The Journal Of Medicine And Philosophy[JOURNAL]
Sun
200 papers
Baby Parts.
Hershenov R
J Med Philos · 2026 Jun · PMID 41510999 · Publisher ↗
In her recent work, Elselijn Kingma applies four criteria for the individuation of an organism to determine whether the fetus is a part of or mereologically distinct from the mother. These criteria are: homeostasis, meta...
In her recent work, Elselijn Kingma applies four criteria for the individuation of an organism to determine whether the fetus is a part of or mereologically distinct from the mother. These criteria are: homeostasis, metabolic and functional integration, topological continuity, and immunological tolerance. She concludes on the basis of these four criteria that the evidence supports a thesis to the effect that the fetus is a part of the mother and that the point of topological continuity is at the placenta, a "shared organ." In this paper, I use Kingma's four criteria offered to argue that the fetus is mereologically distinct from the mother; the fetus is not a maternal part. The placenta, which I argue is a fetal part, is precisely the point at which there is topological discontinuity between mother and fetus.
Fair Consent Transactions and Ethical Pluralism.
Tropman E
J Med Philos · 2026 Apr · PMID 41405944 · Full text
According to the fair transaction view, consent is morally powerful when it occurs in the context of a larger consent transaction that is fair, rather than when one's consent is valid. This fair transaction view represen...
According to the fair transaction view, consent is morally powerful when it occurs in the context of a larger consent transaction that is fair, rather than when one's consent is valid. This fair transaction view represents a novel approach to the ethics of consent and puts pressure on the standard focus on valid consent. If correct, the fair transaction model promises to alter our understanding of when consent in medicine matters morally. In this paper, I examine the prospects for the fair transaction view. I raise both good and bad news for the theory. On the one hand, I show this new approach to consent captures something important when it says that we ought to weigh a number of competing demands fairly. Yet on the other, I argue that this insight is better explained by the larger moral system of ethical pluralism.
Unraveling Networks: The Conceptual Incoherence of the Network Approach.
Oude Maatman FJW, Eronen MI
J Med Philos · 2026 Apr · PMID 41400679 · Publisher ↗
The network approach to psychopathology promises (personalized) visualizations of the structure of mental disorders, in turn allowing for prediction of disorder development and identification of intervention targets. In...
The network approach to psychopathology promises (personalized) visualizations of the structure of mental disorders, in turn allowing for prediction of disorder development and identification of intervention targets. In this paper, we argue that these goals are problematized by conceptual incoherence between the approach's two pillars: the network theory of mental disorders, and the suite of methods known as "network psychometrics." First, we argue that, if it is to be clinically informative, network psychometrics requires (1) an embedding argument to justify that a causally sufficient set of variables has been modeled, and (2) a concomitant argument supporting the assumption that the human-environment system is near-decomposable. Then, we show that current versions of the network theory of psychopathology raise severe obstacles for such arguments, if not outright blocking them. In turn, the network approach to psychopathology appears to unravel unless changes are made to its pillars.
Depressed, Not Disordered: Fittingness and Pathologies of Emotion.
Kramer MF
J Med Philos · 2026 Apr · PMID 41299883 · Publisher ↗
Distressing emotions and emotions that impede social functioning are standard components of psychiatric disorders, but the presence of a pathology requires underlying psychological dysfunction in addition. This article a...
Distressing emotions and emotions that impede social functioning are standard components of psychiatric disorders, but the presence of a pathology requires underlying psychological dysfunction in addition. This article argues that, given a commitment to a popular philosophical picture of emotions (and moods), affective dysfunction should be understood in terms of the normative concept of fittingness. Therefore, an individual should be understood to be affectively disordered only if their emotional responses are systematically unfitting. This view gains support from some quarters; notably, the DSM-V-TR diagnostic criteria for Major Depressive Disorder exhibits an inchoate appreciation of the importance of (un)fittingness to psychiatric disorder, and debates about the pathological status of prolonged grief are naturally interpreted as debates about the fittingness of that attitude. Taking a synoptic perspective, accounting for fittingness can help to establish the limits of psychiatric practice and avoid potential disciplinary injustices.
The Case for Pluralism in Death Determination: From Empirical Data to a Policy Proposal.
Neiders I, Dranseika V
J Med Philos · 2026 Feb · PMID 41128346 · Publisher ↗
The article defends the pluralist policy of death determination. According to this view, competent persons should be free to choose the criteria under which they should be diagnosed as dead. Our argument partly relies on...
The article defends the pluralist policy of death determination. According to this view, competent persons should be free to choose the criteria under which they should be diagnosed as dead. Our argument partly relies on the diagnosis of the current state of the discussion in the bioethical literature on death determination and partly on empirical evidence that lay intuitions about death determination differ, that is, that there is interpersonal psychological pluralism about death determination. The article then introduces empirical evidence for intrapersonal psychological pluralism about death determination. We argue that intrapersonal psychological pluralism strengthens the case for the pluralist policy of death determination.
Compassionate Understanding.
Matthews S
J Med Philos · 2026 Feb · PMID 41100171 · Publisher ↗
The trauma and anguish professional people encounter in their work over time can lead to losses in competence and occupational burnout. However, the practice of detachment designed to avoid these outcomes can tip over in...
The trauma and anguish professional people encounter in their work over time can lead to losses in competence and occupational burnout. However, the practice of detachment designed to avoid these outcomes can tip over into losses in the ability to connect with clients, and even to alienation from the professional role itself. Some have thought that the proper regulation of levels of empathic concern ensures a balance between these two poles. I argue against this and instead advocate for a stance I call compassionate understanding. I contend that this best achieves sustained professionalism while remaining morally attuned to the norms of one's occupation. I focus on health care to illustrate what is at stake in compassionate understanding, though the position I defend has applications across a significant range of professions.
Pellegrino and Thomasma's Anatomy of Clinical Judgments Revisited.
Trimble M, Croskerry P
J Med Philos · 2026 Feb · PMID 41020797 · Publisher ↗
In 1981, Edmund Pellegrino and David Thomasma published A Philosophical Basis of Medical Practice. In this work, they situated the process of clinical judgment in the clinical encounter between an individual doctor and t...
In 1981, Edmund Pellegrino and David Thomasma published A Philosophical Basis of Medical Practice. In this work, they situated the process of clinical judgment in the clinical encounter between an individual doctor and their patient. The encounter revolves around three questions: What can be wrong? What can be done? And what should be done for this patient? They analyzed the complete process of clinical reasoning involving both technical and ethical aspects. Pellegrino and Thomasma's subsequent work focused more on professionalism and ethics, while more recent analysis of clinical decision-making has been in the realm of psychology rather than along philosophical lines, particularly in the use of dual-process theory. Here we seek to review Pellegrino and Thomasma's analysis and to reintegrate the technical and ethical aspects of clinical reasoning.
Artificial Intelligence for Serious Illness Communication: Proactive Approaches to Mitigating Harm.
Tarbi EC, Durieux BN, Kwok A … +2 more , Rizzo DM, Lindvall C
J Med Philos · 2025 Dec · PMID 41020796 · Publisher ↗
Serious illness communication is at the core of palliative care, aligning care with patient preferences and improving patient and family experience. Artificial Intelligence (AI) methods have increasingly been applied to...
Serious illness communication is at the core of palliative care, aligning care with patient preferences and improving patient and family experience. Artificial Intelligence (AI) methods have increasingly been applied to palliative care and provide promising opportunities for measuring and enhancing communication (e.g., capturing speech patterns and delivering feedback). Yet, given known disparities in palliative care and the limitations afforded by our natural communication datasets, this task must be approached with caution. Focusing on the study of communication, we consider assumptions that may be baked into our models (e.g., in data, definitions, measurements, and outcomes) and ways to mitigate potential harm across stages of model development-from setting priorities for AI research and applications in our field, to conducting new data collection efforts which are inclusive and more representative, to incorporating patient-family feedback. Transparency and thoughtfulness in this line of innovation may help us leverage AI to provide more equitable, higher-quality serious illness care (see Figure 1).
A Matter of Judgment? Second-Hand Medical Knowledge and Professional Responsibility.
Eriksen A
J Med Philos · 2026 Feb · PMID 41020793 · Publisher ↗
Professional judgment is of contested value today. Some argue that the current availability of tools for aligning decisions with evidence-based standards implies that individual judgment should be limited as much as poss...
Professional judgment is of contested value today. Some argue that the current availability of tools for aligning decisions with evidence-based standards implies that individual judgment should be limited as much as possible. This article argues to the contrary: professional judgment remains a precondition for responsible practice. Nevertheless, increased epistemic dependence-the turn to second-hand medical knowledge-alters the domains of judgment. As first-order evidence has become overwhelming and opaque to practitioners, they need intelligent ways of placing their trust, of integrating different kinds of epistemic tools, and taking responsibility for consequences. The article suggests how these tasks can be seen as a complement to the original ambition of the evidence movement of promoting research literacy.
The Role of Empathy in Critical Reasoning and the Limitations of Medical AI Systems.
Favaretto M, Stroh K
J Med Philos · 2025 Dec · PMID 41015910 · Publisher ↗
The recent developments of medical AI systems (MAIS) open up questions as to whether and to what extent MAIS can be modeled to include empathetic understanding, as well as what impact MAIS' lack of empathetic understandi...
The recent developments of medical AI systems (MAIS) open up questions as to whether and to what extent MAIS can be modeled to include empathetic understanding, as well as what impact MAIS' lack of empathetic understanding would have on its ability to perform the necessary critical analyses for reaching a diagnosis and recommending medical treatment. In this article, we argue that current medical AI systems' ability to empathize with patients is severely limited due to its lack of first-person experiences with human interests and that efforts to correct for this deficit-by having MAIS interpret patients' medical and non-medical interests-will encounter significant obstacles. Finally, we demonstrate how MAIS' lack of empathy is likely to hinder its performance in crucial aspects of the processes through which useful medical diagnoses are reached and through which appropriate treatment recommendations for patients are determined.
Epistemically Transformative Medical Procedures and Informed Consent.
Dutta RR
J Med Philos · 2026 Feb · PMID 40991559 · Publisher ↗
I argue that true informed consent is impossible to obtain for certain medical procedures in which epistemic transformation occurs. Cases in which undergoing a procedure itself provides new experiential information, that...
I argue that true informed consent is impossible to obtain for certain medical procedures in which epistemic transformation occurs. Cases in which undergoing a procedure itself provides new experiential information, that is, phenomenal knowledge (what I call "knowledge-what-it's-like"), true informed consent for that procedure cannot be attained from knowing facts about the procedure ("knowledge-that") alone. If epistemically transformative medical procedures indeed undermine informed consent as I argue they do, I suggest that there are important implications for the decision-making of patients considering these procedures (e.g., chemotherapy, invasive surgeries, cochlear implants, gender-affirming procedures). Rather than solely communicating biological, clinical, and epidemiological facts about procedures, clinicians should supplement pre-procedure counseling with previous patient testimonials or even virtual/augmented reality to compensate (albeit partially) for the "knowledge-what-it's-like" that is absent prior to undergoing epistemically transformative medical procedures. Although these interventions may not (accurately) convey what it is like to undergo the procedure, they address the traditionally under-explored experiential aspect of medical treatments in medical decision-making from the patient's perspective.
AI and Healthcare Disparities: Lessons from a Cautionary Tale in Knee Radiology.
Hull G
J Med Philos · 2025 Dec · PMID 40971664 · Publisher ↗
Enthusiasm about the use of artificial intelligence (AI) in medicine has been tempered by concern that algorithmic systems can be unfairly biased against racially minoritized populations. This article uses work on racial...
Enthusiasm about the use of artificial intelligence (AI) in medicine has been tempered by concern that algorithmic systems can be unfairly biased against racially minoritized populations. This article uses work on racial disparities in knee osteoarthritis diagnoses to underline that achieving justice in the use of AI in medical imaging requires attention to the entire sociotechnical system within which it operates, rather than isolated properties of algorithms. Using AI to make current diagnostic procedures more efficient risks entrenching existing disparities; a recent algorithm points to some of the problems in current procedures while highlighting systemic normative issues that need to be addressed while designing further AI systems. The article thus contributes to a literature arguing that bias and fairness issues in AI be considered as aspects of structural inequality and injustice and to highlighting ways that AI can be helpful in making progress on these.
A Matter of Trust: Principles to Ethically Assess AI in Health Care.
Pilkington BC, Green BP, Binkley CE
J Med Philos · 2025 Dec · PMID 40971658 · Publisher ↗
In this article, we focus on questions of agency in emerging technologies related to decision-making in medicine. We discuss three principles that were subsumed when bioethics embraced principlism: consent, confidentiali...
In this article, we focus on questions of agency in emerging technologies related to decision-making in medicine. We discuss three principles that were subsumed when bioethics embraced principlism: consent, confidentiality, and veracity. We argue that the advent of artificial intelligence and its employment within health care, impacts the physician-patient relationship in a way that its inclusion in other areas does not. In particular, we take up ethical dilemmas caused by AI related to trust, and illustrate how reflection on these subsumed principles helps to critique accurately policies related to the use of AI in health care and to navigate dilemmas associated with a loss of trust. We conclude by contrasting these principles with the proposed "five principles" system for AI, highlighting some areas of agreement, but also showing where consent, confidentiality, and veracity are necessary additions for ethically employing AI.
Skewed Transgender Narratives in Western Media.
Moeller HG, Ponseti J
J Med Philos · 2025 Oct · PMID 40390379 · Publisher ↗
This essay compares representations of transgender people in Western mass and social media with data drawn from studies on transgender individuals. Three differences between the surveyed data and the media representation...
This essay compares representations of transgender people in Western mass and social media with data drawn from studies on transgender individuals. Three differences between the surveyed data and the media representations stand out: (1) while Western media focus on male-to-female (M-F) individuals, most transgender people in Western societies today are female-to-male (F-M). (2) Western media representations of transgender individuals highlight glamorous, successful people. Empirical data show that the socioeconomic status of transgender individuals in Western societies tends to be lower than that of nontransgender people. (3) In Western media, the transitioning process of transgender people is often portrayed as a successful soteriological journey of becoming one's "true self." Medical surveys show that transgender people suffer from psychological and physical problems both before and after transitioning. It is concluded that the disparity between the empirical data and the media narratives on transgender people is due to the persistence of neoliberal narratives in Western media.
Do Non-Compensating Plasma Centers Exploit Donors?
MacDougall DR
J Med Philos · 2025 Oct · PMID 40390378 · Publisher ↗
Some authors defend prohibiting compensation for blood plasma on the grounds that compensating donors exploits them. James Taylor has recently argued against this view. According to Taylor, not only does compensation not...
Some authors defend prohibiting compensation for blood plasma on the grounds that compensating donors exploits them. James Taylor has recently argued against this view. According to Taylor, not only does compensation not exploit donors but also accepting uncompensated donations in jurisdictions requiring this exploits donors. In this article, I evaluate Taylor's novel market-based account of exploitation and the conclusions about plasma donations he draws from it. I accept and offer further support for his account of exploitation but argue that (contra Taylor) the market-based account suggests that it is only in cases of capped compensation or legal monopsonies that centers can exploit donors. Uncompensated donations required by prohibitions are unlikely to exploit donors because a system of uncompensated donations does not actually benefit plasma centers, assuming a reasonable understanding of "benefits" for these nonprofit organizations. Finally, I discuss whether centers that can increase benefits to everyone by making exploitative offers should.
Illness Experience and Social Suffering: Synthesizing Medical Phenomenology and Critical Theory.
Sik D
J Med Philos · 2025 Oct · PMID 40390372 · Publisher ↗
Medical phenomenology describes the illness experience while providing an alternative to the reductionist biomedical discourse. Phenomenologically oriented critical theories focus on the experiences of structural paradox...
Medical phenomenology describes the illness experience while providing an alternative to the reductionist biomedical discourse. Phenomenologically oriented critical theories focus on the experiences of structural paradoxes manifesting as social suffering. While both approaches elaborate different patterns of suffering, so far, their parallelisms and interactions have not been adequately analyzed. This task is all the more important because illness experience is never only about the disabled body or the distressed mind, it is also inseparable from a distorted intersubjectivity; and vice versa, untreated social suffering also has the potential of turning into illness. After overviewing various experiences characterizing illness and those disrupted intersubjectivities, which can produce a homologous phenomenological pattern, four idealtypical patterns are analyzed. The parallel occurrence of illness and social suffering represents extreme existential disembedding; illness without social suffering represents a chance for countering the bodily disembedding by intersubjective re-embedding; social suffering without illness is a constellation, wherein the chance of medicalizing structural distortions is high; the lack of illness and social suffering represents a carefree, yet unreflective potential. Differentiating between these patterns opens new horizons for medical phenomenology and critical theories as well, both on the theoretical and the practical level.
Justification and Limitations of the Duty to Treat.
Ortiz-Millán G
J Med Philos · 2025 Oct · PMID 40366910 · Full text
Do healthcare workers have a duty to treat contagious patients, even when it poses risks to their own health and lives during a pandemic? This article explores various justifications proposed in the literature to support...
Do healthcare workers have a duty to treat contagious patients, even when it poses risks to their own health and lives during a pandemic? This article explores various justifications proposed in the literature to support such a duty. However, it contends that none of these provides a strong enough basis for establishing an absolute duty to treat-although it acknowledges that the bar of justification may be raised when working on more clear and explicit conditions in contracts and codes of ethics, among others. Furthermore, even if such a duty were acknowledged, it must be weighed against healthcare workers' other duties toward their families, co-workers, and personal well-being. Moreover, the duty to treat is argued to be contingent on the circumstances in which healthcare professionals operate, including access to adequate personal protective equipment provided by their institutions. It would have to be balanced against their right to safe working conditions. Within this context, the duty to treat is inherently tied to the preparedness of the State, healthcare systems, or institutions to effectively respond to emergencies.
Rethinking Phenomenology of Health and Illness: An Alternative Interpretation.
Zhang J
J Med Philos · 2025 Oct · PMID 40325610 · Publisher ↗
This paper critically evaluates Matthew Burch's interpretations and critiques of the phenomenological account of health and illness, which are predominantly situated within the realm of static phenomenology within Husser...
This paper critically evaluates Matthew Burch's interpretations and critiques of the phenomenological account of health and illness, which are predominantly situated within the realm of static phenomenology within Husserl's framework, thereby neglecting the potential insights offered by genetic phenomenology. The primary focus of this paper is to explore genetic phenomenology in order to present an alternative interpretation of PHI. It argues that illness experience involves subjectivity, intersubjectivity, and objectivity, unified within a structural interdependence. Additionally, normality comprises subjective, intersubjective, and objective dimensions, reflecting its multifaceted nature. It encompasses both a pregiven aspect and a constitutive process. Moreover, the distinction between the lived body and the physical body is a result of first-person subjectification and third-person objectification perspectives. These perspectives mutually complement and intertwine, where bodily transparency and bodily conspicuousness do not necessarily conflict.
Why Nonidentity Is Not a Problem: Parfitian Defence of Clinicians Refusing to Provide Assisted Reproductive Technologies.
Hall G
J Med Philos · 2025 May · PMID 40319469 · Publisher ↗
An accepted argument in reproductive rights literature holds that the welfare of future children is irrelevant in the provision of assisted reproductive technology (ART). A foundational philosophical concept underpinning...
An accepted argument in reproductive rights literature holds that the welfare of future children is irrelevant in the provision of assisted reproductive technology (ART). A foundational philosophical concept underpinning such dismissal appeals to the "non-identity" problem. This argument holds that a future ART child's overriding interest lies in being born. I challenge this argument, suggesting it is a shallow and selective interpretation of the concept that narrowly applies the "person-affecting" harm principle to future ART children. I suggest a more extensive reading of the "non-identity" problem defends the opposite argument-that dismissing child welfare concerns in ART provision is wrong. In line with the work of one of the key architects of the "non-identity" problem, I formulate four Parfit-style arguments that justify clinician refusal of treatment. The key substantive claim of this paper is that delay or denial of ART is morally defensible within the "non-identity" problem paradigm in some instances.
Boundaries of Disease: Vagueness and Overdiagnosis.
Boorse C
J Med Philos · 2025 Jul · PMID 40285504 · Publisher ↗
In five related essays, Mary Jean Walker and Wendy Rogers, joined in one essay by Jenny Doust, defend various theses about the concept of disease. First, they argue "disease" is a cluster concept, not a "classically stru...
In five related essays, Mary Jean Walker and Wendy Rogers, joined in one essay by Jenny Doust, defend various theses about the concept of disease. First, they argue "disease" is a cluster concept, not a "classically structured" one definable by necessary and sufficient conditions. Second, "disease" is vague, in the standard philosophical sense of having borderline cases. In fascinating detail, they argue that this vagueness shows up almost everywhere one looks among ordinary diseases, even if disease is taken to require dysfunction. Still, they conclude, vagueness per se need not be a problem because logicians and philosophers know several ways to handle it. Third, Rogers and Walker believe that the vagueness of "disease" is a clue to how to reduce the much-discussed medical problem of "overdiagnosis": the diagnosis of permanently harmless disease. Finally, they find my analysis of disease-the "biostatistical theory" (BST)-defective and dangerous in four different ways: it offers insufficient guidance on how to draw disease boundaries; it does not fit actual medical practice in doing so; it is ambiguous as to reference class; and it facilitates overdiagnosis. In this article, I freely concede the vagueness of disease, but argue that it is considerably less than Rogers and Walker suppose, and no threat to the BST in any case. I also rebut all their other charges of deficiency in my analysis.
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