Decision Making

Lessons for Philosophers and Scientists from Sherlock Holmes and Father Brown

By Charles Foster

Arthur Conan Doyle’s estate has issued proceedings, complaining that Enola Holmes,  a recently released film about Sherlock Holmes’ sister, portrays the great detective as too emotional.

Sherlock Holmes was famously suspicious of emotions. 1 ‘ [L]ove is an emotional thing’, he icily observed, ‘and whatever is emotional is opposed to that true cold reason which I place above all things. ‘2  “I am a brain’, he told Watson. ‘The rest of me is a mere appendix’.3

I can imagine that many professional scientists and philosophers would feel affronted if they were accused of being emotional animals. Holmes is a model for them. He’s rigorous, empirical, and relies on induction.

But here’s the thing. He’s not actually very good. Mere brains might be good at anticipating the behaviour of mere brains, but they’re not good for much else. In particular Holmes is not a patch on his rival, Chesterton’s Father Brown, a Roman Catholic priest. Gramsci writes that Brown ‘totally defeats Sherlock Holmes, makes him look like a pretentious little boy, shows up his narrowness and pettiness.’ 4 Brown is faster, more efficient, and, for the criminal, deadlier. This is because, not despite, his use of his emotions. Continue reading

Consent Without Alternatives

Written by Ben Davies and Joshua Parker

“COVID-19: Do not resuscitate orders might have been put in place without consent, watchdog says”. This recent headline followed an investigation by the Care Quality Commission into Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) decisions early in the pandemic. In a recent post, Dominic Wilkinson highlights two misconceptions in the coverage of this report, one of which is the ‘consent misconception’.

Dominic’s view is that “there is no ethical requirement…to seek the agreement of patients not to offer or provide a treatment” which a medical professional judges inappropriate. Of course, his position is not that consultation and discussion around CPR is inappropriate, only that consent is not necessary. This is the standard view on consent in this context and, due in part to the Tracey judgment, reflects doctors’ practice. Thus, an important distinction emerges between consenting to the withholding of some treatment, and discussion of that decision. Doctors may be ethically required to discuss a decision without also having an obligation to seek the patient’s consent. The absence of consent, then, does not signal that the DNACPR was unethical, whereas a failure to consult probably will.

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The Duty To Ignore Covid-19

By Charles Foster

This is a plea for a self-denying ordinance on the part of philosophers. Ignore Covid-19. It was important that you said what you have said about it, but the job is done. There is nothing more to say. And there are great dangers in continuing to comment. It gives the impression that there is only one issue in the world. But there are many others, and they need your attention. Just as cancer patients were left untreated because Covid closed hospitals, so important philosophical problems are left unaddressed, or viewed only through the distorting lens of Covid. Continue reading

We’re All Vitalists Now

By Charles Foster

It has been a terrible few months for moral philosophers – and for utilitarians in particular. Their relevance to public discourse has never been greater, but never have their analyses been so humiliatingly sidelined by policy makers across the world. The world’s governments are all, it seems, ruled by a rather crude vitalism. Livelihoods and freedoms give way easily to a statistically small risk of individual death.

That might or might not be the morally right result. I’m not considering here the appropriateness of any government measures, and simply note that whatever one says about the UK Government’s response, it has been supremely successful in generating fear. Presumably that was its intention. The fear in the eyes above the masks is mainly an atavistic terror of personal extinction – a fear unmitigated by rational risk assessment. There is also a genuine fear for others (and the crisis has shown humans at their most splendidly altruistic and communitarian as well). But we really don’t have much ballast.

The fear is likely to endure long after the virus itself has receded. Even if we eventually pluck up the courage to hug our friends or go to the theatre, the fear has shown us what we’re really like, and the unflattering picture will be hard to forget.

I wonder what this new view of ourselves will mean for some of the big debates in ethics and law? The obvious examples are euthanasia and assisted suicide. Continue reading

Maximising Ventilators: Some Ethical Complications

Written by Joshua Parker and Ben Davies

One of the impending tragedies of the COVID-19 pandemic is a grave mismatch between the supply of ventilators and the numbers needing them. This situation, as seen in Italy, is predicted to be mirrored here in the UK. Coronavirus can cause acute respiratory distress syndrome for which the management is mechanical ventilation on the ICU. This represents these patients’ only chance at survival. Part of the response to the incoming tsunami of patients requiring ventilation is to produce more ventilators. This is a reasonable way to try to lessen the mismatch between supply and demand. However, producing more ventilators cannot be the solution in isolation. As a complex piece of medical equipment, ventilators need trained staff to operate them and provide the additional care ventilated patients require. There has been a significant push to attempt to ensure enough ventilator trained staff as possible. Both staff and ventilator shortages present significant issues; yet it is shortages of ventilators that account for the bulk of ethical discussion so far. It is therefore worth exploring some of the ethical problems that might arise should there be plenty of ventilators, but not enough staff.

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The Perfect Protocol? Ethics Guidelines in a Pandemic

Written by Joshua Parker and Ben Davies

One question occupying politicians and healthcare workers in the middle of this global pandemic is whether there will be enough ventilators when COVID-19 reaches its peak. As cases in the UK continue to increase, so too will demand for ventilators; Italy has reported overwhelming demand for the equipment and the need to ration access, and the UK will likely face similar dilemmas. Indeed, one UK consultant has predicted a scenario of having 8 patients for every one ventilator. Aside from anything else, this would be truly awful for the healthcare professionals having to make such decisions and live with the consequences.

Ethics is an inescapable part of medical practice, and healthcare professionals face numerous ethical decisions throughout their careers. But ethics is challenging, often involving great uncertainty and ambiguity. Medics often lack the time to sort through the morass that is ethics.  Many therefore prefer heuristics, toolboxes and a handful of principles to simplify, speed up and streamline their ethics.

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Coronavirus: Dark Clouds, But Some Silver Linings?

By Charles Foster

Cross posted from The Conversation

To be clear, and in the hope of heading off some trolls, two observations. First: of course I don’t welcome the epidemic. It will cause death, worry, inconvenience and great physical and economic suffering. Lives and livelihoods will be destroyed. The burden will fall disproportionately on the old, the weak and the poor.

And second: these suggestions are rather trite. They should be obvious to reasonably reflective people of average moral sensibility.

That said, here goes:

1. It will make us realise that national boundaries are artificial

The virus doesn’t carry a passport or recognise frontiers. The only way of stopping its spread would be to shut borders wholly, and not even the most rabid nationalists advocate that. It would mean declaring that nations were prisons, with no one coming in or out – or at least not coming back once they’d left. In a world where we too casually assume that frontiers are significant, it doesn’t do any harm to be reminded of the basic fact that humans occupy an indivisible world.

Cooperation between nations is essential to combating the epidemic. That cooperation is likely to undermine nationalist rhetoric.

2. It will make us realise that people are not islands

The atomistic billiard-ball model of the person – a model that dominates political and ethical thinking in the west – is biologically ludicrous and sociologically unsustainable. Our individual boundaries are porous. We bleed into one another and infect one another with both ills and joys. Infectious disease is a salutary reminder of our interconnectedness. It might help us to recover a sense of society.

3. It may encourage a proper sort of localism

Internationalism may be boosted. I hope so. But if we’re all locked up with one another in local quarantine, we might get to know the neighbours and the family members we’ve always ignored. We might distribute ourselves less widely, and so be more present to the people around us.

We might even find out that our local woods are more beautiful than foreign beaches, and that local farmers grow better and cheaper food than that which is shipped (with the associated harm to the climate) across the globe.

4. It may encourage altruism

Exigencies tend to bring out the best and the worst in us. An epidemic may engender and foster altruistic heroes.

5. It may remind us of some neglected constituencies

Mortality and serious illness are far higher among the old, the very young, and those suffering from other diseases. We tend to think about – and legislate for – the healthy and robust. The epidemic should remind us that they are not the only stakeholders.

6. It may make future epidemics less likely

The lessons learned from the coronavirus epidemic will pay dividends in the future. We will be more realistic about the dangers of viruses crossing the barriers between species. The whole notion of public health (a Cinderella speciality in medicine in most jurisdictions) has been rehabilitated. It is plain that private healthcare can’t be the whole answer. Much has been learned about the containment and mitigation of infectious disease. There are strenuous competitive and cooperative efforts afoot to develop a vaccine, and vaccines against future viral challenges are likely to be developed faster as a result.

7. It might make us more realistic about medicine

Medicine is not omnipotent. Recognising this might make us more aware of our vulnerabilities. The consequences of that are difficult to predict, but living in the world as it really is, rather than in an illusory world, is probably a good thing. And recognising our own vulnerability might make us more humble and less presumptuous.

8. Wildlife may benefit

China has announced a permanent ban on trade in and consumption of wildlife. That in itself is hugely significant from a conservation, an animal welfare, and a human health perspective. Hopefully other nations will follow suit.

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Pandemic Ethics: the Unilateralist Curse and Covid-19, or Why You Should Stay Home

by Anders Sandberg

In Scientific American Zeynep Tufekci writes:

Preparing for the almost inevitable global spread of this virus, … , is one of the most pro-social, altruistic things you can do in response to potential disruptions of this kind.

We should prepare, not because we may feel personally at risk, but so that we can help lessen the risk for everyone.

…you should prepare because your neighbors need you to prepare—especially your elderly neighbors, your neighbors who work at hospitals, your neighbors with chronic illnesses, and your neighbors who may not have the means or the time to prepare because of lack of resources or time.

I think this is well put. As a healthy middle-aged academic my personal risk of dying from Covid-19 seems modest – maybe about 0.4% if I get it, which in turn might be below 10% depending on how widespread the virus becomes. But I could easily spread the disease to people who are far more vulnerable, either directly or indirectly. Even slowing the spread is valuable since it helps avoid overloading the medical system at the peak of the epidemic. Continue reading

Ecological Rationality: When Is Bias A Good Thing?

By Rebecca Brown

Many people will be broadly familiar with the ‘heuristics and biases’ (H&B) program of work, made prominent by the psychologists Amos Tversky and Daniel Kahneman in the 1970s. H&B developed alongside the new sub-discipline of Behavioural Economics, both detailing the ways in which human decision-makers deviate from what would be expected of homo economicus – an imaginary, perfectly rational being that always aims at maximising utility. For instance, in a famous experiment, Tversky and Kahneman gave people the following information (1983: 297):

Linda is 31 years old, single, outspoken and very bright. She majored in philosophy. As a student, she was deeply concerned with issues of discrimination and social justice, and also participated in anti-nuclear demonstrations. 

Participants were then asked which of the two alternatives was more probable:

1. Linda is a bank teller.

2. Linda is a bank teller and is active in the feminist movement.

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Why Epistemologists Should Sniff

By Charles Foster

There are lots of big and clever books about epistemology. It’s a complex business. Although one can do some epistemology (some icy thinkers say all) without making any empirical claims about what the senses show (and hence how the senses work), such empirical claims are essential for the discipline to get any real traction on the world.

Whenever this is acknowledged (and it often is not), the emphasis is very much on sight. There is the same bias in lay speech and thought – so much so that sight and some sort of cognitive process or conclusion are commonly conflated. ‘Seeing is believing’, we say. ‘I see’, we say, when we really mean that we understand.

This is not surprising. Language and cognition are intimately entangled, and so are vision and cognition. Vision and ‘higher order’ cognition (important inverted commas, those) are spatially close to one another in the brain: that spatial closeness is reflected in functional closeness. Evolutionarily older centres – notably olfaction – are buried deep in the brain. Since they don’t have an office near to ‘higher order’ cognition, their contribution tends to be overlooked in the cognitive league tables. The insights of the nose tend to be denigrated. Continue reading

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