Rani Anjum

Evidence based medicine (EBM) is under critical debate, and person centered healthcare (PCH) has been proposed as an improvement. But is PCH offered as a supplement or as a replacement of EBM? Prima facie PCH only concerns the practice of medicine, while the contended features of EBM also include methods and medical model. I here argue that there are good philosophical reasons to see PCH as a radical alternative to the existing medical paradigm of EBM, since the two seem committed to conflicting ontologies. This paper aims to make explicit some of the most fundamental assumptions that motivate EBM and PCH, respectively, in order to show that the choice between them ultimately comes down to ontological preference. While EBM has a solid foundation in positivism, or what I here call Humeanism, PCH is more consistent with causal dispositionalism. I conclude that if there is a paradigmatic revolution on the way in medicine, it is first of all one of ontology.

Hume thought that if you believed in powers, you believed in necessary connections in nature. He was then able to argue that there were none such because anything could follow anything else. But Hume wrong-footed his opponents. A power does not necessitate its manifestations: rather, it disposes towards them in a way that is less than necessary but more than purely contingent. -/- In this paper a dispositional theory of causation is offered. Causes dispose towards their effects and often produce them. But a set of causes, even though they may succeed in producing an effect, cannot necessitate it since the effect could have been counteracted by some additional power. This would require a separation of our concepts of causal production and causal necessitation. The most conspicuous cases of causation are those where powers accumulate and pass a requisite threshold for an effect to occur. -/- We develop a model for representing powers as constituent vectors within an n-dimensional quality space, where composition of causes appears as vector addition. Even our resultant vector, however, has to be understood as having dispositional force only. This model throws new light on causal modality and cases of prevention, causation by absence and probabilistic causation

There has been much discussion of powers or real dispositions in the past decade, but there remains an issue that has been inadequately treated. This concerns the precise modal value that comes with dispositionality. We contend in this paper that dispositionality involves a non-alethic, sui generis, irreducible modality. Dispositions only tend towards their manifestations; they do not necessitate them. Tendency is, of course, a dispositional term itself, so this last statement offers little by way of illumination. But given our thesis on the irreducible nature of dispositionality, we maintain that it cannot be explicated correctly in non-dispositional terms. Nevertheless, we all have experience of dispositionality at work, through the exercise or our own powers and the action of other powers upon us. The notion of dispositionality that we acquire is one that involves a modality stronger than pure contingency but weaker than necessity. The recognition of this distinct modal value for dispositionality is one of the biggest oversights in the growing literature in the area. Yet it is there for all to see in even the most mundane example.

Does A cause B simply if A prevents what would have prevented B? Such a case is known as double prevention: where we have the prevention of a prevention. One theory of causation is that A causes B when B counterfactually depends on A and, as there is such a dependence, proponents of the view must rule that double prevention is causation.<br><br>However, if double prevention is causation, it means that causation can be an extrinsic matter, that the cause and effect need not be connected by a continuous chain of events, that there can be causation by absence, and that there can be causation at a distance. All of these implications jar with strong intuitions we have about the nature of causation. There is, on the other hand, a theory of causation based on an ontology of real dispositions, where causation involves the passing around of powers. This theory in contrast entails that double prevention is not causation and, on this issue, it can claim a victory over the counterfactual dependence account.

The material interpretation of conditionals is commonly recognized as involving some paradoxical results. I here argue that the truth functional approach to natural language is the reason for the inadequacy of this material interpretation, since the truth or falsity of some pair of statements ‘p’ and ‘q’ cannot per se be decisive for the truth or falsity of a conditional relation ‘if p then q’. This inadequacy also affects the ability of the overall formal system to establish whether or not arguments involving conditionals are valid. I also demonstrate that the Paradox of Indicative Conditionals does not actually involve a paradox, but instead contains some paralogistic elements that make it appear to be a paradox. The discussion of the paradox in this paper further reveals that the material interpretation of conditionals adversely affects the treatment of disjunctions. Much has been said about these matters in the literature that point in the same direction. However, there seems to be some reluctance against fully complying with the arguments against the truth functional account of conditionals, since many of the alternative accounts rely on the material conditional, or at least on an understanding of the conditional as a function of antecedent and consequent in a similar sense as the material conditional. My argument against truth functionality indicates that it may in general involve similar problems to treat conditionals as such functions, whether one deals with theories of truth, assertability or probability.

Grice argues that indicative conditionals ‘if p then q’ have conventional, truth conditional meaning according to the material conditional ‘p  q’. In order to explain away the known paradoxes with this interpretation, he distinguishes between truth conditions and assertion conditions, attempting to demonstrate that the assumed connection between ‘p’ and ‘q’ (the Indirectness Condition) is a conversational implicature; hence a matter only relevant for the assertion conditions of a conditional. This paper argues that Grice fails to demonstrate i) that the Indirectness Condition is cancellable, hence a conversational implicature, ii) that the Indirectness Condition is not part of the conventional, truth-relevant meaning of ‘if’, and accordingly, iii) semantic or logical equivalence between indicative and material conditionals.

What is the connection between dispositions and ethics? Some might think very little and those who are interested in dispositions tend to be metaphysicians whose interests are far from value. However, we argue in this paper that dispositions and dispositionality are central to ethics, indeed a precondition. Ethics rests on a number of notions that are either dispositional in nature or involve real dispositions or powers at work. We argue for a dispositional account of value that offers an alternative to the traditional fact-value dichotomy. We explain the place of value within a structure that explains the possibility of ethics. Elsewhere in this structure, we argue that moral responsibility is a precondition for ethics and that it is a dispositional notion depending critically on what Mumford and Anjum have called the dispositional modality. Moral responsibility in turn depends on there being both agency and normativity. We argue that intentionality and agency are preconditions for agency and that value is a precondition of normativity. All these notions are dispositional and make best sense if there are real dispositions or causal powers of agents.

The conditional interpretation of general categorical statements like ‘All men are animals’ as universally quantified material conditionals ‘For all x, if x is F, then x is G’ suggests that the logical structure of law statements is conditional rather than categorical. Disregarding the problem that the universally quantified material conditional is trivially true whenever there are no xs that are F, there are some reasons to be sceptical of Frege’s equivalence between categorical and conditional expressions. Now many philosophers will claim that the material conditional interpretation of laws statements, dispositions ascriptions, or any causal claim is generally accepted as wrong and outdated. Still, there seem to be some basic logical assumptions that are shared by most of the participants in the debate on causal matters which at least stems from the traditional truth functional interpretation of conditionals. This is indicated by the vocabulary in the philosophical debate on causation, where one often speaks of ‘counterfactuals’, ‘possible worlds’ and ‘necessity’ without being explicit on whether or to what extent one accepts the logical-technical definition of these notions. To guarantee a non-Humean and non-extensional approach to causal relations, it is therefore important to be aware of the logical and metaphysical implications of the technical vocabulary. In this paper we want to show why extensional logic cannot deal with causal relations. Via a logical analysis of law-like statements ‘All Fs are Gs’ we hope to throw some new light on interrelated notions like causation, laws, induction, hypotheticality and modality. If successful, our analysis should be of relevance for a deeper understanding of any type of causal relations, whether we understand them to be laws, dispositions, singulars or categoricals.

A standard way of representing causation is with neuron diagrams. This has become popular since the influential work of David Lewis. But it should not be assumed that such representations are metaphysically neutral and amenable to any theory of causation. On the contrary, this way of representing causation already makes several Humean assumptions about what causation is, and which suit Lewis’s programme of Humean Supervenience. An alternative of a vector diagram is better suited for a powers ontology. Causation should be understood as connecting property types and tokens where there are dispositions towards some properties rather than others. Such a model illustrates how an effect is typically polygenous: caused by many powers acting with each other, and sometimes against each other. It models causation as a tendency towards an effect which can be counteracted. The model can represent cases of causal complexity, interference, over-determination and causation of absence (equilibrium).

Free will is a problem of modality, hampered by a commitment to modal dualism: the view that there is only necessity and pure contingency. If we have necessity, then things couldn't have been otherwise, against the Principle of Alternate Possibilities (AP). If there is complete contingency, then the agent seems to have no control over her actions, against the principle of Ultimate Authorship (UA). There is a third modality in natural causal processes, however. AP and UA can be reconciled if we allow both causation and agency to involve the dispositional modality.

In this paper I argue that a truth functional account of conditional statements ‘if A then B’ not only is inadequate, but that it eliminates the very conditionality expressed by ‘if’. Focusing only on the truth-values of the statements ‘A’ and ‘B’ and different combinations of these, one is bound to miss out on the conditional relation expressed between them. But this is not a flaw only of truth functionality and the material conditional. All approaches that try to treat conditionals as mere functions of their antecedents and consequents will end up in some sort of logical atomism where causal matters simply are reduced to the joint occurrence of A and B. What we need is a non-extensional approach to conditionals that can account for hypotheticality, potentiality, and dependency, none of which can be understood by looking to the antecedent or consequent per se.

This paper argues that the technical notion of conditional probability, as given by the ratio analysis, is unsuitable for dealing with our pretheoretical and intuitive understanding of both conditionality and probability. This is an ontological account of conditionals that include an irreducible dispositional connection between the antecedent and consequent conditions and where the conditional has to be treated as an indivisible whole rather than compositional. The relevant type of conditionality is found in some well-defined group of conditional statements. As an alternative, therefore, we briefly offer grounds for what we would call an ontological reading: for both conditionality and conditional probability in general. It is not offered as a fully developed theory of conditionality but can be used, we claim, to explain why calculations according to the RATIO scheme does not coincide with our intuitive notion of conditional probability. What it shows us is that for an understanding of the whole range of conditionals we will need what John Heil (2003), in response to Quine (1953), calls an ontological point of view.

Omissions are sometimes linked to responsibility. A harm can counterfactually depend on an omission to prevent it. If someone had the ability to prevent a harm but didn’t, this could suffice to ground their responsibility for the harm. Michael S. Moore’s claim is illustrated by the tragic case of Peter Parker, shortly after he became Spider-Man. Sick of being pushed around as a weakling kid, Peter became drunk on the power he acquired from the freak bite of a radioactive spider. When a police officer called to Spider-Man to stop an escaping burglar, which he could have done easily, he failed to act. He was through taking orders. The omission was followed by a crime. That very same burglar later robbed Peter’s own house and when challenged he shot dead Peter’s Uncle Ben. Later, Spider-Man tracked down the killer and, when seeing his face close up, the possibility of prevention dawned on him. He could have stopped this crook and had he done so Uncle Ben would still be alive. Stan Lee’s tale of power finished with a Shakespearean twist. Young Peter realised the truth of the WGPCGR-thesis: With Great Power Comes Great Responsibility. We too will endorse the WGPCGR-thesis. There is a close connection between our notions of moral and legal responsibility and the powers we have as causal agents. This will be particularly important when it comes to the case of omissions: where we had the power to act but failed to do so. We hope to show the connections between the notions of power, cause, act, omission and responsibility but also some of the nuances. We will do so with particular reference to Moore’s account in Causation and Responsibility.

The truth functional account of conditional statements ‘if A then B’ is not only inadequate; it eliminates the very conditionality expressed by ‘if’. Focusing only on the truth-values of the statements ‘A’ and ‘B’ and different combinations of these, one is bound to miss out on the conditional relation expressed between them. All approaches that treat conditionals as functions of their antecedents and consequents will end up in some sort of logical atomism where causal matters simply are reduced to the joint occurrence of A and B.

Språket vårt utgjør en stor del av vår identitet. Det er et redskap for kommunikasjon med andre mennesker, men også med oss selv. Vi uttrykker oss gjennom språket, og vi tenker ved hjelp av språket. Men hva er egentlig språk? Gjennom å ta for meg to vesensforskjellige tilnærminger til dette spørsmålet ønsker jeg å vise at det synet vi har på språk, har stor filosofiske betydning. Dette er fordi et språksyn nødvendigvis vil få konsekvenser for hvordan vi tenker om beslektede filosofiske spørsmål, som blant annet: – Hva er forholdet mellom språk og verden? – Hva er sannhet? – Hvordan får vi kunnskap om verden? – Hva gjør vi når vi bruker språk? – Hva er vår rolle som språkbrukere? – Hvordan lærer vi språk? Det er to ting som er viktig å avklare om vinklingen av denne artikkelen: Det første er at når jeg her velger å skissere to ulike filosofiske syn på språk, er det for å belyse de spørsmålene jeg har satt opp ovenfor, snarere enn å angripe eller fremme konkrete filosofiske teorier. Det andre er at når jeg her skriver om forholdet mellom språk og verden, og vår rolle som språkbrukere, vil jeg ta for gitt at dette omfatter alle naturlige språksystemer. Poengene mine er derfor ment å ha overføringsverdi til tegnspråk i sin alminnelighet, og selvfølgelig også til norsk tegnspråk. Dette innebærer at det jeg sier om ord, like gjerne kan sies om tegn. Målet med artikkelen er først og fremst å vise at språket må forstås som et gjennomgripende erkjennelsesmiddel i vårt møte med verden.

In an explanation ‘y because x’, because can be used to express an explanatory relation between an explanandum ‘y’ and an explanans ‘x’. But because can also be used to express the speaker’s reason for uttering ‘y’. This difference will be elucidated by connecting it with the distinction between the at-issue dimension and the speaker dimension of meaning. There are also internal relations between if and because that can help us find and analyse different uses of because, and thus also different types of explanatory relations.

We claim that if a complete philosophy of evidence-based practice is intended, then attention to the nature of causation in health science is necessary. We identify how health science currently conceptualises causation by the way it prioritises some research methods over others. We then show how the current understanding of what causation is serves to constrain scientific progress. An alternative account of causation is offered. This is one of dispositionalism. We claim that by understanding causation from a dispositionalist stance, many of the processes within an evidence-based practice framework are better accounted for. Further, some of the problems associated with the health research, e.g. external validity of causal findings, dissolve.

There are a number of dispositionalist solutions to the free will problem based on freedom consisting in the agent's exercise of a power. But if a subject a is free when they exercise their power P, there is an objection to be overcome from the possibility of power implantation. A brainwasher, rather than directly manipulating a subject's movements, can instead implant in them a desire, to be understood as a disposition to act, and allow the subject to exercise such a power. It seems that, according to the dispositionalist theory of freedom, such an agent would still count as acting freely. There is a strong non-consent intuition that a is not free in such a case because they did not consent to having the power P—the desire in question. Filling out this intuition is not straightforward. But it can be done in terms of the exercise of P being regulated by higher-order powers of self-reflection. Such regulation is what allows an agent to either take ownership of a power or to reject it

If one’s solution to the free will problem is in terms of real causal powers of agents then one ought to be an incompatibilist. Some premises are contentious but the following new argument for incompatibilism is advanced: 1. If causal determinism is true, all events are necessitated2. If all events are necessitated, then there are no powers3. Free will consists in the exercise of an agent’s powersTherefore, if causal determinism is true, there is no free will; which is to say that free will is incompatible with determinism, so compatibilism is false

Medically unexplained symptoms (MUS) remain recalcitrant to the medical profession, proving less suitable for homogenic treatment with respect to their aetiology, taxonomy and diagnosis. While the majority of existing medical research methods are designed for large scale population data and sufficiently homogenous groups, MUS are characterised by their heterogenic and complex nature. As a result, MUS seem to resist medical scrutiny in a way that other conditions do not. This paper approaches the problem of MUS from a philosophical point of view. The aim is to first consider the epistemological problem of MUS in a wider ontological and phenomenological context, particularly in relation to causation. Second, the paper links current medical practice to certain ontological assumptions. Finally, the outlines of an alternative ontology of causation are offered which place characteristic features of MUS, such as genuine complexity, context-sensitivity, holism and medical uniqueness at the centre of any causal set-up, and not only for MUS. This alternative ontology provides a framework in which to better understand complex medical conditions in relation to both their nature and their associated research activity

This book is an interdisciplinary anthology dealing with sign language. It is meant to give some insight into basic philosophical and cultural issues related to sign language, and thus to provide a theoretical foundation for understanding the importance of sign language as language. The 14 authors come from various professional academic disciplines (philosophy, education, linguistics, social anthropology, political science and theology being some of them) and from a variety of professions within the Deaf community (interpreting, translation, pastorate, sign language research, sign language teaching). Online sign language version added here.

In this paper I present some of Robert N. McLaughlin's critique of a truth functional approach to conditionals as it appears in his book On the Logic of Ordinary Conditionals. Based on his criticism I argue that the basic principles of logic together amount to epistemological and metaphysical implications that can only be accepted from a logical atomist perspective. Attempts to account for conditional relations within this philosophical framework will necessarily fail. I thus argue that it is not truth functionality as such that is the problem, but the philosophical foundation of modern logic.

The results of sport would not interest us if either they were necessitated or they were a matter of pure chance. And if either case were true, the playing of sport would seem to make no sense either. This poses a dilemma. But there is something between these two options, namely the dispositional modality. Sporting prowess can be understood as a disposition towards victory and sporting liabilities a disposition towards defeat. The sporting contest then pits these net prowesses against each other. The stronger will tend to beat the weaker but no more than tend. This makes sense of the sporting contest in which the weaker knows they still can win. The stronger team can lose though they do not tend to do so. The dilemma is thus escaped

Often we mean something else than what we have said explicitly. Consider the following scenario. I show up in a new flashy dress and ask my friend what she thinks of it. She always tries to help me improve my style and knows that I value her honest opinion. She looks at my dress and says: ‘Excellent fit, but have you gone colour blind?’. From what she says I do not take it that she is interested in whether I’ve got a colour vision deficiency. Rather, I take her to mean that she does not like the colours of my dress. In this way we constantly communicate more than what our words say, or even something else than what we say. When we do so, we make use of a conversational tool which Paul Grice calls implicatures. His theory of such implicatures has been central for contemporary debates on the relation between semantics and pragmatics, and also that between logic and semantics. In this chapter we will look at the notion of implicatures in some detail.

[EN]Most theories of causation assume that it must involve some kind of necessity, or that the cause must be entirely sufficient for the effect. Others have already suggested that it should be possible to get a theory of causation from a theory of powers or dispositions. Such a project is far from complete but even here we find that the key point in a dispositional theory of causation has been lacking. This paper attempts to establish some of the most important principles of such a theory and in so doing turn the existing discussion in a new direction. [ES]La mayoría de las teorías de causación asumen que debe envolverse algún tipo de necesidad, o que la causa debe ser enteramente suficiente para el efecto. Otros ya han sugerido que debería de ser posible obtener una teoría de causación a partir de una teoría de poderes o disposiciones. Un proyecto tal está muy lejos de estar completo, pero incluso aquí encontramos que ha faltado el punto clave en una teoría dispositiva de causación. Este escrito intenta establecer algunos de los principios más importantes de una teoría tal, y al hacerlo inclina la discusión existente en una nueva dirección.