Med Health Care Philos
· 2025 Sep · PMID 40186698
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In this paper I analyze the phenomenon of normalizing and tabooing menstrual pain as an example of epistemic injustice. I refer to both types of epistemic injustice distinguished by Miranda Fricker: testimonial injustice...In this paper I analyze the phenomenon of normalizing and tabooing menstrual pain as an example of epistemic injustice. I refer to both types of epistemic injustice distinguished by Miranda Fricker: testimonial injustice and hermeneutic injustice. The social approach to the phenomenon of menstrual pain combines both. This poses a significant political and bioethical problem, as ignoring and misunderstanding the experiences of menstrual pain sufferers can contribute to delayed diagnosis and reinforce patients' sense of loneliness.
Med Health Care Philos
· 2025 Sep · PMID 40178710
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The clinical autopsy of foetuses, stillborn babies, or neonates and the examination of the placenta help to inform the mother's decision-making and her medical care for subsequent pregnancies. Indeed, these post-mortem e...The clinical autopsy of foetuses, stillborn babies, or neonates and the examination of the placenta help to inform the mother's decision-making and her medical care for subsequent pregnancies. Indeed, these post-mortem examinations can identify unexpected congenital malformations or the cause of repeated miscarriage or stillbirth. However, the use of clinical pathology for diagnostic purposes in the context of family planning for bereaved parents with an unfulfilled desire to have a child, and IVF couples has received little attention to date. This article applies Beauchamp and Childress' bioethical framework to identify, assess and systematically discuss ethical issues associated with the use of clinical foetal autopsy in reproductive healthcare within the German legal context. In the format of a clinical ethics consultation, the article examines the current policy on perinatal post-mortem examinations in Germany, and asks whether the clinical foetal autopsy for reproductive health purposes should be part of standard clinical examinations offered to bereaved parents. The conclusion of our research recommends clinical foetal autopsy as ethically acceptable, provided that the necessary resources are available. This recommendation is based on the ethical obligation towards the mother as the patient, which is grounded in the bioethical principles of autonomy and beneficence.
Med Health Care Philos
· 2025 Jun · PMID 40097799
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Laurie A. Paul (2014) developed the concept of transformative experience. In describing transformative experience as an experience that is both epistemically and personally transformative, she argues that transformative...Laurie A. Paul (2014) developed the concept of transformative experience. In describing transformative experience as an experience that is both epistemically and personally transformative, she argues that transformative experience challenges the traditional model of rational decision making. Her concept of transformative experiences has been expanded to the field of illness. It has been argued that illness is a transformative experience because it fulfills Paul's criteria for a transformative experience (Carel et al. 2016; Carel and Kidd 2020). Conceptualizing illness as a transformative experience would have far-reaching implications for the agency and for the rational decision-making process of ill persons. In considering these implications, this article questions the assumption that illness is a transformative experience and proposes that illness, especially when it is chronic, can be a transformative activity, in the sense that Agnes Callard (2020), introduced us to the concept of transformative activity. The article argues that conceptualizing (chronic) illness as a transformative activity strengthens the ill person's agency and ability to learn to live with the illness.
Med Health Care Philos
· 2025 Jun · PMID 40089616
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The structural scarcity of healthcare resources has deeply challenged their fair distribution, prompting the need for allocation criteria. Long under the spotlight of the bioethical debate with an extraordinary peak duri...The structural scarcity of healthcare resources has deeply challenged their fair distribution, prompting the need for allocation criteria. Long under the spotlight of the bioethical debate with an extraordinary peak during the recent COVID-19 pandemic, micro-allocation of healthcare has been extensively discussed in the literature with regard to issues of substantive and formal justice. This paper addresses a relatively underdiscussed question within the field of formal justice: who should define micro-allocation criteria in healthcare? To explore this issue, we first establish formal requirements that must be met for allocation criteria to be considered fair and legitimate. Then, we introduce three possible answers to the research question: the attending physician, the team of physicians, and the team of experts. We discuss and then reject all of them, arguing that the task of defining allocation criteria should be assigned to a political representative, supported by a cross-disciplinary team of experts. This proposal is based on the need to take democracy seriously as a tool for making substantive allocative decisions in light of the inevitable disagreement on such matters within a community. To support this claim, we present two key arguments-the democracy argument and the consistency argument. We also pre-emptively respond to two significant critiques: the too-specificity of the decision critique and the catastrophic outcomes critique. In conclusion, we argue that our proposal offers the fairest and most legitimate decision-making process for healthcare micro-allocation.
Med Health Care Philos
· 2025 Jun · PMID 40087254
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It has been difficult historically for physicians, patients, and philosophers alike to quantify pain given that pain is commonly understood as an individual and subjective experience. The process of measuring and diagnos...It has been difficult historically for physicians, patients, and philosophers alike to quantify pain given that pain is commonly understood as an individual and subjective experience. The process of measuring and diagnosing pain is often a fraught and complicated process. New developments in diagnostic technologies assisted by artificial intelligence promise more accurate and efficient diagnosis for patients, but these tools are known to reproduce and further entrench existing issues within the healthcare system, such as poor patient treatment and the replication of systemic biases. In this paper we present the argument that there are several ethical-epistemic issues with the potential implementation of these technologies in pain management settings. We draw on literature about self-trust and epistemic and testimonial injustice to make these claims. We conclude with a proposal that the adoption of epistemic humility on the part of both AI tool developers and clinicians can contribute to a climate of trust in and beyond the pain management context and lead to a more just approach to the implementation of AI in pain diagnosis and management.
Med Health Care Philos
· 2025 Jun · PMID 40087253
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The prevalence of non-communicable diseases, the related increased medical costs, and the recent public health emergency bring out more forcefully pre-existing dilemmas of distributive justice in the healthcare context....The prevalence of non-communicable diseases, the related increased medical costs, and the recent public health emergency bring out more forcefully pre-existing dilemmas of distributive justice in the healthcare context. Under this reality, would it be justified to hold people responsible for their taken lifestyle decisions, or would it constitute an instance of unjustified disrespectful treatment? From a respect-based standpoint, one could argue that a responsibility-sensitive healthcare system morally disrespects the imprudent ones engaging in disadvantageous differential treatment to their detriment. In contrast, however, we might also have luck egalitarian reasons that explain why this differential treatment is not unjust. Luck egalitarianism is a responsibility-sensitive theory of distributive justice, which argues that it is bad if some people are worse off than others through no voluntary fault of their own. In this paper, I clarify the concerns about disrespect raised against the luck egalitarian viewpoint and offer possible respect-based reasons for why this might not be the case grounded in deontological concepts. First, I employ a revised Double-effect case to support responsibility-sensitive rationing. In the last part of the paper, these are further supported through the Kantian Formula of Humanity supplemented by the concept of duties.
Med Health Care Philos
· 2025 Jun · PMID 40053307
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The research field of epistemic justice in healthcare has gained traction in the last decade. However, the importation of Miranda Fricker's original philosophical framework to medicine raises several interrelated issues...The research field of epistemic justice in healthcare has gained traction in the last decade. However, the importation of Miranda Fricker's original philosophical framework to medicine raises several interrelated issues that have largely escaped attention. Instead of pushing forward, crafting new concepts or exploring other medical conditions, we suggest that it is time to take stock, reconsider, and articulate some fundamental issues that confront the field of epistemic injustice in healthcare. This paper articulates such fundamental issues, which we divide into scientific, conceptual, and theoretical issues. Scientifically, the research field is confronted by a lack of empirical evidence. It relies on cases, making generalizations impossible and the field vulnerable to bias. Conceptually, many of the claims advanced in the literature are presented as facts but are merely hypotheses to be tested. Moreover, a criterion for applying the concept of testimonial injustice in medicine is lacking, impeding the development of a construct to empirically measure said injustices. Theoretically, many of the cases discussed in the literature do not prima facie qualify as cases of testimonial injustice, since they lack necessary components of testimonial injustice in Fricker's framework, i.e., being unintentional and caused by identity prejudices in the hearers. If epistemic injustice is as pervasive as it is claimed in this literature, it should be of concern to us all. Addressing the issues raised here may strengthen the conceptualization of epistemic injustice in healthcare and lead to development of constructs that finally can explore its empirical basis.
Med Health Care Philos
· 2025 Jun · PMID 40053306
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An ethical framework for pandemic healthcare distribution typically encompasses multiple ethical values. However, integrating various ethical values and distributive principles into a single framework raises concerns abo...An ethical framework for pandemic healthcare distribution typically encompasses multiple ethical values. However, integrating various ethical values and distributive principles into a single framework raises concerns about their compatibility and the overall coherence of the framework. This issue of value compatibility could lead to moral inconsistencies within the ethical framework, leading to practical indetermination when facing conflicting implications. This paper offers a methodological resolution to the compatibility problem, serving as an effective tool to mitigate the impact of value conflicts where possible. It proposes four pathways: specifying values rather than balancing them, incorporating values rather than weighing them, reinforcing values rather than aggregating them, and seeking scientific evidence. By developing coherent ethical frameworks where values do not contradict each other, this approach also enhances practical ethical decision-making. Using the COVID-19 vaccine distribution as a case study, this approach demonstrates how conflicting values can yield practical prioritization strategies, such as allocating vaccines to healthcare and essential workers, addressing multiple layers of disadvantage, and assessing age-related prioritization. Reflecting on the compatibility of values within ethical frameworks offers crucial insights beyond COVID-19, contributing to the development of robust ethical frameworks for future public health crises.
Med Health Care Philos
· 2025 Jun · PMID 39953268
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Research on understanding the self of persons with dementia (PWD) has increased significantly in the past decades across various fields of research. This has led to a profusion of novel conceptualizations of self. Meanwh...Research on understanding the self of persons with dementia (PWD) has increased significantly in the past decades across various fields of research. This has led to a profusion of novel conceptualizations of self. Meanwhile, the rise in dementia diagnoses worldwide presents us with complex global societal and individual challenges. Since the understanding of the self of PWD is vital for improving their well-being, autonomy and care needs, this article argues that there is a need to integrate and systematize these conceptualizations of self. The current state of conceptual unclarity undermines the wellbeing of PWD, since it impedes the exchange and development of (empirical) research results and ideas. With the aim of uniting and systematizing the conceptualizations of self in research on PWD, in order to develop a pragmatic, clustered approach based on the research of the field itself which can be applied in an empirical setting with PWD, this article departs from the literature reviews from the various fields involved in the research on the self of PWD. By focusing on the theoretical overlap between the conceptualizations of self employed in these reviews, four overarching clusters of self-aspects can be formulated: minimal, embodied-embedded, reflective and socially-embedded self-aspects. These clusters jointly provide the ground for self-continuity in PWD. This clustered approach provides a framework which unites the current field of research, within which new findings can be integrated and which can be applied in an empirical setting.
Med Health Care Philos
· 2025 Jun · PMID 39946019
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In an interesting article, Dr Zuzana Parusniková claimed: (i) that Semmelweis' colleagues did not recognise the importance of his animal experiments, (ii) that the resistance to Semmelweis' hypothesis and results was due...In an interesting article, Dr Zuzana Parusniková claimed: (i) that Semmelweis' colleagues did not recognise the importance of his animal experiments, (ii) that the resistance to Semmelweis' hypothesis and results was due mainly to applying mono-causality and (iii) Semmelweis inability to communicate, (iv) that the New Vienna Medical School applied evidence-based medicine, and (v) that the philosophy of Karl Popper is the best interpretation of Semmelweis' scientific approach. Here, we present some factual aspects of Semmelweis' text from 1861 and discuss Dr Parusniková's claims against this backdrop. We conclude that Semmelweis might intentionally have abstained from communicating his hypothesis and results between 1847 and 1849 - including the results from his animal experiments - as he thought that they would eventually be understood and accepted. Semmelweis' hypothesis was that cadaveric matters and decaying particles were the cause of childbed fever and increased maternal mortality. This hypothesis might have been controversial, but we claim that the major reason for the resistance was eminence-based and induced by the publication of preliminary and suboptimal results, based on a premature version of his hypothesis. If the New Vienna Medical School had been influenced by evidence-based medicine, we believe that Semmelweis' empirical results would have been accepted - as they were based on an almost randomised controlled trial - and if the results had not been associated with his hypothesis but instead had focused on a black box procedure. We agree that the philosophy of Popper might be appropriate when analysing Semmelweis' scientific approach when abandoning low-level theories. However, to understand the resistance against Semmelweis' hypothesis and results, it is not sufficient to refer to a Pickwickian discussion; a Kuhnian framework is more adequate.
Med Health Care Philos
· 2025 Jun · PMID 39907891
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In 2023, thousands of young Norwegian physicians joined an online movement called #legermåleve (#doctorsmustlive) and shared stories of their own mental and somatic health issues, which they considered to be caused by un...In 2023, thousands of young Norwegian physicians joined an online movement called #legermåleve (#doctorsmustlive) and shared stories of their own mental and somatic health issues, which they considered to be caused by unacceptable working conditions. This paper discusses this case as an extreme example of physicians' and healthcare workers' suffering in late modern societies, using Vosman and Niemeijer's approach of rethinking care imaginaries by a structured process of thinking along, counter-thinking and rethinking, bringing to bear suffering as a heuristic device. Thinking along, taking the physicians' stories and arguments literally, reveals an image of an unbearable workload. Counter-thinking resituates their suffering within the broader conditions of late modernity, suggesting that the root cause may lie not in the quantity of the workload itself but in its qualities and in its perceived threat to their integrity as caregivers through epistemic and moral injury and an inability to respond to this threat. In rethinking, the ambiguity of suffering- its dual potential as both a constraint and an opening- becomes central. Following the physicians' own interpretations and the solutions emerging from this framing, both their suffering and that of their patients could paradoxically be exacerbated by further decentering physicians and reinforcing utilitarian, data-driven approaches. However, staying with their suffering and reinterpreting its causes opens possibilities to leverage critiques of medicalization at large and of their own suffering in particular, challenging the assumption that the weight of care must always grow heavier. From this reframing, I argue, it is possible to reclaim and reimagine care and the clinical space as a nexus of epistemic and moral privilege, recentering response-ability both relationally and socially.
Med Health Care Philos
· 2025 Jun · PMID 39878868
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Silence is a byword for socially imposed harm in the burgeoning literature on epistemic injustice in psychiatry. While some silence is harmful and should be broken, this understanding of silence is untenably simplistic....Silence is a byword for socially imposed harm in the burgeoning literature on epistemic injustice in psychiatry. While some silence is harmful and should be broken, this understanding of silence is untenably simplistic. Crucially, it neglects the possibility that silence can also play a constructive epistemic role in the lives of people with mental illness. This paper redresses that neglect. Engaging with first-person accounts of mania, it contends that silence constitutes a crucial form of epistemic agency to people who experience mania and that the prevailing failure to recognise this may harm them. The paper proceeds as follows. After briefly examining the negative understanding of silence in the epistemic injustice literature, it outlines three epistemically agential silences: communicative silence, listening silence, and withholding silence. It then deploys these concepts to explore how the ability to perform epistemically agential silence is impaired in mania and why such silences are vital to people. The penultimate section highlights two ways that the failure to recognise the epistemic value of silence can harm people with mania. The paper concludes by drawing out implications for future research on epistemic injustice in psychiatry.
Med Health Care Philos
· 2025 Jun · PMID 39875641
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Compassion is an essential phenomenon in the therapeutic relationship, and some use it to justify physician-assisted dying practices. The value of compassion in the relationship between healthcare professionals and patie...Compassion is an essential phenomenon in the therapeutic relationship, and some use it to justify physician-assisted dying practices. The value of compassion in the relationship between healthcare professionals and patients is undeniable. However, different approaches to its definition and scope can lead to distinct conclusions about the role of compassion in end-of-life interventions. In this context, the paper aims to compare Mahatma Gandhi's and Aristotle's views on compassion to explore whether it can be utilized to justify physician-assisted dying. Gandhi's thoughts on compassion and Aristotle's standpoint on virtues and vices demonstrate that Gandhi evaluates this concept as a moral duty to relieve intractable suffering, whereas Aristotle relies on balancing all virtues through relevant deficiencies and excesses. Therefore, even though Gandhi's opinion on compassion can for allow assisted dying interventions, Aristotle's idea of virtues and vices restricts compassion to a scope that alleviates suffering through available means without causing death.
Med Health Care Philos
· 2025 Jun · PMID 39856449
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Healthcare systems produce significant greenhouse gas emissions, raising an important question: should healthcare be treated like any other polluter when it comes to reducing its emissions, or is healthcare special becau...Healthcare systems produce significant greenhouse gas emissions, raising an important question: should healthcare be treated like any other polluter when it comes to reducing its emissions, or is healthcare special because of its essential societal role? On one hand, reducing emissions is critical to combat climate change. On the other, healthcare depends on emissions to deliver vital services. The resulting tension surrounds an idea of healthcare exceptionalism and leads to the question I consider in this paper: to what extent (if any) should the valuable goals of healthcare form an exception to the burdens of reducing greenhouse gas emissions? The goals of this paper are twofold. One is to think about how to address the issue of healthcare exceptionalism. Second is to discuss the extent of healthcare's climatic responsibilities. I examine two perspectives on healthcare exceptionalism. The first treats a responsibility to reduce emissions and the delivery of healthcare as separate issues, each governed by its own principle. I reject this view, proposing instead that we consider healthcare's environmental responsibilities in conjunction with its essential functions. I defend an "inability to pay" principle, suggesting that while healthcare should indeed contribute to mitigating climate change, its obligations should be constrained by the necessity of maintaining its core goals like protecting health and preventing disease. Healthcare should be treated differently from other sectors, but not to the extent that it is entirely exempt from efforts to reduce emissions.
Pedersen SH, Radovic S, Nilsson T
… +1 more, Eriksson L
Med Health Care Philos
· 2025 Jun · PMID 39856448
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Forensic mental health services (FMHS) involve restricting certain individual rights to uphold or promote other ethical values - the restriction of liberty in various forms is justified with reference to health and safet...Forensic mental health services (FMHS) involve restricting certain individual rights to uphold or promote other ethical values - the restriction of liberty in various forms is justified with reference to health and safety of the individual and the community. The tension that arises from this has been construed as a hallmark of the practice and an ever-present quandary for practitioners. Stating this ethical dilemma upfront is a common point of departure for many texts discussing FMHS. But do we run the risk of missing something important if setting the ethical scene rather than exploring it? This paper draws on interviews with three types of interested parties in mental health law proceedings - patients, psychiatrists and public defenders, and seeks to tease out what values are enacted when they describe and discuss experiences of FMHS and court proceedings. In doing so, we find emphasized values such as acceptance, telling it like it is, atonement, normality, and ensuring the future. We find that well-delineated and separate values are not necessarily the basis for decisions. We also find potential for explanation and guidance in bringing ethical discourse closer to everyday practice.
Med Health Care Philos
· 2025 Jun · PMID 39843878
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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 w...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.