Medicine Health Care and Philosophy最新文献

False hope is costly for individuals, their loved ones, and society. Scholars have defined false hope as one that involves an epistemically unjustified belief. In this paper, I argue that this account of false hope is incomplete and that false hope should be conceptualized in terms of the way in which the agent attends to or focuses on a highly desired but unlikely outcome. I explain how this account better captures the distinctiveness of false hope.

The principle of trust has been placed at the centre as an attitude for engaging with clinical machine learning systems. However, the notions of trust and distrust remain fiercely debated in the philosophical and ethical literature. In this article, we proceed on a structural level ex negativo as we aim to analyse the concept of "institutional distrustworthiness" to achieve a proper diagnosis of how we should not engage with medical machine learning. First, we begin with several examples that hint at the emergence of a climate of distrust in the context of medical machine learning. Second, we introduce the concept of institutional trustworthiness based on an expansion of Hawley's commitment account. Third, we argue that institutional opacity can undermine the trustworthiness of medical institutions and can lead to new forms of testimonial injustices. Finally, we focus on possible building blocks for repairing institutional distrustworthiness.

In addressing the question of what mental health is we might proceed as if there is a single phenomenon-mental health-denoted by a single overarching concept. The task, then, is to provide an informative analysis of this concept which applies to all and only instances of mental health, and which illuminates what it is to be mentally healthy. In contrast, mental health pluralism is the idea that there are multiple mental health phenomena denoted by multiple concepts of mental health. Analysis and illumination of mental health may still be possible, but there isn't a single phenomenon or concept to be analysed in addressing the question of what mental health is. The question of pluralism has been overlooked in the philosophy of mental health. The discussion to follow is an attempt to get us to take mental health pluralism seriously. To that end, in this essay I have three primary goals: (1) to give a precise account of what mental health pluralism is, (2) to show that the question of pluralism should not be neglected in debate about what mental health is, and (3) to argue for mental health pluralism. I also draw out some implications of this discussion for philosophy, science, and psychotherapy.

In this paper, I assess the role responsibility argument that claims suicidal agents have obligations to specific people not to kill themselves due to their roles. Since the plausibility of the role responsibility argument is clearest in the parent-child relationship, I assess parental obligations. I defend a view that says that normative roles, such as those of a parent, are contractual and voluntary. I then suggest that the normative parameters for some roles preclude permissible suicide because the role-related contract includes a promise to provide continuing care and emotional support. I propose that as we have established criteria for morally acceptable reasons for cancelling, voiding, or amending a contract, we can apply these to the role responsibility argument to establish grounds for releasing a parent from his role-related and contractual obligations. Failure to fulfil one's contractual roles may not be blameworthy, depending upon the circumstances. I propose the factors determining culpability in failure to fulfil one's role-related obligations are: intention, voluntariness, diminished responsibility, mental capacity, and foreseeability.

The impairment argument claims that abortion is immoral, because it results in a greater impairment to a fetus than other actions that are clearly immoral, such as inflicting fetal alcohol syndrome. Alex Gillham argues that the argument requires clarification of the meaning of greater impairment. He proposes two definitions, and points out the difficulties with each. In response, I argue that while the impairment argument's definition of greater impairment is narrow in scope, it is sufficient for its intended purpose. Broadening its scope to more controversial comparisons of impairment is likely to undermine the intuitive appeal of the impairment principle that the argument is based upon.

Recent advancements in developmental biology enable the creation of embryo-like structures from human stem cells, which we refer to as human embryo-like structures (hELS). These structures provide promising tools to complement-and perhaps ultimately replace-the use of human embryos in clinical and fundamental research. But what if these hELS-when further improved-also have a claim to moral status? What would that imply for their research use? In this paper, we explore these questions in relation to the traditional answer as to why human embryos should be given greater protection than other (non-)human cells: the so-called Argument from Potential (AfP). According to the AfP, human embryos deserve special moral status because they have the unique potential to develop into persons. While some take the development of hELS to challenge the very foundations of the AfP, the ongoing debate suggests that its dismissal would be premature. Since the AfP is a spectrum of views with different moral implications, it does not need to imply that research with human embryos or hELS that (may) have 'active' potential should be completely off-limits. However, the problem with determining active potential in hELS is that this depends on development passing through 'potentiality switches' about the precise coordinates of which we are still in the dark. As long as this epistemic uncertainty persists, extending embryo research regulations to research with specific types of hELS would amount to a form of regulative precaution that as such would require further justification.

Every year, hundreds of patients in England die whilst waiting for a kidney transplant, and this is evidence that the current system of altruistic-based donation is not sufficient to address the shortage of kidneys available for transplant. To address this problem, we propose a monopsony system whereby kidney donors can opt-in to receive financial compensation, whilst still preserving the right of individuals to donate without receiving any compensation. A monopsony system describes a market structure where there is only one 'buyer'-in this case the National Health Service. By doing so, several hundred lives could be saved each year in England, wait times for a kidney transplant could be significantly reduced, and it would lessen the burden on dialysis services. Furthermore, compensation would help alleviate the common disincentives to living kidney donation, such as its potential associated health and psychological costs, and it would also help to increase awareness of living kidney donation. The proposed system would also result in significant cost savings that could then be redirected towards preventing kidney disease and reducing health disparities. While concerns about exploitation, coercion, and the 'crowding out' of altruistic donors exist, we believe that careful implementation can mitigate these issues. Therefore, we recommend piloting financial compensation for living kidney donors at a transplant centre in England.

Some of Michel Foucault's work focusses on an archeological and genealogical analysis of certain aspects of the medical episteme, such as 'Madness and Civilization' (1964/2001), 'The Birth of the Clinic' (1973) and 'The History of Sexuality' (1978/2020a). These and other Foucauldian works have often been invoked to characterize, but also to normatively interpret mechanisms of the currently existing medical episteme. Writers conclude that processes of patient objectification, power, medicalization, observation and discipline are widespread in various areas where the medical specialty operates and that these aspects have certain normative implications for how our society operates or should operate. The Foucauldian concepts used to describe the medical episteme and the normative statements surrounding these concepts will be critically analyzed in this paper.By using Foucault's work and several of his interpreters, I will focus on the balance between processes of subjectification and objectification and the normative implications of these processes by relating Foucault's work and the work of his interpreters to the current medical discipline. Additionally, by focusing on the discussion of death and biopower, the role of physicians in the negation and stigmatization of death is being discussed, mainly through the concept of biopower. Lastly, based on the discussion of panopticism in the medical discipline, this paper treats negative and positive forms power, and a focus will be laid upon forms of resistance against power. The discussed aspects will hopefully shed a different and critical light on the relationship between Foucault's work and medicine, something that eventually can also be deduced from Foucault's later work itself.

Jesper Ahlin Marceta published an article in this journal in which he formulated his "argument from testability", stating that it is impossible, at least practically, to operationalize procedural authenticity. That is, using procedural accounts of authenticity, one cannot reliably differentiate between authentic and inauthentic desires. There are roughly two ways to respond to the argument from testability: top-down and bottom-up. Several authors have endeavored the top-down approach by trying to show that some conceptions of authenticity might be operationalizable after all. At present, however, the bottom-up approach has not been put to the test. That is, no attempt has been made to use a currently existing assessment tool to guide the development of an account of authenticity. In this paper, I will investigate what it means to develop an account of authenticity bottom-up based on measures of concordance. More specifically, I will investigate the following three research questions. First, how do concordance and authenticity relate at a conceptual level? As crucial similarities exist between these concepts, concordance measures seem to offer a good starting point for the bottom-up approach. Second, how do judgements of concordance differ from judgements of authenticity? Both their scope and the way they are justified will turn out to be different. This suggests novel ways to react to Marceta's argument from testability. Third, should we develop a theory of concordance? The positive answer to this question will point towards a central limitation of the bottom-up approach.