Journal of Medicine and Philosophy最新文献

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.

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.

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.

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.

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.

We argue that the future-like-ours argument against abortion rests on an important assumption. Namely, in the first trimester of an aborted pregnancy, there exists something that would have gone on to enjoy conscious mental states, had the abortion not occurred. To accommodate this assumption, we argue, a proponent of the future-like-ours argument must presuppose that there is ontic vagueness. We anticipate the objection that our argument achieves "too much" because it also applies mutatis mutandis to conscious humans. We respond by showing that an explanation can be given for why it is wrong to kill conscious humans that is independent of the underlying metaphysics. Our response brings into focus a reason why-at least in the context of an ethical argument like the future-like-ours argument-appeal to a highly controversial metaphysics is ad hoc. Such metaphysics is not necessary to explain the wrongness of killing conscious humans, only nonconscious fetuses.

Many transhumanists see their respective movement as being rooted in ancient ethical thought. However, this alleged connection between the contemporary transhumanist doctrine and the ethical theory of antiquity has come under attack. In this paper, we defend this connection by pointing out a key similarity between the two intellectual traditions. Both traditions are committed to the "radical transformation thesis": ancient ethical theory holds that we should assimilate ourselves to the gods as far as possible, and transhumanists hold that we should enhance ourselves beyond the physical and intellectual parameters of being human so as to become posthuman. By considering the two views in tandem, we develop an account of the assimilation directive that is palatable to contemporary readers and provide a view of posthumanism worth wanting.

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.

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.

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.