Medicine Health Care and Philosophy最新文献

This paper seeks to determine the extent to which individuals with borderline personality disorders can be held morally responsible for a particular subset of their actions: disproportionate anger, aggressions and displays of temper. The rationale for focusing on these aspects lies in their widespread acknowledgment in the literature and their plausible primary association with blame directed at BPD patients. BPD individuals are indeed typically perceived as "difficult patients" (Sulzer 2015:82; Bodner et al. 2011), significantly more so than schizophrenic or depressive patients (Markam 2003). The "responsibility question" for patients with BPD has already been raised (Martin 2010; Zachar and Potter 2009; Bray 2003), but this paper tackles it from a novel perspective. First, I narrow down the category of things for which the responsibility question is specific to individual with BPD. After that, I argue that some of the diagnosis criteria of BPD such as emotional instability or impulsivity might serve as excusing factors targeting the "control condition" on moral responsibility. Second, this paper also considers another widely accepted condition on moral responsibility: the epistemic condition. The view defended in the paper is that the answer to the responsibility question for individuals with BPD, concerning both the control condition and the epistemic condition, hinges on an understanding of their epistemic profile.

This article demonstrates the value of French philosophy of science for medical practice through an exposition of Michel Serres's philosophy of the body. It explores how Serres's examination of the similarity between scientific models and works of art can provide insight into different conceptions of the human body. What makes Serres's method of unique is that it does not see art and literature as subordinate to the natural sciences: they are both involved in mapping the communication lines of the body. Since early modernity, we can roughly speak of three successive communication models of the body: mechanical, thermodynamic and informational. This article finally discusses the relationship between those different conceptions and explains how they help to articulate different aspects of the body, health, and medical ethics.

Endometriosis, a chronic inflammatory condition affecting 10% of biological women, is widely understudied and particularly overlooked in later life. Discussions surrounding endometriosis predominantly centre on medical gender bias during reproductive years, with limited attention to intersecting factors of discrimination and the impact of ageism on affected individuals. As endometriosis is framed as a disease of reproductive age, research is lacking when it comes to the effects of the illness on the older population. Symptoms in (post)menopausal individuals are frequently misattributed to other ailments due to ageist and sexist preconceptions, leading to prolonged diagnoses and mistreatment. This is a social justice issue in which age and sex contribute to the discrimination of a certain population - namely older biological women living with endometriosis. In this paper, we approach this issue from the perspective of epistemic justice. The experiences of the affected persons are shaped by a lack of knowledge about endometriosis among both the healthcare personal and the affected person, as well as a lack of acknowledgement and consideration of the persons experiences. Using the lens of epistemic justice, we develop an analytical model to understand the intersection of age and gender in the experiences of endometriosis patients. This article contributes to ongoing debates on epistemic injustice and intersectionality within medicine and healthcare, offering an analytical model that connects the critical approaches of epistemic injustice and intersectionality to address health injustice. Ultimately, this work advocates for a comprehensive, lifespan approach to endometriosis that acknowledges and addresses intersecting forms of discrimination.

Artificial intelligence-based clinical decision support systems have a potential to improve clinical practice, but they may have a negative impact on the physician-patient dialogue, because of the control problem. Physician-patient dialogue depends on human qualities such as compassion, trust, and empathy, which are shared by both parties. These qualities are necessary for the parties to reach a shared understanding -the merging of horizons- about clinical decisions. The patient attends the clinical encounter not only with a malfunctioning body, but also with an 'unhomelike' experience of illness that is related to a world of values and meanings, a life-world. Making wise individual decisions in accordance with the patient's life-world requires not only scientific analysis of causal relationships, but also listening with empathy to the patient's concerns. For a decision to be made, clinical information should be interpreted considering the patient's life-world. This side of clinical practice is not a job for computers, and they cannot be final decision-makers. On the other hand, in the control problem users blindly accept system output because of over-reliance, rather than evaluating it with their own judgement. This means over-reliant parties leave their place in the dialogue to the system. In this case, the dialogue may be disrupted and mutual trust may be lost. Therefore, it is necessary to design decision support systems to avoid the control problem and to limit their use when this is not possible, in order to protect the physician-patient dialogue.

Sacrificial dilemmas such as the trolley problem play an important role in experimental philosophy (x-phi). But it is increasingly argued that, since we are not likely to encounter runaway trolleys in our daily life, the usefulness of such thought experiments for understanding moral judgments in more ecologically valid contexts may be limited. However, similar sacrificial dilemmas are experienced in real life by animal research decision makers. As part of their job, they must make decisions about the suffering, and often the death, of many non-human animals. For this reason, a context-specific investigation of so-called "3R dilemmas" (i.e., dilemmas where there is a conflict between the principles of replacement, reduction, and refinement of the use of animals in research) is essential to improve the situation of both non-human animals and human stakeholders. An approach well suited for such investigation is experimental philosophical bioethics ("bioxphi"), which draws on methods similar to x-phi to probe more realistic, practical scenarios with an eye to informing normative debates and ethical policy. In this article, we argue for a need to investigate 3R dilemmas among professional decision-makers using the tools of bioxphi. In a first step, we define 3R dilemmas and discuss previous investigations of professionals' attitudes in such cases. In a second step, we show how bioxphi is a promising method to investigate the whys and hows of professional decision-making in 3R dilemmas. In a last step, we provide a bioxphi template for 3R dilemmas, give recommendations on its use, explore the normative relevance of data collected by such means, and discuss important limitations.

Transhumanism is a movement that advocates for the enhancement of human capabilities through the use of advanced technologies such as genetic enhancement. This article explores the definition, history, and development of transhumanism. Then, it compares the stance on genetic enhancement from the perspectives of bio-conservatism, bio-liberalism, and transhumanism. This article posits that transhuman evolution has twofold implications, allowing for the integration of transhumanist research and evolutionary biology. First, it offers a compelling scientific framework for understanding genetic enhancement, avoiding technological progressivism, and incorporating concepts of evolutionary biology. Second, it represents a new evolutionary paradigm distinct from traditional Lamarckism and Darwinism. It marks the third synthesis of evolutionary biology, offering fresh perspectives on established concepts such as artificial selection and gene-culture co-evolution. In recent decades, human enhancement has captivated not only evolutionary biologists, neurobiologists, psychologists, and philosophers, but also those in fields such as cybernetics and artificial intelligence. In addition to genetic enhancement, other human enhancement technologies, including brain-computer interfaces and brain uploading, are currently under development, which the paradigm of transhuman evolution can better integrate into its framework.

The development of gene therapy has always come with the expectation that it will offer a cure for various disorders, of which hemophilia is a paradigm example. However, although the term is used regularly, it is unclear what exactly is meant with "cure". Therefore, the aim of this paper is to analyse how the concept of cure is used in practice and evaluate which of the interpretations is most suitable in discussions surrounding gene therapy. We analysed how cure is used in four different medical fields where the concept raises discussion. We show that cure can be used in three different ways: cure as normalization of the body, cure as obtaining a normal life, or cure as a change in identity. We argue that since cure is a practical term, its interpretation should be context-specific and the various uses can exist simultaneously, as long as their use is suitable to the function the notion of cure plays in each of the settings. We end by highlighting three different settings in the domain of hemophilia gene therapy in which the term cure is used and explore the function(s) it serves in each setting. We conclude that in the clinical application of gene therapy, it could be better to abandon the term cure, whereas more modest and specified definitions of cure are required in the context of health resource allocation decisions and decisions on research funding.

Today's medical ethics involve two different viewpoints based on how we understand the role of conscience in medicine and the purpose of healthcare. The first view, called the health-directed model, sees medicine as a way to improve health and promote healing, while also respecting the values of both patients and doctors. In this model, doctors need some discretionary space to decide how to achieve the best health outcomes in their practice. On the other hand, the service-provider model sees the main goal of medicine as providing a service, especially healthcare, with a strong focus on protecting patient autonomy. In this view, doctors are required to provide care even when it goes against their personal beliefs.The goal of this article is to explore the foundations and arguments of these two medical models. Understanding the key ideas behind these models is important for deciding whether to support or oppose conscientious objection in medical ethics. Additionally, the article aims to figure out which model makes a stronger case and to offer advice on how to engage with the opposing view from a virtue ethics perspective.