Journal of Medicine and Philosophy最新文献

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.

This article presents the results of a rigorous critical interpretive review that maps the current literature on phronesis in medicine. The literature in this area involves varied disciplines, centuries, and conceptions and is extensive, but through a focused review, this study seeks to clarify definitions and key distinctions. It thereby aims to elucidate a depth of meaning and understanding regarding phronesis in medicine to inform future work on the topic. Specifically, 12 themes are inductively identified and analyzed from the literature, and organized into three chronological categories of past, present, and future. A narrative summation of the literature to date is then offered, assessing the varied conceptual applications of phronesis to medical practice, the emerging literature on its applicability to organizations, prospects for empirical work on the concept, and its application in medical education.

The longstanding view of doctors as scientists has been an emphasis in the MCAT and medical school training. However, the AAMC recommended recognizing the importance of social and behavioral science for medicine. There is also a growing realization that being a smart problem solver and the physician as scientist model emphasizes a cold cognitive problem-solving paradigm that overlooks other human capacities that may be critical to medical reasoning and decision-making. Considering a smart physician versus a wise physician, intelligence and problem-solving are important, but a wise physician can use other important capacities beyond intelligence and rationality. This could benefit patients by introducing patient and family perspective taking, as well as compassion in doctor-patient interaction. By reconceptualizing professions from the perspective of practical wisdom, this may increase resilience to problems such as burnout. I outline some psychological capacities viewed as important in wise reasoning that are not about traditional views of intelligence. I argue that wise reasoning is not a native talent but a skill that can be developed. I argue that different kinds of experiences can increase aspects of empathy, epistemic humility, perspective taking, and wise reasoning and I examine evidence that wise reasoning may increase resilience.

As work on practical wisdom and medicine accelerates, now is a good time to outline some important challenges that any approach to developing an account of this virtue faces. More specifically, I develop five challenges having to do with the existence and nature of practical wisdom, and whether it connects with objective and general normative truths. The main goal is to provide a guide to the challenges themselves and some of the options available for tackling them, rather than trying to resolve them here.

This article defends the centrality of practical wisdom in medical practice by building on a monistic view of moral virtue, termed the "Aretai model," according to which possession of practical wisdom is necessary and sufficient for virtuousness, grounding both moral growth and effective moral behavior. From this perspective, we argue that practical wisdom should be conceived as a cross-situational ethical expertise consisting of four skills:moral perception, moral deliberation, emotion regulation, and moral motivation. Conceiving of practical wisdom as both overall virtuousness and ethical expertise makes it possible to deal adequately with the uniqueness of concrete ethically relevant situations. We contend that this becomes particularly evident in the context of medical practice, both in terms of decision-making and action-taking, especially in the most challenging or contentious clinical cases. We conclude the article by suggesting the potential implications of the Aretai model for continuing education in medical and healthcare professions.

The practice of medicine is a complex endeavor requiring high levels of knowledge and technical capability, and the capacity to apply the skills and knowledge to do the right thing in the right way, for the right reason, in a particular context. The orchestration of the virtues, managing uncertainty, applying knowledge and technical skills to a particular individual in a particular circumstance, and exercising the virtues in challenging circumstances, are the tasks of practical wisdom. Centuries ago, Aristotle suggested that capacities for wise action are developed through practice, experience, and reflection. Neuroscience and cognitive psychology are now beginning to contribute to our understanding of the complex interplay between emotion, cognition, and behavior that is necessary for wise action, and how this capacity for wise action can be developed. In this paper, I propose that wisdom offers an appropriate true north for medical education. Wisdom shifts the focus beyond the simple acquisition of knowledge and technical skills and integrates essential virtues like compassion, trustworthiness, humility, and the balancing of the virtues, into the professional formation for medical students. Informed by the humanities, the neurosciences, and the social sciences, we must now integrate the skills and practices necessary to the development of practical wisdom into medical education at all levels.