Papers by Anke Bueter
Studies in History and Philosophy of Science, 2026
A longstanding debate in philosophy of medicine-whether disease concepts are value-free (naturali... more A longstanding debate in philosophy of medicine-whether disease concepts are value-free (naturalism) or valueladen (normativism)-intersects with broader discussions about patient autonomy and the move away from paternalistic practices. An important argument supporting naturalism is the idea that value-freedom is necessary to protect patient autonomy. This paper challenges that view, arguing that autonomy does not require valuefreedom. We first demonstrate that prominent theories of personal autonomy do not demand value-freedom but rather a responsible way of dealing with normative judgements. Drawing on parallels to debates on values in science, we distill three strategies for managing non-epistemic values responsibly: transparency, value diversity, and prioritization of appropriate values. Applying these strategies to medicine, we illustrate how valueladenness can align with patient autonomy when managed appropriately.
Medicine, Healthcare and Philosophy, 2025
Multi-professional teams have become increasingly common in healthcare. Collaboration within such... more Multi-professional teams have become increasingly common in healthcare. Collaboration within such teams aims to enable knowledge amalgamation across specializations and to thereby improve standards of care for patients with complex health issues. However, multi-professional teamwork comes with certain challenges, as it requires successful communication across disciplinary and professional frameworks. In addition, work in multi-professional teams is often characterized by medical dominance, i.e., the perspective of physicians is prioritized over those of nurses, social workers, or other professionals. We argue that medical dominance in multi-professional teams can lead to institutional epistemic injustice, which affects both providers and patients negatively. Firstly, it codifies and promotes a systematic and unfair credibility deflation of the perspectives of professionals other than physicians. Secondly, it indirectly promotes epistemic injustice towards patients via leading to institutional opacity; i.e., via creating an intransparent system of credibility norms that is difficult to navigate. To overcome these problems, multi-professional teamwork requires institutional settings that promote epistemic equity of team members.
Studies in History and Philosophy of Science, 2024
A prevailing view holds that the main goal of mental health promotion is to maintain and improve ... more A prevailing view holds that the main goal of mental health promotion is to maintain and improve positive mental health, which is not merely defined by the absence of mental disorders, but by the presence of certain abilities. There are, however, challenges associated with this view that this paper aims to identify and explore. We start by highlighting three requirements for an ethically and politically justified mental health promotion scheme: (i) using a positive concept of mental health that (ii) respects the neutrality principle while (iii) not being overly permissive. Then, we argue that the WHO's positive concept of health violates (ii), and continue by exploring three philosophical accounts (i.e., Nordenfelt, 1995, 2017; Graham 2010; Wren-Lewis & Alexandrova, 2021) that could potentially provide a solution. We show that these face a dilemma of their own: they either violate (ii) or (iii), and they can rectify one issue only by violating the other. Considering the problems linked to the positive notion of health, the final section explores the alternate route of rejecting proposition (i) and instead embracing a negative concept of health. We argue that this option does not present a more advantageous solution. We conclude by highlighting the necessity for additional research to tackle the challenges we identified.
Studies in History and Philosophy of Science, 2021
Once one abandons the ideal of value-free, impartial science, the question of how to distinguish ... more Once one abandons the ideal of value-free, impartial science, the question of how to distinguish biased from legitimately value-laden science arises. To approach this "new demarcation problem", I argue that one should distinguish different uses of "bias" in a first step: a narrow sense of bias as systematic deviation from the truth, and a wider sense that covers any kind of tendency impacting scientific reasoning. Secondly, the narrow sense exemplifies an ontological notion of bias, which understands bias in terms of deviation from an impartial ideal outcome. I propose to replace it with an epistemic notion of bias, which understands biased research as research that we have good reasons to suspect could have been (done) systematically better. From a socio-epistemic perspective, such good reasons to expect better can be found in a lack of responsiveness to conventional standards and/or critical discourse in the scientific community. In short, bias in an epistemic sense consists in a deviation, not from truth but from current best practice. While this turns bias into something that is dependent on time and context, it allows for value-laden research to be unbiased, if there are no good reasons to expect this research to be better.
Erkenntnis, 2021
People with mental illnesses have higher prevalence and mortality rates with regard to common som... more People with mental illnesses have higher prevalence and mortality rates with regard to common somatic diseases and causes of death, such as cardio-vascular conditions or cancer. One factor contributing to this excess morbidity and mortality is the sub-standard level of physical healthcare offered to the mentally ill. In particular, they are often subject to diagnostic overshadowing: a tendency to attribute physical symptoms to a pre-existing diagnosis of mental illness. This might be seen as an unfortunate instance of epistemic bad luck, where particular features of a group of patients make a timely and correct diagnosis unlikely. While this can explain some cases of diagnostic overshadowing, I argue that in other cases, epistemic injustice is involved. Analyzing the case of diagnostic overshadowing, I distinguish two kinds of testimonial injustice. For one, there are classic cases of transactional testimonial injustice resulting from prejudices against the mentally ill. In addition, there are cases of structural testimonial injustice resulting from features of health care systems. To overcome diagnostic overshadowing, remedies on the individual as well as structural level are thus needed.
Handbook of Rationality, MIT Press
The value-freedom of science has traditionally been regarded as a presumption of scientific ratio... more The value-freedom of science has traditionally been regarded as a presumption of scientific rationality. However, in addition to numerous empirical counterexamples of value-laden science, systematic arguments have put the adequacy of value-freedom as an ideal into doubt during the last decades. This chapter presents the most important debates on the value-free ideal, which concern the epistemic impact of values in the discovery and justification of theories, the distinction between epistemic and nonepistemic values, and the argument from inductive risk. Taken together, these arguments call for new normative models of how to deal with values in science which no longer equate value-laden science with bad science or irrationality. Rather, they suggest that scientific rationality is highly complex, since epistemic issues are interwoven with practical, socio-political, institutional, and ethical ones.
Perspectives on Science, 2019
Psychiatric classification is highly controversial, as could be witnessed again with the latest r... more Psychiatric classification is highly controversial, as could be witnessed again with the latest revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM). These controversies comprise multiple kinds of critiques by a variety of actors. It is unlikely that all these issues will be overcome by one perfect solution in the future. Rather, it is precisely the DSM's "one-size-fits-all-approach" that lies at the root of many of the current problems. To restore the scientific and public credibility of psychiatric classification, a multi-dimensional pluralist response is thus needed: theoretical pluralism, meaning a promotion of different research projects and heuristic strategies (1), taxonomic pluralism, which allows for different classifications used in research versus clinical practice (2), and participatory pluralism, which concerns the diversity of perspectives and stakeholders in DSM-revisions (3).
Philosophy of Science (forthc.)
This paper supports calls for an increased integration of patients into taxonomic decision- makin... more This paper supports calls for an increased integration of patients into taxonomic decision- making in psychiatry by arguing that their exclusion constitutes a special kind of epistemic injustice: Pre-emptive testimonial injustice, which precludes the opportunity for testimony due to a wrongly presumed irrelevance or lack of expertise. Here, this presumption is misguided for two reasons: (1) the role of values in psychiatric classification and (2) the potential function of first-person knowledge as a corrective means against implicitly value- laden, inaccurate, or incomplete diagnostic criteria sets. This kind of epistemic injustice leads to preventable epistemic losses in psychiatric classification, diagnosis, and treatment.
Medicine, Health Care and Philosophy, 2019
The distinction between ‘disease’ and ‘illness’ has played an important role in the debate betwee... more The distinction between ‘disease’ and ‘illness’ has played an important role in the debate between naturalism and nor-mativism. Both employ these notions, yet disagree on whether to assign priority to ‘disease’ or ‘illness’. I argue that this discussion suffers from implicit differences in the underlying interpretations: While for naturalists the distinction between ‘disease’ and ‘illness’ is one between a descriptive and a prescriptive notion, for normativists it is one between cause and effect. This discrepancy is connected to different interpretations of priority, which also tend to be conflated in the debate. I disambiguate these different usages and develop a distinction between ‘disease’ and ‘illness’ that is theoretically neutral with regard to naturalism or normativism. Moreover, I propose a concept of heuristic priority that could serve as a common focus. This framework can avoid common confusions by providing a shared terminology and thereby help to make debates on disease-concepts more fruitful.
Bloomsbury Companion to Philosophy of Psychiatry, 2019
Synthese, 2018
Psychiatric classification, as exemplified by the Diagnostic and Statistical Manual of Mental Dis... more Psychiatric classification, as exemplified by the Diagnostic and Statistical Manual of Mental Disorders (DSM), is dealing with a lack of trust and credibility – in the scientific, but also in the public realm. Regarding the latter in particular, one possible remedial measure for this crisis in trust lies in an increased integration of patients into the DSM revision process. The DSM, as a manual for clinical practice, is forced to make decisions that exceed available data and involve value-judgments. Regarding such decisions, public epistemic trustworthiness requires (1) that these value-judgments should be representative of those of the affected public, and (2) that the public has a reason to believe such a representation to be realized. Due to the long tradition of (public) distrust in psychiatry, such a reason can in this case best be provided by an actual integration of patients into the decision-making process, rather than by their representation through scientific experts.
Topoi, 2017
Gender-medicine has been very successful in discovering gaps in medical knowledge, disclosing bia... more Gender-medicine has been very successful in discovering gaps in medical knowledge, disclosing biases in earlier research, and generating new results. It has superseded a more androcentric and sexist medicine. Yet, its development should not be understood in terms of a further approximation of value-freedom. Rather, it is a case of better value-laden science due to an enhanced pluralism in medicine and society. This interpretation is based on an account of the origins of gender-medicine in the feminist women’s health movement and an analysis of the debate on inclusion of women in clinical trials. Consequently, the history of gender-medicine provides support for a procedural account of objectivity that stresses the importance of a diversity of perspectives.
Uncorrected proofs - please do not cite this version.
Abstract: Criticisms of the value-free ide... more Uncorrected proofs - please do not cite this version.
Abstract: Criticisms of the value-free ideal often proceed on the basis of underdetermination theses, arguing that empirical evidence and cognitive values are not (always) sufficient to determine theory choice, wherefore other values came to bear. A common strategy against such criticisms can be found in the Agnosticism-Argument. It claims that, first, not all theory assessment is permanently underdetermined. Second, in cases where theory assessment is at current underdetermined, the epistemologically correct reaction is to stay agnostic until further evidence is generated, rather than making theory assessment dependent on non-cognitive values. While agreeing with the first point, I argue that agnosticism is not a successful defense of the value-free ideal. It fails because not all epistemically relevant decisions can possibly be postponed or determined by further evidence. Ultimately, this proves fatal for the ideal of value-freedom itself, since even a complete adherence to its prescriptions can lead to value-laden results.
In his treatise on predestination, Ockham discusses the philosophical riddles caused by this Chri... more In his treatise on predestination, Ockham discusses the philosophical riddles caused by this Christian dogma as a specific case of the problem of logical determinism. Ockham does not succeed in solving this problem, which is due to his semantic notion of truth as well as to a missing differentiation between an ontological and logical interpretation of contingency. These points lead to a number of ambivalences in his argumentation, which suggest that Ockham has the conditions of a possible solution available but his ontological parsimony inhibits their coherent implementation.
The value-freedom of scienti c knowledge is commonly held to be a necessary condition for objecti... more The value-freedom of scienti c knowledge is commonly held to be a necessary condition for objectivity. Helen Longino's contextual empiricism aims to overcome this connection. She questions the suitability of the normative ideal of value-freedom and develops an alternative conception of objectivity, which integrates social and epistemic aspects of scienti c enquiry. The function of this notion of 'social objectivity' is to make value-laden assumptions assessable through a process of criticism, even if there cannot
be any guarantee of their elimination. This assessability requires common standards of evaluation, which are threatened by Longino's rejection of the distinction between cognitive and non-cognitive values guiding theory choice. I will argue that in order
to resolve this inherent tension, social objectivity has to be understood as based on a procedural epistemology; and, diering from Longino's own approach, must include the normative requirement to strive for consensus instead of allowing for epistemological pluralism.
The current ideal of value-freedom holds non-cognitive values to be illegitimate in theory apprai... more The current ideal of value-freedom holds non-cognitive values to be illegitimate in theory appraisal but legitimate in earlier stages of the research process, for example, when affecting the selection of topics or the generation of hypotheses. Respective decisions are often considered as part of a context of discovery and as irrelevant for the justification and assessment of theories. I will argue that this premise of an epistemic independence of theory appraisal, though often taken for granted, is false. Due to the possibility of value-laden blind spots, decisions in discovery can have an indirect impact on theory assessment that the value-free ideal cannot deal with. This argument is illustrated by a case study from women’s health research, namely the assessment of hormone replacement therapy as a prevention of coronary heart diseases. In consequence, the epistemic trustworthiness of science is promoted more by a pluralism of non-cognitive values than by their exclusion; and a normative philosophy of science needs to enlarge its focus to include the context of discovery as well as the social conditions of science.
Books by Anke Bueter
Die Wertfreiheit der Wissenschaft gilt als Bedingung ihrer Objektivität. Eine Analyse des entspre... more Die Wertfreiheit der Wissenschaft gilt als Bedingung ihrer Objektivität. Eine Analyse des entsprechenden Wertfreiheitsideals zeigt jedoch, dass dieses auf einer Reihe von Voraussetzungen beruht – wie der Trennbarkeit kognitiver von anderen Werten und der epistemischen Unabhängigkeit der Rechtfertigung – die sich als problematisch erweisen. Eine Fallstudie zur Frauengesundheitsforschung untermauert zudem, dass die Möglichkeiten für Werteinflüsse in der Wissenschaft weit komplexer sind, als dieses Ideal zu erfassen vermag. Daher bietet ein sozialepistemologischer Ansatz, der auf Wertvielfalt statt Wertfreiheit setzt, die bessere Grundlage für Objektivität: Epistemische Vertrauenswürdigkeit erfordert nicht Neutralität, sondern einen pluralistischen und konsensorientierten kritischen Prozess.
Book Reviews by Anke Bueter
Metapsychology Online Reviews , 2017
Fueled by the latest revision of the Diagnostic and Statistical Manual of Mental Disorders (APA 2... more Fueled by the latest revision of the Diagnostic and Statistical Manual of Mental Disorders (APA 2013, DSM-5), psychiatric classification and the research based upon it have received an enormous amount of critical attention lately. Jeffrey Poland's and Serife Tekin's edited volume brings together different perspectives from philosophy and mental health research on these controversies.
Science & Education, 2018
Book review: Elliott, Kevin and Ted Richards, eds. (2017). Exploring Inductive Risk: Case Studies... more Book review: Elliott, Kevin and Ted Richards, eds. (2017). Exploring Inductive Risk: Case Studies of Values in Science. Oxford University Press, New York. ISBN: 019046772X, 304 pages, $44.00 (paperback).
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Papers by Anke Bueter
Abstract: Criticisms of the value-free ideal often proceed on the basis of underdetermination theses, arguing that empirical evidence and cognitive values are not (always) sufficient to determine theory choice, wherefore other values came to bear. A common strategy against such criticisms can be found in the Agnosticism-Argument. It claims that, first, not all theory assessment is permanently underdetermined. Second, in cases where theory assessment is at current underdetermined, the epistemologically correct reaction is to stay agnostic until further evidence is generated, rather than making theory assessment dependent on non-cognitive values. While agreeing with the first point, I argue that agnosticism is not a successful defense of the value-free ideal. It fails because not all epistemically relevant decisions can possibly be postponed or determined by further evidence. Ultimately, this proves fatal for the ideal of value-freedom itself, since even a complete adherence to its prescriptions can lead to value-laden results.
be any guarantee of their elimination. This assessability requires common standards of evaluation, which are threatened by Longino's rejection of the distinction between cognitive and non-cognitive values guiding theory choice. I will argue that in order
to resolve this inherent tension, social objectivity has to be understood as based on a procedural epistemology; and, diering from Longino's own approach, must include the normative requirement to strive for consensus instead of allowing for epistemological pluralism.
Books by Anke Bueter
Book Reviews by Anke Bueter