Abstract
Jesper Ahlin Marceta published an article in this journal in which he formulated his “argument from testability”, stating that it is impossible, at least practically, to operationalize procedural authenticity. That is, using procedural accounts of authenticity, one cannot reliably differentiate between authentic and inauthentic desires. There are roughly two ways to respond to the argument from testability: top-down and bottom-up. Several authors have endeavored the top-down approach by trying to show that some conceptions of authenticity might be operationalizable after all. At present, however, the bottom-up approach has not been put to the test. That is, no attempt has been made to use a currently existing assessment tool to guide the development of an account of authenticity. In this paper, I will investigate what it means to develop an account of authenticity bottom-up based on measures of concordance. More specifically, I will investigate the following three research questions. First, how do concordance and authenticity relate at a conceptual level? As crucial similarities exist between these concepts, concordance measures seem to offer a good starting point for the bottom-up approach. Second, how do judgements of concordance differ from judgements of authenticity? Both their scope and the way they are justified will turn out to be different. This suggests novel ways to react to Marceta’s argument from testability. Third, should we develop a theory of concordance? The positive answer to this question will point towards a central limitation of the bottom-up approach.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Alexandrova, Anna. 2017. A philosophy for the Science of Well-Being. Oxford: Oxford University Press.
Debrabander, Jasper. 2022. ‘On the relation between decision quality and autonomy in times of patient-centered care: a case study’. Medicine Health Care and Philosophy 25 (4): 629–639. https://doi.org/10.1007/s11019-022-10108-w.
Banner, Natalie F., and George Szmukler. 2013. ‘“Radical Interpretation” and the assessment of decision-making capacity’. Journal of Applied Philosophy 30 (4): 379–394. https://doi.org/10.1111/japp.12035.
Durand, Marie-Anne, Renata W. Yen, A. James O’Malley, Danielle Schubbe, Mary C. Politi, and Catherine H. Saunders, Shubhada Dhage, et al. 2021. ‘What matters most: randomized controlled trial of breast cancer surgery conversation aids across socioeconomic strata’. Cancer 127 (3): 422–436. https://doi.org/10.1002/cncr.33248.
Ekstrom, Laura Waddell. 1993. ‘A coherence theory of autonomy’. Philosophy and Phenomenological Research 53 (3): 599. https://doi.org/10.2307/2108082.
Faden, Ruth R., and Tom L. Beauchamp. 1986. A history and theory of informed consent. New York: Oxford University Press.
Frankfurt, Harry G. 1971. ‘Freedom of the Will and the Concept of a Person’. The Journal of Philosophy 68 (1): 5. https://doi.org/10.2307/2024717.
Ghanouni, Alex, Cristina Renzi, Susanne F Meisel, and Jo Waller. 2016. ‘Common methods of measuring “Informed Choice” in Screening participation: Challenges and future directions’. Preventive Medicine Reports 4 (December): 601–607. https://doi.org/10.1016/j.pmedr.2016.10.017.
Hawley, Sarah T., Yun Li, Lawrence C. An, Kenneth Resnicow, Nancy K. Janz, Michael S. Sabel, and Kevin C. Ward, et al. 2018. ‘Improving breast Cancer Surgical treatment decision making: the ICanDecide randomized clinical trial’. Journal of Clinical Oncology 36 (7): 659–666. https://doi.org/10.1200/JCO.2017.74.8442.
Joseph-Williams, Natalie, Adrian Edwards, and Glyn Elwyn. 2011. ‘The importance and complexity of regret in the measurement of “Good” decisions: a systematic review and a content analysis of existing Assessment Instruments: systematic review of Regret Instruments’. Health Expectations 14 (1): 59–83. https://doi.org/10.1111/j.1369-7625.2010.00621.x.
Lee, Clara N, H. Matthew, Yuchiao Wetschler, Jeffrey K Chang, Beverly Belkora, Ann Moy, Partridge, and R Sepucha Karen. 2014. ‘Measuring decision quality: psychometric evaluation of a new instrument for breast cancer chemotherapy’. BMC Medical Informatics and Decision Making 14 (1): 73. https://doi.org/10.1186/1472-6947-14-73.
Marceta, Jesper Ahlin. 2018a. ‘The impossibility of reliably determining the authenticity of desires: implications for informed consent’. Medicine Health Care and Philosophy 21 (1): 43–50. https://doi.org/10.1007/s11019-017-9783-0.
Marceta, Jesper Ahlin. 2018b. ‘What justifies judgments of inauthenticity?’. Hec Forum 30 (4): 361–377. https://doi.org/10.1007/s10730-018-9356-5.
Marceta, Jesper Ahlin. 2019. ‘A non-ideal authenticity-based conceptualization of personal autonomy’. Medicine Health Care and Philosophy 22 (3): 387–395. https://doi.org/10.1007/s11019-018-9879-1.
Marteau, Theresa M., Elizabeth Dormandy, and Susan Michie. 2001. ‘A measure of informed choice: a measure of informed choice’. Health Expectations 4 (2): 99–108. https://doi.org/10.1046/j.1369-6513.2001.00140.x.
McQueen, Paddy. 2017. ‘The role of regret in medical decision-making’. Ethical Theory and Moral Practice 20 (5): 1051–1065. https://doi.org/10.1007/s10677-017-9844-8.
Mele, Alfred R. 1995. Autonomous Agents: from self-control to autonomy. New york: Oxford University Press.
MGH Health Decision Sciences Center. 2022. Decision Quality Instruments. https://mghdecisionsciences.org/tools-training/decision-quality-instruments/. Accessed July 5, 2022.
Michie, Susan, Elizabeth Dormandy, and M Marteau Theresa. 2002. ‘The multi-dimensional measure of informed choice: a validation study’. Patient Education and Counseling 48 (1): 87–91. https://doi.org/10.1016/S0738-3991(02)00089-7.
Noggle, Robert. 2005. ‘Autonomy and the Paradox of Self-Creation: Infinite Regresses, Finite Selves, and the Limits of Authenticity’. In Personal Autonomy, edited by James Stacey Taylor, 87–108. Cambridge: Cambridge University Press.
Parfit, Derek. 1992. Reasons and persons. Oxford: Clarendon press.
Pugh, Jonathan. 2020. Autonomy, rationality, and contemporary bioethics. Oxford: Oxford University Press.
Schwartz, Peter H., and Greg A. Sachs. 2022. ‘Rethinking decision quality: measures, meaning, and bioethics’. Hastings Center Report 52 (6): 13–22. https://doi.org/10.1002/hast.1443.
Sepucha, Karen R., J. Floyd, Fowler, and Albert G. Mulley. 2004. ‘Policy Support For Patient-Centered Care: The Need For Measurable Improvements In Decision Quality.’ Health Affairs 23(Suppl2): VAR-54-VAR-62. https://doi.org/10.1377/hlthaff.var.54.
Sepucha, Karen R, Catharine F Dawn Stacey, Yuchiao Clay, Carol Chang, Geoffrey Cosenza, Janet Dervin, and Dorrwachter, et al. 2011. ‘Decision quality instrument for treatment of hip and knee osteoarthritis: a psychometric evaluation’. BMC Musculoskeletal Disorders 12 (1): 149. https://doi.org/10.1186/1471-2474-12-149.
Sepucha, Karen R, K. Jeffrey, Yuchiao Belkora, Carol Chang, A. Cosenza, Carrie, Beverly Levin, Ann Moy, Partridge, and N Lee Clara. 2012. ‘Measuring decision quality: psychometric evaluation of a new instrument for breast cancer surgery’. BMC Medical Informatics and Decision Making 12 (1): 51. https://doi.org/10.1186/1472-6947-12-51.
Stacey, Dawn, France Légaré, Krystina Lewis, Michael J Barry, Carol L Bennett, Karen B Eden, and Margaret Holmes-Rovner, et al. 2017. ‘Decision aids for people facing health treatment or screening decisions’. Edited by Cochrane Consumers and Communication Group. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD001431.pub5.
Trenaman, Logan, Jesse Jansen, Jennifer Blumenthal-Barby, Mirjam Körner, Joanne Lally, Daniel Matlock, and Lilisbeth Perestelo-Perez, et al. 2021. ‘Are we improving? Update and critical appraisal of the reporting of decision process and quality measures in trials evaluating patient decision aids’. Medical Decision Making 41 (7): 954–959. https://doi.org/10.1177/0272989X211011120.
Tyner, Tracy E., and Wyona M. Freysteinson. 2022. ‘A Concept analysis of decision regret in women with breast cancer’. Nursing Forum 57 (1): 112–120. https://doi.org/10.1111/nuf.12642.
White, Lucie. 2018. ‘The need for authenticity-based autonomy in medical ethics’. Hec Forum 30 (3): 191–209. https://doi.org/10.1007/s10730-017-9335-2.
Winn, Karen, and Elissa Ozanne, and Karen Sepucha. 2015. ‘Measuring patient-centered care: an updated systematic review of how studies define and report concordance between patients’ preferences and medical treatments’. Patient Education and Counseling 98 (7): 811–821. https://doi.org/10.1016/j.pec.2015.03.012.
Wolf, Susan. 2013. ‘Sanity and the Metaphysics of Responsibility’. In Ethical Theory: An Anthology, edited by Russ Shafer-Landau. Malden MA: Wiley-Blackwell.
Acknowledgements
I would like to thank Heidi Mertes, Seppe Segers and an anonymous reviewer for their valuable comments on earlier drafts.
Funding
This research was made possible by grant BOFSTG2020002501 of Ghent University’s Special Research Fund.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The author has no relevant financial or non-financial interests to disclose.
Ethics approval
Not applicable.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Debrabander, J. Authenticity and the argument from testability: a bottom-up approach. Med Health Care and Philos 26, 583–589 (2023). https://doi.org/10.1007/s11019-023-10166-8
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11019-023-10166-8