The Journal Of Medicine And Philosophy[JOURNAL]
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200 papers
On The Problem of Defending Basic Equality: Natural Law and The Substance View.
Friberg-Fernros H
J Med Philos · 2023 Nov · PMID 37406644 · Full text
While most theorists agree with the claim that human beings have high and equal moral standing, there are strong disagreements about how to justify this claim. These disagreements arise because there are different ways o...
While most theorists agree with the claim that human beings have high and equal moral standing, there are strong disagreements about how to justify this claim. These disagreements arise because there are different ways of managing the difficulty of finding a basis for this claim, which is sufficiently substantial to do this justifying work, but not vary in degree in order to not give rise to inequality of moral considerability. The aim of this paper is to review previous attempts to address this difficulty and to demonstrate why they fail and then to defend another way of dealing with this challenge by applying two views: the substance view on the human person and the natural-law account of morality. My claim is that this approach has comparative advantages because it provides a binary and a normatively significant basis of justification for equality without being implausibly inclusive.
What's the Harm in Cardiopulmonary Resuscitation?
Koch PM
J Med Philos · 2023 Nov · PMID 37395528 · Publisher ↗
In clinical ethics, there remains a great deal of uncertainty regarding the appropriateness of attempting cardiopulmonary resuscitation (CPR) for certain patients. Although the issue continues to receive ample attention...
In clinical ethics, there remains a great deal of uncertainty regarding the appropriateness of attempting cardiopulmonary resuscitation (CPR) for certain patients. Although the issue continues to receive ample attention and various frameworks have been proposed for navigating such cases, most discussions draw heavily on the notion of harm as a central consideration. In the following, I use emerging philosophical literature on the notion of harm to argue that the ambiguities and disagreement about harm create important and oft-overlooked challenges for the ethics of CPR. I begin by elucidating the standard account of harm, called the Counterfactual Comparative Account (CCA). I then show that three challenges to the CCA-preemptive harms, the harm of death, and non-experiential harms-are particularly salient when assessing potential harms for candidates of CPR and likely impact-related decision-making and communication. I extend this argument to explore how the ambiguities of harm might extend to other realms of clinical decision-making, such as the use and limitations of life-sustaining treatments. To address these challenges, I propose two strategies for identifying and minimizing the impact of such uncertainty: first, clinicians and ethicists ought to promote pluralistic conversations that account for different understandings of harm; second, they ought to invoke harm-independent considerations when discussing the ethics of CPR in order to reflect the nuances of such conversations. These strategies, coupled with a richer philosophical understanding of harm, promise to help clinicians and ethicists navigate the prevalent and difficult cases involving patient resuscitation and many other harm-based decisions in the clinical setting.
Evictionism, Libertarianism, and Duties of the Fetus.
Dominiak Ł, Wysocki I
J Med Philos · 2023 Nov · PMID 37395500 · Publisher ↗
In "Evictionism and Libertarianism," published in this journal, Walter Block defends the view that, although the fetus is a human being with all the rights to its body, it may nonetheless be evicted from the woman's body...
In "Evictionism and Libertarianism," published in this journal, Walter Block defends the view that, although the fetus is a human being with all the rights to its body, it may nonetheless be evicted from the woman's body as a trespasser, provided the pregnancy is unwanted. We argue that this view is untenable: the statement that the unwanted fetus is a trespasser does not follow from the premises that the fetus uninvitedly resides in the woman's body and that the woman is a full self-owner. For this statement to follow, one more statement would have to be true; namely, the woman would have to hold her self-ownership rights specifically against the fetus, and for this to be the case, the fetus would have to have a correlative duty to the woman to abstain from interfering with her body. This statement, however, is false.
Abortion, Impairment, and Well-Being.
Gillham AR
J Med Philos · 2023 Nov · PMID 37379827 · Publisher ↗
Hendricks' The Impairment Argument (TIA) claims that it is immoral to impair a fetus by causing it to have fetal alcohol syndrome (FAS). Since aborting a fetus impairs it to a greater degree than causing it to have FAS,...
Hendricks' The Impairment Argument (TIA) claims that it is immoral to impair a fetus by causing it to have fetal alcohol syndrome (FAS). Since aborting a fetus impairs it to a greater degree than causing it to have FAS, then abortion is also immoral. In this article, I argue that TIA ought to be rejected. This is because TIA can only succeed if it explains why causing an organism to have FAS impairs it to a morally objectionable degree, entails that abortion impairs an organism to a morally objectionable and greater degree than causing FAS, and satisfies The Impairment Principle's ceteris paribus clause. In order to do all three things, TIA must presuppose some theory of well-being. Even then, no theory of well-being accomplishes all three tasks that TIA must in order to succeed. However, even if this is false and TIA can meet all three objectives by presupposing some theory of well-being, it would not do very much to advance the debate about the morality of abortion. As I argue, TIA would essentially restate well-established arguments against abortion based on whatever theory of well-being it must presuppose in order to be successful.
Inconsistency between the Circulatory and the Brain Criteria of Death in the Uniform Determination of Death Act.
Molina-Pérez A, Bernat JL, Dalle Ave A
J Med Philos · 2023 Sep · PMID 37364165 · Full text
The Uniform Determination of Death Act (UDDA) provides that "an individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions or (2) irreversible cessation of all functions of th...
The Uniform Determination of Death Act (UDDA) provides that "an individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead." We show that the UDDA contains two conflicting interpretations of the phrase "cessation of functions." By one interpretation, what matters for the determination of death is the cessation of spontaneous functions only, regardless of their generation by artificial means. By the other, what matters is the cessation of both spontaneous and artificially supported functions. Because each UDDA criterion uses a different interpretation, the law is conceptually inconsistent. A single consistent interpretation would lead to the conclusion that conscious individuals whose respiratory and circulatory functions are artificially supported are actually dead, or that individuals whose brain is entirely and irreversibly destroyed may be alive. We explore solutions to mitigate the inconsistency.
On Drugs.
Baron S, Linton S, O'Malley MA
J Med Philos · 2023 Nov · PMID 37352546 · Full text
Despite their centrality to medicine, drugs are not easily defined. We introduce two desiderata for a basic definition of medical drugs. It should: (a) capture everything considered to be a drug in medical contexts and (...
Despite their centrality to medicine, drugs are not easily defined. We introduce two desiderata for a basic definition of medical drugs. It should: (a) capture everything considered to be a drug in medical contexts and (b) rule out anything that is not considered to be a drug. After canvassing a range of options, we find that no single definition of drugs can satisfy both desiderata. We conclude with three responses to our exploration of the drug concept: maintain a monistic concept, or choose one of two pluralistic outcomes. Notably, the distinction between drugs and other substances is placed under pressure by the most plausible of the options available.
Is Death Irreversible?
Gligorov N
J Med Philos · 2023 Sep · PMID 37329567 · Publisher ↗
There are currently two legally established criteria for death: the irreversible cessation of circulation and respiration and the irreversible cessation of neurologic function. Recently, there have been technological dev...
There are currently two legally established criteria for death: the irreversible cessation of circulation and respiration and the irreversible cessation of neurologic function. Recently, there have been technological developments that could undermine the irreversibility requirement. In this paper, I focus both on whether death should be identified as an irreversible state and on the proper scope of irreversibility in the biological definition of death. In this paper, I tackle the distinction between the commonsense definition of death and the biological definition of death to show that even the commonsense concept of death is specified by biological facts. Resting on this argument, I argue that any definition of death is a posteriori. Thus, irreversibility is part of any definition of death because the actual phenomenon of death is irreversible. In addition, I show that the proper domain of irreversibility in a definition of death is circumscribed by physical possibilities and that irreversibility in the definition of death refers to current possibilities for the reversal of relevant biological processes. I conclude that, despite recent technological advancements, death is still irreversible.
Memories without Survival: Personal Identity and the Ascending Reticular Activating System.
Meier LJ
J Med Philos · 2023 Sep · PMID 37314862 · Full text
Lockean views of personal identity maintain that we are essentially persons who persist diachronically by virtue of being psychologically continuous with our former selves. In this article, I present a novel objection to...
Lockean views of personal identity maintain that we are essentially persons who persist diachronically by virtue of being psychologically continuous with our former selves. In this article, I present a novel objection to this variant of psychological accounts, which is based on neurophysiological characteristics of the brain. While the mental states that constitute said psychological continuity reside in the cerebral hemispheres, so that for the former to persist only the upper brain must remain intact, being conscious additionally requires that a structure originating in the brainstem-the ascending reticular activating system-be functional. Hence, there can be situations in which even small brainstem lesions render individuals irreversibly comatose and thus forever preclude access to their mental states, while the neural correlates of the states themselves are retained. In these situations, Lockeans are forced to regard as fulfilled their criterion of diachronic persistence since psychological continuity, as they construe it, is not disrupted. Deeming an entity that is never again going to have any mental experiences to be a person, however, is an untenable position for a psychological account to adopt. In their current form, Lockean views of personal identity are therefore incompatible with human neurophysiology.
Human Nature and Aspiring the Divine: On Antiquity and Transhumanism.
Malanowski S, Baima NR
J Med Philos · 2022 Nov · PMID 37314103 · Publisher ↗
Many transhumanists see their respective movement as being rooted in ancient ethical thought. However, this alleged connection between the contemporary transhumanist doctrine and the ethical theory of antiquity has come...
Many transhumanists see their respective movement as being rooted in ancient ethical thought. However, this alleged connection between the contemporary transhumanist doctrine and the ethical theory of antiquity has come under attack. In this paper, we defend this connection by pointing out a key similarity between the two intellectual traditions. Both traditions are committed to the "radical transformation thesis": ancient ethical theory holds that we should assimilate ourselves to the gods as far as possible, and transhumanists hold that we should enhance ourselves beyond the physical and intellectual parameters of being human so as to become posthuman. By considering the two views in tandem, we develop an account of the assimilation directive that is palatable to contemporary readers and provide a view of posthumanism worth wanting.
Involuntary Childlessness, Suffering, and Equality of Resources: An Argument for Expanding State-funded Fertility Treatment Provision.
Cavaliere G
J Med Philos · 2023 Jun · PMID 37280115 · Full text
Assessing what counts as infertility has practical implications: access to (state-funded) fertility treatment is usually premised on meeting the criteria that constitute the chosen definition of infertility. In this pape...
Assessing what counts as infertility has practical implications: access to (state-funded) fertility treatment is usually premised on meeting the criteria that constitute the chosen definition of infertility. In this paper, I argue that we should adopt the expression "involuntary childlessness" to discuss the normative dimensions of people's inability to conceive. Once this conceptualization is adopted, it becomes clear that there exists a mismatch between those who experience involuntary childlessness and those that are currently able to access fertility treatment. My concern in this article is explaining why such a mismatch deserves attention and what reasons can be advanced to justify addressing it. My case rests on a three-part argument: that there are good reasons to address the suffering associated with involuntary childlessness; that people would decide to insure against it; and that involuntary childlessness is characterized by a prima facie exceptional kind of desire.
Toward a Hybrid Theory of How to Allocate Health-related Resources.
Herlitz A
J Med Philos · 2023 Jun · PMID 37279934 · Full text
How should scarce health-related resources be allocated? This paper argues that values that apply to these decisions fail to always fully determine what we should do. Health maximization and allocation-according-to-need...
How should scarce health-related resources be allocated? This paper argues that values that apply to these decisions fail to always fully determine what we should do. Health maximization and allocation-according-to-need are suggested as two values that should be part of a general theory of how to allocate health-related resources. The "small improvement argument" is used to argue that it is implausible that one alternative is always better, worse, or equal to another alternative with respect to these values. Approaches that rely on these values are thus incomplete. To deal with this, it is suggested that we ought to use incomplete theories in a two-step process. Such a process first discards ineligible alternatives, and, second, uses reasons grounded in collective commitments to identify a unique, best alternative in the remaining set.
On the Anatomy of Health-related Actions for Which People Could Reasonably be Held Responsible: A Framework.
Bærøe K, Albertsen A, Cappelen C
J Med Philos · 2023 Jun · PMID 37256826 · Full text
Should we let personal responsibility for health-related behavior influence the allocation of healthcare resources? In this paper, we clarify what it means to be responsible for an action. We rely on a crucial conceptual...
Should we let personal responsibility for health-related behavior influence the allocation of healthcare resources? In this paper, we clarify what it means to be responsible for an action. We rely on a crucial conceptual distinction between being responsible and holding someone responsible, and show that even though we might be considered responsible and blameworthy for our health-related actions, there could still be well-justified reasons for not considering it reasonable to hold us responsible by giving us lower priority. We transform these philosophical considerations into analytical use first by assessing the general features of health-related actions and the corresponding healthcare needs. Then, we identify clusters of structural features that even adversely affected people cannot reasonably deny constitute actions for which they should be held responsible. We summarize the results in an analytical framework that can be used by decision-makers when considering personal responsibility for health as a criterion for setting priorities.
Priority for Organ Donors in the Allocation of Organs: Priority Rules from the Perspective of Equality of Opportunity.
Albertsen A
J Med Philos · 2023 Jun · PMID 37235745 · Publisher ↗
Should priority in the allocation of organs be given to those who have previously donated or declared their willingness to do so? This article examines the Israeli priority rule in light of two prominent critiques of pri...
Should priority in the allocation of organs be given to those who have previously donated or declared their willingness to do so? This article examines the Israeli priority rule in light of two prominent critiques of priority rules, pertaining to failure to reciprocate and unfairness. The scope and content of these critiques are interpreted from the perspective of equality of opportunity. Because the Israeli priority rule may be reasonably criticized for unfairness and failing to reward certain behaviors, the article develops an adjusted priority rule, which removes and adjust the elements in the Israeli priority rule deemed problematic. However, such a priority rule is complex to the extent that it may fail to increase donation rates and furthermore introduce new concerns of fairness, as the better off may be better able to navigate the complex adjusted priority rule.
Democratic Justifications for Patient Public Involvement and Engagement in Health Research: An Exploration of the Theoretical Debates and Practical Challenges.
Frith L
J Med Philos · 2023 Jun · PMID 37229555 · Full text
The literature on patient public involvement and engagement (PPIE) in health research has grown significantly in the last decade, with a diverse range of definitions and topologies promulgated. This has led to disputes o...
The literature on patient public involvement and engagement (PPIE) in health research has grown significantly in the last decade, with a diverse range of definitions and topologies promulgated. This has led to disputes over what the central functions and purpose of PPIE in health research is, and this in turn makes it difficult to assess and evaluate PPIE in practice. This paper argues that the most important function of PPIE is the attempt to make health research more democratic. Bringing this function to the fore and locating PPIE in the wider context of changes in contemporary forms of democratic engagement provides greater conceptual clarity over what PPIE in research should be trying to achieve. Conceptualizing PPIE as a form of democratization has a number of benefits. First, theories of what are appropriate, normatively justifiable and workable criteria for PPIE practices can be developed, and this can provide tools to address the legitimacy and accountability questions that have troubled the PPIE community. Second, this work can be used to form the basis of a research agenda to investigate how PPIE in health research operates, and how it can facilitate and/or improve democratic processes in health research.
Preclinical Disease or Risk Factor? Alzheimer's Disease as a Case Study of Changing Conceptualizations of Disease.
Schermer MHN
J Med Philos · 2023 Jun · PMID 37202835 · Full text
Alzheimer's Disease (AD) provides an excellent case study to investigate emerging conceptions of health, disease, pre-disease, and risk. Two scientific working groups have recently reconceptualized AD and created a new c...
Alzheimer's Disease (AD) provides an excellent case study to investigate emerging conceptions of health, disease, pre-disease, and risk. Two scientific working groups have recently reconceptualized AD and created a new category of asymptomatic biomarker positive persons, who are either said to have preclinical AD, or to be at risk for AD. This article examines how prominent theories of health and disease would classify this condition: healthy or diseased? Next, the notion of being "at risk"-a state somewhere in-between health and disease-is considered from various angles. It is concluded that medical-scientific developments urge us to let go of dichotomous ways of understanding disease, that the notion of "risk," conceptualized as an increased chance of getting a symptomatic disease, might be a useful addition to our conceptual framework, and that we should pay more attention to the practical usefulness and implications of the ways in which we draw lines and define concepts.
Prevention of Disease and the Absent Body: A Phenomenological Approach to Periodontitis.
Rakhra D, Grīnfelde M
J Med Philos · 2023 May · PMID 37189304 · Publisher ↗
A large part of the contemporary phenomenology of medicine has been devoted to accounts of health and illness, arguing that they contribute to the improvement of health care. Less focus has been paid to the issue of prev...
A large part of the contemporary phenomenology of medicine has been devoted to accounts of health and illness, arguing that they contribute to the improvement of health care. Less focus has been paid to the issue of prevention of disease and the associated difficulty of adhering to health-promoting behaviours, which is arguably of equal importance. This article offers a phenomenological account of this disease prevention, focusing on how we-as embodied beings-engage with health-promoting behaviours. It specifically considers how we engage with oral hygiene regimens to prevent periodontitis and why we are not good at it. The article suggests that poor adherence to health-promoting behaviours can be explained with reference to the concept of the absent body, because prevention of disease is generally concerned with pre-symptomatic illness experience. The final section contains a discussion of some strategies for the improvement of disease prevention based on this viewpoint.
Evidence-based Medicine and Mechanistic Evidence: The Case of the Failed Rollout of Efavirenz in Zimbabwe.
Park A, Steel D, Maine E
J Med Philos · 2023 Jun · PMID 37137159 · Full text
Evidence-based medicine (EBM) has long deemphasized mechanistic reasoning and pathophysiological rationale in assessing the effectiveness of interventions. The EBM+ movement has challenged this stance, arguing that evide...
Evidence-based medicine (EBM) has long deemphasized mechanistic reasoning and pathophysiological rationale in assessing the effectiveness of interventions. The EBM+ movement has challenged this stance, arguing that evidence of mechanisms and comparative studies should both be seen as necessary and complementary. Advocates of EBM+ provide a combination of theoretical arguments and examples of mechanistic reasoning in medical research. However, EBM+ proponents have not provided recent examples of how downplaying mechanistic reasoning resulted in worse medical results than would have occurred otherwise. Such examples are necessary to make the case that EBM+ responds to a problem in clinical practice that urgently demands a solution. In light of this, we examine the failed rollout of efavirenz as a first-line HIV treatment in Zimbabwe as evidence of the importance of mechanistic reasoning in improving clinical practice and public health policy decisions. We suggest that this case is analogous to examples commonly given to support EBM.
Death as the Cessation of an Organism and the Moral Status Alternative.
Nowak PG
J Med Philos · 2023 Sep · PMID 37134311 · Full text
The mainstream concept of death-the biological one-identifies death with the cessation of an organism. In this article, I challenge the mainstream position, showing that there is no single well-established concept of an...
The mainstream concept of death-the biological one-identifies death with the cessation of an organism. In this article, I challenge the mainstream position, showing that there is no single well-established concept of an organism and no universal concept of death in biological terms. Moreover, some of the biological views on death, if applied in the context of bedside decisions, might imply unacceptable consequences. I argue the moral concept of death-one similar to that of Robert Veatch-overcomes such difficulties. The moral view identifies death with the irreversible cessation of a patient's moral status, that is, a state when she can no longer be harmed or wronged. The death of a patient takes place when she is no longer capable of regaining her consciousness. In this regard, the proposal elaborated herein resembles that of Veatch yet differs from Veatch's original project since it is universal. In essence, it is applicable in the case of other living beings such as animals and plants, provided that they have some moral status.
A Human Right to What Kind of Medicine?
Muyskens K
J Med Philos · 2023 Nov · PMID 37129452 · Publisher ↗
The human right to health, insofar as it is widely recognized, is typically thought to include the right to fair access to adequate healthcare, but the operating conception of healthcare in this context has been under-de...
The human right to health, insofar as it is widely recognized, is typically thought to include the right to fair access to adequate healthcare, but the operating conception of healthcare in this context has been under-defined. This lack of conceptual clarity has often led in practice to largely Western cultural assumptions about what validly constitutes "healthcare" and "medicine." Ethnocentric and parochial assumptions ought to be avoided, lest they give justification to the accusation that universal human rights are mere tools for Western imperial agendas. At the same time, a right to healthcare that is not also explicitly the right to effective healthcare rapidly loses meaning. This paper strives to provide an account of medicine with the flexibility to accommodate cultural difference in forms of practice, while also aiding in the articulation of a minimum for medical systems to meet the standards set out in a human right.
Anti-abortionist Action Theory and the Asymmetry between Spontaneous and Induced Abortions.
Anderson ML
J Med Philos · 2023 May · PMID 37078978 · Publisher ↗
This essay defends the asymmetry between the badness of spontaneous and induced abortions in order to explain why anti-abortionists prioritize stopping induced abortions over preventing spontaneous abortions. Specificall...
This essay defends the asymmetry between the badness of spontaneous and induced abortions in order to explain why anti-abortionists prioritize stopping induced abortions over preventing spontaneous abortions. Specifically, it argues (1) the distinction between killing and letting-die is of more limited use in explaining the asymmetry than has sometimes been presumed, and (2) that accounting for intentions in moral agency does not render performances morally inert. Instead, anti-abortionists adopt a pluralist, nonreductive account of moral analysis which is situated against a backdrop that sees the limits of our ability to control the process of fertility as themselves valuable. Although this view is complex, the paper concludes by arguing that it has the advantage of explaining features of the anti-abortion outlook that have sometimes been overlooked. First, it accounts for why the pre-Roe regime of abortion restrictions primarily imposed penalties on doctors who induced abortions rather than the women who seek them. Second, it explains why the advent of ectogestation will not prompt anti-abortionists to compromise on 'disconnect abortions,' which putatively let the embryo die by extracting it from the mother's womb.
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