Ethics of medical AI: the case of Watson for Oncology

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Introduction: intersubjectivity and empathy

Editors Introduction to the Special Issue, Intersubjectivity and Empathy, of Phenomenology and the Cognitive SciencesAuthor has checked copyrightSB. 25/4/2013

Introduction: intersubjectivity and empathy

Empathy may be understood as a particular topic within the larger discussion of the nature of intersubjectivity, i.e. discussions about how we are to understand the basic communicative relations between subjects and the importance of such interpersonal relations for our way of relating to the world as a whole. We routinely say of other persons such things as: 'she is angry'; 'he failed to understand my point', 'we are both looking for the same thing', 'we share a point of view', 'I feel your pain', 'I was upset to see Mary in pain', 'I can differentiate between what he said and what he meant', and so on. (The Cambridge Behaviour Scale gives a good series of questions that highlight various forms of empathic understanding, see No quality of human nature is more remarkable, both in itself and in its consequences, than that propensity we have to sympathize with others, and to receive by communication their inclinations and sentiments, however, different from, or even contrary to our own. (Hume 1978, pp. 316-17) At some point in the 1970s, cognitive scientists and philosophers of mind started using the catchy term 'mind reading' to describe what most humans do most of the time in their perceiving, emotionally apprehending, understanding, interpreting and predicting the intentional activity and behaviour (cognitive and emotive) of other humans and some higher animals. The term was probably first introduced into philosophy by Daniel C. Dennett in his 'Brain Writing and Mind Reading ' (originally 1975' (originally , reprinted in Dennett 1978. Dennett himself was responding to issues raised in Elizabeth Anscombe's groundbreaking book Intention concerning the special ways we seem to acquire knowledge about our own intentional actions (Anscombe 1957). The notion of mind reading is often defined simply as the capacity to attribute mental states to self or other and so is not reserved for our understanding of other minds (cf. Goldman 2008). In fact, those traditionally interested in understanding the functioning of empathy (including Husserl and Lipps) included a person's attempts to recall in memory or to understand earlier stages of his or her self as phenomena falling under the concept. Generally, 'mindreading' is regarded as a subspecies of what is known in psychology as 'metarepresentation' (see Whiten 1991; Sperber 2000), i.e. the ability to represent the representations of oneself or others (see also Goldman 2009; Goldman and Shanton 2010). However, if we define 'mind reading' as the ability to attribute mental states to oneself and to others, it can be used as a theory-neutral term that stands for a crucial explanandum for research in social cognition that allows for different explanantia. What is not uncontroversial, however, is whether 'mind reading' in this sense is always based on the use of capacities that exceed those already in play in our sensory experiences, such as the ordinary meaning of the word suggests. Broadly speaking the majority of recent explanatory theories concerning our mind reading capacities can be classified as falling under one of two broad approaches: -the 'theory theory' approach (attribution of mental states via the application of a naïve theory of psychological states and their implications; involves theory-based inferences); -the 'simulation theory' approach (attribution of mental states via emulation or replication of states of the other; does not necessarily involve inferences). As James O'Shea highlights in his contribution to this special issue the American philosopher Wilfrid Sellars (1912Sellars ( -1989 is often said to have been the progenitor of the 'theory theory' approach to social cognition. In the form of an empirical theory about mind reading, however, the theory theory is usually said to have originated in a 1978 paper by Premack and Woodruff, 'Does the chimpanzee have a theory of mind?' R.T. Jensen, D. Moran published in Behavioral and Brain Sciences As a number of authors have recently argued, the analyses of empathy found in the works of some of the classical phenomenologists (notably Husserl and Scheler) challenge both the theory theory and the simulation theory by considering empathy as an irreducible, perception-based understanding of the other, which depends neither on inferences nor on simulation processes (cf. All four papers in this issue present versions of the idea that perception can be a direct source of knowledge about the minds of others. We can call this the 'direct perception' thesis (DP). In its most comprehensive version, DP is both a thesis about the psychological mechanisms involved in the formation of certain judgement about other minds and a thesis about the ultimate source of justification of such judgements. This, the comprehensive version of DP, claims that perception can provide the perceiver with knowledge of other minds without the perceiver relying on any actual theorizing or simulation and without the observational judgement receiving its epistemic status as knowledge because of a potential inferential justification. This-the strongest version of the direct perception thesis-involves a commitment to both the psychological immediacy and the epistemic immediacy of certain pieces of knowledge of other minds. However, the epistemic version of DP need not be combined with the psychological version and the psychological version-regardless of whether it is a thesis concerning personal or sub-personal processes-need not be combined with the epistemic version. Both Rowland Stout and Joel Krueger defend epistemic versions of DP in their respective contributions. Krueger explicitly combines the epistemic thesis with the psychological version both at the personal and at the sub-personal level. James O'Shea, in his paper 'The "theory theory" of mind and the aims of Sellars' original Myth of Jones', argues that Wilfrid Sellars' original version of the 'theory theory' can accommodate many, if not all, of the objections Introduction: intersubjectivity and empathy raised against the 'theory theory' by proponents of the direct perception approach. It can do so because it subscribes to a psychological version of DP at the personal level, while denying that our knowledge of others is epistemically non-inferential. As O'Shea notes, this combination of a personal level psychological immediacy and epistemic indirectness can coherently be combined with both a theory theory account and a simulation account at the sub-personal level. Finally, in their paper 'The extended body: a case study in the neurophenomenology of social interaction', Froese and Fuchs argue for the possibility of accounting for some basic phenomena of social interaction via a dynamical systems theory approach. They argue for the psychological version of DP both at the personal and at the sub-personal level. In what follows, we provide a brief summary of the four papers and point out certain points of agreement and disagreement as well as questions for future research. In his paper, Rowland Stout raises the question of how we should think of the relation between other people's behaviour and their emotional states if it is to be so much as possible that we can directly perceive people's emotional states when we perceive their behaviour. Stout does not argue for the thesis that we can in fact directly perceive the emotional states of other people, but rather he takes it for granted that we can, and proceeds to ask how we can make this possibility theoretically intelligible. This does not mean that he denies that there is a substantial philosophical question about the possibility of such a direct perceptual access to other minds. On the contrary, he proceeds by identifying a certain conception of causal relations (the Humean event-causal model) that can make it look like such a direct perception is indeed impossible. On the Humean account, the causal relation is conceived as a relation between events and it is regarded as extrinsic to both the causing event and the caused event. The causal relation itself is not regarded as part of the perceivable world. All we see is a sequence of events or event stages, one following the other, but that one sequence is the cause of another can only be established by going beyond that which is given in perception. This means that the attribution of mental state to others must remain a hypothesis about a hidden cause that gives rise to the independently observable behaviour. One way to hold on to the idea of the direct perception thesis in the face of the Humean analysis would be to dismiss the very idea that we should analyse the relation between mental items and expressive behaviour in terms of causality. This is not Stout's response. Stout takes the idea that for instance, my anger causes my face to contort as just as much a part of our datum as the possibility of direct perception of emotions. With this premise, it is obvious that what we need in order to show that we are not obligated to deny DP is an alternative to the Humean conception of causality. This is exactly what Stout presents in the form of the Aristotelian process-causal model. According to the Aristotelian model, the mental state is to be conceived as a potential, and the expressive behaviour is conceived as the process of realizing the potential rather than as an observable sequence of event stages caused by an inner, unobservable event. Just as we can immediately feel, the strength of a person in her handshake, we can immediately see her anger in her facial expressions, now understood not as a sequence of facial distortions but as the process of actualizing the anger. The process is ongoing here and now in plain sight, whereas the event can really only be referred to after the fact. The papers of Krueger and of Froese and Fuchs also highlight the idea of the mental as unobservable as an unquestioned assumption common to and motivating R.T. Jensen, D. Moran both the theory theory approach and the simulation theory approach. What is distinctive about Stout's contribution is how he diagnoses this 'unobservability principle' as the upshot of certain basic metaphysical assumptions about the nature of causality and a certain metaphysical prioritizing of events over processes. In addition, Stout brings out how these metaphysical assumptions go hand in hand with a conception of perception as a passive receiving of impressions. Opposing this passive picture of perception, Stout opts for an enactive account. Here, it becomes obvious that Stout's approach is not just diagnostic. He does not just point to the abstract possibility of an alternative conception of causality but further argues that this conception neatly fits a specific theory of perception. Like Stout, Krueger, in his paper 'Seeing mind in action', asks how we should conceive of expressive behaviour if we are to make sense of the direct perception thesis. Krueger argues that the best way to spell out DP is by exploiting ideas developed within the framework of the extended mind hypothesis. Krueger's main thesis is that we ought to understand the relation between expressive behaviour and expressed mental states as a constitutional relation: the behaviour literally constitutes parts of mental states or processes. Just like Otto's notebook, in Clark and Chalmers (1998) famous example, allegedly forms a constitutive part of cognitive processes, so, Krueger argues, gestures in certain instances form constitutive parts of a thinking process and, similarly, facial expressions can be constitutive parts of an emotional state or process. Krueger's overall argument has two steps. In the first step, he argues that the constitution interpretation of the expressive relation is required in order for us to hold on to the direct perception thesis (DP) in its epistemic version. Krueger's argument here parallels Stout's argument to the effect that only if we adopt an Aristotelian process-causal interpretation of the expressive relation can we make sense of the possibility of direct perceptual access to other minds. This raises interesting questions about the relation between the two authors respective conceptions of the expressive relation between mental phenomena and bodily behaviour. Krueger in his paper explicitly follows Stout, whom he acknowledges, in rejecting the Humean event-causal model and states the constitution thesis via the notion of processes: It is the cognitive or emotional process that is distributed across both intracranial and extracranial behavioural elements and the perceivable parts of the mental phenomena are parts of a dynamic process. However, Krueger also explicitly denies that we can directly perceive dispositions, something Stout, as Krueger notes, argues is vital for a defence DP. Krueger's denial of the possibility of direct perception of dispositions is part of his arguments against Joel Smith's recent defence of the epistemic direct perception thesis. The second step in Krueger's overall argument differs from the argumentative strategy followed by Stout by explicitly drawing on empirical research. In the first step, Krueger argued that the constitution interpretation of the expressive relation, in contrast to Smith's copresence interpretation (Smith 2010), can make sense of the epistemic version of DP. Just as Stout's arguments for the need to adopt the Aristotelian model rest upon the assumption that this model is the only alternative to the Humean model that will allow us to make sense of the direct perception thesis, so the first step of Krueger's argument rely on the lack of alternatives to the two accounts considered, namely, the constitution and the copresence interpretation of DP. The second step of Krueger's argument serves the purpose of providing independent empirical support for the idea that the mind literally extends into perceivable gestures Introduction: intersubjectivity and empath