While resilience is a major concept in development, climate adaptation, and related do-mains, many doubts remain about how to interpret this term, its relationship with closely overlap-ping terms, or its normativity. One major view is that, while resilience originally was a descriptive concept denoting some adaptive property of ecosystems, subsequent applications to social contexts distorted its meaning and purpose by framing it as a transformative and normative quality. This article advances an alternative philosophical account based on the scrutiny of C.S. Holling’s original work on resilience. We show that resilience had a central role among Holling’s proposals for re-forming environmental science and management, and that Holling framed resilience as an ecosys-tem’s capacity of absorbing change and exploiting it for adapting or evolving, but also as the social ability of maintaining and opportunistically exploiting that natural capacity. Resilience therefore appears as a transformative social-ecological property that is normative in three ways: as an intrinsic ecological value, as a virtue of organizations or management styles, and as a virtuous understanding of human–nature relations. This interpretation accounts for the practical relevance of resilience, clar-ifies the relations between resilience and related terms, and is a firm ground for further normative work on resilience.

This book is intended as an intellectual resource for clinicians and healthcare professionals who are interested in digging deeper into the philosophical foundations of their daily practice. It is a tool for understanding some of the philosophical motivations and rationality behind the way medicine and healthcare are studied, evaluated and practiced. In particular, this book illustrates the impact that our thinking about causality, both philosophically and conceptually, has on the clinical encounter. The aim is to engage and empower healthcare professionals to take part in changing and defining the premises for their own practice. After all, if clinical decisions should be based on evidence, this ought to be evidence that is relevant and well-suited for the clinic. The book has two parts, Philosophical Framework and Application to the Clinic. The first part is written from the philosophical perspective and presents a singular overall framework. The second part is written primarily by clinicians who address some implications of the philosophical framework for different aspects of their own practice.

From the early days of Responsible Research and Innovation (RRI), luck has played the role of an antagonist to responsibility: responsible innovation is, in part, an effort to control for the possible negative effects of luck–the chance that chance itself will take our technologies in directions that we would rather avoid. If we are to have innovations that are socially desirable and ethically acceptable, it seems, we must prevent bad luck by controlling for uncertainty wherever we can. This control-based approach has, however, proven to be impossible, with consequences for the practice of research, for the institutions that fund and guide research directions, and for how we as a society conceive of the potential for responsible research to deal well with the uncertainties of our contemporary and future world. This special issue of the Journal of Responsible Innovation tackles the relationship between responsibility and luck head on, with authors providing assessments and potential solutions for the problems that luck creates, for how researchers conceive of their own responsibilities, how institutions can be more responsible toward research itself, and how we can take luck up into our innovation practices in a productive way.

More than any other facet of resilience, social resilience raises the inherent tension within the concept between identity or persistence, and transformation. Is a community the people who make it up, or the geography or physical infrastructure they share? What about the resilience of communities that transform, as a result of a sudden disaster or over time? In this paper, we explore the impact of this tension on how social resilience indicators can be developed and used. Beginning with a close look at the ways in which our concepts of resilience and our use of indicators interact, several points are raised. First, that how we identify a community and frame its resilience conveys particular conceptualisations of resilience, which in turn have normative implications for the communities themselves. In part, this is because of the difficulty in capturing important adaptations and transformative actions within and by those communities. Further, measuring and comparing the resilience of communities, and aspects of quantification that go along with selecting, aggregating and comparing indicator values, ensure that the decisions made about how indicators ought to be used carry normative weight. Through this exploration, we identify several normative implications of choices in indicator design and application. We conclude with recommendations for moving forward with greater transparency and responsibility toward those communities whose social resilience we hope to measure in order to improve.

From the philosophical perspective presented in the first part of this book, together with the clinical application of this framework in the second part, it follows that we must change the way we approach causal evidence of health and illness conceptually, methodologically and practically. This has some practical consequences for the clinical encounter, as discussed throughout the book. We here offer some specific CauseHealth recommendations for making causal evidence more clinically relevant and better informed by the clinical encounter. The recommendations follow from an overall consideration of the previous chapters, both the philosophical framework and its clinical implications.

Pharmacovigilance currently faces several unsolved challenges. Of particular importance are issues concerning how to ascertain, collect, confirm, and communicate the best evidence to assist the clinical choice for individual patients. Here, we propose that these practical challenges partially stem from deeper fundamental issues concerning the epistemology of pharmacovigilance. After reviewing some of the persistent challenges, recent measures, and suggestions in the current pharmacovigilance literature, we support the argument that the detection of potential adverse drug reactions ought to be seen as a serendipitous scientific discovery. We further take up recent innovations from the multidisciplinary field of serendipity research about the importance of networks, diversity of expertise, and plurality of methodological perspectives for cultivating serendipitous discovery. Following this discussion, we explore how pharmacovigilance could be systematized in a way that optimizes serendipitous discoveries of untargeted drug effects, emerging from the clinical application. Specifically, we argue for the promotion of a trans-disciplinary responsive network of scientists and stakeholders. Trans-disciplinarity includes extending the involvement of stakeholders beyond the regulatory community, integrating diverse methods and sources of evidence, and enhancing the ability of diverse groups to raise signals of harms that ought to be followed up by the network. Consequently, promoting a trans-disciplinary approach to pharmacovigilance is a long-term effort that requires structural changes in medical education, research, and enterprise. We suggest a number of such changes, discuss to what extent they are already in process, and indicate the advantages from both epistemological and ethical perspectives.

There is now broad agreement that ideas like person-centred care, patient expertise and shared decision-making are no longer peripheral to health discourse, fine ideals or merely desirable additions to sound, scientific clinical practice. Rather, their incorporation into our thinking and planning of health and social care is essential if we are to respond adequately to the problems that confront us: they need to be seen not as “ethical add-ons” but core components of any genuinely integrated, realistic and conceptually sound account of healthcare practice. This, the tenth philosophy thematic edition of the journal, presents papers conducting urgent research into the social context of scientific knowledge and the significance of viewing clinical knowledge not as something that “sits within the minds” of researchers and practitioners, but as a relational concept, the product of social interactions. It includes papers on the nature of reasoning and evidence, the on-going problems of how to ‘integrate’ different forms of scientific knowledge with broader, humanistic understandings of reasoning and judgement, patient and community perspectives. Discussions of the epistemological contribution of patient perspectives to the nature of care, and the crucial and still under-developed role of phenomenology in medical epistemology, are followed by a broad range of papers focussing on shared decision-making, analysing its proper meaning, its role in policy, methods for realising it and its limitations in real-world contexts.