Medicine Health Care and Philosophy最新文献

Healthcare providers often rely on the following sort of concerning reasoning when encountering patients with difficult-to-explain symptoms: in the absence of evidence for a physical cause, the symptoms are presumed to be psychological in origin. In this paper, we take up this concern in the context of chronic pain, with particular attention to how such reasoning disproportionately affects women and how it interacts with the many levels of gender bias in medicine. We first examine the unwarranted inference from diagnostic uncertainty to psychogenic diagnosis and explore how identity prejudice and diagnostic uncertainty interact in clinical practice. We then consider additional contributors to diagnostic uncertainty concerning women's pain: gendered research gaps and male-centered diagnostic paradigms. After outlining the harms associated with psychogenic diagnoses, we consider the objection that such diagnoses might be pragmatically justified. We end by calling for a more nuanced approach to diagnosing and treating chronic pain.​​.

The use of social robotics in care for older persons is increasingly discussed as one way of meeting emerging care needs due to scarce resources. While many potential benefits are associated with robotic care technologies, there is a variety of ethical challenges. To support steps towards a responsible implementation and use, this review develops an overview on ethical aspects of the use of social robots in care for older people from a decision-makers' perspective. Electronic databases were queried using a comprehensive search strategy based on the key concepts of "ethical aspects", "social robotics" and "elderly care". Abstract and title screening was conducted by two authors independently. Full-text screening was conducted by one author following a joint consolidation phase. Data was extracted using MAXQDA24 by one author, based on a consolidated coding framework. Analysis was performed through modified qualitative content analysis. A total of 1,518 publications were screened, and 248 publications were included. We have organized our analysis in a scheme of ethical hazards, ethical opportunities and unsettled questions, identifying at least 60 broad ethical aspects affecting three different stakeholder groups. While some ethical issues are well-known and broadly discussed our analysis shows a plethora of potentially relevant aspects, often only marginally recognized, that are worthy of consideration from a practical perspective. The findings highlight the need for a contextual and detailed evaluation of implementation scenarios. To make use of the vast knowledge of the ethical discourse, we hypothesize that decision-makers need to understand the specific nature of this discourse to be able to engage in careful ethical deliberation.

Health nudges have become popular in public health and health promotion, not least in countries that have liberal or libertarian policies. One reason is that nudges aim to change people's health-related behavior in a positive direction without infringing upon their freedom. There are other strategies to try to achieve health. Comparing behavior change and empowerment models, previous research found that empowerment is morally recommendable, both as a strategy and as a goal. Empowered people are good at taking care of their health. Using empowerment as an evaluative model, this paper investigates to what extent nudging as a health-promotion strategy leads to empowerment. Nudging can be empowering insofar as it leads to better health, although its effects on people's empowerment might be rather small, depending on whether the nudge creates a healthy habit or not. However, nudges do not, in general, have positive effects on other empowering factors, such as a person's knowledge, skills, self-confidence, self-esteem, or autonomy, since nudges typically bypass deliberate reflection. Moreover, nudging belongs to a group of manipulative strategies that appear to be detrimental to people's ability for autonomy. Thus, nudges risk being disempowering.

Choice has become a defining lens through which modern people imagine dying. A 'good death' is increasingly associated with the ability to articulate and realise personal preferences regarding the dying process: how, where, with whom, and even when one dies. In this paper, I examine the cultural shift that has elevated choice to a central moral ideal at the end of life. My research questions are: Why does choice matter so profoundly in contemporary societies? And how does this aspiration shape the way people live towards the end of life, and ultimately die? To answer these questions, I first offer a historical-cultural account of how choice has gradually come to function as a goal in itself. Drawing primarily on Charles Taylor's analyses, I bring his work into dialogue with that of other scholars including Giddens, Rosa, Dodds, and Mol. I then identify three existential implications of this shift that complicate contemporary engagement with death and dying: (1) an increasingly mastery-oriented stance towards life and death, (2) the arbitrariness of meaning, and (3) an understanding of respect as unquestioning compliance with individual preferences. Finally, I propose several ways to respond to these challenges by moving beyond a narrow focus on choice and control. I argue for a rethinking of the current dominant end-of-life discourse through a more dialogical and ambivalent understanding of our relation to life and death; one that is more attuned to the lived experience and unsettling realities of dying, and better suited to enriching contemporary debates and practices surrounding the end of life.

Radical neurophenomenology offers new ways to re-thinking subjectivity and objectivity, and the relation between them. More specifically, radical neurophenomenology crucially relies on the notion of constitution to circumvent the pitfalls that were associated with older, dualistic frameworks. Building on existing work, our paper has two primary goals. First, we will argue that Merleau-Ponty's later work provides a suitable framework for elaborating a viable concept of (co-)constitution. As we will discuss, it is especially Merleau-Ponty's notion of the flesh which allows for a better way to understand the concept of constitution. However, our paper extends beyond purely theoretical analysis and interpretation. Our second goal is to illustrate the pragmatic gain of our clarificatory efforts by discussing how a viable concept of constitution should affect and inform the understanding of modern neuroimaging techniques and a qualitative phenomenological philosophy analysis of subjectivity and lived experience, and how this contributes to neurophenomenological inquiries.

This article is grounded in a phenomenological and autoethnographic approach, with the neurologist's remark, It's you it's about!, serving as an existential starting point. The aim of this text is to explore quality of life as an existential challenge and opportunity when living with the chronic illness myasthenia gravis, drawing on lived experience and existential philosophy. Through three existential anecdotes based on the first author's experiences with myasthenia gravis, the tension between the body's limitations and the patient's desire to continue living meaningfully, as well as the role of the clinician in supporting the patient's process, is illuminated. Each anecdote is followed by a philosophical reflection - from glimpse to resonance - which deepens the exploration of the complex dimensions of quality of life. The article examines key themes such as; Running, existential positioning, and holding on to quality of life; The stoic trust that sustains a patient's quality of life; and The restoration of clarity and direction for quality of life - one that is not measured, but felt, held, and sustained in relation. By exploring these dimensions, the article proposes a shift from traditional, measurable outcomes to a broader understanding of quality of life that transcends physical symptoms.

The concept of aesthetic experience is essential to understand the ways people interact with, immerse in, and interpret aesthetic objects, such as artworks, literature, or natural beauty. Aesthetic experience is also important within the health and medical humanities in explaining the effects and benefits of engaging with art, but philosophical perspectives on the concept within the field are surprisingly scarce. This article addresses this research gap by delving into one such perspective in the Western philosophical tradition that draws on the aesthetic theory of Theodor W. Adorno. I argue that Adorno's understanding of aesthetic experience offers valuable support for the critical turn in the health and medical humanities, which seeks to move beyond the clinical encounter toward the broader societal context of health and illness. Adorno's relevance lies in his vehement argumentation against an instrumentalising understanding of aesthetic experience. According to Adorno, the experiencing subject ought not to be understood simply as someone who judges between good and bad art, beautiful and ugly, or aesthetic and nonaesthetic, because such judgements can ultimately be reduced to arguments about art as having or not having exchange value. Instead, aesthetic experience is something more profound: a mode of knowledge rarely accessible through other means, in which the experiencing subject enters into the artwork and activates its own subjectivity. This argument offers the health and medical humanities insight into how art might be approached in relation to its potentially transformative role in society.