Clinical judgement, expertise and skilled coping

Medicine involves specific practical expertise as well as more general context-independent medical knowledge. This raises the question, what is the nature of the expertise involved? Is there a model of clinical judgement or understanding that can accommodate both elements? This paper begins with a summary of a published account of the kinds of situation-specific skill found in anaesthesia. It authors claim that such skills are often neglected because of a prejudice in favour of the ‘technical rationality’ exemplified in evidence-based medicine but they do not themselves offer a general account of the relation of practical expertise and general medical knowledge. The philosopher Hubert Dreyfus provides one model of the relation of general knowledge to situation-specific skilled coping. He claims that the former logically depends on the latter and provides two arguments, which I articulate in the second section, for this. But he mars those arguments by building in the further assumption that such situation-specific responses must be understood as concept-free and thus mindless. That assumption is held in place by three arguments all of which I criticize in the next section to give a unified account of clinical judgement as both practical and conceptually structured and thus justified in the face of a prejudice in favour of ‘technical rationality’

Computable Rationality, NUTS, and the Nuclear Leviathan

This paper explores how the Leviathan that projects power through nuclear arms exercises a unique nuclearized sovereignty. In the case of nuclear superpowers, this sovereignty extends to wielding the power to destroy human civilization as we know it across the globe. Nuclearized sovereignty depends on a hybrid form of power encompassing human decision-makers in a hierarchical chain of command, and all of the technical and computerized functions necessary to maintain command and control at every moment of the sovereign's existence: this sovereign power cannot sleep. This article analyzes how the form of rationality that informs this hybrid exercise of power historically developed to be computable. By definition, computable rationality must be able to function without any intelligible grasp of the context or the comprehensive significance of decision-making outcomes. Thus, maintaining nuclearized sovereignty necessarily must be able to execute momentous life and death decisions without the type of sentience we usually associate with ethical individual and collective decisions

Robustness to fundamental uncertainty in AGI alignment

The AGI alignment problem has a bimodal distribution of outcomes with most outcomes clustering around the poles of total success and existential, catastrophic failure. Consequently, attempts to solve AGI alignment should, all else equal, prefer false negatives (ignoring research programs that would have been successful) to false positives (pursuing research programs that will unexpectedly fail). Thus, we propose adopting a policy of responding to points of metaphysical and practical uncertainty associated with the alignment problem by limiting and choosing necessary assumptions to reduce the risk false positives. Herein we explore in detail some of the relevant points of uncertainty that AGI alignment research hinges on and consider how to reduce false positives in response to them

On Fodor on Darwin on Evolution

Jerry Fodor argues that Darwin was wrong about "natural selection" because (1) it is only a tautology rather than a scientific law that can support counterfactuals ("If X had happened, Y would have happened") and because (2) only minds can select. Hence Darwin's analogy with "artificial selection" by animal breeders was misleading and evolutionary explanation is nothing but post-hoc historical narrative. I argue that Darwin was right on all counts. Until Darwin's "tautology," it had been believed that either (a) God had created all organisms as they are, or (b) organisms had always been as they are. Darwin revealed instead that (c) organisms have heritable traits that evolved across time through random variation, with survival and reproduction in (changing) environments determining (mindlessly) which variants were successfully transmitted to the next generation. This not only provided the (true) alternative (c), but also the methodology for investigating which traits had been adaptive, how and why; it also led to the discovery of the genetic mechanism of the encoding, variation and evolution of heritable traits. Fodor also draws erroneous conclusions from the analogy between Darwinian evolution and Skinnerian reinforcement learning. Fodor’s skepticism about both evolution and learning may be motivated by an overgeneralization of Chomsky’s “poverty of the stimulus argument” -- from the origin of Universal Grammar (UG) to the origin of the “concepts” underlying word meaning, which, Fodor thinks, must be “endogenous,” rather than evolved or learned

Considering the role of cognitive control in expert performance

© 2014, Springer Science+Business Media Dordrecht. Dreyfus and Dreyfus’ (1986) influential phenomenological analysis of skill acquisition proposes that expert performance is guided by non-cognitive responses which are fast, effortless and apparently intuitive in nature. Although this model has been criticised (e.g., by Breivik Journal of Philosophy of Sport, 34, 116–134 2007, Journal of the Philosophy of Sport, 40, 85–106 2013; Eriksen 2010; Montero Inquiry:An interdisciplinary Journal of Philosophy, 53, 105–122 2010; Montero and Evans 2011) for over-emphasising the role that intuition plays in facilitating skilled performance, it does recognise that on occasions (e.g., when performance goes awry for some reason) a form of ‘detached deliberative rationality’ may be used by experts to improve their performance. However, Dreyfus and Dreyfus (1986) see no role for calculative problem solving or deliberation (i.e., drawing on rules or mental representations) when performance is going well. In the current paper, we draw on empirical evidence, insights from athletes, and phenomenological description to argue that ‘continuous improvement’ (i.e., the phenomenon whereby certain skilled performers appear to be capable of increasing their proficiency even though they are already experts; Toner and Moran 2014) among experts is mediated by cognitive (or executive) control in three distinct sporting situations (i.e., in training, during pre-performance routines, and while engaged in on-line skill execution). We conclude by arguing that Sutton et al. Journal of the British Society for Phenomenology, 42, 78–103 (2011) ‘applying intelligence to the reflexes’ (AIR) approach may help to elucidate the process by which expert performers achieve continuous improvement through analytical/mindful behaviour during training and competition

On the Origin of Purpose: Une Faux Probleme

In this essay we analyze the question of the origin of purpose. Due to the overwhelming success of science in explaining phenomena, it is often asked, when, and how science could explain purpose and consciousness by use of purely mechanical laws. Here I argue that such a reduction is impossible

From cognitive science to cognitive neuroscience to neuroeconomics

As an emerging discipline, neuroeconomics faces considerable methodological and practical challenges. In this paper, I suggest that these challenges can be understood by exploring the similarities and dissimilarities between the emergence of neuroeconomics and the emergence of cognitive and computational neuroscience two decades ago. From these parallels, I suggest the major challenge facing theory formation in the neural and behavioural sciences is that of being under-constrained by data, making a detailed understanding of physical implementation necessary for theory construction in neuroeconomics. Rather than following a top-down strategy, neuroeconomists should be pragmatic in the use of available data from animal models, information regarding neural pathways and projections, computational models of neural function, functional imaging and behavioural data. By providing convergent evidence across multiple levels of organization, neuroeconomics will have its most promising prospects of success