The Journal Of Medicine And Philosophy[JOURNAL]
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200 papers
The Desirability of Difference: Georges Canguilhem and Body Integrity Identity Disorder.
Gibson RB
J Med Philos · 2022 Dec · PMID 36562839 · Publisher ↗
Opponents of the provision of therapeutic, healthy limb amputation in Body Integrity Identity Disorder cases argue that such surgeries stand in contrast to the goal of medical practice - that of health restoration and ma...
Opponents of the provision of therapeutic, healthy limb amputation in Body Integrity Identity Disorder cases argue that such surgeries stand in contrast to the goal of medical practice - that of health restoration and maintenance. This paper refutes such a conclusion via an appeal to the nuanced and reflective model of health proposed by Georges Canguilhem. The paper examines the conceptual entanglement of the statistically common with the normatively desirable, arguing that a healthy body can take multiple forms, including that of an amputee, provided that such a form enables the continuing ability to initiate new norms of existence. It concludes that the practice of healthy limb amputation in cases of Body Integrity Identity Disorder is not only compatible with the goal of medicine but is potentially the only method of achieving this goal in the face of a complex and often mischaracterized disorder.
"Accompanied Only by My Thoughts": A Kantian Perspective on Autonomy at the End of Life.
Elsner AM, Rampton V
J Med Philos · 2022 Dec · PMID 36562838 · Full text
Within bioethics, Kant's conception of autonomy is often portrayed as excessively rationalistic, abstract, and individualistic, and, therefore, far removed from the reality of patients' needs. Drawing on recent contribut...
Within bioethics, Kant's conception of autonomy is often portrayed as excessively rationalistic, abstract, and individualistic, and, therefore, far removed from the reality of patients' needs. Drawing on recent contributions in Kantian philosophy, we argue that specific features of Kantian autonomy remain relevant for medical ethics and for patient experience. We use contemporary end-of-life illness narratives-a resource that has not been analyzed with respect to autonomy-and show how they illustrate important Kantian themes, namely, the duty to know oneself, the interest in elaborating universalizable principles, and the emphasis on ideals as points of orientation that guide behavior without ever being fully realized. As Kant does, the patient-authors discussed here perceive the end of life as a moment to reflect on the constitutive principles which have governed that life, thereby offering a privileged moment to pursue self-knowledge. We argue that bioethical conceptions of autonomy stand to gain if they revise their conception of Kantian moral philosophy as too formal, abstract, and detached from emotions and personal relationships to be helpfully applied.
Assisted Death, Dignity, and Respect for Humanity.
Dige M
J Med Philos · 2022 Dec · PMID 36562837 · Publisher ↗
Recent works on the concept of dignity have opened up the otherwise quite deadlocked debate about assisted death (AD). Rather than just reinforcing already fixed positions, it seems to me that these conceptions of dignit...
Recent works on the concept of dignity have opened up the otherwise quite deadlocked debate about assisted death (AD). Rather than just reinforcing already fixed positions, it seems to me that these conceptions of dignity make room for a moderate and normatively richer position on the moral permissibility of AD. I do not think that we have seen the full potential of the said conceptions and interpretations. I try in this article to contribute my part. First, I briefly recapitulate some of the paradoxical ways in which dignity is typically invoked in the debate and try to clear up some of the obvious confusions. Then, I go on to explore a particular Kantian line of thought in some recent works on dignity and AD that seems to pave the way for a moderate position with a more principled foundation than the usual compromise positions.
Tōjisha Research and Narrative Medicine: Contribution of a Japanese Experiment in the Investigation of Patients' Personal Experience.
Gaillard M
J Med Philos · 2022 Dec · PMID 36562836 · Publisher ↗
Tōjisha research is a methodology intended to help psychiatric patients through dialogue. It was introduced in the context of community care in Bethel House (Hokkaido, Japan) in the early 2000s and later spread to other...
Tōjisha research is a methodology intended to help psychiatric patients through dialogue. It was introduced in the context of community care in Bethel House (Hokkaido, Japan) in the early 2000s and later spread to other parts of Japan as well as abroad because of its originality and apparent therapeutic success. It offers patients a framework to investigate their own problems, symptoms, and delusions and to build a discourse around them. In this paper, I present a short account of tōjisha research and I put it in the context of current debates over the benefits and drawbacks of narrative medicine. I argue that there is an original conception of the self and of empowerment of patients in tōjisha research compared to other models of narrative medicine. Finally, I mobilize these original aspects to address some rebuttals of narrative medicine.
Critically Appraising Pragmatist Critiques of Evidence-Based Medicine: Is EBM Defensible on Pragmatist Grounds?
Thomas SJ
J Med Philos · 2023 Feb · PMID 36519764 · Publisher ↗
Significant contributions to debates in the philosophy of evidence-based medicine (EBM) have come from a variety of different philosophical quarters, yet mainstream discourse in the field has been largely devoid of contr...
Significant contributions to debates in the philosophy of evidence-based medicine (EBM) have come from a variety of different philosophical quarters, yet mainstream discourse in the field has been largely devoid of contributions from scholars working in the pragmatist tradition. This is a particularly conspicuous omission, given pragmatism's commitment to the melioristic view that philosophy both can, and should, be about the business of concretely bettering the human estate. Two exceptions to this oversight come from Brian Walsh and Maya Goldenberg. Unfortunately, in both cases, the misapplication of pragmatist thinking leads to the mistaken view that EBM is committed to some form of pernicious objectivism. This article aims to revise these pragmatist critiques in order to bring them more consistently in line with pragmatist values and commitments. Doing so shows that EBM is defensible on pragmatist grounds against objectivist attacks.
Recognizing the Diverse Faces of Later Life: Old Age as a Category of Intersectional Analysis in Medical Ethics.
Weßel M, Schweda M
J Med Philos · 2023 Feb · PMID 36519751 · Publisher ↗
Public and academic medical ethics debates surrounding justice and age discrimination often proceed from a problematic understanding of old age that ignores the diversity of older people. This article introduces the femi...
Public and academic medical ethics debates surrounding justice and age discrimination often proceed from a problematic understanding of old age that ignores the diversity of older people. This article introduces the feminist perspective of intersectionality to medical ethical debates on aging and old age in order to analyze the structural discrimination of older people in medicine and health care. While current intersectional approaches in this field focus on race, gender, and sexuality, we thus set out to introduce aging and old age as an additional category that is becoming more relevant in the context of longer life expectancies and increasing population aging. We analyze three exemplary cases on the individual, institutional, and public health level, and argue that considering the intersections of old age with other social categories helps to accommodate the diverse identities of older people and detect inequality and structural discrimination.
The Fraught Notion of a "Good Death" in Pediatrics.
Moore B
J Med Philos · 2023 Feb · PMID 36516411 · Publisher ↗
In this article, I sort through some of the confusion surrounding what constitutes the controversial notion of a "good death" for children. I distinguish, first, between metaphysical and practical disagreements about the...
In this article, I sort through some of the confusion surrounding what constitutes the controversial notion of a "good death" for children. I distinguish, first, between metaphysical and practical disagreements about the notion of a good death, and, second, between accounts of a good death that minimally and maximally promote the dying child's interests. I propose a narrowed account of the dying child's interests, because they differ from the interests of non-dying children. Importantly, this account illustrates how disagreements at the end of a child's life are sometimes the result of a shift from a future to a present-oriented understanding of the child's interests on the part of some stakeholders but not others, and sometimes the result of a values-based disagreement about how different interests should be weighted. This brings into sharper focus the questions of for whom, and in what way, a child's death might be considered good.
Take Pity: What Disability Rights Can Learn from Religious Charity.
Braswell H
J Med Philos · 2022 Nov · PMID 36409312 · Publisher ↗
Disability rights advocates have traditionally denigrated charity as politically counterproductive and inherently demeaning. This article argues that this perspective mischaracterizes charity of a religious kind. Religio...
Disability rights advocates have traditionally denigrated charity as politically counterproductive and inherently demeaning. This article argues that this perspective mischaracterizes charity of a religious kind. Religious charity, I argue, must be understood immanently, through an exploration of the virtues cultivated in particular religious organizations. I consider two Catholic charities: L'Arche, a community for intellectually disabled people, and the end-of-life care facility Our Lady of Perpetual Help Home. At each organization, individual acts of charity are emblematic of an underlying virtue that I call caritas or charity-love. This transforms them into gestures that advance goals that are consonant with those of the disability rights movement. In the case of Our Lady, this is even true of pity, perhaps the most despised emotion of the disability rights tradition. But while disability rights advocates have characterized pity as essentially devaluing disabled people, at Our Lady, it is an emotion that freely circulates, undoing hierarchical distinctions between ability and disability, and even human and divine. This redefined notion of pity-which I term misericordia-can, I conclude provide a new foundation for disability politics, one that radicalizes the goals of the disability rights movement, while also positing objectives that go beyond legal compliance.
Why Medicine Needs a Theology of Monstrosity.
Stahl D
J Med Philos · 2022 Nov · PMID 36409311 · Publisher ↗
For centuries, philosophers and theologians debated the meaning of monstrous births. This article describes the debates that took place in the early modern period concerning the origins of monstrous births and examines h...
For centuries, philosophers and theologians debated the meaning of monstrous births. This article describes the debates that took place in the early modern period concerning the origins of monstrous births and examines how they might be relevant to our understanding of disability today. I begin with the central questions that accompanied the birth of conjoined twins in the early 17th century as well as the theological origins of those questions. I then show the shifts that occurred in philosophical debate in the 18th century, which reveal the changing understanding of God's interaction with creation, as well as the burgeoning medical responses to monstrous births. By reexamining these earlier debates, I claim some of the earlier questions posed by philosophers and theologians have been neglected but remain relevant in bioethics debates concerning how best to consider and treat newborns with certain disabilities.
"Marked" Bodies, Medical Intervention, and Courageous Humility: Spiritual Identity Formation in Nathaniel Hawthorne's The Birthmark.
Dow K
J Med Philos · 2022 Nov · PMID 36409310 · Publisher ↗
Nathaniel Hawthorne's The Birthmark offers a sharp lens through which to examine power, purity, and personal identity. Scientist and spiritual idealist, Aylmer, is obsessed with "correcting" the only flaw he perceives in...
Nathaniel Hawthorne's The Birthmark offers a sharp lens through which to examine power, purity, and personal identity. Scientist and spiritual idealist, Aylmer, is obsessed with "correcting" the only flaw he perceives in his wife Georgina, the imprint of a small red hand on her pale cheek. For Alymer, this one "imperfection" reaches deep into Georgina's heart, a sign of sin, decay, and mortality. It is the natural that must be overcome with science. Drawing on Hawthorne's tragic fiction, this paper questions the influence of stigma, power dynamics, and mind-body dualism in constructing disability identity within the framework of medical and spiritual practices of care. Whether in the role of a spiritual leader, chaplain, or medical professional, people providing care must first address ableism and perceptions of normalcy in relation to their own identity and calling before offering professional advice to disabled people seeking guidance or support. It is only as professional fields adopt a posture marked by courageous humility that healing practices will promote the flourishing of all people, including those with disabilities.
Disability, Enhancement, and Flourishing.
Eberl JT
J Med Philos · 2022 Nov · PMID 36409309 · Publisher ↗
Recent debate among bioethicists concerns the potential to enhance human beings' physical or cognitive capacities by means of genetic, pharmacological, cybernetic, or surgical interventions. Between "transhumanists," who...
Recent debate among bioethicists concerns the potential to enhance human beings' physical or cognitive capacities by means of genetic, pharmacological, cybernetic, or surgical interventions. Between "transhumanists," who argue for unreserved enhancement of human capabilities, and "bioconservatives," who warn against any non-therapeutic manipulation of humanity's natural condition, lie those who support limited forms of enhancement for the sake of individual and collective human flourishing. Many scholars representing these views also share a concern over the status and interests of human beings with various types of cognitive and physical disabilities, some of which may be ameliorable by enhancement interventions. The question addressed in this paper is whether valuing the enhancement of human capabilities may be reconciled with valuing the existence and phenomenological experiences of human beings with various disabilities. Can we value enhanced capabilities without disvaluing those whose capabilities fall below a defined threshold of "normal function"? Furthermore, if certain forms of disability, particularly cognitive disabilities, negatively impact one's flourishing, could the enhancement of one's cognitive capacities through biotechnological means enhance one's flourishing.
Denying a Unified Concept of Disability.
Timpe K
J Med Philos · 2022 Nov · PMID 36409308 · Publisher ↗
This paper argues that there are reasons to believe that there is no single concept or category which demarcates all individuals who have a disability from those individuals who do not. The paper begins by describing tha...
This paper argues that there are reasons to believe that there is no single concept or category which demarcates all individuals who have a disability from those individuals who do not. The paper begins by describing that I call 'a Unified Concept View of Disability' and the role that such a view plays in debates about the nature of disability. After considering reasons to think that our concept of disability is not unified in the way that the Unified Concept View assumes, I outline what a non-unified approach to disability might look like. The paper concludes by considering implications of rejecting the Unified Concept View of disability.
Speaker Responsibility for Synthetic Speech Derived from Neural Activity.
Rainey S
J Med Philos · 2022 Nov · PMID 36333930 · Publisher ↗
This article provides analysis of the mechanisms and outputs involved in language-use mediated by a neuroprosthetic device. It is motivated by the thought that users of speech neuroprostheses require sufficient control o...
This article provides analysis of the mechanisms and outputs involved in language-use mediated by a neuroprosthetic device. It is motivated by the thought that users of speech neuroprostheses require sufficient control over what their devices externalize as synthetic speech if they are to be thought of as responsible for it, but that the nature of this control, and so the status of their responsibility, is not clear.
A Critique and Refinement of the Wakefieldian Concept of Disorder: An Improvement of the Harmful Dysfunction Analysis.
Smith E
J Med Philos · 2022 Nov · PMID 36333929 · Publisher ↗
One way in which bioethicists can benefit the medical community is by clarifying the concept of disorder. Since insurance companies refer to the DSM for whether a patient should receive assistance, one must consider the...
One way in which bioethicists can benefit the medical community is by clarifying the concept of disorder. Since insurance companies refer to the DSM for whether a patient should receive assistance, one must consider the consequences of one's concept of disorder for who should be provided with care. I offer a refinement of Jerome Wakefield's hybrid concept of disorder, the harmful dysfunction analysis. I criticize both the factual component and the value component of Wakefield's account and suggest how they might be improved. I propose that the factual component should be statistical variation analyzed in multilevel and chronological compilations of physiological data. I propose that the value component should prioritize the individual's authority regarding the experience of suffering from a physiological condition. My account preserves the insight of using a factual and a value component while avoiding the problems that Wakefield's original account faces.
A Mixed Judgment Standard for Surrogate Decision-Making.
Stout N
J Med Philos · 2022 Nov · PMID 36333928 · Publisher ↗
The Substituted Judgment Standard (SJS) for surrogate decision-making dictates that a surrogate, when making medical decisions on behalf of an incapacitated patient, ought to make the decision that the patient would have...
The Substituted Judgment Standard (SJS) for surrogate decision-making dictates that a surrogate, when making medical decisions on behalf of an incapacitated patient, ought to make the decision that the patient would have made if the patient had decisional capacity. Despite its intuitive appeal, however, SJS has been the target of a variety of criticisms. Most objections to SJS appeal to epistemic difficulties involved in determining what a patient would have decided in a given case. In this article, I offer an alternative standard for surrogate decision-making that avoids these difficulties. I then offer an account of its theoretical underpinnings which shows that it preserves the central moral justification for SJS, namely, respect for patient autonomy.
Deceiving Research Participants: Is It Inconsistent With Valid Consent?
Wendler D
J Med Philos · 2022 Nov · PMID 36333927 · Full text
It is widely assumed that the use of deception in research is always inconsistent with obtaining valid consent. In addition, guidelines and regulations permit research without valid consent only when it poses no greater...
It is widely assumed that the use of deception in research is always inconsistent with obtaining valid consent. In addition, guidelines and regulations permit research without valid consent only when it poses no greater than minimal risk. Current practice thus prohibits studies that use deception and pose greater than minimal risk, including studies that rely on deceptive methods to evaluate experimental treatments. To assess whether these prohibitions are justified, the present paper evaluates five arguments that might be thought to support the assumption that deception is always inconsistent with valid consent. Analysis of these arguments reveals that deception is frequently, but not always, inconsistent with obtaining valid consent for research. This conclusion suggests that, in order to avoid unnecessarily blocking valuable research, current policies and practice should be revised to recognize the conditions under which the use of deception can be consistent with obtaining research participants' valid consent.
Can a MacIntyrian Care about Severely Disabled Strangers?
McCracken G
J Med Philos · 2022 Dec · PMID 36326714 · Publisher ↗
I argue that Alasdair MacIntyre has important resources to provide in the debate over the moral status of severely disabled people. In contrast, Gregory Poore suggests that MacIntyre's virtue theory cannot account for ou...
I argue that Alasdair MacIntyre has important resources to provide in the debate over the moral status of severely disabled people. In contrast, Gregory Poore suggests that MacIntyre's virtue theory cannot account for our responsibilities to severely disabled people. Given that MacIntyre bases his theory around community membership, this charge is made especially severe in the case of severely disabled strangers. I present an interpretation of MacIntyre that accounts for responsibilities to severely disabled strangers. I then argue that Poore is wrong to conclude that MacIntyre does not include severely disabled people in communities.
Reasoning about Death in Biomedical Decision-Making.
Weissman J
J Med Philos · 2022 Aug · PMID 35926174 · Publisher ↗
Depending on our mode of reasoning-moral, prudential, instrumental, empirical, dialectical, and so on-we may come to vastly different conclusions on the nature of death and the appropriate orientation toward matters such...
Depending on our mode of reasoning-moral, prudential, instrumental, empirical, dialectical, and so on-we may come to vastly different conclusions on the nature of death and the appropriate orientation toward matters such as euthanasia or procuring organs from brain-dead patients. These differing orientations have resulted in some of the most enduring conflicts in biomedical decision-making with roots in the earliest strands of philosophical discourse. Through continually grappling with questions over matters of death, we continually step closer to clarity, even if certainty on these matters remains necessarily as elusive as death itself.
How the Body Became Integrated: Cybernetics in the History of the Brain Death Debate.
Scherz P
J Med Philos · 2022 Aug · PMID 35926173 · Publisher ↗
Although the term integration is central to the definition of brain death, there is little agreement on what it means. Through a genealogical analysis, this essay argues that there have been two primary ways of understan...
Although the term integration is central to the definition of brain death, there is little agreement on what it means. Through a genealogical analysis, this essay argues that there have been two primary ways of understanding integration in regard to organismal wholeness. One stems from neuroscience, focusing on the role of the brain in responding to external stimuli, which was taken up in phenomenological accounts of life. A second, arising out of cybernetics, focuses on the brain's role in homeostasis. Recent debates over brain death are largely over this cybernetic understanding of integration. However, the phenomenological understanding of organismal wholeness can be seen in arguments by the President's Council on Bioethics in favor of brain death. This essay argues that the cybernetic understanding of life is problematic and should be discarded. A phenomenological understanding of life can provide a better basis for arguments over definitions of life and death.
Conscientious Objection in Health Care: Why the Professional Duty Argument is Unconvincing.
Symons X
J Med Philos · 2022 Nov · PMID 35920746 · Publisher ↗
The past decade has seen a burgeoning of scholarly interest in conscientious objection in health care. Specifically, several commentators have discussed the implications that conscientious objection has for the delivery...
The past decade has seen a burgeoning of scholarly interest in conscientious objection in health care. Specifically, several commentators have discussed the implications that conscientious objection has for the delivery of timely, efficient, and nondiscriminatory medical care. In this paper, I discuss the main argument put forward by the most prominent critics of conscientious objection-what I call the Professional Duty Argument or PDA. According to proponents of PDA, doctors should place patients' well-being and rights at the center of their professional practice. Doctors should be prepared to set their personal moral or religious beliefs aside where these beliefs conflict with what is legal and considered good medical practice by relevant professional associations. Conscientious objection, on this account, should be heavily restricted, if even allowed at all. I discuss two powerful objections against PDA. The first objection, which I call the fallibility objection, notes that law and professional codes of conduct are fallible guides for ethical conduct and that conscientious objection has in the past and continues today to provide a check on aberrations in law and professional convention. The second, which I call the professional discretion objection, states that restrictions on conscientious objection undermine one of the cornerstones of good medical practice, namely, a practitioner's right to independent professional judgment. I argue that these two objections give us reason to retain conscience clauses in professional codes of conduct.
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