Medicine Health Care and Philosophy最新文献

Background: Stoicism (with an upper-case 'S') as a life philosophy promotes resilience, self-control and rational acceptance of adversity. In contrast, lower-case stoicism, including pseudo-stoicism or stoic attitudes-characterised by emotional suppression and the silent endurance of pain or hardship-has been linked to adverse health outcomes among cancer patients. Thus, further research is needed to understand the drawbacks of stoic attitudes in cancer patients. This scoping review aims to map stoic attitudes in cancer patients, particularly in relation to potential health consequences. The review adhered to Levac et al.'s framework for scoping reviews. A systematic search was conducted from five electronic databases: CINAHL, Emcare, Medline Ovid, Scopus, and Web of Science. Manual searches were conducted using Google and Google Scholar. A total of 955 records were identified, 526 were screened (title and abstracts), and 450 were excluded. After reviewing 76 full-text articles, 12 studies satisfied the inclusion criteria for data extraction and thematic analysis, consisting of five qualitative and seven quantitative studies. A time frame of 10 years was considered, ranging from 2014 to 2024. This scoping review revealed that pseudo-stoic attitudes in cancer patients often lead to emotional suppression, reduced social support, delayed help-seeking and poor management of symptoms such as pain. These attitudes were linked to poorer psychological outcomes and underreporting of symptoms, especially among older males and rural cancer patients. Studies found that stoic traits were sometimes associated with persistence and treatment adherence among cancer patients. Pseudo-stoicism hinders emotional expression and delays help-seeking, leading to adverse health outcomes; however, stoic attitudes are also associated with adaptive qualities, such as psychological endurance and a commitment to care. Therefore, it is vital to promote balanced coping strategies that honour resilience while encouraging open emotional engagement among cancer patients.

There is a basic contradiction in modern healthcare: while there is an urgent need for more resources to provide documented effective care in many health systems, the same systems provide extensive services that are reported to have little or no effect on people's health. This induces long wait times, delayed diagnoses and treatments, poorer prognosis, and worse outcomes. That is, a wide range of studies have demonstrated health care systems to provide large volumes of low-value services while not being able to provide much needed high-value services. This contradiction between simultaneous overuse and underuse can be analysed in a paradox framework. Moreover, identifying the drivers of overuse and underuse can help us develop strategies to curb the problem, its implications, and free resources for reducing underuse. Hence, resolving the overuse-underuse paradox is crucial for the viability of healthcare systems: for the safety, quality, effectiveness, efficiency, and sustainability of care.

Contemporary healthcare ethics often invokes the concept of human dignity as a normative cornerstone. Yet beneath this apparent consensus lies a fragmentation of meaning: dignity is variably interpreted as autonomy, capacity, recognition, or social construction-with little agreement on its essential content or justification. This conceptual disarray weakens the ethical coherence of bioethical decision-making and obscures the true nature of the human person. This article offers a critical review of the predominant contemporary theories of human dignity, including recognition-based approaches, capabilities theory, procedural pragmatism, and postmodern critiques. We expose the internal tensions and philosophical fragilities of each, especially when applied to medical practice. In contrast, we defend an ontologically grounded understanding of dignity-one that recognizes the human being as a unified, rational, embodied substance possessing intrinsic worth by virtue of being. By recovering this ontological foundation, we argue for a more coherent, universal, and morally resilient framework for healthcare ethics-one capable of upholding the inviolability of the person beyond shifting cultural, legal, or utilitarian paradigms.

In a scientific report published 2003 a psychiatric research group in Sweden proposed to the National Board of Health and Welfare that a new diagnosis with the name "exhaustion disorder" ("utmattningssyndrom") (ED) should be created in the Swedish diagnostic system. Two years later the board approved the proposal and the diagnosis was registred in the Swedish version of ICD-10. Since 2005 the prevalence of ED in Sweden has gradually increased and at the current date more than 40 000 people are on long-term sick leave as a result of the diagnosis. Interestingly, there is no corresponding medical diagnosis outside of Sweden, although patients in other countries are declared ill with similar symptoms, receiving other diagnoses, such as burnout, depression, acute stress or adjustment disorder. In this paper, the history of ED is told and an attempt is made to answer the question why it has come to exist and prevail in Sweden despite no evidence of validity. The analysis is performed by scrutinizing the criteria for the diagnosis and how it has been connected to the granting of sick leave in the Swedish social insurance system. In conjunction with this, a phenomenological analysis is provided of how ED has been named and interpreted in the Swedish society as a particular form of life-narrative pattern. This pattern of break-down and rebuild of a more in-tune-with-nature version of oneself in recovering from ED is found in Swedish popular culture, and it is supported by academic studies, self-help books and the strategies of rehabcenters.

Doing scientific research with animals is a subject of intense societal debate, often involving polarized and public discussions with stakeholders and groups interested in animal research. Patients, given their medical conditions, have a high stake in biomedical research, including research involving animals. However, their perspectives are rarely heard in policy-related discussions on animal experiments. This essay discusses the positions and stakes of groups involved in public discourse and policy-relevant engagements. It further explores the legitimate interest of patients and the need for an all-inclusive approach to animal research policy. This subject is complex and democratic societies must address societal issues with an all-inclusive approach to reach policy decisions reflecting the interests of all stakeholders. The positions of groups-pro-animal research stakeholders and anti-animal-research advocates-with vested interests involved in animal research discourse considerably shape research policies. Animal research policies arguably affect patients. Through democratic ideals, inclusive approaches that are suitable for resolving science-driven societal issues, and initiatives currently guiding animal research policies, patients need to actively be involved in public discourses and policy-relevant decision-making processes in deciding the place of animal research in biomedical advancement as a society.

In recent decades, with the advancement of technologies facilitating reproduction, parents have been able to make decisions regarding their childrens' reproductive potential: to preserve their fertility when threatened by genetic conditions or medical treatment; to use their gametes or embryos to make grandchildren; or even to collect their gametes posthumously and then use them to make grandchildren. While these interventions tend to be framed in terms of the interests of the children themselves, parents are not indifferent as to whether they become grandparents. At the same time, while the interest in becoming a parent and parents' interests have been discussed extensively in reproductive and family ethics, grandparents and grandparenthood have been at best marginal in this growing literature. Against this background, I ask the question whether parents have an interest in becoming grandparents - and if so, which claims this interest generates against other parties (such as children themselves, healthcare professionals, or the state), if any. I explore possible paths towards conceptualising such an interest and the degree to which it could ground a claim to facilitate its fulfilment.

Artificial intelligence (AI) scribes-systems that record and summarise patient-clinician interactions-are promoted as solutions to administrative overload. This paper argues that their significance lies not in efficiency gains but in how they reshape medical attention itself. Offering a conceptual analysis, it situates AI scribes within a broader philosophical lineage concerned with the externalisation of human thought and skill. Drawing on Iain McGilchrist's hemisphere theory and Lewis Mumford's philosophy of technics, the paper examines how technology embodies and amplifies a particular mode of attention. AI scribes, it contends, exemplify the dominance of a left-hemispheric, calculative mindset that privileges the measurable and procedural over the intuitive and relational. As this mode of attention becomes further embedded in medical practice, it risks narrowing the field of care, eroding clinical expertise, and reducing physicians to operators within an increasingly mechanised system.

The essay examines how prominent scientists, politicians, and managers respond to the condition of human existence that a human being is only a short time in the long time of the world. In connection with the accelerated medicine and its predicted progress, they segment the future and imagine themselves at a new stage of humanity. They strive for a. privileged relationship to the world by claiming to conclude humanity's prehistory in the foreseeable future, if possible, in their own lifetime. They are trying to synchronise their lifetime with the world-time. In this way they hope for consolation, draw on old religious motifs and attribute religious elements to medicine.

Recent and ongoing advances in medical AI promise to revolutionise medicine by improving the accuracy, speed, and efficiency of clinical care. These promises are responses to the continuous quest of modern medicine to eliminate uncertainty and find answers to crucial questions of diagnosis, prognosis and treatment, while the impressive reported results of medical AI have raised the question of whether medical AI can be perceived as an epistemic authority that challenges the authority of doctors. In this paper, we examine this question by approaching it from the standpoint of what epistemic goods medical AI can offer, or else, what medical AI can claim to "know". Using Popowicz' account of epistemic authority in medical practice, which he locates in the scientific method that underpins the practice, we argue that medical AI uses a different scientific method to the one that has given rise and forms the epistemic foundations of traditional western medicine, and this presents a problem. As long as we are seeking not only statistically accurate correlations, but empirically grounded causations in medicine, AI cannot be treated as an epistemic authority in this field. We conclude that until medical practice finds ways to successfully incorporate such epistemological differences, medical AI should submit to the epistemic authority of medical practice and take its place on the long list of important and useful epistemic tools doctors can use to improve the health of patients.

Precision prevention refers to the use of data-intensive technologies to detect early indicators of disease and risk factors at the individual level. Precision prevention is not just a policy vision for a distant future but a development currently gaining momentum through wearables and self-tests marketed directly to consumers. We critically analyze one of the applications already on the market, namely detection of asymptomatic atrial fibrillation via smartwatches. We examine the promises made by manufacturers of smartwatches in relation to perspectives of general practitioners (GPs) in Denmark, who experience that new opportunities for disease prevention often come with new challenges. As one informant termed it, heart rate notifications are a form of "unauthorized screening" with uncertain benefits for individual patients and the healthcare system. The case of device-detected asymptomatic atrial fibrillation illustrates how precision prevention, via wellness technologies, can lead to a temporal disruption of evidence. We use this term to highlight the concern that evidence becomes the result of implementation, rather than the basis for it, thus turning consumers into experimental research subjects. The case of heart rate notifications also illustrates how the proactive approach to disease prevention, promoted by the wellness technology industry, drives a need for reactive research evaluating the benefits and harms of detection after the fact. We call for more attention to how big tech expansionism impacts the organization of health care and health research, as well as how the wellness technology industry shapes our understanding of disease and health.