Medical knowledge in a social world: Introduction to the special issue

Philosophy of medicine has traditionally examined two issues: the scientific ontology for medicine and the epistemic significance of the types of evidence used in medical research. In answering each question, philosophers have typically brought to bear tools from traditional analytic philosophy. In contrast, this volume explores medical knowledge from the perspective offered by social epistemology. While many of the same issues are addressed, the approach to these issues generates both fresh questions and new insights into old debates. In addition, the broader purview offered by social epistemology opens up opportunities to address new topics such as the role of consensus conferences, epistemic injustice, the value of medical knowledge, continuing medical education, and industry funding. This article situates and summarizes the contributions to this special issue.

     

Character in Epistemology

This paper examines the claim made by certain virtue epistemologists that intellectual character virtues like fair-mindedness, open-mindedness and intellectual courage merit an important and fundamental role in epistemology. I begin by considering whether these traits merit an important role in the analysis of knowledge. I argue that they do not and that in fact they are unlikely to be of much relevance to any of the traditional problems in epistemology. This presents a serious challenge for virtue epistemology. I go on to examine the work of two other virtue epistemologists in light of this challenge and then sketch an alternative approach that reveals how the intellectual virtues might merit a substantial role in epistemology even if not a role in connection with more traditional epistemological projects.     

From Standpoint Epistemology to Epistemic Oppression

Standpoint epistemology is committed to a cluster of views that pays special attention to the role of social identity in knowledge‐acquisition. Of particular interest here is the situated knowledge thesis. This thesis holds that for certain propositions p, whether an epistemic agent is in a position to know that p depends on some nonepistemic facts related to the epistemic agent's social identity. In this article, I examine two possible ways to interpret this thesis. My first goal here is to clarify existing interpretations of this thesis that appear in the literature but that are undeveloped and often mistakenly conflated. In so doing, I aim to make clear the different versions of standpoint epistemology that one might accept and defend. This project is of significance, I argue, because standpoint epistemology provides helpful tools for understanding a phenomenon of recent interest: epistemic oppression. My second goal is to provide an analysis that makes clear how each of the readings I put forth can be used to illuminate forms of epistemic oppression.     

Perceptual Evidence and Information

Quite recently, Luciano Floridi has put forward the fascinating suggestion that knowledge should be analyzed as special kind of information, in particular as accounted information. As I will try tentatively to show, one important consequence of Floridi’s proposal is that the notion of justification, and of evidence, should play no role in a philosophical understanding of knowledge. In this paper, I shall suggest one potential difficulty with which Floridi’s proposal might be consequently afflicted, yet accept the fundamental suggestion that traditional epistemology should be merrily wedded with the philosophy of information; in particular, I shall plead for the less drastic conclusion, according to which, although knowledge should be taken to entail justification, it is the very notion of evidence—in particular of perceptual evidence—that should be analyzed in information-theoretic terms. By so doing, my principal aim will be to explain away an apparent difficulty—which is preliminary to the preoccupations motivating Floridi’s more ambitious attempt—from which Conee and Feldman’s Evidentialism is apparently afflicted. So, the conclusion that I will try to establish is that the notion of perceptual evidence, once it is appropriately analyzed in information-theoretic terms, should play an important role in our understanding of knowledge.     

Epistemic Injustice in Social Cognition

Silencing is a practice that disrupts linguistic and communicative acts, but its relationship to knowledge and justice is not fully understood. Prior models of epistemic injustice tend to characterize silencing as a symptom that follows as a result of underrepresenting the knowledge of others. In this paper, I advance a model of epistemic injustice in which the opposite sometimes happens. Drawing on recent work in experimental cognitive science, I argue that silencing can cause misrepresentations of knowledge and, subsequently, epistemic injustice to occur. Drawing on recent work in epistemology, I also argue that, according to some leading theories, silencing potentially causes ignorance by depriving individuals and communities of knowledge itself. These findings expand our understanding of silencing in social practice, contribute a broader model of epistemic injustice for research at the intersection of ethics and philosophy of mind, and have implications for leading theories of knowledge in epistemology.     

Epistemic Presuppositions and their Consequences

Traditional epistemology has, in the main, presupposed that the primary task is to give a complete account of the concept knowledge and to state under what conditions it is possible to have it. In so doing, most accounts have been hierarchical, and all assume an idealized knower. The assumption of an idealized knower is essential for the traditional goal of generating an unassailable account of knowledge acquisition. Yet we, as individuals, fail to reach the ideal. Perhaps more important, we have epistemic goals not addressed in the traditional approach – among them, the ability to reach understanding in areas we deem important for our lives. Understanding is an epistemic concept. But how we obtain it has not traditionally been a focus. Developing an epistemic account that starts from a set of assumptions that differ from the traditional starting points will allow a different sort of epistemic theory, one on which generating understanding is a central goal and the idealized knower is replaced with an inquirer who is not merely fallible but working from a particular context with particular goals. Insight into how an epistemic account can include the particular concerns of an embedded inquirer can be found by examining the parallels between ethics and epistemology and, in particular, by examining the structure and starting points of virtue accounts. Here I develop several interrelated issues that contrast the goals and evaluative concepts that form the structure of both standard, traditional epistemological and ethical theories and virtue–centered theories. In the end, I sketch a virtue–centered epistemology that accords with who we are and how we gain understanding.     

Epistemic Presuppositions and their Consequences

Traditional epistemology has, in the main, presupposed that the primary task is to give a complete account of the concept knowledge and to state under what conditions it is possible to have it. In so doing, most accounts have been hierarchical, and all assume an idealized knower. The assumption of an idealized knower is essential for the traditional goal of generating an unassailable account of knowledge acquisition. Yet we, as individuals, fail to reach the ideal. Perhaps more important, we have epistemic goals not addressed in the traditional approach – among them, the ability to reach understanding in areas we deem important for our lives. Understanding is an epistemic concept. But how we obtain it has not traditionally been a focus. Developing an epistemic account that starts from a set of assumptions that differ from the traditional starting points will allow a different sort of epistemic theory, one on which generating understanding is a central goal and the idealized knower is replaced with an inquirer who is not merely fallible but working from a particular context with particular goals. Insight into how an epistemic account can include the particular concerns of an embedded inquirer can be found by examining the parallels between ethics and epistemology and, in particular, by examining the structure and starting points of virtue accounts. Here I develop several interrelated issues that contrast the goals and evaluative concepts that form the structure of both standard, traditional epistemological and ethical theories and virtue–centered theories. In the end, I sketch a virtue–centered epistemology that accords with who we are and how we gain understanding.     

The Future of The Structure of Scientific Revolutions

I examine the value and limitations of Kuhn’s Structure of Scientific Revolutions. In the interests of developing a social epistemology of science, I argue that we should draw on Kuhn’s later work, published in The Road since Structure. There, Kuhn draws attention to the important role that specialty formation plays in resolving crises in science, a topic he did not discuss in Structure. I argue that we need to develop a better understanding of specialty research communities. Kuhn’s later work provides a research agenda for those who want to study scientific specialization. I briefly discuss some recent studies that promise to provide valuable insight into the social structure of science.     

On regulating what is known: A way to social epistemology

This paper lays the groundwork for normative-yet-naturalistic social epistemology. I start by presenting two scenarios for the history of epistemology since Kant, one in which social epistemology is the natural outcome and the other in which it represents a not entirely satisfactory break with classical theories of knowledge. Next I argue that the current trend toward naturalizing epistemology threatens to destroy the distinctiveness of the sociological approach by presuming that it complements standard psychological and historical approaches. I then try to reassert, in Comtean fashion, the epistemologist's credentials in regulating knowledge production. Finally, I consider how social epistemology may have something exciting and relevant to say about contemporary debates in the theory of knowledge.A version of this paper appears as chapter one of Fuller (1988). My warmest thanks goes to Fred Schmitt, who saved me from many unclarities and howlers, as well as provided many probing remarks and criticisms with which I have barely begun to grapple.     

Caught in the Language-Game

In this paper, I first introduce the main motivations for the internalism/externalism dichotomy in epistemology and explore different accounts of epistemic justification, mostly externalist, arising from Dretske’s relevant alternatives theory of knowledge, namely the reliabilism of Goldman and Nozick, the contextualism of Cohen and DeRose, which is governed by fallibilist standards, and Lewis’ version of contextualism, to which infallibilist standards apply. I then argue that Wittgenstein critically anticipates many of these strategies and tries to avoid such a dichotomy by assuming a form of infallibilism which is neither internal nor external. After introducing the idea of a Wittgensteinian hinge epistemology and how it responds to the problem of epistemic justification and to the particular challenge posed by radical scepticism, I defend the view that infallibility is logically unavoidable when we realize that we are always trapped in one language-game or another, even if we constantly switch between language-games.

     

Managing Salience: The Importance of Intellectual Virtue in Analyses of Biased Scientific Reasoning

Feminist critiques of science show that systematic biases strongly influence what scientific communities find salient. Features of reality relevant to women, for instance, may be under‐appreciated or disregarded because of bias. Many feminist analyses of values in science identify problems with salience and suggest better epistemologies. But overlooked in such analyses are important discussions about intellectual virtues and the role they play in determining salience. Intellectual virtues influence what we should find salient. They do this in part by managing the emotions, which are cognitively involved in what we actually do find salient. One reason intellectual virtues do not factor more strongly in feminist epistemology is the mistaken assumption that they could not serve as explicit epistemic community standards for scientific inquiry. There are good reasons, however, to think in terms of community intellectual virtue and consequently, to advance explicit public standards of intellectual virtue for scientific research. To show how explicit public standards for intellectual virtue might improve reasoning in biased conditions, I analyze a striking oversight in several evolutionary immunological hypotheses concerning women's reproduction and sexuality. I conclude that feminist epistemology would benefit from greater consideration of intellectual virtues, particularly in connection with social epistemological insights.     

Reminiscing together: joint experiences,epistemic groups,and sense of self

In this essay, I consider a kind of social group that I call ‘epistemic’. It is constituted by its members’ possession of perceptually grounded common knowledge, which endows them with a particular kind of epistemic authority. This authority, I argue, is invoked in the activity of ‘joint reminiscing’—of remembering together a past jointly experienced event. Joint reminiscing, in turn, plays an important role in the constitution of social and personal identity. The notion of an epistemic group, then, is a concept that helps explain an important aspect of a subject’s understanding of who she is.

     

Specific and Generic Objects in Cavell and Thomas Aquinas

Here I establish a parallel between modern epistemology and traditional metaphysics: between the way we know an object, on the one hand, and the way an object's causes cause it to exist, on the other. I show that different efficient causes in the Thomistic system correspond to different questions of knowledge, as analyzed by Stanley Cavell, and that in particular the question the Cavellian skeptic asks corresponds to God's causation in creation. As I have explained in detail elsewhere, and discuss briefly here, this parallel represents far more than a formal analogy between a series of issues in epistemology and a series of issues in metaphysics. It helps to explain, in fact, why modern philosophers (e.g., Husserl) were ultimately driven to put the human ego in the place of God, as creating (or "positing") the objects of its knowledge, thereby denying the very distinction between epistemology and ontology.     

Historical Epistemology or History of Epistemology? The Case of the Relation Between Perception and Judgment Dedicated to Günther Patzig on his 85th birthday

This essay aims to sharpen debates on the pros and cons of historical epistemology, which is now understood as a novel approach to the study of knowledge, by comparing it with the history of epistemology as traditionally pursued by philosophers. The many versions of both approaches are not always easily discernable. Yet, a reasoned comparison of certain versions can and should be made. In the first section of this article, I argue that the most interesting difference involves neither the subject matter nor goal, but the methods used by the two approaches. In the second section, I ask which of the two approaches or methods is more promising given that both historical epistemologists and historians of epistemology claim to contribute to epistemology simpliciter. Using traditional problems concerning the epistemic role of perception, I argue that the historical epistemologies of Wartofsky and Daston and Galison fail to show that studying practices of perception is philosophically significant. Standard methods from the history of epistemology are more promising, as I show by means of reconstructing arguments in a debate about the relation between perception and judgment in psychological research on the famous moon illusion.     

The noetic effects of sin: a dispositional framework

One of the well-known theses of Alvin Plantinga’s epistemology of religious belief is his claim about the noetic effects of sin. But Plantinga does not clearly spell out how sin functions to undermine or weaken the believer’s natural knowledge of God. In this paper, I want to suggest a dispositional gloss on his account of religious epistemology that properly identifies the epistemic role of sin and other factors that may undermine knowledge of God. It will be further argued that the dispositional framework provides us with a principled basis for deriving some of the main contours of Plantinga’s general epistemology.

     

Reflective Equilibrium as an Ameliorative Framework for Feminist Epistemology

As Helen Longino's overview of Hypatia's engagement with feminist epistemology suggests, the last twenty‐five years’ contributions to this field reveal a strong focus on the topic of knowledge. In her short outline, Longino questions this narrow focus on knowledge in epistemological inquiry. The main purpose of this article is to provide a framework for systematically taking up the questions raised by Longino, one that prevents us from running the risk of becoming unreflectively involved in sexist, racist, or otherwise problematic inquiry. I argue that a specific form of the method of Reflective Equilibrium, as it is widely discussed in moral epistemology, logic, and theories of rationality, enables us to cope with the problems of traditional epistemology, which feminist theorizers such as Sally Haslanger have pointed to. With the account of Reflective Equilibrium I am offering—drawing in many respects on the model provided by Catherine Z. Elgin—we have an ameliorative method that allows us to rethink epistemological values, goals, and standards in a systematic way, and that largely avoids implicit and explicit biases in epistemology.     

Feminist Radical Empiricism,Values, and Evidence

Feminist epistemologies consider ways in which gender (among other social factors) influences knowledge. In this article, I want to consider a particular kind of feminist empiricism that has been called feminist radical empiricism (where the empiricism, not the feminism, is radical). I am particularly interested in this view's treatment of values as empirical, and consequently up for revision on the basis of empirical evidence. Proponents of this view cite the fact that it allows us to talk about certain things such as racial and gender equality as objective facts: not just whether we have achieved said equality in our society, but whether we are, in fact, all equal. I will raise the concern that the way in which they model the role of values in epistemology may be a problematic idealization of the open‐mindedness of human agents. In some cases, resistance to value‐change cannot be diagnosed as a failure to respond adequately to evidence. If so, the strategy of empirically testing our values that some feminist radical empiricists suggest may not be as useful a tool for social change as they think.     

Feminist Epistemology, Contextualism, and Philosophical Skepticism

Abstract: This essay explores the relation between feminist epistemology and the problem of philosophical skepticism. Even though feminist epistemology has not typically focused on skepticism as a problem, I argue that a feminist contextualist epistemology may solve many of the difficulties facing recent contextualist responses to skepticism. Philosophical skepticism appears to succeed in casting doubt on the very possibility of knowledge by shifting our attention to abnormal contexts. I argue that this shift in context constitutes an attempt to exercise unearned social and epistemic power and that it should be resisted on epistemic and pragmatic grounds. I conclude that skepticism is a problem that feminists can and should take up as they address the social aspects of traditional epistemological problems.     

Community Science, Philosophy of Science, and the Practice of Research

Embedded in community science are implicit theories on the nature of reality (ontology), the justification of knowledge claims (epistemology), and how knowledge is constructed (methodology). These implicit theories influence the conceptualization and practice of research, and open up or constrain its possibilities. The purpose of this paper is to make some of these theories explicit, trace their intellectual history, and propose a shift in the way research in the social and behavioral sciences, and community science in particular, is conceptualized and practiced. After describing the influence and decline of logical empiricism, the underlying philosophical framework for science for the past century, I summarize contemporary views in the philosophy of science that are alternatives to logical empiricism. These include contextualism, normative naturalism, and scientific realism, and propose that a modified version of contextualism, known as perspectivism, affords the philosophical framework for an emerging community science. I then discuss the implications of perspectivism for community science in the form of four propositions to guide the practice of research.Portions of this paper are based on an invited paper presented at the May 1997 Pre-Conference Workshop of the Biennial Conference of the Society for Community Research and Action, Columbia, South Carolina.     

ON THE POSSIBILITY OF FEMINIST EPISTEMOLOGY

Abstract: In this article, I propose one way of understanding the expression "feminist epistemology." I begin from the premise that improper philosophical attention has been paid to the implications of what I call The Fact of Preconditions for Agency: that moral and rational agents become such only through a long, deliberate, and intensive process of intervention and teaching, a process that requires commitments of time, effort and emotion on the part of other agents. I contend that this is a sufficiently important aspect of what it is to be a person that accounting for its philosophical implications may have repercussions not only for moral and political theory, but for epistemology as well. I contend further that, given the current configuration of social possibilities, a theory that acknowledges this Fact might appropriately be deemed "feminist."
My argument is presented in four segments. In Section II, I show how such a theory could be feminist by providing a discussion of categories of social identity; in Section III, I show how such a theory could be epistemology by describing a strategy of argument from parity. In Section IV, I apply this strategy to a case from political philosophy to show why its counter-intuitive implications do not provide good grounds for rejecting the suggested redistricting. And in Section V, I apply the same strategy to a case from epistemology to bring out how it might lead to a theory that might legitimately claim to be feminist epistemology.