Journal of Medicine and Philosophy最新文献

The practice of force-feeding dangerously malnourished patients with anorexia nervosa (AN) raises a puzzle for clinical ethics. Force-feeding AN patients may seem justified to save their lives and to help them recover from a debilitating pathological condition. Yet, clinical ethics seems committed to a robust anti-paternalism principle, on which it is normally wrong to force treatment on decisionally capacitated patients for their own good. Some AN patients do retain decisional capacity, at least by standard criteria. Thus, routinely force-feeding AN patients seems to constitute an unjustifiable exception to a well-established principle of clinical decision-making. Call this the moral puzzle of AN. I examine three attempts to solve the puzzle and argue that, individually or taken together, they cannot justify force-feeding those AN patients for whom this intervention would be potentially effective at enabling recovery. I conclude that no such justification is currently available. A solution to the moral puzzle of AN may come from a reevaluation of the anti-paternalism principle, a deeper clinical understanding of the psychology of AN, or even a novel reconceptualization of decisional capacity.

This project explores what it means to be a 'biofixture': a medical implant, transplant, or therapy that is morally analogous to a native body part. A motivating case is provided wherein a decision to deactivate a ventricular assist device (VAD) provokes discomfort in medical providers. Taking as a starting point a previous project where a similar case of provider discomfort around pacemaker deactivation led to the conclusion that pacemakers are biofixtures, an argument is made that VADs are likewise biofixtures, the deactivation of which would be more morally analogous to active euthanasia than to standard cases of withdrawal of life support. To this end, criteria for biofixture status are developed, motivated, and applied to VADs and other cardiopulmonary therapies. Clinical entailments of this account of biofixture status are considered and further avenues of research for better understanding the nature and moral import of biofixtures are proposed.

In her recent work, Elselijn Kingma applies four criteria for the individuation of an organism to determine whether the fetus is a part of or mereologically distinct from the mother. These criteria are: homeostasis, metabolic and functional integration, topological continuity, and immunological tolerance. She concludes on the basis of these four criteria that the evidence supports a thesis to the effect that the fetus is a part of the mother and that the point of topological continuity is at the placenta, a "shared organ." In this paper, I use Kingma's four criteria offered to argue that the fetus is mereologically distinct from the mother; the fetus is not a maternal part. The placenta, which I argue is a fetal part, is precisely the point at which there is topological discontinuity between mother and fetus.

According to the fair transaction view, consent is morally powerful when it occurs in the context of a larger consent transaction that is fair, rather than when one's consent is valid. This fair transaction view represents a novel approach to the ethics of consent and puts pressure on the standard focus on valid consent. If correct, the fair transaction model promises to alter our understanding of when consent in medicine matters morally. In this paper, I examine the prospects for the fair transaction view. I raise both good and bad news for the theory. On the one hand, I show this new approach to consent captures something important when it says that we ought to weigh a number of competing demands fairly. Yet on the other, I argue that this insight is better explained by the larger moral system of ethical pluralism.

The network approach to psychopathology promises (personalized) visualizations of the structure of mental disorders, in turn allowing for prediction of disorder development and identification of intervention targets. In this paper, we argue that these goals are problematized by conceptual incoherence between the approach's two pillars: the network theory of mental disorders, and the suite of methods known as "network psychometrics." First, we argue that, if it is to be clinically informative, network psychometrics requires (1) an embedding argument to justify that a causally sufficient set of variables has been modeled, and (2) a concomitant argument supporting the assumption that the human-environment system is near-decomposable. Then, we show that current versions of the network theory of psychopathology raise severe obstacles for such arguments, if not outright blocking them. In turn, the network approach to psychopathology appears to unravel unless changes are made to its pillars.

Distressing emotions and emotions that impede social functioning are standard components of psychiatric disorders, but the presence of a pathology requires underlying psychological dysfunction in addition. This article argues that, given a commitment to a popular philosophical picture of emotions (and moods), affective dysfunction should be understood in terms of the normative concept of fittingness. Therefore, an individual should be understood to be affectively disordered only if their emotional responses are systematically unfitting. This view gains support from some quarters; notably, the DSM-V-TR diagnostic criteria for Major Depressive Disorder exhibits an inchoate appreciation of the importance of (un)fittingness to psychiatric disorder, and debates about the pathological status of prolonged grief are naturally interpreted as debates about the fittingness of that attitude. Taking a synoptic perspective, accounting for fittingness can help to establish the limits of psychiatric practice and avoid potential disciplinary injustices.

The article defends the pluralist policy of death determination. According to this view, competent persons should be free to choose the criteria under which they should be diagnosed as dead. Our argument partly relies on the diagnosis of the current state of the discussion in the bioethical literature on death determination and partly on empirical evidence that lay intuitions about death determination differ, that is, that there is interpersonal psychological pluralism about death determination. The article then introduces empirical evidence for intrapersonal psychological pluralism about death determination. We argue that intrapersonal psychological pluralism strengthens the case for the pluralist policy of death determination.

The trauma and anguish professional people encounter in their work over time can lead to losses in competence and occupational burnout. However, the practice of detachment designed to avoid these outcomes can tip over into losses in the ability to connect with clients, and even to alienation from the professional role itself. Some have thought that the proper regulation of levels of empathic concern ensures a balance between these two poles. I argue against this and instead advocate for a stance I call compassionate understanding. I contend that this best achieves sustained professionalism while remaining morally attuned to the norms of one's occupation. I focus on health care to illustrate what is at stake in compassionate understanding, though the position I defend has applications across a significant range of professions.

Medical phenomenology describes the illness experience while providing an alternative to the reductionist biomedical discourse. Phenomenologically oriented critical theories focus on the experiences of structural paradoxes manifesting as social suffering. While both approaches elaborate different patterns of suffering, so far, their parallelisms and interactions have not been adequately analyzed. This task is all the more important because illness experience is never only about the disabled body or the distressed mind, it is also inseparable from a distorted intersubjectivity; and vice versa, untreated social suffering also has the potential of turning into illness. After overviewing various experiences characterizing illness and those disrupted intersubjectivities, which can produce a homologous phenomenological pattern, four idealtypical patterns are analyzed. The parallel occurrence of illness and social suffering represents extreme existential disembedding; illness without social suffering represents a chance for countering the bodily disembedding by intersubjective re-embedding; social suffering without illness is a constellation, wherein the chance of medicalizing structural distortions is high; the lack of illness and social suffering represents a carefree, yet unreflective potential. Differentiating between these patterns opens new horizons for medical phenomenology and critical theories as well, both on the theoretical and the practical level.

Some authors defend prohibiting compensation for blood plasma on the grounds that compensating donors exploits them. James Taylor has recently argued against this view. According to Taylor, not only does compensation not exploit donors but also accepting uncompensated donations in jurisdictions requiring this exploits donors. In this article, I evaluate Taylor's novel market-based account of exploitation and the conclusions about plasma donations he draws from it. I accept and offer further support for his account of exploitation but argue that (contra Taylor) the market-based account suggests that it is only in cases of capped compensation or legal monopsonies that centers can exploit donors. Uncompensated donations required by prohibitions are unlikely to exploit donors because a system of uncompensated donations does not actually benefit plasma centers, assuming a reasonable understanding of "benefits" for these nonprofit organizations. Finally, I discuss whether centers that can increase benefits to everyone by making exploitative offers should.