The Journal Of Medicine And Philosophy[JOURNAL]
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200 papers
Why Moral Bioenhancement Cannot Reliably Produce Virtue.
Lebkuecher G, Hornewer M, Roytman MV … +2 more , Samoska S, Vukov JM
J Med Philos · 2024 Nov · PMID 39244780 · Publisher ↗
Moral bioenhancement presents the possibility of enhancing morally desirable emotions and dispositions. While some scholars have proposed that moral bioenhancement can produce virtue, we argue that within a virtue ethics...
Moral bioenhancement presents the possibility of enhancing morally desirable emotions and dispositions. While some scholars have proposed that moral bioenhancement can produce virtue, we argue that within a virtue ethics framework moral bioenhancement cannot reliably produce virtue. Moreover, on a virtue ethics framework, the pursuit of moral bioenhancement carries moral risks. To make this argument, we consider three aspects of virtue-its motivational, rational, and behavioral components. In order to be virtuous, we argue, a person must (i) take pleasure in doing the right thing and have the correct motivational attitudes; (ii) reason correctly about what is called for in a particular ethical dilemma; and (iii) intentionally and continuously practice and cultivate virtues. These dimensions of morality-in short: precisely those emphasized in a virtue ethics framework-cannot be consistently or reliably met using existing moral bioenhancement technology.
A Defense of the Obligation to Keep Promises to the Dead.
Taylor JS
J Med Philos · 2024 Nov · PMID 39244778 · Publisher ↗
It is widely held that to break a promise that one made to a person who is now dead would be to wrong her. This view undergirds many positions in bioethics, ranging from those that concern who may access a person's medic...
It is widely held that to break a promise that one made to a person who is now dead would be to wrong her. This view undergirds many positions in bioethics, ranging from those that concern who may access a person's medical records after she has died, to questions concerning organ procurement and posthumous procreation. Ashley Dressel has argued that there is no reason to believe that promissory obligations can be owed to people who are dead. Although her arguments are unsuccessful, others establish that neither of the promissory obligation accounts that she considers (the "Authority Account" and the "harm-based view") can justify the standard view that directed posthumous promissory obligation is possible. However, this does not mean that the received view that we should keep our promises to the dead is mistaken. First, the theoretical commitments and argumentative strategies of those who endorse the possibility of posthumous promissory obligations preclude them from grounding such on either of these accounts of directed promissory obligation. They are thus already committed to justifying such obligations in other ways. Second, the obligation to keep promises to the dead could be justified on the grounds that not to do so would adversely affect the living.
Plastic Resilience: Rethinking Resilience in Illness with Catherine Malabou.
Ó Fathaigh C
J Med Philos · 2024 Nov · PMID 39227013 · Publisher ↗
Drawing on Catherine Malabou's notion of plasticity, this article argues for a conception of resilience as plastic. Resilience has proven an important concept in health care, describing how we manage life-changing illnes...
Drawing on Catherine Malabou's notion of plasticity, this article argues for a conception of resilience as plastic. Resilience has proven an important concept in health care, describing how we manage life-changing illnesses. Yet, resilience is not without its critics, who suggest it neglects a political, social, or personal dimension in illness. In this article, I propose that a concept of plastic resilience can address these criticisms. On this account, success should not be based on a return to function, but rather on how actively we are involved in the formation of a new self after illness. I address some approaches that can benefit from "plastic resilience," namely, art therapy, expert companionship, and shared decision-making. In each case, I underline how we should help patients thematize and engage with their new selves, while also being constantly vigilant for how these changes might impact our current assumptions around their preferences for treatment.
Kidney Sales and Disrespectful Demands: A Reply to Rippon.
Semrau L
J Med Philos · 2024 Nov · PMID 39222933 · Publisher ↗
Simon Rippon, revising an earlier argument against kidney sales, now claims that offers involving the performance of invasive acts, when extended to people under pressure, constitute a kind of rights violation, Impermiss...
Simon Rippon, revising an earlier argument against kidney sales, now claims that offers involving the performance of invasive acts, when extended to people under pressure, constitute a kind of rights violation, Impermissibly Disrespectful Demands. Since offers involving kidney sales so qualify, Rippon finds prima facie reason to prohibit them. The present article levels four independent objections to Rippon's argument: the account of Impermissibly Disrespectful Demands implausibly condemns kidney donation as much as kidney sales; the normative importance of having autonomous veto control over bodily incursions does not plausibly underwrite a right to not be extended invasive offers under pressure; Impermissibly Disrespectful Demands can easily be transformed into innocuous offers; and the prohibition has greater welfare costs than Rippon acknowledges.
Disability, Offense, and the Expressivist Objection to Medical Aid in Dying.
Kious BM
J Med Philos · 2024 Nov · PMID 39186563 · Full text
One criticism of medical aid in dying (MAID) is the expressivist objection: MAID is morally wrong because it expresses judgments about disabilities or persons with disabilities, that are offensive, disrespectful, or disc...
One criticism of medical aid in dying (MAID) is the expressivist objection: MAID is morally wrong because it expresses judgments about disabilities or persons with disabilities, that are offensive, disrespectful, or discriminatory. The expressivist objection can be made at the level of individual patients, medical providers, or the state. The expressivist objection originated with selective abortion, and responses to it in that context typically claim either that selective abortion does not express specific judgments about disabilities, or that any judgments expressed are not offensive. This response is inadequate: MAID often does express negative judgments about disabilities, which could reasonably be seen as offensive. But, does this offensiveness make MAID wrong? Drawing on Joel Feinberg's account of offense, I argue that it is unlikely that the offensiveness of the judgments expressed by individuals who seek MAID or through the state's legalization of MAID is enough to make it morally impermissible.
Genetic Enhancement, Human Rights, and Regioglobal Bioethics.
Fan R
J Med Philos · 2024 Jul · PMID 38960386 · Publisher ↗
This article examines the cross-cultural bioethical concerns stemming from the potential use of CRISPR-Cas9 for genetic enhancement projects. It emphasizes the need to differentiate between basic and non-basic human righ...
This article examines the cross-cultural bioethical concerns stemming from the potential use of CRISPR-Cas9 for genetic enhancement projects. It emphasizes the need to differentiate between basic and non-basic human rights when considering genetic enhancement, as recent international declarations lack this distinction. Basic rights possess a universal nature and are applicable across cultures, while non-basic rights are culturally specific and should be determined within respective regions. To illustrate this, the study explores the acceptance or rejection of non-basic rights related to genetic enhancement in two distinct cultural categories: Type-A and Type-B cultures. Type-A cultures predominantly adhere to a liberal moral framework, while Type-B cultures are rooted in Confucian morality. Additionally, the article argues for two basic rights in genetic enhancement: the right to be free from bodily harm and the right to be free from deception. These rights differ from non-basic rights and should be universally upheld in all cultures. By analyzing a hypothetical case and drawing parallels with the He Jiankui incident, the article investigates the violation of these two basic rights in each scenario, regardless of cultural context. Consequently, both cases should be unequivocally rejected in both Type-A and Type-B cultures.
Cognitive Enhancement, Hyperagency, and Responsibility Explosion.
Gordon EC
J Med Philos · 2024 Sep · PMID 38913851 · Full text
Hyperagency objections appeal to the risk that cognitive enhancement may negatively impact our well-being by giving us too much control. I charitably formulate and engage with a prominent version of this objection due to...
Hyperagency objections appeal to the risk that cognitive enhancement may negatively impact our well-being by giving us too much control. I charitably formulate and engage with a prominent version of this objection due to Sandel (2009) -viz., that cognitive enhancement may negatively impact our well-being by creating an "explosion" of responsibilities. I first outline why this worry might look prima facie persuasive, and then I show that it can ultimately be defended against. At the end of the day, if we are to resist cognitive enhancement, it should not be based on a Sandel-style hyperagency argument.
Wakefield's Harm-Based Critique of the Biostatistical Theory.
Boorse C
J Med Philos · 2024 Jul · PMID 38885259 · Publisher ↗
Jerome Wakefield criticizes my biostatistical analysis of the pathological-as statistically subnormal biological part-functional ability relative to species, sex, and age-for its lack of a harm clause. He first charges m...
Jerome Wakefield criticizes my biostatistical analysis of the pathological-as statistically subnormal biological part-functional ability relative to species, sex, and age-for its lack of a harm clause. He first charges me with ignoring two general distinctions: biological versus medical pathology, and disease of a part versus disease of a whole organism. He then offers 10 counterexamples that, he says, are harmless dysfunctions but not medical disorders. Wakefield ends by arguing that we need a harm clause to explain American psychiatry's 1973 decision to declassify homosexuality. I reply, first, that his two distinctions are philosophic fantasies alien to medical usage, invented only to save his own harmful-dysfunction analysis (HDA) from a host of obvious counterexamples. In any case, they do not coincide with the harmless/harmful distinction. In reality, medicine admits countless chronic diseases that are, contrary to Wakefield, subclinical for most of their course, as well as many kinds of typically harmless skin pathology. As for his 10 counterexamples, no medical source he cites describes them as he does. I argue that none of his examples contradicts the biostatistical analysis: all either are not part-dysfunctions (situs inversus, incompetent sperm, normal-flora infection) or are indeed classified as medical disorders (donated kidney, Typhoid Mary's carrier status, latent tuberculosis or HIV, cherry angiomas). And if Wakefield's HDA fits psychiatry, the fact that it does not fit medicine casts doubt on psychiatry's status as a medical specialty.
Unshared Minds, Decaying Worlds: Towards a Pathology of Chronic Loneliness.
Corbin IM, Dhand A
J Med Philos · 2024 Jul · PMID 38815253 · Full text
The moment when a person's actual relationships fall short of desired relationships is commonly identified as the etiological moment of chronic loneliness, which can lead to physical and psychological effects like depres...
The moment when a person's actual relationships fall short of desired relationships is commonly identified as the etiological moment of chronic loneliness, which can lead to physical and psychological effects like depression, worse recovery from illness and increased mortality. But, this etiology fails to explain the nature and severe impact of loneliness. Here, we use philosophical analysis and neuroscience to show that human beings develop and maintain our world-picture (our sense of what is true, important, and good) through joint attention and action, motivated by friendship, in the Aristotelian sense of "other selves" who share a sense of the true and the good, and desire the good for each other as much as for themselves. The true etiological event of loneliness is the moment one's world-picture becomes unshared. The pathogenesis is a resultant decay of our world-picture, with brain and behavior changes following as sequelae.
Is Cryocide an Ethically Feasible Alternative to Euthanasia?
Andrade G, Campo Redondo M
J Med Philos · 2024 Sep · PMID 38805705 · Publisher ↗
While some countries are moving toward legalization, euthanasia is still criticized on various fronts. Most importantly, it is considered a violation of the medical ethics principle of non-maleficence, because it activel...
While some countries are moving toward legalization, euthanasia is still criticized on various fronts. Most importantly, it is considered a violation of the medical ethics principle of non-maleficence, because it actively seeks a patient's death. But, medical ethicists should consider an ethical alternative to euthanasia. In this article, we defend cryocide as one such alternative. Under this procedure, with the consent of terminally-ill patients, their clinical death is induced, in order to prevent the further advance of their brain's deterioration. Their body is then cryogenically preserved, in the hope that in the future, there will be a technology to reanimate it. This prospect is ethically distinct from euthanasia if a different criterion of death is assumed. In the information-theoretic criterion of death, a person is not considered dead when brain and cardiopulmonary functions cease, but rather, when information constituting psychology and memory is lost.
What Happens When the Zygote Divides? On the Metaphysics of Monozygotic Twinning.
Skrzypek JW
J Med Philos · 2024 Jul · PMID 38805694 · Publisher ↗
It is often argued that certain metaphysical complications surrounding the phenomenon of monozygotic twinning force us to conclude that, prior to the point at which twinning is no longer possible, the zygote or early emb...
It is often argued that certain metaphysical complications surrounding the phenomenon of monozygotic twinning force us to conclude that, prior to the point at which twinning is no longer possible, the zygote or early embryo cannot be considered an individual human organism. In this essay, I argue, on the contrary, that there are in fact several ways of making sense of monozygotic twinning that uphold the humanity of the original zygote, but also that there is no easy answer to what happens when the human zygote twins. All of the options available carry with them one or more surprising, alarming, or otherwise counterintuitive implications. All things considered, I conclude that the "budding option," according to which the original human organism present before twinning carries on as one of the resulting embryos but not the other, is the most plausible explanation of what happens when a human zygote twins.
To Know Me Is to Exonerate Me: Appeals to Character in Defense of the Willowbrook Hepatitis Study.
Lynch J
J Med Philos · 2024 Sep · PMID 38801725 · Publisher ↗
The Willowbrook Hepatitis Study is one of the best-known examples of unethical medical research, but the research has always had defenders. One of the more intriguing defenses continually used was that critics did not kn...
The Willowbrook Hepatitis Study is one of the best-known examples of unethical medical research, but the research has always had defenders. One of the more intriguing defenses continually used was that critics did not know the researchers on the study and, therefore, could not assess their ethics. This essay traces the appeal to the researchers' characters across published research and archival sources from the 1960s through today. These appeals reflect the observation as old as Aristotle that one of the most potent modes of persuasion is ethos or character. The specific types of character in these appeals develop out of the paternalistic nature of clinical and research practice in the mid-twentieth century. If the individual physician is the locus of medical judgment, then the physician's character becomes a key concern for bioethics. These appeals still appear and have implications for bioethics in the present day.
Organ Donation by the Imminently Dead: Addressing the Organ Shortage and the Dead Donor Rule.
Chen S, Sade RM, Entwistle JW
J Med Philos · 2024 Sep · PMID 38801219 · Publisher ↗
The dead donor rule (DDR) has facilitated the saving of hundreds of thousands of lives. Recent advances in heart donation, however, have exposed how DDR has limited donation of all organs. We propose advancing the moment...
The dead donor rule (DDR) has facilitated the saving of hundreds of thousands of lives. Recent advances in heart donation, however, have exposed how DDR has limited donation of all organs. We propose advancing the moment in the dying process at which death can be determined to increase substantially the supply of organs for transplantation. We justify this approach by identifying certain flaws in the Uniform Determination of Death Act and proposing a modification of that law that permits earlier procurement of healthier organs in greater numbers.
Disability and Achievement: A Reply to Campbell, Nyholm, and Walter.
Dunkle ID
J Med Philos · 2024 Sep · PMID 38795382 · Publisher ↗
In this article, I explore the impact of disability on one of life's goods: achievement. Contra Campbell, Nyholm, and Walter. I argue that construing the magnitude of achievements in terms of subjective effort trivialize...
In this article, I explore the impact of disability on one of life's goods: achievement. Contra Campbell, Nyholm, and Walter. I argue that construing the magnitude of achievements in terms of subjective effort trivializes what it means to achieve. This poses a problem for the authors' argument that disability, in general, does not reduce access to this good. I draw on an alternative construal of achievement that I have proposed elsewhere to show that, indeed, many disabilities do not restrict access to achievement. I defend this argument against an objection that it problematically relativizes the achievements of persons with disability, and I close with general lessons for future work.
Impairment Arguments, Interests, and Circularity.
Napier S
J Med Philos · 2024 Sep · PMID 38739039 · Full text
A common justification for abortion rights is that the death of the fetus does not violate any of the fetus's time-relative interests. The time-relative interest account (TRIA) of harm and wrongdoing tells us that a nece...
A common justification for abortion rights is that the death of the fetus does not violate any of the fetus's time-relative interests. The time-relative interest account (TRIA) of harm and wrongdoing tells us that a necessary condition for harming someone is that his or her time-relative interests are frustrated. Regarding the justification for abortion, this account falls prey to impairment arguments. Impairment arguments entertain cases of prenatal injury, such as the mother using illicit drugs that disable the child. The intuition is that the child who is born with such disabilities is harmed by the mother's drug use. But it is unclear what time-relative interest is violated in cases of prenatal harm. Typical responses to impairment arguments point out that the abortion case is different because the child does not exist to experience such harms; but in prenatal injury + survival cases, the child does live to experience those harms. Thus, the TRIA justification for abortion is not impugned by impairment counter-examples. This article argues that this response to impairment arguments is viciously circular. The response must say that so long as you kill the child, no harm is done. But this assumes that killing itself is morally inconsequential and is not itself a case of harm. The response to impairment arguments, then, assumes the permissibility of abortion.
Ethical Problems of Observational Studies and Big Data Compared to Randomized Trials.
Raymond J, Fahed R, Darsaut TE
J Med Philos · 2024 Jul · PMID 38739037 · Publisher ↗
The temptation to use prospective observational studies (POS) instead of conducting difficult trials (RCTs) has always existed, but with the advent of powerful computers and large databases, it can become almost irresist...
The temptation to use prospective observational studies (POS) instead of conducting difficult trials (RCTs) has always existed, but with the advent of powerful computers and large databases, it can become almost irresistible. We examine the potential consequences, were this to occur, by comparing two hypothetical studies of a new treatment: one RCT, and one POS. The POS inevitably submits more patients to inferior research methodology. In RCTs, patients are clearly informed of the research context, and 1:1 randomized allocation between experimental and validated treatment balances risks for each patient. In POS, for each patient, the risks of receiving inferior treatment are impossible to estimate. The research context and the uncertainty are down-played, and patients and clinicians are at risk of becoming passive research subjects in studies performed from an outsider's view, which potentially has extraneous objectives, and is conducted without their explicit, autonomous, and voluntary involvement and consent.
Do Not Risk Homicide: Abortion After 10 Weeks Gestation.
Braddock M
J Med Philos · 2024 Jul · PMID 38728420 · Publisher ↗
When an abortion is performed, someone dies. Are we killing a human person? Widespread disagreement exists. However, it is not necessary to establish personhood in order to establish the wrongness of abortion: a substant...
When an abortion is performed, someone dies. Are we killing a human person? Widespread disagreement exists. However, it is not necessary to establish personhood in order to establish the wrongness of abortion: a substantial chance of personhood is enough. We defend The Do Not Risk Homicide Argument: abortions are wrong after 10 weeks gestation because they substantially and unjustifiably risk homicide, the unjust killing of a human person. Why 10 weeks? Because the cumulative evidence establishes a substantial chance (a more than one in five chance) that preborn human beings are persons after 10 weeks (if not before then). We submit evidence from our bad track record, widespread disagreement about personhood (after 10 weeks gestation), problems with theories of personhood, the similarity between preborn human beings and premature newborns, miscalculations of gestational age, and the common intuitive responses of women to their pregnancies and miscarriages. Our argument is cogent because it bypasses the stalemate over preborn personhood and rests on common ground rather than contentious metaphysics. It also strongly suggests that society must do more to protect preborn human beings. We briefly discuss its practical implications for fetal pain relief, social policy, and abortion law.
What We Argue About When We Argue About Death.
Aas S
J Med Philos · 2024 Jul · PMID 38708985 · Publisher ↗
The literature on the determination of death has often if not always assumed that the concept of human death should be defined in terms of the end of the human organism. I argue that this broadly biological conceptualiza...
The literature on the determination of death has often if not always assumed that the concept of human death should be defined in terms of the end of the human organism. I argue that this broadly biological conceptualization of human death cannot constitute a basis for agreement in a pluralistic society characterized by a variety of reasonable views on the nature of our existence as embodied beings. Rather, following Robert Veatch, I suggest that we must define death in moralized terms, as the loss of an especially significant sort of moral standing. Departing from Veatch, however, I argue that we should not understand death in terms of the loss of all moral status whatsoever. Rather, I argue, what we should argue about, when we argue about death, is when and why people lose their rights-claims to the protection and promotion of their basic bodily functioning.
Three Arguments Against Institutional Conscientious Objection, and Why They Are (Metaphysically) Unconvincing.
Symons X, Chua RM
J Med Philos · 2024 Apr · PMID 38557784 · Full text
The past decade has seen a burgeoning of scholarly interest in conscientious objection in healthcare. While the literature to date has focused primarily on individual healthcare practitioners who object to participation...
The past decade has seen a burgeoning of scholarly interest in conscientious objection in healthcare. While the literature to date has focused primarily on individual healthcare practitioners who object to participation in morally controversial procedures, in this article we consider a different albeit related issue, namely, whether publicly funded healthcare institutions should be required to provide morally controversial services such as abortions, emergency contraception, voluntary sterilizations, and voluntary euthanasia. Substantive debates about institutional responsibility have remained largely at the level of first-order ethical debate over medical practices which institutions have refused to offer; in this article, we argue that more fundamental questions about the metaphysics of institutions provide a neglected avenue for understanding the basis of institutional conscientious objection. To do so, we articulate a metaphysical model of institutional conscience, and consider three well-known arguments for undermining institutional conscientious objection in light of this model. We show how our metaphysical analysis of institutions creates difficulties for justifying sanctions on institutions that conscientiously object. Thus, we argue, questions about the metaphysics of institutions are deserving of serious attention from both critics and defenders of institutional conscientious objection.
The Dynamics of Disease: Toward a Processual Theory of Health.
Nielsen TH
J Med Philos · 2024 Apr · PMID 38557763 · Publisher ↗
The following article presents preliminary reflections on a processual theory of health and disease. It does this by steering the discussion more toward an ontology of organisms rather than conceptual analysis of the sem...
The following article presents preliminary reflections on a processual theory of health and disease. It does this by steering the discussion more toward an ontology of organisms rather than conceptual analysis of the semantic content of the terms "health" and "disease." In the first section, four meta-theoretical assumptions of the traditional debate are identified and alternative approaches to the problems are presented. Afterwards, the view that health and disease are constituted by a dynamic relation between demands imposed on an organism and individual presuppositions for adequate response is developed. In the last section, the paper takes stock of three possible objections to and clarifies some implications of this approach to the notions of health and disease.
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