Med Health Care Philos
· 2025 Jun · PMID 39792232
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There are an increasing number of ways to enhance human abilities, characteristics, and performance. In recent years, the ethical debate on enhancement has focused mainly on the ethical evaluation of new enhancement tech...There are an increasing number of ways to enhance human abilities, characteristics, and performance. In recent years, the ethical debate on enhancement has focused mainly on the ethical evaluation of new enhancement technologies. Yet, the search for an adequate and shared understanding of enhancement has always remained an important part of the debate. It was initially undertaken with the intention of defining the ethical boundaries of enhancement, often by attempting to distinguish enhancements from medical treatments. One of the more recent approaches comes from Julian Savulescu, Anders Sandberg, and Guy Kahane. With their welfarist account, they define enhancement in terms of its contribution to individual well-being: as any state of a person that increases the chances of living a good life in the given set of circumstances. The account aims to contribute both to a shared and clear understanding of enhancement and to answering the question of whether we should enhance in certain ways or not. I will argue that it cannot live up to either claim, in particular because of its inherent normativity and its failure to adequately define well-being. Nevertheless, it can make a valuable contribution to an ethics of enhancement. As I will show, the welfarist account refocuses the debate on a central value in health care: well-being, which can be a relevant aspect in assessing the permissibility of biomedical interventions - especially against the background of new bioethical challenges. To fulfil this function, however, a more differentiated understanding of well-being is needed.
Med Health Care Philos
· 2025 Mar · PMID 39754698
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This paper seeks to determine the extent to which individuals with borderline personality disorders can be held morally responsible for a particular subset of their actions: disproportionate anger, aggressions and displa...This paper seeks to determine the extent to which individuals with borderline personality disorders can be held morally responsible for a particular subset of their actions: disproportionate anger, aggressions and displays of temper. The rationale for focusing on these aspects lies in their widespread acknowledgment in the literature and their plausible primary association with blame directed at BPD patients. BPD individuals are indeed typically perceived as "difficult patients" (Sulzer 2015:82; Bodner et al. 2011), significantly more so than schizophrenic or depressive patients (Markam 2003). The "responsibility question" for patients with BPD has already been raised (Martin 2010; Zachar and Potter 2009; Bray 2003), but this paper tackles it from a novel perspective. First, I narrow down the category of things for which the responsibility question is specific to individual with BPD. After that, I argue that some of the diagnosis criteria of BPD such as emotional instability or impulsivity might serve as excusing factors targeting the "control condition" on moral responsibility. Second, this paper also considers another widely accepted condition on moral responsibility: the epistemic condition. The view defended in the paper is that the answer to the responsibility question for individuals with BPD, concerning both the control condition and the epistemic condition, hinges on an understanding of their epistemic profile.
Med Health Care Philos
· 2025 Mar · PMID 39722077
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This article demonstrates the value of French philosophy of science for medical practice through an exposition of Michel Serres's philosophy of the body. It explores how Serres's examination of the similarity between sci...This article demonstrates the value of French philosophy of science for medical practice through an exposition of Michel Serres's philosophy of the body. It explores how Serres's examination of the similarity between scientific models and works of art can provide insight into different conceptions of the human body. What makes Serres's method of unique is that it does not see art and literature as subordinate to the natural sciences: they are both involved in mapping the communication lines of the body. Since early modernity, we can roughly speak of three successive communication models of the body: mechanical, thermodynamic and informational. This article finally discusses the relationship between those different conceptions and explains how they help to articulate different aspects of the body, health, and medical ethics.
Langmann E, Kainradl AC, Weßel M
… +1 more, Rokvity A
Med Health Care Philos
· 2025 Mar · PMID 39704896
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Endometriosis, a chronic inflammatory condition affecting 10% of biological women, is widely understudied and particularly overlooked in later life. Discussions surrounding endometriosis predominantly centre on medical g...Endometriosis, a chronic inflammatory condition affecting 10% of biological women, is widely understudied and particularly overlooked in later life. Discussions surrounding endometriosis predominantly centre on medical gender bias during reproductive years, with limited attention to intersecting factors of discrimination and the impact of ageism on affected individuals. As endometriosis is framed as a disease of reproductive age, research is lacking when it comes to the effects of the illness on the older population. Symptoms in (post)menopausal individuals are frequently misattributed to other ailments due to ageist and sexist preconceptions, leading to prolonged diagnoses and mistreatment. This is a social justice issue in which age and sex contribute to the discrimination of a certain population - namely older biological women living with endometriosis. In this paper, we approach this issue from the perspective of epistemic justice. The experiences of the affected persons are shaped by a lack of knowledge about endometriosis among both the healthcare personal and the affected person, as well as a lack of acknowledgement and consideration of the persons experiences. Using the lens of epistemic justice, we develop an analytical model to understand the intersection of age and gender in the experiences of endometriosis patients. This article contributes to ongoing debates on epistemic injustice and intersectionality within medicine and healthcare, offering an analytical model that connects the critical approaches of epistemic injustice and intersectionality to address health injustice. Ultimately, this work advocates for a comprehensive, lifespan approach to endometriosis that acknowledges and addresses intersecting forms of discrimination.
Med Health Care Philos
· 2025 Mar · PMID 39644445
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Artificial intelligence-based clinical decision support systems have a potential to improve clinical practice, but they may have a negative impact on the physician-patient dialogue, because of the control problem. Physic...Artificial intelligence-based clinical decision support systems have a potential to improve clinical practice, but they may have a negative impact on the physician-patient dialogue, because of the control problem. Physician-patient dialogue depends on human qualities such as compassion, trust, and empathy, which are shared by both parties. These qualities are necessary for the parties to reach a shared understanding -the merging of horizons- about clinical decisions. The patient attends the clinical encounter not only with a malfunctioning body, but also with an 'unhomelike' experience of illness that is related to a world of values and meanings, a life-world. Making wise individual decisions in accordance with the patient's life-world requires not only scientific analysis of causal relationships, but also listening with empathy to the patient's concerns. For a decision to be made, clinical information should be interpreted considering the patient's life-world. This side of clinical practice is not a job for computers, and they cannot be final decision-makers. On the other hand, in the control problem users blindly accept system output because of over-reliance, rather than evaluating it with their own judgement. This means over-reliant parties leave their place in the dialogue to the system. In this case, the dialogue may be disrupted and mutual trust may be lost. Therefore, it is necessary to design decision support systems to avoid the control problem and to limit their use when this is not possible, in order to protect the physician-patient dialogue.
Med Health Care Philos
· 2025 Mar · PMID 39614946
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Empirical research on moral injury (MI) has rapidly evolved since 2009. Originally developed to address the moral dimensions of traumatic experiences among US veterans, MI has also found application in the context of tra...Empirical research on moral injury (MI) has rapidly evolved since 2009. Originally developed to address the moral dimensions of traumatic experiences among US veterans, MI has also found application in the context of traumatized refugees. This paper delves into the ethical and epistemological questions that arise when applying a concept originally rooted in a qualitatively distinct experience and a demographically different population to refugees. It is argued that the prevailing clinical and psychological conceptualization of MI may not adequately accommodate the unique needs and experiences of refugee populations. This examination underscores the imperative of conceptualizing to better serve the ethical and epistemic demands of refugee communities.
Meier E, Rigter T, Schijven MP
… +2 more, van den Hoven M, Bak MAR
Med Health Care Philos
· 2025 Mar · PMID 39614032
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Recent publications on digital health technologies highlight the importance of 'responsible' use. References to the concept of responsibility are, however, frequently made without providing clear definitions of responsib...Recent publications on digital health technologies highlight the importance of 'responsible' use. References to the concept of responsibility are, however, frequently made without providing clear definitions of responsibility, thus leaving room for ambiguities. Addressing these uncertainties is critical since they might lead to misunderstandings, impacting the quality and safety of healthcare delivery. Therefore, this study investigates how responsibility is interpreted in the context of using digital health technologies, including artificial intelligence (AI), telemonitoring, wearables and mobile apps. We conducted a scoping review with a systematic search in PubMed, Web of Science, Embase, CINAHL and Philosopher's Index. A total of 34 articles were included and categorized using a theoretical framework of responsibility aspects, and revealed two main findings. First, we found that digital health technologies can expand and shift existing 'role responsibilities' among caregivers, patients and technology. Second, moral responsibility is often equated with liability or accountability, without clear justification. Articles describe new ways in which physicians can be held accountable, particularly in the context of AI, and discuss the emergence of a 'responsibility gap' where no-one can be fully responsible for AI-generated outcomes. The literature also shows that m-Health technologies can increase patients' accountability for their own health. However, there was limited discussion in the reviewed literature on whether these attributions of accountability are appropriate. We conclude with implications for practice and suggestions for expanding the theoretical framework of moral responsibility, recommending further study on responsibility of collectives and artificial entities, and on the role of virtue in digital health.
Med Health Care Philos
· 2025 Mar · PMID 39611875
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The present paper highlights the urgency for a revitalization of the field of bioethics. The authors have identified the "malaise" present in contemporary bioethics, and they claim that it has become a boring way to appr...The present paper highlights the urgency for a revitalization of the field of bioethics. The authors have identified the "malaise" present in contemporary bioethics, and they claim that it has become a boring way to approach medicine and life sciences instead of challenging them. Starting from a brief explanation of the origin of bioethics, this paper analyzes the main issues at the core of its malaise, i.e., its depersonalization and extreme specialization which exclude of a holistic view of the patient. Clinical ethics, an applied branch of bioethics, provides a prime example of a bioethical discipline that operates in real-world contexts, and it contrasts with the more theoretical nature of traditional bioethical frameworks. Thus, the inherent multidisciplinary nature of clinical ethics offers an opportunity to a way of connecting the hard and soft sciences, and, ultimately, of transcending this distinction in the medical humanities. The cure of the malaise of bioethics proposed in this article comes from the medical humanities, specifically from the applied humanities perspective, which offers a comprehensive approach to current world issues, including the fast evolution of technologies with applications to the health field.
Med Health Care Philos
· 2025 Mar · PMID 39601903
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Some philosophical and metaethical theories have tried to provide a fundamental background for bioethics but miss the fundamental question about what medicine is, its nature and its end. We argue that the philosophy of m...Some philosophical and metaethical theories have tried to provide a fundamental background for bioethics but miss the fundamental question about what medicine is, its nature and its end. We argue that the philosophy of medicine, through the development that Edmund Pellegrino and David Thomasma gave to this field of study, allied with Aristotle's practical and teleological ethics, can provide an ontological background for bioethics beyond the tradition of principles and deontology, with particular emphasis on the uniqueness of the doctor-patient encounter. Some difficulties and criticisms of this ontological model are also examined.
Med Health Care Philos
· 2025 Mar · PMID 39579288
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Saving as many lives as possible while ensuring equity for vulnerable groups through access to triage resources has been the dominant position since the onset of the COVID-19 pandemic in 2020. However, the exact relation...Saving as many lives as possible while ensuring equity for vulnerable groups through access to triage resources has been the dominant position since the onset of the COVID-19 pandemic in 2020. However, the exact relationship between the principles of social justice and efficiency remains a controversial and unresolved issue. In this paper, we aim to systematically distinguish between different models of this relationship and show that conceptualizing social justice as a 'moral side-constraint' or adopting a 'balancing approach' that attempt to reconcile social justice with efficiency inevitably lead to significant moral costs that require further justification. Based on this discussion, we propose a novel "threshold model" for trading-off moral costs. According to this model, the structural impact of triage must be considered in order to determine whether one opts for triage with the primary aim of efficiency or social justice. This contextualization further explains why, in some societies and circumstances, social justice can rightly be seen as the primary concern, while in other societies and circumstances, efficiency can be defended as the primary concern.
Med Health Care Philos
· 2025 Mar · PMID 39549168
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False hope is costly for individuals, their loved ones, and society. Scholars have defined false hope as one that involves an epistemically unjustified belief. In this paper, I argue that this account of false hope is in...False hope is costly for individuals, their loved ones, and society. Scholars have defined false hope as one that involves an epistemically unjustified belief. In this paper, I argue that this account of false hope is incomplete and that false hope should be conceptualized in terms of the way in which the agent attends to or focuses on a highly desired but unlikely outcome. I explain how this account better captures the distinctiveness of false hope.
Med Health Care Philos
· 2025 Mar · PMID 39537901
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In addressing the question of what mental health is we might proceed as if there is a single phenomenon-mental health-denoted by a single overarching concept. The task, then, is to provide an informative analysis of this...In addressing the question of what mental health is we might proceed as if there is a single phenomenon-mental health-denoted by a single overarching concept. The task, then, is to provide an informative analysis of this concept which applies to all and only instances of mental health, and which illuminates what it is to be mentally healthy. In contrast, mental health pluralism is the idea that there are multiple mental health phenomena denoted by multiple concepts of mental health. Analysis and illumination of mental health may still be possible, but there isn't a single phenomenon or concept to be analysed in addressing the question of what mental health is. The question of pluralism has been overlooked in the philosophy of mental health. The discussion to follow is an attempt to get us to take mental health pluralism seriously. To that end, in this essay I have three primary goals: (1) to give a precise account of what mental health pluralism is, (2) to show that the question of pluralism should not be neglected in debate about what mental health is, and (3) to argue for mental health pluralism. I also draw out some implications of this discussion for philosophy, science, and psychotherapy.
Med Health Care Philos
· 2025 Mar · PMID 39537900
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The principle of trust has been placed at the centre as an attitude for engaging with clinical machine learning systems. However, the notions of trust and distrust remain fiercely debated in the philosophical and ethical...The principle of trust has been placed at the centre as an attitude for engaging with clinical machine learning systems. However, the notions of trust and distrust remain fiercely debated in the philosophical and ethical literature. In this article, we proceed on a structural level ex negativo as we aim to analyse the concept of "institutional distrustworthiness" to achieve a proper diagnosis of how we should not engage with medical machine learning. First, we begin with several examples that hint at the emergence of a climate of distrust in the context of medical machine learning. Second, we introduce the concept of institutional trustworthiness based on an expansion of Hawley's commitment account. Third, we argue that institutional opacity can undermine the trustworthiness of medical institutions and can lead to new forms of testimonial injustices. Finally, we focus on possible building blocks for repairing institutional distrustworthiness.
Med Health Care Philos
· 2025 Mar · PMID 39466359
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This paper consists of two parts. In the first part, I will introduce a philosophical toolbox that I call 'conceptual scaffolding,' which helps to reflect holistically on phenomena and concepts. I situate this framework...This paper consists of two parts. In the first part, I will introduce a philosophical toolbox that I call 'conceptual scaffolding,' which helps to reflect holistically on phenomena and concepts. I situate this framework within the landscape of conceptual analysis and conceptual engineering, exemplified by the debate about the concept of disease. Within the framework of conceptual scaffolding, I develop the main idea of the paper, which is 'the binocular model of plural medicine', a holistic framework for analyzing medical concepts and phenomena. In the second part, I demonstrate the use and value of the binocular model by analyzing, through the lenses of the model, the phenomenon of health wearable devices and their effects on the concept of diagnosis.
Med Health Care Philos
· 2025 Mar · PMID 39390303
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In recent years, data-driven approaches to chronic pain care have increased dramatically. However, people living with chronic pain are ambivalent about datafication practices. Drawing on in-depth interviews with individu...In recent years, data-driven approaches to chronic pain care have increased dramatically. However, people living with chronic pain are ambivalent about datafication practices. Drawing on in-depth interviews with individuals living with chronic pain, I discuss and analyze this ambivalence. On the one hand, participants imbibe the promissory rhetoric of data as that which may organize and control the body in pain. On the other hand, they dismiss and critique the type of data collected. This micro-level analysis of the pain tracking experience illuminates a tension between datafication and chronic pain. Datafication demands that the patient relay information about their body that is free of ambiguity. However, chronic pain is ambiguous and full of paradox. This article illuminates the emotional chasm between datafication enthusiasts and chronic pain patients who track their pain and suggests that such enthusiasm may lead to bad faith.
Med Health Care Philos
· 2024 Dec · PMID 39377978
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This paper analyses the information disclosures in two biobank consent documents used by biobanks operating under the General Data Protection Regulation (GDPR). The aim of the analysis is to investigate how these documen...This paper analyses the information disclosures in two biobank consent documents used by biobanks operating under the General Data Protection Regulation (GDPR). The aim of the analysis is to investigate how these documents inform potential sample donors about possible future uses of biobank data. The findings suggest that the consent documents provide potentially misleading information regarding the range of possible future uses of biobank data. Based on these information disclosures, potential sample donors may reasonably believe that the data can only be used for a narrowly defined range of research purposes. However, the range of lawful uses of the data is much broader and less clearly defined. Consent provided based on misleading information is not morally transformative, even if it were legally valid. To facilitate morally transformative biobank consent, this paper provides two recommendations for information disclosure to potential sample donors regarding future uses of biobank data: first, potential sample donors should be informed about the legal scope of consent; and second, they should be informed about the full range of lawful uses of biobank data.
Abdulrazeq F, März J, Biller-Andorno N
… +1 more, Gastmans C
Med Health Care Philos
· 2024 Dec · PMID 39370496
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Delivering healthcare to undocumented migrants presents a complex challenge for healthcare providers. Integrating advocacy efforts into their daily practices can be ambiguous in practical terms, stemming from the intrica...Delivering healthcare to undocumented migrants presents a complex challenge for healthcare providers. Integrating advocacy efforts into their daily practices can be ambiguous in practical terms, stemming from the intricate task of addressing the health needs of this population while simultaneously advocating for their health rights within the constraints imposed on them. This study seeks to consolidate findings from literature regarding the advocacy approaches employed by healthcare providers and the correlated ethical challenges. We conducted a scoping review of qualitative literature by systematically searching four databases-PubMed/Medline, Embase, Cinahl, and Cochrane Library. For developing our search strategy, we employed the PICO (Population, Intervention, Comparison, Outcome) scheme. Our analysis followed the qualitative content analysis approach proposed by Graneheim and Lundman. 30 studies were included, revealing a cumulative total of 915 healthcare providers who were interviewed. A total of 30 themes emerged comprising 14 advocacy approaches and 16 ethical challenges. Healthcare providers made a deliberate choice to engage in advocacy, responding to injustices experienced by undocumented migrants. The spectrum of advocacy initiatives varied, encompassing voluntary participation in healthcare provision, empathetic understanding, and healthcare-focused strategies. We also identified numerous correlated ethical challenges, necessitating healthcare providers to strike a balance between their eagerness to assist and their professional competence, respect the autonomy of undocumented migrants, and establish trust with them. These findings not only offer practical guidance for healthcare providers to enhance accessibility to healthcare services for undocumented migrant patients but also foster awareness of the ethical challenges that may arise in their advocacy roles.