45 research outputs found
Jamesâs Epistemology and the Will to Believe
William Jamesâs paper âThe Will to Believeâ defends some distinctive and controversial views about the normative standards that should be adopted when we are reflecting upon what we should believe. He holds that, in certain special kinds of cases, it is rational to believe propositions even if we have little or no evidence to support our beliefs. And, in such cases, he holds that our beliefs can be determined by what he calls âpassional considerationsâ which include âfear and hope, prejudice and passion, imitation and partisanship, the circumpressure of our caste and setâ (1897: 9). On most occasions âwe find ourselves believing, we hardly know how or why.â When James allows passional considerations a major role in determining the rationality of belief and argues that it is rational to form beliefs in advance of the evidence, he can easily be understood as holding that belief can be responsible when it is not warranted by epistemological norms. Belief can be rational and responsible when the reasons which support it are entirely prudential or practical. The question I am concerned with here is: how far can Jamesâs argument in âThe Will to Believeâ be understood as an application of some views which are genuinely epistemological? One question we can ask about these views is: how far are they an application of a distinctively pragmatist approach to epistemological concerns about when belief is justified? One possibility is that James is making some original contributions to epistemology which may have echoes in contemporary epistemology. I shall argue that this interpretation of Jamesâs argument is more plausible than it at first appears
When Deduction leads to Belief
T h e paper questions the common assumption that rational individuals believe all propositions which they know to be logical consequences of their other beliefs: although we must acknowledge the truth of a proposition which is a deductive consequence ofour beliefs, we may not genuinely believe it. This conclusion is defended by arguing that some familiar counter- examples to the claim that knowledge isjustified true belief fail because they involve propositions which are not really believed. Beliefs guide conduct or issue in assertion by answering questions which arise in the course of deliberation and conversation, but the troublesome cases present proposi- tions which do not present the agent's answer to any question. The paper concludes by sketching the conditions under which the deductive conse- quences of our beliefs can be believe
British Champions of Peirce
When the history of American philosophy in the nineteenth century can be written in great detail than hitherto, the important place of Charles S. Peirce as a pathfinder in every one of the many fields that his work touched will have to receive fuller recognition than has as yet been accorded to it. This quotation is from âCharles Peirceâs Pragmatism,â a paper by John Henry Muirhead that was published in The Philosophical Review in 1930s. It is evidence that the value of Peirceâs work was reco..
El escepticismo y el principio de justificacion inferencial
In his book Metaepistemology and Skepticism, Richard Fumerton formulates a "principle of inferential justification" which he takes to be fundamental to our practice of reflection on the epistemic status of our beliefs and which he takes to provide the basis of some powerful skeptical arguments. After introducing Fumerton's principle and the role it is given in skeptical arguments, the paper argues that it does not have the force that he claims
Lotze and the Classical Pragmatists
It has been said that, after the fall of modernism, Hermann Lotze (1817-81) reigned as the single most influential philosopher in Germany, perhaps the worldâ (Sullivan 2008: 2). It is now not easy to take such claims about Lotze seriously, and historical surveys of nineteenth century philosophy treat him as a marginal figure, if they mention him at all. Part of the explanation of this change in his standing becomes clear if we accept Sullivanâs helpful observation that Lotze was a âprominent ..
Radical surgery versus organ preservation via short-course radiotherapy followed by transanal endoscopic microsurgery for early-stage rectal cancer (TREC): a randomised, open-label feasibility study
Background:
Radical surgery via total mesorectal excision might not be the optimal first-line treatment for early-stage rectal cancer. An organ-preserving strategy with selective total mesorectal excision could reduce the adverse effects of treatment without substantially compromising oncological outcomes. We investigated the feasibility of recruiting patients to a randomised trial comparing an organ-preserving strategy with total mesorectal excision.
Methods:
TREC was a randomised, open-label feasibility study done at 21 tertiary referral centres in the UK. Eligible participants were aged 18 years or older with rectal adenocarcinoma, staged T2 or lower, with a maximum diameter of 30 mm or less; patients with lymph node involvement or metastases were excluded. Patients were randomly allocated (1:1) by use of a computer-based randomisation service to undergo organ preservation with short-course radiotherapy followed by transanal endoscopic microsurgery after 8â10 weeks, or total mesorectal excision. Where the transanal endoscopic microsurgery specimen showed histopathological features associated with an increased risk of local recurrence, patients were considered for planned early conversion to total mesorectal excision. A non-randomised prospective registry captured patients for whom randomisation was considered inappropriate, because of a strong clinical indication for one treatment group. The primary endpoint was cumulative randomisation at 12, 18, and 24 months. Secondary outcomes evaluated safety, efficacy, and health-related quality of life assessed with the European Organisation for Research and Treatment of Cancer (EORTC) QLQ C30 and CR29 in the intention-to-treat population. This trial is registered with the ISRCTN Registry, ISRCTN14422743.
Findings:
Between Feb 22, 2012, and Dec 19, 2014, 55 patients were randomly assigned at 15 sites; 27 to organ preservation and 28 to radical surgery. Cumulatively, 18 patients had been randomly assigned at 12 months, 31 at 18 months, and 39 at 24 months. No patients died within 30 days of initial treatment, but one patient randomly assigned to organ preservation died within 6 months following conversion to total mesorectal excision with anastomotic leakage. Eight (30%) of 27 patients randomly assigned to organ preservation were converted to total mesorectal excision. Serious adverse events were reported in four (15%) of 27 patients randomly assigned to organ preservation versus 11 (39%) of 28 randomly assigned to total mesorectal excision (p=0·04, Ï2 test). Serious adverse events associated with organ preservation were most commonly due to rectal bleeding or pain following transanal endoscopic microsurgery (reported in three cases). Radical total mesorectal excision was associated with medical and surgical complications including anastomotic leakage (two patients), kidney injury (two patients), cardiac arrest (one patient), and pneumonia (two patients). Histopathological features that would be considered to be associated with increased risk of tumour recurrence if observed after transanal endoscopic microsurgery alone were present in 16 (59%) of 27 patients randomly assigned to organ preservation, versus 24 (86%) of 28 randomly assigned to total mesorectal excision (p=0·03, Ï2 test). Eight (30%) of 27 patients assigned to organ preservation achieved a complete response to radiotherapy. Patients who were randomly assigned to organ preservation showed improvements in patient-reported bowel toxicities and quality of life and function scores in multiple items compared to those who were randomly assigned to total mesorectal excision, which were sustained over 36 monthsâ follow-up. The non-randomised registry comprised 61 patients who underwent organ preservation and seven who underwent radical surgery. Non-randomised patients who underwent organ preservation were older than randomised patients and more likely to have life-limiting comorbidities. Serious adverse events occurred in ten (16%) of 61 non-randomised patients who underwent organ preservation versus one (14%) of seven who underwent total mesorectal excision. 24 (39%) of 61 non-randomised patients who underwent organ preservation had high-risk histopathological features, while 25 (41%) of 61 achieved a complete response. Overall, organ preservation was achieved in 19 (70%) of 27 randomised patients and 56 (92%) of 61 non-randomised patients.
Interpretation:
Short-course radiotherapy followed by transanal endoscopic microsurgery achieves high levels of organ preservation, with relatively low morbidity and indications of improved quality of life. These data support the use of organ preservation for patients considered unsuitable for primary total mesorectal excision due to the short-term risks associated with this surgery, and support further evaluation of short-course radiotherapy to achieve organ preservation in patients considered fit for total mesorectal excision. Larger randomised studies, such as the ongoing STAR-TREC study, are needed to more precisely determine oncological outcomes following different organ preservation treatment schedules.
Funding:
Cancer Research UK