J Med Philos
· 2022 Feb · PMID 35137170
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The practice of health-care professional involvement in capital punishment has come under scrutiny since the implementation of lethal injection as a method of execution, raising questions of the goals of medicine and the...The practice of health-care professional involvement in capital punishment has come under scrutiny since the implementation of lethal injection as a method of execution, raising questions of the goals of medicine and the ethics of medicalized procedures. The American Medical Association and other professional associations have issued statements prohibiting physician involvement in capital punishment because medicine is dedicated to preserving life. I address the three primary arguments against health-care professionals being involved in lethal injection (healing, trust, and nonmaleficence) and argue that they are not strong enough to prohibit physician involvement in the lethal injection process.
J Med Philos
· 2022 Feb · PMID 34962268
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According to the widely accepted principles of beneficence and distributive justice, I argue that healthcare providers and facilities have an ethical duty to reduce the ecological footprint of the services they provide....According to the widely accepted principles of beneficence and distributive justice, I argue that healthcare providers and facilities have an ethical duty to reduce the ecological footprint of the services they provide. I also address the question of whether the reductions in footprint need or should be patient-facing. I review Andrew Jameton and Jessica Pierce's claim that achieving ecological sustainability in the healthcare sector requires rationing the treatment options offered to patients. I present a number of reasons to think that we should not ration health care to achieve sufficient reductions in a society's overall consumption of ecological goods. Moreover, given the complexities of ecological rationing, I argue that there are good reasons to think that the ethical duty to reduce the ecological footprint of health care should focus on only nonpatient-facing changes. I review a number of case studies of hospitals who have successfully retrofitted facilities to make them more efficient and reduced their resource and waste streams.
J Med Philos
· 2022 Feb · PMID 34922380
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While copious quantities of ink have been spilled on the topic of autonomy in the context of health care, little has been written about autonomy in relation to intellectual disability. After presenting the received accou...While copious quantities of ink have been spilled on the topic of autonomy in the context of health care, little has been written about autonomy in relation to intellectual disability. After presenting the received account of capacity, we argue that it cannot account for the moral permissibility of limiting an individual with intellectual disability's access to diet soda. In cases of preventative medicine and intellectual disability, the philosophical motivation for the received account of capacity is incompatible with the actions it recommends. We consider and reject several potential solutions; then, drawing on applied behavior analysis and the phenomenon of automatic reinforcement, we propose our own solution. The article concludes by considering the broader implications of our discussion.
J Med Philos
· 2021 Dec · PMID 34865062
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In this article, I explore difficult and sensitive questions regarding the nature of transgender identity claims and the appropriate medical treatment for those suffering from gender dysphoria. I first analyze conception...In this article, I explore difficult and sensitive questions regarding the nature of transgender identity claims and the appropriate medical treatment for those suffering from gender dysphoria. I first analyze conceptions of transgender identity, highlighting the prominence of the wrong-body narrative and its dualist presuppositions. I then briefly argue that dualism is false because our bodily identity (including our body's biological organization for sexual reproduction as male or female) is essential and intrinsic to our overall personal identity and explain why a sound, nondualist anthropology implies that gender identity cannot be entirely divorced from sexual identity. Finally, I make the case that arguments in favor of hormonal and surgical treatments for gender dysphoria rest on this mistaken dualist anthropology, and that these treatments therefore give false hope to those suffering from gender dysphoria, while causing irreversible bodily harm and diverting attention from underlying psychological problems that often need to be addressed. I also briefly discuss how these philosophical claims relate to empirical studies on the outcomes of hormonal and surgical treatments for gender dysphoria and to testimonies of transgender individuals who regret having undergone these treatments.
J Med Philos
· 2021 Dec · PMID 34865061
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The so-called Disability Paradox arises from the apparent tension between the popular view that disability leads to low well-being and the relatively high life-satisfaction reports of disabled people. Our aim in this ess...The so-called Disability Paradox arises from the apparent tension between the popular view that disability leads to low well-being and the relatively high life-satisfaction reports of disabled people. Our aim in this essay is to make some progress toward dissolving this alleged paradox by exploring the relationship between disability and various "goods of life"-that is, components of a life that typically make a person's life go better for them. We focus on four widely recognized goods of life (happiness, rewarding relationships, knowledge, achievement) and four common types of disability (sensory, mobility, intellectual, and social) and systematically examine the extent to which the four disability types are in principle compatible with obtaining the four goods of life. Our findings suggest that there is a high degree of compatibility. This undermines the widespread view that disabilities, by their very nature, substantially limit a person's ability to access the goods of life, and it provides some guidance on how to dissolve the Disability Paradox.
J Med Philos
· 2021 Dec · PMID 34724049
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The Significant Interest view entails that even if there were no medical reasons to have access to genetic knowledge, there would still be reason(s) for prospective parents to use an identity-release donor as opposed to...The Significant Interest view entails that even if there were no medical reasons to have access to genetic knowledge, there would still be reason(s) for prospective parents to use an identity-release donor as opposed to an anonymous donor. This view does not depend on either the idea that genetic knowledge is profoundly prudentially important or that donor-conceived people have a right to genetic knowledge. Rather, it turns on general claims about (1) parents' obligations to help promote their children's well-being and (2) the connection between a person's well-being and the satisfaction of what I call their "worthwhile significant subjective interests." To put this view (too) simply, the fact that a donor-conceived person-who knows she is donor-conceived-is likely to be very interested in acquiring genetic knowledge gives prospective parents a weighty reason to use an identity-release donor. This is because parents should promote their children's well-being through the satisfaction of their children's worthwhile significant interests.
J Med Philos
· 2021 Dec · PMID 34668012
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What is it to be mentally healthy? In the ongoing movement to promote mental health, to reduce stigma, and to establish parity between mental and physical health, there is a clear enthusiasm about this concept and a reco...What is it to be mentally healthy? In the ongoing movement to promote mental health, to reduce stigma, and to establish parity between mental and physical health, there is a clear enthusiasm about this concept and a recognition of its value in human life. However, it is often unclear what mental health means in all these efforts and whether there is a single concept underlying them. Sometimes, the initiatives for the sake of mental health are aimed just at reducing mental illness, thus implicitly identifying mental health with the absence of diagnosable psychiatric disease. More ambitiously, there are high-profile proposals to adopt a positive definition, identifying mental health with psychic or even overall well-being. We argue against both: a definition of mental health as mere absence of mental illness is too thin, too undemanding, and too closely linked to psychiatric value judgments, while the definition in terms of well-being is too demanding and potentially oppressive. As a compromise, we sketch out a middle position. On this view, mental health is a primary good, that is, the psychological preconditions of pursuing any conception of the good life, including well-being, without being identical to well-being.
J Med Philos
· 2021 Dec · PMID 34665228
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Although voluntarily stopping eating and drinking (VSED) as a way to hasten one's death is not yet a widely recognized practice in the United States, it has received increasing attention in the medical and bioethics lite...Although voluntarily stopping eating and drinking (VSED) as a way to hasten one's death is not yet a widely recognized practice in the United States, it has received increasing attention in the medical and bioethics literature in recent years. After a brief review of the broader context of human death and dying, this article poses and examines 11 conceptual, personal, and public policy questions about VSED. The article identifies essential features of VSED and discusses whether VSED is a type of suicide. It identifies reasons why people may or may not choose VSED, and it considers responses by family members and professional caregivers to people who have chosen VSED. It also considers how public policies may permit and regulate or restrict the practice of VSED. Examination of these questions is designed to increase understanding of VSED and to inform moral evaluation of this practice.
J Med Philos
· 2021 Dec · PMID 34655222
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Medical ethics would be better if people were taught to think more clearly about well-being or (what I take to be the same thing) the concept of what is good for a person. Yet for a variety of reasons, bioethicists have...Medical ethics would be better if people were taught to think more clearly about well-being or (what I take to be the same thing) the concept of what is good for a person. Yet for a variety of reasons, bioethicists have generally paid little attention to this concept. Here, I argue, first, that focusing on general theories of welfare is not useful for practical medical ethics. I argue, second, for what I call the "theory-without-theories approach" to welfare in practical contexts. The first element of this approach is a focus on examining important and relatively uncontroversial constituents of welfare as opposed to general theories. The second key element is a framework for thinking about choice in relation to welfare, a framework I refer to as "the mild objectivity framework." I conclude with illustrations of the way in which the "theory without theories approach" can improve thinking in medicine.
J Med Philos
· 2021 Dec · PMID 34655220
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Patients with severe disorders of consciousness are thought to be unaware of themselves or their environment. However, research suggests that a minority of patients diagnosed as having a disorder of consciousness remain...Patients with severe disorders of consciousness are thought to be unaware of themselves or their environment. However, research suggests that a minority of patients diagnosed as having a disorder of consciousness remain aware. These patients, designated as having "cognitive motor dissociation" (CMD), can demonstrate awareness by imagining specific tasks, which generates brain activity detectable via functional neuroimaging. The discovery of consciousness in these patients raises difficult questions about their well-being, and it has been argued that it would be better for these patients if they were allowed to die. Conversely, I argue that CMD patients may have a much higher level of well-being than is generally acknowledged. It is far from clear that their lives are not worth living, because there are still significant gaps in our understanding of how these patients experience the world. I attempt to fill these gaps, by analyzing the neuroscientific research that has taken place with these patients to date. Having generated as comprehensive a picture as possible of the capacities of CMD patients, I examine this picture through the lens of traditional philosophical theories of well-being. I conclude that the presumption that CMD patients do not have lives worth living is not adequately supported.
J Med Philos
· 2022 Nov · PMID 34655219
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We argue that the future-like-ours argument against abortion rests on an important assumption. Namely, in the first trimester of an aborted pregnancy, there exists something that would have gone on to enjoy conscious men...We argue that the future-like-ours argument against abortion rests on an important assumption. Namely, in the first trimester of an aborted pregnancy, there exists something that would have gone on to enjoy conscious mental states, had the abortion not occurred. To accommodate this assumption, we argue, a proponent of the future-like-ours argument must presuppose that there is ontic vagueness. We anticipate the objection that our argument achieves "too much" because it also applies mutatis mutandis to conscious humans. We respond by showing that an explanation can be given for why it is wrong to kill conscious humans that is independent of the underlying metaphysics. Our response brings into focus a reason why-at least in the context of an ethical argument like the future-like-ours argument-appeal to a highly controversial metaphysics is ad hoc. Such metaphysics is not necessary to explain the wrongness of killing conscious humans, only nonconscious fetuses.
J Med Philos
· 2022 May · PMID 34655215
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This essay draws on classical Confucian intellectual resources to argue that the person who emerges from a head transplant would be neither the person who provided the head, nor the person who provided the body, but a ne...This essay draws on classical Confucian intellectual resources to argue that the person who emerges from a head transplant would be neither the person who provided the head, nor the person who provided the body, but a new, different person. We construct two types of argument to support this conclusion: one is based on the classical Confucian metaphysics of human life as qi activity; the other is grounded in the Confucian view of personal identity as being inseparable from one's familial relations. These Confucian ideas provide a reasonable alternative to the currently dominant view that one's personal identity "follows" one's head. Together, these arguments imply that head transplantation is ethically inappropriate.
J Med Philos
· 2021 Oct · PMID 34596228
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The biophilosophic justification for the idea that "brain death" (or total brain failure) is death needs to support two claims: (1) that what dies in human death is a human organism, not merely a psychological entity dis...The biophilosophic justification for the idea that "brain death" (or total brain failure) is death needs to support two claims: (1) that what dies in human death is a human organism, not merely a psychological entity distinct from it; (2) that total brain failure signifies the end of the human organism as a whole. Defenders of brain death typically assume without argument that the first claim is true and argue for the second by defending the "integrative unity" rationale. Yet the integrative unity rationale has fallen on hard times. In this article, I give reasons for why we should think of ourselves as organisms, and why the "fundamental work" rationale put forward by the 2008 President's Council is better than the integrative unity rationale, despite persistent objections to it.
J Med Philos
· 2021 Oct · PMID 34596227
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The "right not to know" has generated significant discussion, especially regarding genetic information. In this paper, I argue that this purported right is better understood as a preference and that treating it as a subs...The "right not to know" has generated significant discussion, especially regarding genetic information. In this paper, I argue that this purported right is better understood as a preference and that treating it as a substantive right has led to confusion. To support this claim, I present three critiques of the way the right not to know has been characterized. First, I demonstrate that the many conceptualizations of this right have hampered debate. Second, I show that the way autonomy is conceptualized in this literature is also problematic. Third, I examine the notion of a right in more detail, to support my third critique: that the right to know and the right not to know genetic information are often erroneously treated as having equivalent status. On my understanding, the claim being made is better thought of as a preference, not a right, and a preference not to know certain information becomes only one of several considerations relevant to medical decision making.
van der Zande ISE, van der Graaf R, Oudijk MA
… +1 more, van Delden JJM
J Med Philos
· 2021 Oct · PMID 34596226
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The precautionary principle is often invoked in relation to pregnant women and may be one of the underlying reasons for their continuous underrepresentation in clinical research. The principle is appealing, because poten...The precautionary principle is often invoked in relation to pregnant women and may be one of the underlying reasons for their continuous underrepresentation in clinical research. The principle is appealing, because potential fetal harm as a result of research participation is considered to be serious and irreversible. In our paper, we explore through conceptual analysis whether and if so how the precautionary principle should apply to pregnant women. We argue that the principle is a decision-making strategy underlying risk-benefit decisions in clinical research, which can be applied to pregnant women. However, the current application is a strong one, leading to the promotion of absolute exclusion or, less often, absolute inclusion of pregnant women. In order to change this paralyzing situation, a shift toward weak precautionary thinking is necessary. Instead of automatic extreme precaution, a balance will be found between harms and potential benefits of including pregnant women in clinical research.
J Med Philos
· 2021 Oct · PMID 34423826
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This essay provides an account of how to distinguish between health and pathology of trait tokens in medical theory. It (1) proposes to distinguish between two health/pathology concepts-health/pathology pertaining to sur...This essay provides an account of how to distinguish between health and pathology of trait tokens in medical theory. It (1) proposes to distinguish between two health/pathology concepts-health/pathology pertaining to survival and health/pathology pertaining to reproduction. It (2) defines measures for survival-efficiency and reproduction-efficiency of performances of physiological functions. It (3) provides an account of how, using the efficiency measures, to draw the line between health and pathology. The account draws, but seeks to improve, on Christopher Boorse's biostatistical theory. In relation to that theory, the suggested account has the advantages (1) that it defines efficiency and (2) that it harmonizes with judgments in medical theory in cases of common diseases and "normal aging." Furthermore, the essay argues against a competing idea of how to improve on the biostatistical theory, advocated by Peter Schwartz and Daniel Hausman.
J Med Philos
· 2022 Aug · PMID 34370029
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This paper offers a philosophical analysis of the connection between mental disorder and suicide risk. In contemporary psychiatry, it is commonly suggested that this connection is a causal connection that has been establ...This paper offers a philosophical analysis of the connection between mental disorder and suicide risk. In contemporary psychiatry, it is commonly suggested that this connection is a causal connection that has been established through empirical discovery. Herein, I examine the extent to which this claim can be sustained. I argue that the connection between mental disorder and increased suicide risk is not wholly causal but is partly conceptual. This in part relates to the way suicidality is built into the definitions of some psychiatric diagnoses. It also relates to the broader normative assumption that suicidal behavior is by definition mentally disordered behavior. The above has significant epistemological implications, which I explore. I propose that the claim that suicide is connected with mental disorder cannot be justified solely by appealing to empirical evidence but also warrants a justification on conceptual and normative grounds.
J Med Philos
· 2021 Oct · PMID 34370028
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Phenomenology informs a number of contemporary attempts to give more weight to the lived experience of patients and overcome the limitations of a one-sidedly biomedical understanding of illness. Susan Bredlau has recentl...Phenomenology informs a number of contemporary attempts to give more weight to the lived experience of patients and overcome the limitations of a one-sidedly biomedical understanding of illness. Susan Bredlau has recently presented a reading of Plato's dialogue Charmides, which portrays Socrates as a pioneer of the phenomenological approach to illness. I use a critical discussion of Bredlau's interpretation of the Charmides to show that the phenomenology of illness also has its shortcomings and needs to be complemented by still other approaches. While Bredlau does make a number of highly apt and relevant suggestions as to how a narrow biomedical approach to illness may be corrected, some (but not all) of which are related to phenomenology, the attribution to Plato's Socrates of a phenomenological approach is mistaken. Characteristically, Socrates shows little interest in the personal experience of a patient. He is more concerned with the patient's lifestyle and conduct and so suggests an alternative or complementary perspective, stressing the importance of education and prevention to health care.
J Med Philos
· 2021 Oct · PMID 34302349
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The relevance of double effect for end-of-life decision-making has been challenged recently by a number of scholars. The principal reason is that opioids such as morphine do not usually hasten death when administered to...The relevance of double effect for end-of-life decision-making has been challenged recently by a number of scholars. The principal reason is that opioids such as morphine do not usually hasten death when administered to relieve pain at the end of life; therefore, no secondary "double" effect is brought about. In my article, I argue against this view, showing how the doctrine of double effect is relevant to the administration of opioids at the end of life. I contend that the prevailing view suffers from a misunderstanding of the nature of double effect, which includes application to risking a grave harm.
J Med Philos
· 2021 Oct · PMID 34302337
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Much research has studied the importance of play for children's development. However, questions of its political importance and our public institutions' duties to protect it have been largely neglected. This article argu...Much research has studied the importance of play for children's development. However, questions of its political importance and our public institutions' duties to protect it have been largely neglected. This article argues that childhood play is politically important due to having both intrinsic and instrumental value, and it suggests that the duty to protect the capability for play in childhood falls especially on the public health system. If this argument succeeds, it follows that we have stronger duties toward our children than we currently believe.