The Journal Of Medicine And Philosophy[JOURNAL]
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200 papers
Miscarriage, Abortion, and Disease.
Waters T
J Med Philos · 2023 May · PMID 37078977 · Publisher ↗
The frequency of death from miscarriage is very high, greater than the number of deaths from induced abortion or major diseases. Berg (2017 , Philosophical Studies 174:1217-26) argues that, given this, those who contend...
The frequency of death from miscarriage is very high, greater than the number of deaths from induced abortion or major diseases. Berg (2017 , Philosophical Studies 174:1217-26) argues that, given this, those who contend that personhood begins at conception (PAC) are obliged to reorient their resources accordingly-towards stopping miscarriage, in preference to stopping abortion or diseases. This argument depends on there being a basic moral similarity between these deaths. I argue that, for those that hold to PAC, there are good reasons to think that there is no such similarity. There is a morally relevant difference between preventing killing and letting die, giving PAC supporters reasons to prioritize reducing abortion over reducing miscarriage. And the time-relative interest account provides a morally relevant difference in the badness of death of miscarriages and deaths of born adults, justifying attempts to combat major diseases over attempts to combat miscarriage. I consider recent developments in the literature and contend that these new arguments are unsuccessful in establishing moral similarities between deaths from miscarriage and abortion, and deaths from miscarriage and disease.
The Logic of Pregnancy.
Bornemark J
J Med Philos · 2023 Apr · PMID 37078733 · Full text
This article takes its point of departure in Bracha Ettinger's discussion on the "matrixial borderspace": the structure of the experience of "the womb," both from a "mother-pole" and a "fetus-pole". Ettinger describes th...
This article takes its point of departure in Bracha Ettinger's discussion on the "matrixial borderspace": the structure of the experience of "the womb," both from a "mother-pole" and a "fetus-pole". Ettinger describes this borderspace as a place of differentiation-in-co-emergence, separation-in-jointness, and distance-in-proximity. The question this article poses is what kind of logic this experience is an expression of, as there seems to be a discrepancy in relation to the classical Aristotelian logic of identity. As an alternative to classical Aristotelian logic, Nicholas of Cusa's logic of the non-aliud is explored as a paradigm more in line with Ettinger's description of pregnancy specifically and more generally, to an understanding of life as a co-poietic emergence of structures of pactivity and permeability.
Solastalgia: Climatic Anxiety-An Emotional Geography to Find Our Way Out.
Ferrarello S
J Med Philos · 2023 Apr · PMID 37078732 · Publisher ↗
This paper will discuss the notion of solastalgia or climatic anxiety (Albrecht et al., 2007; Galea et al., 2005) as a form of anxiety connected to traumatic environmental changes that generate an emotional blockage betw...
This paper will discuss the notion of solastalgia or climatic anxiety (Albrecht et al., 2007; Galea et al., 2005) as a form of anxiety connected to traumatic environmental changes that generate an emotional blockage between individuals, their environment (Cloke et al., 2004) and their place (Nancy, 1993). I will use a phenomenological approach to explain the way in which emotions shape our constitution of reality (Husserl, 1970; Sartre, 1983, 1993, 1996; Seamon and Sowers, 2009; Shaw and Ward, 2009). The article's overall goal is to describe the relationship between environment and "climatic" emotions to understand what we can do to improve our well-being. I believe that scientistic and reductionistic ways of looking at climatic anxiety do not consider this complex dynamic and fail to propose actual solutions for the well-being of both the environment and the individuals.
The Phenomenology of Objectification in and Through Medical Practice and Technology Development.
Svenaeus F
J Med Philos · 2023 Apr · PMID 37078731 · Full text
Objectification is a real problem in medicine that can lead to bad medical practice or, in the worst case, dehumanization of the patient. Nevertheless, objectification also plays a major and necessary role in medicine: t...
Objectification is a real problem in medicine that can lead to bad medical practice or, in the worst case, dehumanization of the patient. Nevertheless, objectification also plays a major and necessary role in medicine: the patient's body should be viewed as a biological organism in order to find diseases and be able to cure them. Listening to the patient's illness story should not be replaced, but, indeed, developed by the physical examination of his body searching for the causes of his complaints. Whereas phenomenologists have so far mainly been identifying the back sides of objectification in medicine, in this paper the aim is to analyze differences between detrimental objectifications and objectifications that do not deprive the patient of his subjectivity but, rather, at least in some cases, may lead the patient to feel more at home with his body.
Which Kind of Body in "Mental" Pathologies? Phenomenological Insights on the Nature of the Disrupted Self.
Bizzari V
J Med Philos · 2023 Apr · PMID 37078730 · Publisher ↗
Guided by a phenomenological perspective, this paper aims to account for the existence of a corporeal consciousness-something that clinicians should take into account, not merely in the case of physical pathologies but e...
Guided by a phenomenological perspective, this paper aims to account for the existence of a corporeal consciousness-something that clinicians should take into account, not merely in the case of physical pathologies but especially in the case of mental disorders. Firstly, I will highlight three cases: schizophrenia, depression, and autism spectrum disorder. Then, I will show how these cases correspond to three different kinds of bodily existence: disembodiment (in the case of schizophrenia), chrematization (in melancholic depression), and dyssynchrony (in the autism spectrum disorder). Finally, I will argue for the importance of an "expressive common environment" between the patient and the clinician, who are two distinct, embodied conscious subjects resonating with one another. In this view, the primary goal of the therapeutic process seems to develop a shared understanding of the patient's life-world, which finds its main expression through the disrupted body.
What is Phenomenological Bioethics? A Critical Appraisal of Its Ends and Means.
Coyne L
J Med Philos · 2023 Apr · PMID 37078729 · Full text
In recent years the phenomenological approach to bioethics has been rejuvenated and reformulated by, among others, the Swedish philosopher Fredrik Svenaeus. Building on the now-relatively mainstream phenomenological appr...
In recent years the phenomenological approach to bioethics has been rejuvenated and reformulated by, among others, the Swedish philosopher Fredrik Svenaeus. Building on the now-relatively mainstream phenomenological approach to health and illness, Svenaeus has sought to bring phenomenological insights to bear on the bioethical enterprise, with a view to critiquing and refining the "philosophical anthropology" presupposed by the latter. This article offers a critical but sympathetic analysis of Svenaeus' efforts, focusing on both his conception of the ends of phenomenological bioethics and the predominantly Heideggerian means he employs. Doing so reveals certain problems with both. I argue that the main aim of phenomenological bioethics as set out by Svenaeus needs to be reformulated, and that there are important oversights in his approach to reaching this end. I conclude by arguing that to overcome the latter problem we should draw instead on the works of Max Scheler and Hans Jonas.
Bioethics, Sociality, and Mental Illness.
Englander M
J Med Philos · 2023 Apr · PMID 37078728 · Full text
The phenomenology of bioethics is approached here in relation to the lived experience as it relates to the everyday lifeworld of persons suffering from mental illness. Taking a road less traveled, the purpose here is to...
The phenomenology of bioethics is approached here in relation to the lived experience as it relates to the everyday lifeworld of persons suffering from mental illness. Taking a road less traveled, the purpose here is to elucidate ethical issues relating to sociality, using findings from qualitative phenomenological psychological research. Qualitative studies of schizophrenia and postpartum depression serve as examples. Layered throughout is the applied phenomenological argument pointing to the importance of returning to mundane intersubjectivity and the reversibility between mental illness, the existential context of suffering, and sociality.
The Saturated Phenomenon of Flesh and Mineness and Otherness of the Body in Illness.
Grīnfelde M
J Med Philos · 2023 Apr · PMID 37078727 · Publisher ↗
A key topic within the field of the phenomenology of medicine has been the relationship between body and self in illness, including discussions about the otherness and mineness of the body. The aim of this article is to...
A key topic within the field of the phenomenology of medicine has been the relationship between body and self in illness, including discussions about the otherness and mineness of the body. The aim of this article is to distinguish between different meanings of bodily otherness and mineness in illness with reference to the interpretation of the body as "saturated phenomenon," inspired by the phenomenology of Jean-Luc Marion. With the help of Marion's ideas it is possible to distinguish between two meanings of bodily otherness and of mineness (objective and non-objective forms). These distinctions support and elaborate on ideas already found in the phenomenology of medicine and offer further insights into the nature of the experience of illness.
The Scourges: Why Abortion Is Even More Morally Serious than Miscarriage.
Miller C
J Med Philos · 2023 May · PMID 37061804 · Full text
Several recent papers have suggested that the pro-life view entails a radical, implausible thesis: that miscarriage is the biggest public health crisis in the history of our species and requires radical diversion of fund...
Several recent papers have suggested that the pro-life view entails a radical, implausible thesis: that miscarriage is the biggest public health crisis in the history of our species and requires radical diversion of funds to combat. In this paper, I clarify the extent of the problem, showing that the number of miscarriages about which we can do anything morally significant is plausibly much lower than previously thought, then describing some of the work already being done on this topic. I then briefly survey a range of reasons why abortion might be thought more serious and more worthy of prevention than miscarriage. Finally, I lay out my central argument: that reflection on the wrongness of killing reveals that the norms for ending life and failing to save life are different, in such a way that could justify the prioritization of anti-abortion advocacy over anti-miscarriage efforts. Such an account can also respond to similar problems posed to the pro-lifer, such as the question of whom to save in a "burning lab" type scenario.
Embryo Loss and Moral Status.
Delaney J
J Med Philos · 2023 May · PMID 37061803 · Publisher ↗
There is a significant debate over the moral status of human embryos. This debate has important implications for practices like abortion and IVF. Some argue that embryos have the same moral status as infants, children, a...
There is a significant debate over the moral status of human embryos. This debate has important implications for practices like abortion and IVF. Some argue that embryos have the same moral status as infants, children, and adults. However, critics claim that the frequency of pregnancy loss/miscarriage/spontaneous abortion shows a moral inconsistency in this view. One line of criticism is that those who know the facts about pregnancy loss and nevertheless attempt to conceive children are willing to sacrifice embryos lost for the healthy children they ultimately have. I respond to this criticism and argue that on the most plausible accounts of well-being, these embryos are not made worse off and thus not "sacrifices." I then make some more general remarks about what people's typical views about pregnancy loss show about their views toward the moral status of embryos.
The Mereotopology of Pregnancy.
Finn S
J Med Philos · 2023 May · PMID 37061801 · Full text
Consider the following two metaphysical questions about pregnancy: (1) When does a new organism of a certain kind start to exist? (2) What is the mereological and topological relationship between the pregnant organism an...
Consider the following two metaphysical questions about pregnancy: (1) When does a new organism of a certain kind start to exist? (2) What is the mereological and topological relationship between the pregnant organism and with what it is pregnant? Despite assumptions made in the literature, I take these questions to be independent of each other, such that an answer to one does not provide an answer to the other. I argue that the way to connect them is via a maximality principle that prevents one organism being a proper part of another organism of the same kind. That being said, such a maximality principle need not be held, and may not apply in the case of pregnancy. The aims of this paper are thus to distinguish and connect these metaphysical questions, in order to outline a taxonomy of rival mereotopological models of pregnancy that result from the various combinations of their answers.
When Words Fail: "Miscarriage," Referential Ambiguity, and Psychological Harm.
Bohn JA
J Med Philos · 2023 May · PMID 37061800 · Publisher ↗
Despite significant efforts to support those bereaved by intrauterine death, they remain susceptible to avoidable psychological harm such as disenfranchised grief, misplaced guilt, and emotional shock. This is in part be...
Despite significant efforts to support those bereaved by intrauterine death, they remain susceptible to avoidable psychological harm such as disenfranchised grief, misplaced guilt, and emotional shock. This is in part because the words available to describe intrauterine death-"miscarriage," "spontaneous abortion," and "pregnancy loss"-are referentially ambiguous. Despite appearing to refer to one event, they can refer to two distinct events: the baby's death and his preterm delivery. Disenfranchised grief increases when people understand "miscarriage" as the physical process of preterm delivery alone, for this obscures the baby's death and excludes non-gestational parents, such as the father. Additionally, focusing on the delivery reinforces the mistaken idea that a gestational mother bears responsibility for her baby's death, increasing misplaced guilt. When these terms instead shift the focus to the baby's intrauterine death rather than the preterm delivery, they can obscure the physically difficult and often traumatic experience women have when they deliver their dead children, leaving women shocked by preterm delivery's physical reality. Given their outsized role in framing the bereaved's experiences, and their duty to avoid harming their patients, healthcare practitioners in particular should take special care to discuss intrauterine death and preterm delivery appropriately with patients and their families. Changing language to describe intrauterine death and preterm delivery clearly and precisely helps mitigate disenfranchised grief, misplaced guilt, and shock, while also helping to reframe the social response to intrauterine death, making it more obvious why certain steps, such as allowing bereavement leave following an intrauterine death, promote healing.
A New Defense of Brain Death as the Death of the Human Organism.
McGee A, Gardiner D, Jansen M
J Med Philos · 2023 Sep · PMID 36661259 · Publisher ↗
This paper provides a new rationale for equating brain death with the death of the human organism, in light of well-known criticisms made by Alan D Shewmon, Franklin Miller and Robert Truog and a number of other writers....
This paper provides a new rationale for equating brain death with the death of the human organism, in light of well-known criticisms made by Alan D Shewmon, Franklin Miller and Robert Truog and a number of other writers. We claim that these criticisms can be answered, but only if we accept that we have slightly redefined the concept of death when equating brain death with death simpliciter. Accordingly, much of the paper defends the legitimacy of redefining death against objections, before turning to the specific task of defending a new rationale for equating brain death with death as slightly redefined.
Uncertainty, Evidence, and the Integration of Machine Learning into Medical Practice.
Grote T, Berens P
J Med Philos · 2023 Feb · PMID 36630292 · Publisher ↗
In light of recent advances in machine learning for medical applications, the automation of medical diagnostics is imminent. That said, before machine learning algorithms find their way into clinical practice, various pr...
In light of recent advances in machine learning for medical applications, the automation of medical diagnostics is imminent. That said, before machine learning algorithms find their way into clinical practice, various problems at the epistemic level need to be overcome. In this paper, we discuss different sources of uncertainty arising for clinicians trying to evaluate the trustworthiness of algorithmic evidence when making diagnostic judgments. Thereby, we examine many of the limitations of current machine learning algorithms (with deep learning in particular) and highlight their relevance for medical diagnostics. Among the problems we inspect are the theoretical foundations of deep learning (which are not yet adequately understood), the opacity of algorithmic decisions, and the vulnerabilities of machine learning models, as well as concerns regarding the quality of medical data used to train the models. Building on this, we discuss different desiderata for an uncertainty amelioration strategy that ensures that the integration of machine learning into clinical settings proves to be medically beneficial in a meaningful way.
Alzheimer's, Advance Directives, and Interpretive Authority.
Barzun CL
J Med Philos · 2023 Feb · PMID 36630263 · Publisher ↗
Philosophers have debated whether the advance directives of Alzheimer's patients should be enforced, even if patients seem content in their demented state. The debate raises deep questions about the nature of human auton...
Philosophers have debated whether the advance directives of Alzheimer's patients should be enforced, even if patients seem content in their demented state. The debate raises deep questions about the nature of human autonomy and personal identity. But it tends to proceed on the assumption that the advance directive's terms are clear, whereas in practice they are often vague or ambiguous, requiring the patient's healthcare proxy to make difficult judgment calls. This practical wrinkle raises its own, distinct but related, philosophical question: what criteria may the proxy bring to bear when making such interpretive judgments on which the patient's life may depend? After defending a general policy of enforcing advance directives on normative (rather than metaphysical) grounds, I argue that when advance directives are vague, a patient's proxy may permissibly make her own fresh evaluation of the patient's life as a whole and, in so doing, consider how the patient's character as a demented person contributes or fails to contribute to that life.
Patient Safety and the Question of Dignitary Harms.
Mitchell P, Cribb A, Entwistle V
J Med Philos · 2023 Feb · PMID 36592336 · Full text
Patient safety is a central aspect of healthcare quality, focusing on preventable, iatrogenic harm. Harm, in this context, is typically assumed to mean physical injury to patients, often caused by technical error. Howeve...
Patient safety is a central aspect of healthcare quality, focusing on preventable, iatrogenic harm. Harm, in this context, is typically assumed to mean physical injury to patients, often caused by technical error. However, some contributions to the patient safety literature have argued that disrespectful behavior towards patients can cause harm, even when it does not lead to physical injury. This paper investigates the nature of such dignitary harms and explores whether they should be included within the scope of patient safety as a field of practice. We argue that dignitary harms in health care are-at least sometimes-preventable, iatrogenic harms. While we caution against including dignitary harms within the scope of patient safety just because they are relevantly similar to other iatrogenic harms, we suggest that thinking about dignitary harms can help to elucidate the value of patient safety, and to illuminate the evolving relationship between safety and quality.
Philosophical Failure and the Reasonability View of Conscientious Objection: Can Reason Adjudicate Metaphysical or Religious Claims?
Brummett AL
J Med Philos · 2023 Feb · PMID 36573544 · Publisher ↗
Robert Card has proposed a reasonability view of conscientious objection that asks providers to state the reasons for their objection for evaluation and approval by a review board. Jason Marsh has challenged Card to prov...
Robert Card has proposed a reasonability view of conscientious objection that asks providers to state the reasons for their objection for evaluation and approval by a review board. Jason Marsh has challenged Card to provide explicit criteria for what makes a conscientious objection reasonable, which he claims will be too difficult a task given that such objections often involve contentious metaphysical or religious claims. Card has responded by outlining standards by which a conscientious objection could be judged reasonable. In this paper, I extend Marsh's critique to key concepts in the standards outlined by Card such as abortifacient, harm, emergency, and discrimination, showing they can be given radically different interpretations given different metaphysical or religious presumptions. To resolve these conflicting interpretations, a reasonability view of conscientious objection will need more than the criteria outlined by Card, it will need the resources to evaluate the reasonability of metaphysical or religious claims.
Pathologizing Ugliness: A Conceptual Analysis of the Naturalist and Normativist Claims in "Aesthetic Pathology".
Aquino YSJ
J Med Philos · 2022 Dec · PMID 36562842 · Full text
Pathologizing ugliness refers to the use of disease language and medical processes to foster and support the claim that undesirable features are pathological conditions requiring medical or surgical intervention. Primari...
Pathologizing ugliness refers to the use of disease language and medical processes to foster and support the claim that undesirable features are pathological conditions requiring medical or surgical intervention. Primarily situated in cosmetic surgery, the practice appeals to the concept of "aesthetic pathology", which is a medical designation for features that deviate from some designated aesthetic norms. This article offers a two-pronged conceptual analysis of aesthetic pathology. First, I argue that three sets of claims, derived from normativist and naturalistic accounts of disease, inform the framing of ugliness as a disease. These claims concern: (1) aesthetic harms, (2) aesthetic dysfunction, and (3) aesthetic deviation. Second, I introduce the notion of a hybridization loop in medicine, which merges the naturalist and normative understanding of the disease that potentially enables pathologizing practices. In the context of cosmetic surgery, the loop simultaneously promotes the framing of beauty ideals as normal biological attributes and the framing of normal appearance as an aesthetic ideal to legitimize the need for cosmetic interventions. The article thus offers an original discussion of the conceptual problems arising from a specific practice in cosmetic surgery that depicts ugliness as the disease.
Is Aging a Disease? The Theoretical Definition of Aging in the Light of the Philosophy of Medicine.
Saborido C, García-Barranquero P
J Med Philos · 2022 Dec · PMID 36562841 · Publisher ↗
In the philosophical debate on aging, it is common to raise the question of the theoretical definition of aging in terms of its possible characterization as a disease. Understanding aging as a disease seems to imply its...
In the philosophical debate on aging, it is common to raise the question of the theoretical definition of aging in terms of its possible characterization as a disease. Understanding aging as a disease seems to imply its medicalization, which has important practical consequences. In this paper, we analyze the question of whether aging is a disease by appealing to the concept of disease in the philosophy of medicine. As a result of this analysis, we argue that a pragmatist approach to the conception of disease is the best alternative to highlight the relevance of the medicalization of aging. From this pragmatist perspective, it can be seen that the notion of aging is going through a conceptual change, and aging can today be understood as a not radically different process from any other condition that is usually considered a disease.
Moral Injury, Moral Identity, and "Dirty Hands" in War Fighting and Police Work.
Miller S
J Med Philos · 2022 Dec · PMID 36562840 · Publisher ↗
In this article, I undertake three main tasks. First, I argue that, contrary to the standard view, moral injury is not a species of PTSD (post-traumatic stress disorder) but rather, on the most coherent conception of mor...
In this article, I undertake three main tasks. First, I argue that, contrary to the standard view, moral injury is not a species of PTSD (post-traumatic stress disorder) but rather, on the most coherent conception of moral injury, PTSD is (in effect) a species of moral injury. In doing so, I make use of the notion of caring deeply about something or someone worthy of being cared deeply about. Second, I consider so-called "dirty hands" actions in police work and in war, and distinguish these from the morally legitimate, but harmful, actions of police officers and of war fighters, such as the morally legitimate use of coercive force and lethal force (respectively). While the morally legitimate use of harmful methods is constitutive of these occupational roles, "dirty hands" methods are not. Roughly speaking, a "dirty hands" action is one that is morally wrong and (typically) unlawful but done for the sake of a good outcome. Both categories of action are conducive to moral injury, but "dirty hands" actions much more so, especially given the slippery moral slope from "dirty hands" actions to egregious moral wrongdoing. Third, I offer some recommendations for reducing moral injury among police officers and war fighters.
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