Theoretical Medicine and Bioethics最新文献

The aim of this paper is to enhance doctors' awareness of implicit understandings between doctors and patients in the context of pre-operative communication of risks. This paper draws on insights from the philosophy of language - in particular pragmatic analysis tools - that make explicit the implicit understandings of the interaction. Mastering not only what is said but also what is unsaid allows doctors to improve their communication with their patients. I suggest that being aware of the implications of the interactions is useful for improving both the doctor's and the patient's experience, further strengthening the therapeutic alliance. In this article I analyze actual cases involving pre-operative evaluation before cardiac surgery from a philosophy of language perspective. The paper is structured as follows: a description of the relevant philosophy of language tools that I will apply; an overview of the risk-communication context; an explanation of the link between "the implicit dimension" and trust, addressing whether the doctor needs to convey the whole truth; and the analysis of real cases. In conclusion, I re-emphasize the importance of implicit meanings during risk communication.

In a recent article, Tyler Tate argues that the suffering of children - especially children with severe cognitive impairments - should be regarded as the antithesis of flourishing, where flourishing is relative to one's individual characteristics and essentially involves receiving care from others. Although initially persuasive, Tate's theory is ambiguous in several ways, leading to significant conceptual problems. By identifying flourishing with receiving care, Tate raises questions about the importance of care that he does not address, giving rise to a bootstrapping problem. By making flourishing relative to an individual's circumstances, Tate is forced to confront questions about exactly how relative it can be, suggesting the possibility that, on his view, to flourish is simply to be however one is. In an attempt to surmount these problems, I offer a revision and restatement of Tate's view that defines the relationship between individualized flourishing and the more conventional, species-relative concept, and describe more clearly the role that care should play with respect to flourishing - one that is instrumental and not merely constitutive. Even this restated view, however, fails to answer difficult questions about how one should respond to the medical needs of some children, highlighting the fact that a conceptual analysis of suffering may do little, in the end, to untangle ethical dilemmas in the care of severely ill children.

The article examines five controversial views, expressed in Jonathan Swift's A Modest Proposal, Helga Kuhse and Peter Singer's Should the Baby Live? The Problem of Handicapped Infants, Alberto Giubilini and Francesca Minerva's "After-birth abortion: why should the baby live?", Julian Savulescu's "Procreative beneficence: why we should select the best children", and the author's "A rational cure for prereproductive stress syndrome". These views have similarities and differences on five levels: the grievances they raise, the proposals they make, the justifications they explicitly use, the justifications they implicitly rely on, and the criticisms that they have encountered. A comparison of these similarities and differences produces two findings. First, some controversial views based on utilitarian considerations would probably fare better flipped upside down and presented as Juvenalian satires. Secondly, a modicum of humor or modesty could help presenters of controversial views to stir polite critical discussion on the themes that they put forward.

The Human Condition is neither a well-defined nor well-described concept-nevertheless, it is generally agreed that human sexuality is a fundamental and constituent part of it. For most able-bodied persons, accessing and expressing one's sexuality is a (relatively) trouble-free process. However, many disabled persons experience difficulty in accessing their sexuality, while others experience such significant barriers that they are often precluded from sexual citizenship altogether. Recognising the barriers to the sexual citizenship of disabled persons, the concept of a Welfare-Funded Sex Doula Program has been advanced - a program specifically aimed at meeting the various (and often complex) sexual needs of disabled people. Below we show how that program can be justified within at least two different moral frameworks, the capabilities approach and liberal utilitarianism, and consider and repudiate arguments against it.

Ethical vegans and vegetarians believe that it is seriously immoral to bring into existence animals whose lives would be miserable. In this paper, I will discuss whether such a belief also leads to the conclusion that it is seriously immoral to bring human beings into existence. I will argue that vegans should abstain from having children since they believe that unnecessary suffering should be avoided. After all, humans will suffer in life, and having children is not necessary for a good life. Thus vegans, and probably vegetarians as well, should not have children. I will consider several objections against this controversial claim, show why the objections fail and conclude that it would be best for ethical vegans to abstain from procreation.

It is argued that the emergence of controversial views in discussions of theoretical medicine and bioethics is best explained by the assumption of moral realism within those discursive practices. Neither of the main alternatives of realism in contemporary meta-ethics - moral expressivism and anti-realism - can account for the rise of controversies in the bioethical debate. This argument draws from the contemporary expressivist or anti-representationalist pragmatism as advanced by Richard Rorty and Huw Price, as well as the pragmatist scientific realism and fallibilism of the founder of pragmatism, Charles S. Peirce. In accordance with the fallibilist view, it is proposed that presenting controversial positions may serve epistemic purposes within bioethical debates, providing opportunities for inquiry by pointing towards problems to be solved and arguments and evidence for and against to be put forward.