Medicine Health Care and Philosophy最新文献

The reality of ageing population, with loneliness among older people recognised as a public health concern, and a significant shortage of caregivers-call for techno-creative solutions. Artificial intelligence (AI)-based humanoid carebots (AIhCs) are one emerging solution, where care for humans is being outsourced to robots, in what we dub as "techno-care". The humanisation of carebots, employing anthropomorphism to influence care-recipients' trust in and compliance with AIhCs, is a key issue, uniquely involving deception to achieve care-related goals, which may violate care-recipients' autonomy, among other things. This problem, and other autonomy-related issues, underscore the need for techno-care-specific ethical governance. We therefore set out to examine the appropriateness of existing ethical frameworks for governing AIhC design and implementation, focusing on autonomy and transparency, which are fundamental for AIhC ethicality. We intuitively start by considering the more novel frameworks of AI ethics and roboethics, then move to examine the well-established bioethics and ethics of care (EoC) frameworks. Our analysis concludes that no existing ethical framework adequately copes with the autonomy-related and other challenges of techno-care by AIhCs. We consequently suggest that a new derivative framework needs to be developed and applied to this setting-that of "ethics of techno-care" (EtC). We first distinguish EoC care setting and care-relationships from those of EtC, then offer a preliminary outline for this new normative guidance, comprised of the following key elements: human care-sensitive design, minimally-necessary deception, techno-care transparency, techno-care privacy design, techno-care autonomy, techno-care responsibility and accountability, and diversity and cultural sensitivity in AIhC design.

Respect for autonomy is a central ethical principle in end-of-life care. However, due to cognitive decline, emotional distress, and the existential weight of end-of-life decisions, many patients may struggle to articulate or sustain their preferences without appropriate forms of support. The question, then, is not solely how to respect patients' autonomy in end-of-life care, but how autonomy, understood in relational terms, can be genuinely fostered. To address this question, the article advances a normative and practice-oriented model of decision-making that integrates two approaches often treated separately: shared decision-making and supported decision-making. Taking an original position in the philosophical debate between procedural and substantive accounts of autonomy, and drawing on the ethical analysis of a composite clinical case, we ground our model in a transformative ethics of deliberation that links relational autonomy with democratic habits and skills. In doing so, the article bridges clinical experience and philosophical inquiry to offer a richer account of how autonomy can be meaningfully fostered in end-of-life care, while also opening new questions about the institutional conditions required for its realisation.

Disease, this essay contends, lives at the threshold where the felt immediacy of the lifeworld touches the measured abstractions of science, each continually shaping the other. Seen from that border, a lesion or lab value is never complete without its human resonance, and a story of pain or fear is never fully told until its biological underpinnings come into view. Every diagnostic exchange therefore pauses the flow of ordinary life, translates it into clinical language, and then returns it, changed, to the person who must carry it forward. The stakes of that translation grow sharper wherever social power skews who is heard and who is helped. A medicine that keeps faith with both sides of the threshold can investigate molecules without losing sight of meanings, meet suffering with knowledge as well as compassion, and in doing so open fresh paths for teaching, policy, and practice.

This paper re-examines phenomenological accounts of autism in light of the double empathy theory. I fully endorse the compelling critique by contemporary phenomenologists such as Gallagher, Fuchs, and Zahavi of the Theory of Mind framework, as they ground autistic social difficulties in impairments of primary and secondary intersubjectivity. However, their analyses tend to underemphasize or overlook the reciprocal structure of empathy, an aspect that is crucial for a comprehensive understanding of autistic-allistic social interactions. This omission has been rightly criticized by proponents of the double empathy theory, such as Rizzo and Ekdahl, who emphasize that social breakdowns between autistic and allistic individuals are bidirectional. Drawing on Husserl's classical phenomenology of empathy, I argue that a deeper phenomenological understanding reveals empathy to be inherently reciprocal and co-constituted. Thus, Husserlian phenomenology not only aligns with the core insights of the double empathy theory but also offers a conceptual foundation for rethinking autistic experience beyond unidirectional deficit models.

Kidney stone disease is a highly prevalent condition, and has received significant attention in medical research due to its substantial impact on quality of life and the strain it places on healthcare systems. Despite its prominence, philosophical perspectives on kidney stone disease remain underexplored. This paper presents the first comprehensive phenomenological analysis of kidney stone disease, integrating both classical and contemporary phenomenological approaches with insights from qualitative and quantitative studies. We examine the lived experience of renal colic, the role of medical imaging, the diverse methods of treatment, and the challenges posed by recurrent chronic kidney stone disease, providing philosophical depth to these medical issues. We argue that kidney stone disease, along with its treatment, can deeply affect the patient's relationship with their own body, sense of self, environment, and interpersonal connections. We conclude by discussing the practical implications of our phenomenological analysis for clinical care, advocating a more holistic, humanistic approach to kidney stone disease and its treatment. This approach recognizes not only the physical, but also the lived aspects of the condition, thereby enhancing patient care and well-being.

Semaglutide, marketed as Wegovy, Ozempic, and Rybelsus, is a glucagon-like peptide-1 receptor agonist (GLP-1 RA) that has attracted significant global attention for its appetite-suppressing and weight-loss effects. Approved for pediatric use in children aged 12 and older, Wegovy has been described as a "miracle drug" and hailed as a potential solution to the so-called "obesity epidemic." However, prescribing medication to children raises complex ethical questions, including how best to respect young patients' autonomy and promote their well-being. This paper focuses on one such concern: the "argument from virtue." According to this view, Wegovy represents a morally problematic approach to weight loss because it circumvents the development of character traits-such as self-control and resilience-that are seen as integral to autonomy. We critically examine this argument, rejecting the claim that there is a single morally "right way" to lose weight, and argue that Wegovy, when prescribed within a supportive framework, may help children build and exercise autonomy. We review the drug's function and efficacy, analyze how it might promote or hinder autonomy, and offer recommendations to support ethical prescribing practices that align with respect for children's agency.

Whether (1) vaccines produced in response to a pandemic should be considered "global public goods" and whether (2) Big Pharma companies should waive intellectual property rights for pandemic disease vaccines are important questions in global health ethics and public health policy. The extended argument advanced here (a) affirms such vaccines are global public goods and (b) supports those among low- and middle-income nations who, during the COVID-19 pandemic, proposed waiver of intellectual property rights. As a matter of distributive justice, we argue that (c) Big Pharma, national regulatory agencies, and international intergovernmental organizations such as the World Health Organisation and the World Trade Organisation have a moral responsibility to ensure developing countries have equitable access to pandemic vaccines. Hence, (d) there should be appropriate technology transfer for production and distribution of pandemic-responsive vaccines in these nations.

While nursing and midwifery have long drawn from Western and Eastern philosophies, the transformative potential of African philosophy remains only a recent phenomenon, perpetuating a gap in culturally grounded care paradigms. This scholarship addresses this lacuna by interrogating the nature of African philosophy and its implications for nursing and midwifery practice using an African hermeneutic approach. Six distinct approaches to defining African philosophy emerged. Across these schools, two unifying themes redefine core disciplinary concepts: communitarian personhood, which positions identity as a relational, moral achievement rather than an individual birthright; and holism, which interweaves physical, spiritual, social, and environmental well-being into an indivisible whole.

Digital technologies, especially social media, have become everyday tools. In care settings, the use of social media is considered a possible guarantee to maintain quality practices. This trend is specifically relevant for social care, including social work, psychology, psychiatry, rehabilitation etc., due to their communicative nature. Nevertheless, this use is joined by ethical vulnerabilities. To get insight into these, a systematic review of relevant normative-ethical literature was carried out following a 4-step methodology: developing ethical-conceptual questions; a literature search in four electronic databases (CINAHL, Philosopher's Index, Web of Science, ProQuest Database Psychology); assessment and inclusion of articles based on predefined criteria; extracting, analysing, and synthesizing reported data. Thirty-three articles were included, showing that current ethical debates are governed by nine themes: Benefits of social media; Relations, limits, and boundaries; Searches; Privacy, confidentiality, and trust; Documentation and records; Competency and client suitability; Consultation and referral; Informed consent; and Identity and image. We found that most ethical literature on social media use in social care settings adheres to the principles of biomedical ethics (respect for autonomy, beneficence, non-maleficence, justice) and to an ethics of carefulness, i.e. an ethics which takes social media for granted and considers its impact only on the particular therapeutic relationship. It loses sight of those ethical issues which occur on organizational, societal, and global levels. A full account of the ethics of social media use can only be given by considering these different levels and by informing the ethics of carefulness by an ethics of desirability.

Mobile health tools often claim to empower their users by giving them the knowledge they need to take control of their health. However, this notion of empowerment, what we refer to as the knowledge-control paradigm, only superficially engages with the concept and leaves out the different ways in which people come to be empowered. We first identify two distinct elements of empowerment: psychological empowerment, which pertains to beliefs about one's power and control over their health, and relational empowerment, which is connected with one's actual power to control their health, as well as the ability to hold those in positions of power (the empowered) accountable. The knowledge-control paradigm is incapable of creating empowered individuals in the relational sense, and it is only when knowledge is coupled with both the means and the motivations to control health and/or hold the empowered to account, that one can be considered empowered. Mobile health tools that overemphasize knowledge as the empowering mechanism often misempower their users, that is, they create a belief in users about their power to control their health that does not align with their actual capacity to do so. This mismatch between beliefs and reality can have far reaching consequences as with knowledge, ability, control, and power comes responsibility. We worry not only that the misempowered will be viewed as more responsible for their health than the circumstances permit, but also, that these individuals will lose the ability to hold those in positions of power accountable..