon them, especially because essentialist beliefs also do not. I conclude by discussing some of the real-world implications of my argument for the use of generics, both in communication with children, who may not be reasonably expected to meet certain norms of reasoning, and for achieving other ends than those that genetic generics may initially be thought to suggest.

Background: We combined simulation-based learning and ethics education for a unique, educational experience for nursing students. We aimed to assess students’ feelings of confidence, efficacy, and moral distress before and after a simulation session focused primarily on handling an ethical dilemma. Methods: A simulation session featuring an ethical dilemma was enacted as an in-class activity for a nursing ethics course. Optional pre- and post-surveys were made available to nursing students (n=13) to collect both quantitative (five-point Likert) and qualitative data, including a modified version of the Measure of Moral Distress—Healthcare Professionals tool. Results: Students reported significantly increased levels of confidence in handling real-life ethical dilemmas, knowledge of working with a physician in real-life ethical dilemmas, and competence in selecting appropriate actions in ethical dilemmas. Overall moral distress was not found to be significantly increased in participants. Conclusions: Nursing students describe ethics simulation as a valuable, innovative tool for preparing them to handle eventual ethical challenges in their career and anticipating moral distress.

The idea that delusions are beliefs is supported by the observation that delusions, similarly to beliefs, are used in reasoning. However, delusions also exhibit other features that are difficult to explain under this doxastic view—they strongly resist evidence and sometimes conflict with an agent’s actions (in ways in which beliefs seemingly do not), giving rise to what is known as the double bookkeeping phenomenon. These features have motivated non-doxastic views, arguing that delusions are other types of mental phenomena (e.g., imaginings or empty speech acts). While these non-doxastic views account for the features of delusions like evidence resistance and double bookkeeping, they struggle to explain the belief-like features of delusions. We are thus at an impasse, where neither the doxastic nor the non-doxastic account of delusions can explain all the features of delusions. In this paper, I aim to make progress in this debate by showing that the doxastic view can, after all, account for both the belief-like and the other features of delusions. Drawing on recent literature in epistemology, I argue that (rational) beliefs can be motivated by non-evidential (e.g., pragmatic and emotional) factors, and that these factors help explain delusions’ otherwise puzzling features. I also propose that categorizing beliefs across two functional compartments, the implicit and the explicit, is helpful for understanding the dynamic interplay of delusions and non-delusional beliefs.

Narrative medicine has emerged over the past few decades as an exciting approach to medical practice, interweaving the practice of medicine with the practices of literary analysis and reflective writing. It is often claimed that narrative medicine enables practitioners to understand and empathize with patient stories, effectively ‘joining’ patients in illness. However, I argue that there are reasons to be suspicious of narrative medicine’s ability to promote patient-centered care. I begin by questioning the distinctiveness of narrative knowledge, suggesting that it is neither able to be propositional knowledge (‘knowledge-that’) nor phenomenal/experiential knowledge (‘knowledge-what-it’s-like’). Then, I consider an alternative reading of narrative medicine, by which narratives are simply ways to structure patient information so that a physician can more readily empathize with the patient. I dismiss this alternative as unsatisfactory given that it depends on either all patients building narratives or physicians imposing narrative structure(s) where one does not inherently exist, thus overriding patients. Finally, I provide possible supplements and alternatives to narrative medicine, proposing that active listening and the removal of systemic barriers to physicians’ abilities to provide humanistic care (e.g., lower administrative, profit, and documentation burdens) may be a first step to putting empathetic patient care on the forefront. Ultimately, I think that these efforts (while their fruition may present difficulty), rather than sifting through patient information to construct and elevate narratives, present the opportunity to accurately refocus patient-centered care.

I argue that generic generalizations expressed in language (i.e., “generics”) are apt for good clinical reasoning. I begin by introducing what generics are in language and describe two problems in the use and interpretation of generics: Generics can license inaccurate judgements about the frequency of events or properties within a group (i.e., a problem with the “truth-aptness” of generics) and can facilitate problematic beliefs about social kinds (e.g., prejudice or essentializing). I provide an account of clinical reasoning and describe some features of what I call “good” clinical reasoning. I offer examples of generics in clinical contexts and examine how the two problems with generics (i.e., of truth-aptness and social generics) can be harmful to patients and impair clinical reasoning. However, I ultimately argue that generics are important for good clinical reasoning because they track “conspicuous” features of disease processes (e.g., severe possible outcomes). Further, I argue that prejudicial generics are often irrational to believe, and social generics that are rational to believe need not lead to problematic implicatures about social kinds and can, in principle, instead facilitate meaningfully articulating societal injustices. I then argue that statistical statements, which are tempting alternatives to generics in clinical reasoning, are no better than generics for good clinical reasoning, even with respect to the two problems identified in the use of generics.