Journal of Medicine and Philosophy最新文献

In this article, I argue that approximating virtues such as care and respectfulness are necessary to conduct an informed consent discussion for clinical trials adequately. I argue against Beauchamp and Childress' principlism insofar as it claims that virtues do not have "advantages" over the principle of respecting autonomy. When we elaborate what it means to facilitate autonomy in a consent discussion adequately, we find we are describing the virtues. This is because virtues do have an advantage over principles insofar as virtues provide us with rich descriptions of not only what we should do (respect autonomy), but how to do so (with the virtues of respectfulness, care, etc.). Thus, the principle of respecting autonomy points back to the virtues. I conclude by showing how cultivation of these virtues can help rectify well-known shortcomings in the informed consent process.

In five related essays, Mary Jean Walker and Wendy Rogers, joined in one essay by Jenny Doust, defend various theses about the concept of disease. First, they argue "disease" is a cluster concept, not a "classically structured" one definable by necessary and sufficient conditions. Second, "disease" is vague, in the standard philosophical sense of having borderline cases. In fascinating detail, they argue that this vagueness shows up almost everywhere one looks among ordinary diseases, even if disease is taken to require dysfunction. Still, they conclude, vagueness per se need not be a problem because logicians and philosophers know several ways to handle it. Third, Rogers and Walker believe that the vagueness of "disease" is a clue to how to reduce the much-discussed medical problem of "overdiagnosis": the diagnosis of permanently harmless disease. Finally, they find my analysis of disease-the "biostatistical theory" (BST)-defective and dangerous in four different ways: it offers insufficient guidance on how to draw disease boundaries; it does not fit actual medical practice in doing so; it is ambiguous as to reference class; and it facilitates overdiagnosis. In this article, I freely concede the vagueness of disease, but argue that it is considerably less than Rogers and Walker suppose, and no threat to the BST in any case. I also rebut all their other charges of deficiency in my analysis.

The standard view in medical practice is that patients have to be in an appropriate state of mind to count as autonomous. For example, according to the Macarthur Competency Assessment Tool for Treatment patients need to be able to: (1) communicate a choice; (2) factually understand the issues; (3) appreciate their situation; and (4) rationally manipulate information. These capacities are normally taken to be compromised by factors that may diminish one's capacity to properly assess one's situation. One of these diminishing factors is depression, which is especially relevant to decisions about assisted suicide or termination of treatment, since depression might contribute to the patient's leaning towards an action resulting in her death. I argue, however, that in certain circumstances, depression and the accompanying desires can be appropriate. Specifically, I demonstrate that even when depression is a factor in the patient's decision, it does not automatically undermine autonomy.

This essay analyzes the morality of assisted dying. To do this, it is necessary to recognize that assisted dying is the outworking of a larger process. This process unavoidably begins with the key moral conception of human dignity. Emphasis upon individualism in society has caused a restructuring of the dignity concept, changing what is most highly valued. This altered concept of dignity gives rise to assisted dying, yet is morally flawed. This is because it is an understanding of dignity that minimizes people's vulnerability, dismisses coercive forces that are brought into effect, encourages undue confidence in safeguards, and removes any sustained basis for respect of the individual. Autonomy, as the primary justification for assisted dying in contemporary society, is an abbreviated understanding of the restructured concept of dignity and therefore subject to the same criticisms. Assisted dying arises from a deficient and self-defeating foundation that mark it as immoral.

The arrival of some diagnoses tends to bring about relief because it validates suffering and grants access to social legitimization, medical resources, and economic aid. This is the case of the Ehlers-Danlos Syndrome (EDS), a pathology with multisystemic involvement characterized by general laxity. Patients find it difficult to secure a diagnosis of one of its types-hypermobile EDS-due to a lack of awareness among physicians, the multiple changes that the diagnostic criteria undergo, and their increasing restrictivity. Consequently, several patients are intermittently let in and out of the diagnostic label, which leads some members of family, friends, administration, working environment, and healthcare professionals to view these patients with a skeptical gaze. This article argues that the ambiguity and contradictions surrounding the diagnosis of hEDS partially result from and reflect two philosophical controversies on the nature of disease. First, the debate between naturalists and normativists. Second, the discussion on the line-drawing problem. It concludes by urging healthcare practitioners to tell patients the implications of these contradictions-mainly, that medicine can work, and does work, without definitive diagnostic criteria.

An accepted argument in reproductive rights literature holds that the welfare of future children is irrelevant in the provision of assisted reproductive technology (ART). A foundational philosophical concept underpinning such dismissal appeals to the "non-identity" problem. This argument holds that a future ART child's overriding interest lies in being born. I challenge this argument, suggesting it is a shallow and selective interpretation of the concept that narrowly applies the "person-affecting" harm principle to future ART children. I suggest a more extensive reading of the "non-identity" problem defends the opposite argument-that dismissing child welfare concerns in ART provision is wrong. In line with the work of one of the key architects of the "non-identity" problem, I formulate four Parfit-style arguments that justify clinician refusal of treatment. The key substantive claim of this paper is that delay or denial of ART is morally defensible within the "non-identity" problem paradigm in some instances.

Dominiak and Wysocki (2023, hence, DW) offer a series of criticisms of my analysis of abortion: evictionism, which is a compromise position between the pro-life and the pro-choice viewpoints. The present article is a response to DW.

In the United States, individuals who authorize organ donation through various mechanisms make a legally binding decision that only they may revoke. When a person who has given first-person authorization for organ donation becomes eligible to donate organs, according to laws across the United States, their next-of-kin should be informed, not asked, about the impending organ procurement. Despite this, sometimes families are asked for permission to proceed with donation, or they express unsolicited objections to donation. Some scholars and activists argue for the importance of honoring first-person authorization and not accepting what are sometimes called "family overrides" or "family vetoes" of donation. We consider two arguments for this view, the respect-for-wishes and the prevent-harm arguments and defend a more nuanced approach to family objections to organ donation in the presence of first-person authorization. We also examine the role of families or legally authorized representatives in making decisions regarding premortem interventions for potential donors who are not yet deceased. We argue that such decisions are about living patients and should be treated like all other clinical decisions that legally authorized representatives make for incapacitated living patients.

Supporting the 14-day rule or other embryo research time limits raises puzzling questions for those wishing to protect older embryos (or indeed, more developed human subjects). What are, or should be, our more immediate aims in setting or implementing such time limits? May death for the research subject be sought as the limit approaches? If the embryo is worth protecting, is it in the embryo's interests to be sustained by a scientist, albeit for instrumental reasons? Should embryo research, including observational research, be prevented, despite the embryo's interest in living further? This paper argues that the aim to prevent more prolonged experimentation, while reasonable, should not be promoted via the means of deliberately arranging the embryo's death. Time limits can encourage such intentions, even if they do not require them. The case is made that while a regulatory status quo should not be amended in favor of a worse alternative, there are several morally preferable options with which the 14-day rule or more permissive alternatives might be replaced.

Hypochondriasis-currently split into the "somatic symptom disorder" and the "illness anxiety disorder" diagnoses-is characterized by the patient's conviction that minor symptoms are signs of a severe illness, even after undertaking medical exams that could not detect any disorder. In this paper, I analyze the basic hypochondriacal doubt, that is, calling into question the practitioners' reassurance that no evidence of serious disease has been found to account for his symptom. Specifically, I take as reference Ludwig Wittgenstein's posthumous work, On Certainty, to explain how a genuine doubt differs from a behavior that merely seems to be a doubt. On this basis, I clarify in which respects hypochondriacal doubt turns out to be a consistent doubt. But then, I reveal why such doubt makes no sense. Lastly, I show how medical and nurse staff as well as the hypochondriac's family can progressively help him overcome the aforementioned doubt.