Implicit trust in clinical decision-making by multidisciplinary teams

In clinical practice, decision-making is not performed by individual knowers but by an assemblage of people and instruments in which no one member has full access to every piece of evidence. This is due to decision making teams consisting of members with different kinds of expertise, as well as to organisational and time constraints. This raises important questions for the epistemology of medicine, which is inherently social in this kind of setting, and implies epistemic dependence on others. Trust in these contexts is a highly complex social practice, involving different forms of relationships between trust and reasons for trust: based on reasons, and not based on reasons; based on reasons that are easily accessible to reflection and others that are not. In this paper, we focus on what it means to have reasons to trust colleagues in an established clinical team, collectively supporting or carrying out every day clinical decision-making. We show two important points about these reasons, firstly, they are not sought or given in advance of a situation of epistemic dependence, but are established within these situations; secondly they are implicit in the sense of being contained or nested within other actions that are not directly about trusting another person. The processes of establishing these reasons are directly about accomplishing a task, and indirectly about trusting someone else’s expertise or competence. These processes establish a space of reasons within which what it means to have reasons for trust, or not, gains a meaning and traction in these team-work settings. Based on a qualitative study of decision-making in image assisted diagnosis and treatment of a complex disease called pulmonary hypertension (PH), we show how an intersubjective framework, or ‘space of reasons’ is established through team members forging together a common way of identifying and dealing with evidence. In dealing with images as a central diagnostic tool, this also involves a common way of looking at the images, a common mode or style of perception. These frameworks are developed through many iterations of adjusting and calibrating interpretations in relation to those of others, establishing what counts as evidence, and ranking different kinds of evidence. Implicit trust is at work throughout this process. Trusting the expertise of others in clinical decision-making teams occurs while the members of the team are busy on other tasks, most importantly, building up a framework of common modes of seeing, and common ways of identifying and assessing evidence emerge. It is only in this way that trusting or mistrusting becomes meaningful in these contexts, and that a framework for epistemic dependence is established

Implicit trust in clinical decision-making by multidisciplinary teams

In clinical practice, decision-making is not performed by individual knowers but by an assemblage of people and instruments in which no one member has full access to every piece of evidence. This is due to decision making teams consisting of members with different kinds of expertise, as well as to organisational and time constraints. This raises important questions for the epistemology of medicine, which is inherently social in this kind of setting, and implies epistemic dependence on others. Trust in these contexts is a highly complex social practice, involving different forms of relationships between trust and reasons for trust: based on reasons, and not based on reasons; based on reasons that are easily accessible to reflection and others that are not. In this paper, we focus on what it means to have reasons to trust colleagues in an established clinical team, collectively supporting or carrying out every day clinical decision-making. We show two important points about these reasons, firstly, they are not sought or given in advance of a situation of epistemic dependence, but are established within these situations; secondly they are implicit in the sense of being contained or nested within other actions that are not directly about trusting another person. The processes of establishing these reasons are directly about accomplishing a task, and indirectly about trusting someone else’s expertise or competence. These processes establish a space of reasons within which what it means to have reasons for trust, or not, gains a meaning and traction in these team-work settings. Based on a qualitative study of decision-making in image assisted diagnosis and treatment of a complex disease called pulmonary hypertension (PH), we show how an intersubjective framework, or ‘space of reasons’ is established through team members forging together a common way of identifying and dealing with evidence. In dealing with images as a central diagnostic tool, this also involves a common way of looking at the images, a common mode or style of perception. These frameworks are developed through many iterations of adjusting and calibrating interpretations in relation to those of others, establishing what counts as evidence, and ranking different kinds of evidence. Implicit trust is at work throughout this process. Trusting the expertise of others in clinical decision-making teams occurs while the members of the team are busy on other tasks, most importantly, building up a framework of common modes of seeing, and common ways of identifying and assessing evidence emerge. It is only in this way that trusting or mistrusting becomes meaningful in these contexts, and that a framework for epistemic dependence is established

Spreading the Credit: Virtue Reliabilism and Weak Epistemic Anti-Individualism

Mainstream epistemologists have recently made a few isolated attempts to demonstrate the particular ways, in which specific types of knowledge are partly social. Two promising cases in point are Lackey’s (Learning from words: testimony as a source of knowledge. Oxford University Press, Oxford, 2008) dualism in the epistemology of testimony and Goldberg’s (Relying on others: an essay in epistemology. Oxford University Press, Oxford, 2010) process reliabilist treatment of testimonial and coverage-support justification. What seems to be missing from the literature, however, is a general approach to knowledge that could reveal the partly social nature of the latter anytime this may be the case. Indicatively, even though Lackey (Synthese 158(3):345–361, 2007) has recently launched an attack against the Credit Account of Knowledge (CAK) on the basis of testimony, she has not classified her view of testimonial knowledge into any of the alternative, general approaches to knowledge. Similarly, even if Goldberg’s attempt to provide a process reliabilist explanation of the social nature of testimonial knowledge is deemed satisfactory, his attempt to do the same in the case of coverage-support justification does not deliver the requisite result. This paper demonstrates that CAK can in fact provide, pace Lackey’s renunciation of the view, a promising account of the social nature of both testimonial and coverage-supported knowledge. Additionally, however, it can display further explanatory power by also revealing the social nature of knowledge produced on the basis of epistemic artifacts. Despite their disparities, all these types of knowledge count as partly social in nature, because in all these cases, according to CAK, the epistemic credit for the individual agent’s true belief must spread between the individual agent and certain parts of her epistemic community. Accordingly, CAK is a promising candidate for providing a unified approach to several and, perhaps all possible, instances of what we may call ‘weak epistemic anti-individualism’ within mainstream epistemology: i.e., the claim that the nature of knowledge can occasionally be both social and individual at the same time

In the space of reasonable doubt

This paper explores ‘reasonable doubt’ as an enlightening notion to think of reasoning and decision-making generally, beyond the judicial domain. The paper starts from a decision-theoretic understanding of the notion, whereby it can be defined in terms of degrees of belief and a probabilistic confirmation threshold for action. It then highlights some of the limits of this notion, and proposes a richer analysis of epistemic states and reasoning through the lens of ‘reasonable doubt’, which in turn is likely to supplement the DT framework. The strategy consists in fighting on two fronts: with DT, the paper claims that there is no absolute (i.e. decision-independent) notion of ‘reasonable doubt’ but, pace DT, it shows that reasonable doubt cannot be accounted for only in terms of degrees of belief and probabilistic threshold. We argue that the lens of reasonable doubt sheds light on aspects of belief dynamics, as well as of the nature of epistemic attitudes, which are often obscured by belief-centred approaches. In particular, when it comes to acknowledging the necessary ignorance and irreducible uncertainty that we face in our everyday-life decisions, studying the various facets of doubt rather than focusing on what can be believed, enables one to do justice to the richness and diversity of the mental states in play

Crowdsourced science: sociotechnical epistemology in the e-research paradigm

Recent years have seen a surge in online collaboration between experts and amateurs on scientific research. In this article, we analyse the epistemological implications of these crowdsourced projects, with a focus on Zooniverse, the world’s largest citizen science web portal. We use quantitative methods to evaluate the platform’s success in producing large volumes of observation statements and high impact scientific discoveries relative to more conventional means of data processing. Through empirical evidence, Bayesian reasoning, and conceptual analysis, we show how information and communication technologies enhance the reliability, scalability, and connectivity of crowdsourced e-research, giving online citizen science projects powerful epistemic advantages over more traditional modes of scientific investigation. These results highlight the essential role played by technologically mediated social interaction in contemporary knowledge production. We conclude by calling for an explicitly sociotechnical turn in the philosophy of science that combines insights from statistics and logic to analyse the latest developments in scientific research