The Journal Of Medicine And Philosophy[JOURNAL]
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200 papers
Eugène Bouchut's (1818-1891) Early Anticipation of the Concept of Brain Death.
Saad T
J Med Philos · 2022 Aug · PMID 35880590 · Publisher ↗
The conventional historical account of the concept of brain death credits developments and discoveries of the twentieth century with its inception, emphasizing the role of technological developments and professional conf...
The conventional historical account of the concept of brain death credits developments and discoveries of the twentieth century with its inception, emphasizing the role of technological developments and professional conferences, notably the 1968 Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death. This essay argues that the French physician Eugène Bouchut anticipated the concept of brain death as early as 1846. Correspondence with Bouchut's understanding of brain death and one important contemporary concept of brain death is established then contrasted with current trends of defining death as the death of the brain. The philosophical factors that influenced Bouchut and the later developments of concepts of brain death are considered, with special reference to mechanistic philosophy and vitalism.
Promoting Equity in Health Care through Human Flourishing, Justice, and Solidarity.
Jotterand F, Spellecy R, Homan M … +1 more , Derse AR
J Med Philos · 2023 Feb · PMID 35849078 · Publisher ↗
In this article, we develop a non-rights-based argument based on beneficence (i.e., the welfare of individuals and communities) and justice as the disposition to act justly to promote equity in health care resource alloc...
In this article, we develop a non-rights-based argument based on beneficence (i.e., the welfare of individuals and communities) and justice as the disposition to act justly to promote equity in health care resource allocation. To this end, we structured our analysis according to the following main sections. The first section examines the work of Amartya Sen and his equality of capabilities approach and outlines a framework of health care as a fundamental human need. In the subsequent section, we provide a definition of health equity based on the moral imperative to guarantee that every individual ought to have the freedom to pursue health goals and well-being. In the later part of the article, we outline a non-right approach to health care based on three pillars: (1) human flourishing, (2) justice as a disposition not a process, and (3) solidarity.
A New Approach to Disease, Risk, and Boundaries Based on Emergent Probability.
Daly P
J Med Philos · 2022 Aug · PMID 35779075 · Publisher ↗
The status of risk factors and disease remains a disputed question in the theory and practice of medicine and healthcare, and so does the related question of delineating disease boundaries. I present a framework based on...
The status of risk factors and disease remains a disputed question in the theory and practice of medicine and healthcare, and so does the related question of delineating disease boundaries. I present a framework based on Bernard Lonergan's account of emergent probability for differentiating (1) generically distinct levels of systematic function within organisms and between organisms and their environments and (2) the methods of functional, genetic, and statistical investigation. I then argue on this basis that it is possible to understand disease in terms of biological or higher intra-level dysfunction, risk factors-including genetic risk factors-in terms of statistical inter-level conditioning of a given stage or developmental sequence of systematic functioning, and the empirical boundaries of disease in terms of the limits of both functional categorization (from an epistemic standpoint) and upper-level integration of lower-level processes and events (from an ontological standpoint).
Depression and Physician-Aid-in-Dying.
Tully I
J Med Philos · 2022 Aug · PMID 35779073 · Publisher ↗
In this paper, I address the question of whether it is ever permissible to grant a request for physician-aid-in-dying (PAD) from an individual suffering from treatment-resistant depression. I assume for the sake of argum...
In this paper, I address the question of whether it is ever permissible to grant a request for physician-aid-in-dying (PAD) from an individual suffering from treatment-resistant depression. I assume for the sake of argument that PAD is sometimes permissible. There are three requirements for PAD: suffering, prognosis, and competence. First, an individual must be suffering from an illness or injury which is sufficient to cause serious, ongoing hardship. Second, one must have exhausted effective treatment options, and one's prospects for recovery must be poor. Third, the individual must be judged competent to request PAD. I argue that many cases of treatment-resistant depression meet the first two requirements. Thus, the key question concerns the third. I consider four features of depression that might compromise a person's decision-making capacity. Ultimately, I conclude that PAD requests from depressed patients can be permissibly granted in some circumstances.
The Moral Authority of Consensus.
Walker P, Lovat T
J Med Philos · 2022 Aug · PMID 35751628 · Full text
Prompted by recent comments on the moral authority of dialogic consensus, we argue that consensus, specifically dialogic consensus, possesses a unique form of moral authority. Given our multicultural era and its pluralit...
Prompted by recent comments on the moral authority of dialogic consensus, we argue that consensus, specifically dialogic consensus, possesses a unique form of moral authority. Given our multicultural era and its plurality of values, we contend that traditional ethical frameworks or principles derived from them cannot be viewed substantively. Both philosophers and clinicians prioritize the need for a decision to be morally justifiable, and also for the decision to be action-guiding. We argue that, especially against the background of our pluralistic society, it is only via unforced dialogue and properly founded argumentation, aiming for consensus, that we can ascribe rightness or wrongness in a normative fashion to dilemmatic situations. We argue that both the process of dialogue, properly constituted, and the consensual outcome itself have moral authority vested within them. Finally, we argue that the consensual decision made is able to withstand moral scrutiny and is action-guiding, without claiming absolute moral authority in other contexts.
Rationally Navigating Subjective Preferences in Memory Modification.
Vukov JM
J Med Philos · 2022 Aug · PMID 35640023 · Publisher ↗
Discussion of the ethics of memory modification technologies (MMTs) has often focused on questions about the limits of their permissibility. In the current paper, I focus primarily on a different issue: when (if ever) is...
Discussion of the ethics of memory modification technologies (MMTs) has often focused on questions about the limits of their permissibility. In the current paper, I focus primarily on a different issue: when (if ever) is it rational to prefer MMTs to alternative interventions? My conclusion is that these conditions are rare. The reason stems from considerations of autonomy. When compared with other interventions, MMTs do a particularly poor job at promoting the autonomy of their users. If this conclusion is true, moreover, it provides a fresh perspective on debates about the permissibility of MMTs. On the one hand, for those who would limit the use of MMTs to a narrow range of circumstances, the conclusion that MMTs are rarely preferable gives them further reason to eye MMTs with suspicion. On the other hand, for those who view MMTs as permissible in a wide range of circumstances, the conclusion may deflate their endorsement.
Heads, Bodies, Brains, and Selves: Personal Identity and the Ethics of Whole-Body Transplantation.
Iltis A
J Med Philos · 2022 May · PMID 35543469 · Publisher ↗
Plans to attempt what has been called a head transplant, a body transplant, and a head-to-body transplant in human beings raise numerous ethical, social, and legal questions, including the circumstances, if any, under wh...
Plans to attempt what has been called a head transplant, a body transplant, and a head-to-body transplant in human beings raise numerous ethical, social, and legal questions, including the circumstances, if any, under which it would be ethically permissible to attempt whole-body transplantation (WBT) in human beings, the possible effect of WBT on family relationships, and how families should shape WBT decisions. Our assessment of many of these questions depends partially on how we respond to sometimes centuries-old philosophical thought experiments about personal identity. As with so much in bioethics, it is impossible to escape, or at least inadvisable to try to bypass, the relevant foundational philosophical concerns.
What Happens if the Brain Goes Elsewhere? Reflections on Head Transplantation and Personal Embodiment.
Cherry MJ
J Med Philos · 2022 May · PMID 35543468 · Publisher ↗
Brain transplants have long been no more than the subject of science fiction and engaging thought experiments. That is no longer true. Neuroscientists have announced their intention to transplant the head of a volunteer...
Brain transplants have long been no more than the subject of science fiction and engaging thought experiments. That is no longer true. Neuroscientists have announced their intention to transplant the head of a volunteer onto a donated body. Response has been decidedly mixed. How should we think about the moral permissibility of head transplants? Is it a life-saving/life-enhancing opportunity that appropriately expands the boundaries of medical practice? Or, is it a bioethical morass that ought not to be attempted? For the purposes of this paper, I set aside questions regarding the surgical operation's technological plausibility so as to focus on very basic questions regarding personal identity and the morality of head transplantation. The analysis begins with an exploration of the embodiment of persons. It considers whether persons can be conceptually distinguished from all parts of their body, even if they cannot be physically separated from some parts without loss of personhood. It argues that in most cases replacing body parts with reasonably similar parts will not destroy the conditions for sustaining personhood. However, as I explore, the phenomenology of personhood is such that some physical changes may prove to be too significant to maintain personal identity successfully over time. Given such complexity and the significance of the costs involved, the moral permissibility of head transplantation likely depends on recognizing that persons may give permission to collaborate in common activities, including projects with which others deeply disagree, provided that they only utilize the services and resources of free and consenting others.
Naturalism, Disease, and Levels of Functional Description.
Varga S, Gray DM
J Med Philos · 2022 Aug · PMID 35532319 · Publisher ↗
The paper engages Christopher Boorse's Bio-Statistical Theory (BST). In its current form, BST runs into a significant challenge. For BST to account for its central tenet-that lower-level part-dysfunction is sufficient fo...
The paper engages Christopher Boorse's Bio-Statistical Theory (BST). In its current form, BST runs into a significant challenge. For BST to account for its central tenet-that lower-level part-dysfunction is sufficient for higher-level pathology-it must provide criteria for how to decide which lower-level parts are the ones to be analyzed for health or pathology. As BST is a naturalistic theory, such choices must be based solely on naturalistic considerations. An argument is provided to show that, if BST is to be preserved, such parthood choices are based on non-naturalistic considerations. We demonstrate that even when parthood choices are based on the best way to preserve BST, there are counterintuitive results which bring the central tenet of BST into question.
Political Bioethics.
Gregg B
J Med Philos · 2022 Nov · PMID 35512122 · Publisher ↗
If bioethical questions cannot be resolved in a widely acceptable manner by rational argument, and if they can be regulated only on the basis of political decision-making, then bioethics belongs to the political sphere....
If bioethical questions cannot be resolved in a widely acceptable manner by rational argument, and if they can be regulated only on the basis of political decision-making, then bioethics belongs to the political sphere. The particular kind of politics practiced in any given society matters greatly: it will determine the kind of bioethical regulation, legislation, and public policy generated there. I propose approaching bioethical questions politically in terms of decisions that cannot be "correct" but that can be "procedurally legitimate." Two procedures in particular can deliver legitimate bioethical decisions, once combined: expert bioethics committees and deliberative democracy. Bioethics so understood can exceed bioethics as a moral project or as a set of administrative principles to regulate medical practice; it can now aspire to a democratic project that involves ordinary citizens as far as reasonably possible. I advance this argument in four steps: (1) using the example of human germline gene editing, (2) I propose a general understanding of proceduralism, and (3) then combine two types and (4) conclude with a defense of majoritarian proceduralism. I develop this argument in terms of one example: germline gene editing.
The Ethics of Head Transplant from the Confucian Perspective of Human Virtues.
Li J, Li Y
J Med Philos · 2022 May · PMID 35452097 · Publisher ↗
Head transplantation has ignited intense discussions about whether it should be done scientifically and ethically. This paper examines the ethics of head transplantation from a Confucian perspective and offers arguments...
Head transplantation has ignited intense discussions about whether it should be done scientifically and ethically. This paper examines the ethics of head transplantation from a Confucian perspective and offers arguments against the permissibility of head transplantation. From a Confucian point of view, human beings are the most precious organisms in the world, and ren (benevolence) and li (propriety) are the basic moral principles of human beings. As long as head transplant technology remains underdeveloped, this procedure should not be done because it will pose a serious risk of harm to humans and thus violate the principles of Confucian ren and li. If head transplant technology matures to the point that it would be safe to try in humans, it still should not be performed because it would change the selfhood or identity of the head donor and the body donor and create a new person. Confucian personal virtues greatly depend on selfhood or personal identity, and selfhood or personal identity depend on one's body cultivation and mind rectification. Through the hard effort of body cultivation and mind rectification, one transforms one's selfhood or identity and personality. This selfhood, identity, and personality cannot be separated from one's body but are embedded in one's body. Thus, head transplant would destroy two persons' identities and result in a new person, and the characteristics of this new person's identity are still unknown.
A Dilemma for Respecting Autonomy: Bridge Technologies and the Hazards of Sequential Decision-Making.
Kestigian A, London AJ
J Med Philos · 2022 May · PMID 35452092 · Publisher ↗
Respect for patient autonomy can apply at two levels: ensuring that patient care reflects their considered values and wishes and honoring patient preferences about how to make momentous decisions. Caregivers who seek to...
Respect for patient autonomy can apply at two levels: ensuring that patient care reflects their considered values and wishes and honoring patient preferences about how to make momentous decisions. Caregivers who seek to respect patient autonomy in the context of some end-of-life decisions face a dilemma. Because these decisions are fraught, patients may prefer to approach them sequentially, only making decisions at the time they arise. However, respecting patients' preferences for a sequential approach can increase the likelihood that surrogates and care teams wind up in situations in which they lack information needed to ensure patients receive care that conforms to their considered values after they are no longer competent to make decisions for themselves. Sequential decision-making can thus conflict with the goal of ensuring care reflects the wishes of patients. After illustrating how this dilemma can arise in the use of life-sustaining "bridge" technologies, we argue that care teams may be warranted in requiring patients to articulate their wishes in an advance care plan before treatment begins. In some cases, care teams may even be permitted to refuse to undertake certain courses of care, unless patients articulate their wishes in an advance care plan.
Nosological Diagnosis, Theories of Categorization, and Argumentations by Analogy.
Gagliardi F
J Med Philos · 2022 May · PMID 35435979 · Publisher ↗
The nosological diagnosis is a particular type of nontheoretical diagnosis consisting of identifying the disease that afflicts the patient without explaining the underlying etiopathological mechanisms. Its origins are wi...
The nosological diagnosis is a particular type of nontheoretical diagnosis consisting of identifying the disease that afflicts the patient without explaining the underlying etiopathological mechanisms. Its origins are within the essentialist point of view on the nature of diseases, which dates back at least to 18th-century taxonomy studies. In this article, we propose a model of nosological diagnosis as a two-phase process composed of the categorization of inductive inferences and argumentations by analogy. In the inductive phase, disease entities are identified by means of typicality-based categorization processes, and meaningful clinical samples are learned (abstract clinical cases, i.e., syndromes and actual cases); in the subsequent phase, those samples are used as the bases of argumentations by analogy to obtain a diagnosis for a given patient. This model extends the prototype resemblance theory of disease including also the exemplar theory proposed in cognitive science and, moreover, it frames the clinical activity of nosological diagnosis and how it can be explained within the theory of argumentation. According to it, diagnosis based on the recognition of a typical syndrome is explained in terms of the prototype theory of categorization and the antisymmetrical argumentation by analogy, while diagnosis based on a comparison with a previous clinical case is explained by the exemplar theory of categorization and by the symmetrical argumentation by analogy.
Losing One's Head or Gaining a New Body?
Eberl JT
J Med Philos · 2022 May · PMID 35435964 · Publisher ↗
A surgical head-transplant technique, HEAVEN, promises to offer significantly improved quality of life for quadriplegics and others whose minds are functional, but whose bodies require artificial support to continue livi...
A surgical head-transplant technique, HEAVEN, promises to offer significantly improved quality of life for quadriplegics and others whose minds are functional, but whose bodies require artificial support to continue living. HEAVEN putatively actualizes a thought-experiment long debated by philosophers concerning the definition of personhood and criterion of personal identity through time and change. HEAVEN's advocates presume to preserve the identity of the person whose head is transplanted onto another's living body, leaving one's previous body behind as one would their corpse. Various classical and contemporary theories of personhood and personal identity would support this presumption, while others would contest it as providing an accurate or complete view of what is essential for a human person to persist through this procedure. This paper brings such theories to bear in analyzing whether HEAVEN can indeed deliver on its promise of complete ontological survival for the person whose head is transplanted.
Head Transplantation and Immortality: When Is Life Worth Living Forever?
Parker JC
J Med Philos · 2022 May · PMID 35435952 · Publisher ↗
Head transplantation fits within the broader conceptual space occupied by transhumanists and others who seek to extend the lives of human beings indefinitely. It is reasonable to reflect on whether, under what circumstan...
Head transplantation fits within the broader conceptual space occupied by transhumanists and others who seek to extend the lives of human beings indefinitely. It is reasonable to reflect on whether, under what circumstances, and in what ways human immortality would be good. In this paper, I disambiguate the ways in which immortality might be considered a human good and then argue that immortality is neither necessary nor sufficient condition for objective meaning in life. I also argue that mortality is not a necessary condition for objective meaning in life.
Doctor Ex Machina: A Critical Assessment of the Use of Artificial Intelligence in Health Care.
Svensson AM, Jotterand F
J Med Philos · 2022 Feb · PMID 35137175 · Publisher ↗
This article examines the potential implications of the implementation of artificial intelligence (AI) in health care for both its delivery and the medical profession. To this end, the first section explores the basic fe...
This article examines the potential implications of the implementation of artificial intelligence (AI) in health care for both its delivery and the medical profession. To this end, the first section explores the basic features of AI and the yet theoretical concept of autonomous AI followed by an overview of current and developing AI applications. Against this background, the second section discusses the transforming roles of physicians and changes in the patient-physician relationship that could be a consequence of gradual expansion of AI in health care. Subsequently, an examination of the responsibilities physicians should assume in this process is explored. The third section describes conceivable practical and ethical challenges that implementation of a single all-encompassing AI healthcare system would pose. The fourth section presents arguments for regulation of AI in health care to ensure that these applications do not violate basic ethical principles and that human control of AI will be preserved in the future. In the final section, fundamental components of a moral framework from which such regulation may be derived are brought forward, and some possible strategies for building a moral framework are discussed.
Access-to-Care and Conscience: Conflicting or Coherent?
Gamble JL, Gamble NK
J Med Philos · 2022 Feb · PMID 35137174 · Publisher ↗
"Intervention" is not synonymous with "care." For an intervention to constitute care-which patients should have a right to access-it must be technically feasible and licit. Now these criteria do not prove sufficient; num...
"Intervention" is not synonymous with "care." For an intervention to constitute care-which patients should have a right to access-it must be technically feasible and licit. Now these criteria do not prove sufficient; numerous archaic interventions remain feasible and legally permissible, yet are now bywords for spurious care. Therefore, we propound another necessary condition for an intervention to become care: the physician must rationally judge the intervention to be conducive to the patient's good. Consequently, the right of access-to-care relies on physicians being free to practice medicine in accord with their consciences, conscience being the rational faculty with which they judge the reasonableness of even mundane medical decisions. Since physicians operate as part of a community, it is further necessary to consider when central bodies may reasonably compel physicians to engage in interventions that the physician believes are not consistent with the patient's good and/or are not congruent with the purposes of medicine.
Reconciling Regulation with Scientific Autonomy in Dual-Use Research.
Evans NG, Selgelid MJ, Simpson RM
J Med Philos · 2022 Feb · PMID 35137173 · Publisher ↗
In debates over the regulation of communication related to dual-use research, the risks that such communication creates must be weighed against against the value of scientific autonomy. The censorship of such communicati...
In debates over the regulation of communication related to dual-use research, the risks that such communication creates must be weighed against against the value of scientific autonomy. The censorship of such communication seems justifiable in certain cases, given the potentially catastrophic applications of some dual-use research. This conclusion however, gives rise to another kind of danger: that regulators will use overly simplistic cost-benefit analysis to rationalize excessive regulation of scientific research. In response to this, we show how institutional design principles and normative frameworks from free speech theory can be used to help extend the argument for regulating dangerous dual-use research beyond overly simplistic cost-benefit reasoning, but without reverting to an implausibly absolutist view of scientific autonomy.
The Phenomenology of Healing: Eight Ways of Dealing With the Ill and Impaired Body.
Leder D
J Med Philos · 2022 Feb · PMID 35137172 · Publisher ↗
Encounters with illness, impairment, and aging can disrupt one's experiential relationship with self, body, others, and world. "Healing" takes place when the individual is able to re-integrate his or her world, even if t...
Encounters with illness, impairment, and aging can disrupt one's experiential relationship with self, body, others, and world. "Healing" takes place when the individual is able to re-integrate his or her world, even if the condition is not medically curable. Drawing on work in the phenomenology of the body, this article examines a series of eight "healing strategies" individuals employ, each representing a different way of orienting toward the painful or impaired body. One may lean into freeing oneself from the body, through strategies of "refusing," "ignoring," "objectifying," or "transcending" its problems. Conversely, one may choose to embrace the body, through strategies such as "accepting," "listening," "befriending," or "witnessing." It can be beneficial to have a good number of such coping strategies at one's disposal, enhancing flexible response to chronic challenges. They also are often used in synergistic or complementary combinations.
Medical Ethics as Taught and as Practiced: Principlism, Narrative Ethics, and the Case of Living Donor Liver Transplantation.
O'Brien DC
J Med Philos · 2022 Feb · PMID 35137171 · Publisher ↗
The dominant model for bioethical inquiry taught in medical schools is that of principlism. The heritage of this methodology can be traced to the Enlightenment project of generating a universalizable justification for no...
The dominant model for bioethical inquiry taught in medical schools is that of principlism. The heritage of this methodology can be traced to the Enlightenment project of generating a universalizable justification for normative morality arising from within the individual, rational agent. This project has been criticized by Alasdair MacIntyre who suggests that its failure has resulted in a fragmented and incoherent contemporary ethical framework characterized by fundamental intractability in moral debate. This incoherence implicates principlist conceptions of bioethics. Medical ethics as practiced, though, is partially in keeping with teleological alternatives to principlism. Nonetheless, the hegemony of principlism threatens to harm the practice of good medicine whenever it is used to provide justification for the sanction or prohibition of practices, despite not being equipped to grant moral authority to such justifications. An example of this failure and its resulting harm is expressed in the growing obsolescence of living donor liver transplantation.
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