Medicine Health Care and Philosophy最新文献

This paper develops a Foucauldian analysis of artificial intelligence (AI) in medical diagnosis, arguing that AI introduces an "algorithmic gaze" that reshapes the epistemic and moral structure of clinical practice. By converting illness narratives into data while generating forms of simulated empathy, AI systems reorder how patients become visible, intelligible, and governable within medical discourse. These developments produce three structural tensions: first, algorithmic opacity alters the conditions under which informed consent, contestation, and responsibility can meaningfully operate; second, simulated empathy appears to acknowledge suffering while subtly directing patients' expressive possibilities; and third, the delegation of emotional engagement to AI fragments the unity of care traditionally embodied in the clinician-patient relationship.Rather than treating these shifts as technologically inevitable, the paper argues that their ethical significance depends on institutional design. Four directions for reconstruction are proposed: securing identifiable responsibility and human-overridable decision pathways; integrating algorithmic outputs into dialogical clinical communication; adopting participatory data governance and strengthening algorithmic literacy; and grounding AI development in a renewed conception of medical humanism that guides design from the outset. The analysis concludes that AI can support, rather than erode, the moral foundations of medicine only if embedded within institutional arrangements that sustain autonomy, dignity, and relational understanding.

Current challenges in medicine and healthcare raise new questions regarding the moral relations between generations, thus highlighting the increasing relevance of intergenerational perspectives in healthcare ethics. However, the underlying notions of generations often remain vague and heterogeneous. This contribution aims to clarify the scope of conceptual meanings of 'generation' through explication and differentiation in order to advance the analytical potential of intergenerational perspectives in healthcare ethics. We argue that the concept of generations needs theoretical elaboration with regard to the dimensions of collectivity and temporality. We first introduce three approaches towards the theoretical conceptualization of generations: a genealogical, a chronological, and a socio-cultural approach. Regardless of their differences, all three essentially share an understanding of generations as collectives situated in time. Accordingly, we then examine the scope of underlying notions of collectivity and temporality, touching upon fundamental ontological, epistemological, and moral philosophical implications. We distinguish a skeptical individualist, an aggregationist, and an entity view of collectivity, as well as a formal, linear, a subjective, existential-narrative, and a socio-cultural understanding of temporality. The combination of these dimensions allows the development of a systematic matrix of conceptions of generations and intergenerational relations in healthcare ethics whose analytical potential we illustrate with regard to three paradigmatic examples. We provide a systematic summary of our considerations and outline a research agenda that addresses desiderata for intergenerational perspectives in healthcare ethics, encompassing clinical ethics, research ethics, and public health ethics, as well as meta-ethical questions.

There is considerable interest in moving ethics theory and methods in healthcare and biomedical research settings toward more engaging practices. This is the chief goal of contemporary open eudemonism which calls for a focus on human flourishing and encourages the use of participatory and dialogical methods to support progress in this direction. This is notably taking the form of diverse approaches and interventions inspired by pragmatism and hermeneutics where ethics grows more organically, and moral learning is valued beyond mere ethical compliance. However, open eudemonism faces numerous epistemological and procedural challenges. The former concern potential challenges with the idea of open and participatory accounts of human flourishing (e.g., ethics agreement on human flourishing is unachievable; skepticism about the contribution of ethics to human flourishing) itself while the latter concern the actual ability to enact such an orientation in practice (e.g., motivation for human flourishing; ethics leadership and the role of the ethicist in open-ended eudemonism). Both sets of challenges require attention and responses in a fuller defense of the promises of this orientation in healthcare, in biomedical research settings, and beyond.

This study explores how rehabilitation professionals engage with the dynamic nature of hope in acquired brain injury rehabilitation, identifying the qualities and competencies needed to respond with care. Using a qualitative design, data were collected through focus groups and individual interviews with cross-disciplinary professionals at a Danish rehabilitation centre. Reflexive thematic analysis revealed four distinct episodes of hope, each demanding a different response. Drawing on the concepts of 'relational caring' and 'practicing presence', and engaging with empirical data, essential qualities and competencies were revealed: being present, attuned, giving and sharing time, moving along, faithfully staying with, and embracing powerlessness and uncertainty. We conclude that current rehabilitation competency frameworks, such as Wade (Clin Rehabil 34(8):995-1003, 2020) and the Rehabilitation Competency Framework as reported by World Health Organization (Rehabilitation Competency Framework, World Health Organization, Geneva, 2020), fail to capture the more nuanced competencies required to address hopelessness in rehabilitation practice. This indicates that acknowledging and validating the full dynamics of hope and hopelessness within the frameworks shaping rehabilitation practice is essential to recognising the comprehensive range of qualities and competencies needed by rehabilitation professionals. This encompasses the capacity to navigate the shifting nature of hope as well as endure and 'stay with' the person in need during hardship. Specifically, education of rehabilitation professionals could gain from integrating the theoretical framework from relational caring and presence theory as a supplement to the International Classification of Functioning, disability and Health (ICF), enabling professionals to effectively navigate the psychosocial and existential dimensions of hope in their practice.

Discourse about Complementary and alternative medicine (CAM) is also controversial in several respects, including terminology. Understanding and using the term 'CAM' precisely remains necessary in some discussions. This article provides a contribution to a terminologically more reflected debate about CAM. Analytical methods are applied to analyse 'CAM' conceptually: reasons to define CAM are discussed, common definitions are critically analysed in light of argumentative plausibility, and typical conceptual needs in the debate about CAM are described. Based on this, an evidence definition of CAM is sketched. Complementary and alternative medicine is typically defined by positive attributes or (more usefully) by unconventionality. While the latter provides a viable definitional strategy, several questions remain regarding the logic and applicability. Attempts to improve CAM definitions should consider (a) presenting necessary and sufficient conditions, (b) separating 'complementary', 'alternative' and 'integrative', (c) understanding 'CAM' relative to specific diseases and (d) being explicit about possible changes of the CAM status. These requirements are used to develop a definition of CAM centring around the notion of probable specific effectiveness-a definitional strategy that might solve flaws in the current CAM discourse by spelling out some of the reasons why certain practices are not part of conventional treatment. The example of the cancer drug Imatinib serves to demonstrate the usefulness of focusing on plausibility of effectiveness instead of conventionality. Defining CAM in light of evidence properties might improve the debate. Independent of the terminological strategy pursued, articles and guidelines on CAM should at least reflect the implications and pros and cons of their own terminological decision. An evidence definition should be developed in detail.

It is widely agreed that moral reasoning skills are an important aspect of ethical competency in the health professions and that students should acquire those skills. Nevertheless, ethics instructors might find it difficult to choose specific exercises and methods to further those skills because there is no shared understanding of what the term "moral reasoning skills" implies. As a result, there is a didactical gap between learning objective and methodology. In this paper, I demonstrate that and why the term "moral reasoning" is an underdetermined concept in the didactics literature of the health professions. With reference to the discipline of informal logic I will introduce a definition of the term and quality criteria for good moral reasoning that facilitate didactical interventions. I introduce three basic suggestions that instructors can follow if they want to further moral reasoning skills in students. I show how the three suggestions translate into specific learning objectives, which help instructors design exercises and choose appropriate methods for teaching and learning. Towards the end, I will discuss the critical factor of time in educational settings.

Fricker (Epistemic Injustice. Power and the Ethics of Knowing, Oxford University Press, Oxford, 2007) coined the term epistemic injustice to refer to the downgrading of credibility of speakers provoked either by prejudices-which she labeled testimonial injustice-or by a gap in interpretative resources that account for a given phenomenon-which she referred to as hermeneutical injustice. This paper reviews the existing literature on how patients with rare diseases, poorly understood diseases, and underdiagnosed diseases are questioned by the healthcare practitioners who assist them in order to explore how they suffer from both these types of epistemic injustice. At the same time, the paper argues that the very epistemic marginalization suffered by these patients actually grants them some epistemic advantages over patients with better-known diseases, and even some meta-epistemic advantages-that is, a deeper understanding of how the very taxonomy that marginalizes or excludes them is, to some extent, a sociocultural construction. The paper therefore applies the notion of "epistemic advantage", coined by contemporary standpoint theorists, to the field of healthcare.

The author argues for the substantive doing of philosophy (as opposed to learning about it) as part of medical training. The paper presents a view of medical education as diminishing the critical thinking skills and humanistic values of future clinicians in favour of fact-recall and pattern recognition. This is due to increasingly assessment-driven curriculums and the need to meet extremely high, and rigorous, institutional and industry/sector standards. The author argues that current medical training favours a particular kind of learning, and therefore produces a particular kind of clinician, that may meet these standards and thrive in competitive and high-pressure practice but may not be best for patients. Furthermore, as artificial intelligence (AI) and emerging technologies rapidly change the landscape of medicine, current medical training may also not be best for these clinicians. The 'good doctors' that we are currently training, face a 'survival of the fittest situation' whereby they are no longer able to survive in a changing landscape, and therefore medical education is failing our future 'good doctors'. Changes to the content and delivery of medical education need to happen now to mitigate this failing and give doctors: first, what they need to survive; and second, what they need to properly care for patients in a changing industry, increasingly served by AI. Doing philosophy has the potential to cultivate the thinking skills, inter-personal skills, personal attributes, and humanistic values needed by the 'good doctor' of the future.

The question of what constitutes a good life, whether a human existence is considered fulfilling and how to respond to a life perceived as no longer worth living has long been one of the great inquiries of medical ethics. With the increasing liberalization of various forms of assisted dying worldwide, these fundamental questions are gaining renewed relevance. An emerging field of interest explores films as sociocultural laboratories, offering an intriguing approach to a more nuanced perspective on personal narratives. Applied to the subject of end-of-life decisions this practice turns abstract constructs such as the quest for a meaningful life into tangible plotlines and vivid case studies. Far more than conceptual discussions about morally right or wrong, the storyline on screen enables the viewer to gain a deep and unique insight into the personal life and contextual embeddedness of protagonists struggling with end-of-life decisions. This paper aims to explore the idea and narrative of 'a life fully lived' in the movies focussing on end-of-life decisions. It focuses on the implications, demands, and influences on choices concerning death and dying using the example of ten of the most impactful and most debated movies featuring end-of-life decisions. Using film analysis, commonly held assumptions and value judgments that influence public discourse about end-of-life decisions are to be revealed and made accessible for ethical reflection.