Medicine Health Care and Philosophy最新文献

The advent of innovative techniques, such as the CRISPR/Cas system, has opened up a new range of possibilities for modifying the genome, with the potential to address previously unmet therapeutic needs of patients with genetic diseases. These new possibilities have not only raised ethical concerns but also challenged existing classifications of genome modification techniques. While the legal status of some of these new therapies remains uncertain, there is an ongoing debate within philosophy of biology about the information-related metaphors adopted by scientists to describe and classify the genome and its therapeutic modification. Given the continuing advance of new genomic therapies, we show, employing an interdisciplinary approach, that a comprehensive framework for the classification of these technologies is needed to resolve legal and philosophical issues. The first section provides an analysis of the current state of novel genome-modifying techniques in medical genetics. In the second section, we assess the regulatory status of these techniques within the European regulatory framework for advanced therapy medicinal products (ATMPs). Drawing on these results, we argue in the third section from a philosophical perspective that metaphors, such as 'editing' the genome, which are based on a conception of the genome as linear information, cannot adequately capture the breadth of advanced genomic technologies. To accurately categorise these techniques in a manner that meets their diverse applications, we propose introducing the umbrella term 'somatic genomic therapies' (SGTs). Urging an integrative approach to defining and classifying new technologies in medical genetics, we advocate for the development of an integrative concept of SGTs.

Conflicts of interest are widely regarded as being morally, socially, and scientifically problematic in the many sectors, including in the health sector. There has been considerable attention paid to managing conflicts of interest in clinical practice, medical research and health policy through strategies such as recusal, disinvestment, and disclosure. While these efforts have been important, they are often based on a superficial account of "interests", as few in healthcare and biomedical science have sought to unpack the concept. In this paper, we argue that adopting an historically and philosophically informed account of interests can enrich our thinking about COI in healthcare and biomedical science, and lead to the improvement of COI management strategies. To support this claim, we first provide an overview of contemporary debates about COI in these domains. We then summarise the historical trajectory of the concept of "interest" and show how these insights can be used to inform the management of COI in healthcare and biomedical science using the example of physicians' relationships with the pharmaceutical industry. In particular, we challenge assumed hierarchies of interests and call for increased attention to the multiplicities of interests, both financial and non-financial, that may at times converge and conflict.

Research into traumatic memory has focused heavily upon re-experiencing symptoms (e.g. flashbacks). Features predominantly associated with complex trauma, such as gaps in the recollection of traumatic events, remain comparatively underexplored. In this article, I draw on the testimonies of survivors of complex trauma who participated in a survey informed by Phenomenologically Grounded Qualitative Research (Køster and Fernandez in Phenomenol Cogn Sci 22:149, 2023). I provide a phenomenological account of how survivors often experience memory blanks as inchoately disturbing, despite being unable to recount 'missing' events. Although challenging and equivocal, the notion of body memory offers one way of articulating this phenomenon. Specifically, I suggest that the troubling feelings accompanying perceived gaps in recollection arise alongside a form of non-conceptual body memory, which, lacking in propositional content, fails to be meaningfully contextualised. Drawing on the literature on body memory, dissociation, and Husserl's (Collected works. Kluwer, Dordrecht, 1991 [1893-1917]) internal time consciousness, I distinguish this as dissociative body memory and describe two central, non-exhaustive, features: (1) habitual dissociation, and (2) protentive salience. What is taken to be a gap in traumatic memory is in fact only a partial gap, involving a kind of pre-reflective remembering that is not recognised as such. Dissociative body memory additionally prevents the narrative integration required for minimising these perceived gaps, leading to an ongoing sense of foreboding concerning one's past. This has significant clinical implications, highlighting that what survivors experience as forgotten must not be disregarded. At the theoretical level, the phenomenon may be a hitherto unrecognised characteristic of complex posttraumatic stress disorder and related conditions.

In recent years, medical research has sparked hope that up to a third of dementia cases could be prevented. This optimism is driven by a shift in the understanding of dementia and, in particular, Alzheimer's Disease (AD)-from being a rapid-onset brain disease in later life to a condition strongly linked to lifestyle factors, progressing slowly and gradually through asymptomatic, pre-symptomatic, and symptomatic stages with varying degrees of severity. Accompanying this evolving perception, the use of mobile healthcare applications (mHealth apps) based on dementia prevention research has been on the rise. Health policymakers and companies increasingly advocate for these apps. However, concerns remain about the medical quality of such mHealth apps for dementia prevention. Bioethical research has highlighted significant challenges associated with their use. This paper critically examines dementia prevention strategies through the lenses of mHealth technologies. Exploring four mHealth apps for dementia prevention as case studies, we identify and analyze unsolved ethical issues related to primary, secondary, and tertiary prevention. Hereby we offer a new perspective on familiar ethical dilemmas in dementia prevention, and emphasize the need to examine potentially intensified challenges in the context of digital health in the future in more depth.

Deceiving participants is an ethically complicated research practice which remains an important challenge for research ethics committees (RECs) and researchers, despite the availability of abundant research ethics guidance. Exploring this persistent policy-practice divide, we develop a framework for assessing the needs of the REC review of deceptive studies in a context-sensitive way. Different guidance formats are evaluated in light of their potential contribution to the frequently recurring REC review need for consistent and representative rules that set a perimeter for precise, coherent and representative discretionary review to take place. Research ethics guidelines and a new format of "descriptive living documents" are argued to respectively provide perimeter-setting rules and support discretionary decision-making about the justifiability of deceptive studies. REC review coordination is argued to benefit from analogous guidance formats to ensure conditions that facilitate successful REC review. As the needs of REC review may differ depending on the context, different mixes of these and possibly other guidance formats may support the REC review of deceptive studies and offer a way out of the policy-practice divide.

Video consultations represent a relatively new way of delivering face-to-face consultation in the context of general practice. The aim of the present analysis is to examine how video consultations influence patients' experiences of their ability to communicate their emotions, needs, and vulnerabilities, as well as their experiences with their general practitioner's ability to respond to these. The empirical base consists of 43 semi-structured interviews with patients (23 women and 20 men), aged between 17 and 81 years old, who have used video consultation as part of their treatment for various health issues in general practice. Emmanuel Levinas' theory of the face was used as an analytical and interpretative tool. The analysis showed that in video consultations, patients experience a digital obscuring of the face, i.e., of their emotions, needs and vulnerabilities. This complicates the GP's ability to perceive their vulnerability, making it challenging to recognize the patients' needs. Moreover, this obscuration hinders the patients' capacity to connect to their own vulnerabilities, which can lead to a diminished awareness of their own suffering. However, this mechanism might help patients who wish to obtain shielding from their face and from difficult emotions. Overall, we argue that significant relational and ethical dimensions of care within the doctor-patient relationship in general practice may be challenged in video consultations. We propose integrating Buber's dialogical principles with the present Levinasian analysis as it may offer a promising approach to enhancing relational and ethical dynamics in video consultations.

Currently, we have developed a range of neurotechnologies to intervene in neurological and psychiatric disorders, with some of these interventions considered reversible. However, the term "reversibility," although widely used in clinical and research contexts, remains ambiguously defined, and is often applied inconsistently in different contexts, which may pose ethical risks for patients. In fact, reversibility can be classified into three categories: ontological reversibility (including structural, functional, and psychological reversibility), methodological reversibility (including current and future methodological reversibility), and ethical reversibility (including autonomy, well-being, and harm reversibility). However, each of these forms of reversibility has inherent problems when applied in clinical settings. To ensure that patients are fully informed about the reversibility of neurotechnological interventions, we should adopt a perspective of practical reversibility to address this issue, improving the informed consent procedures for neurotechnological interventions, and clarifying the actual needs of patients regarding reversibility in terms of individual conditions, technological consequences, and value assessments.

This article explores the lived experiences and ethical complexities of the decision- and meaning-making journey involved in living donor liver transplantation (LDLT) through a case study of a young adult who donated part of his liver to his father. Utilising embodied phenomenology and narrative analysis, we present an in-depth exploration of personal stories and interconnected narratives that reveal the intricate layers and nuances inherent in child-to-parent LDLT within the Taiwanese sociocultural milieu. This study examines the embodied, relational, temporal and normative dimensions through a dynamic, iterative process of careful reading and analysis, from which four plotlines emerged [(1) indebtedness, (2) thrownness, (3) struggle for selfhood and (4) family seniority] along with a postscript. The findings illuminate the complex interplay of body, self, family, intergenerational dynamics and sociocultural norms throughout the decision-making process. The analysis aims to lay the groundwork for a refined framework for understanding concepts such as giving, relationality, agency, temporality and normativity within bioethical discourses on organ transplantation. Furthermore, the study offers insights for healthcare professionals to develop culturally sensitive approaches in LDLT care ethics and practice, with particular attention to vulnerability, relational autonomy and embodied intersubjectivity as normative foundations.

The clinical autopsy of foetuses, stillborn babies, or neonates and the examination of the placenta help to inform the mother's decision-making and her medical care for subsequent pregnancies. Indeed, these post-mortem examinations can identify unexpected congenital malformations or the cause of repeated miscarriage or stillbirth. However, the use of clinical pathology for diagnostic purposes in the context of family planning for bereaved parents with an unfulfilled desire to have a child, and IVF couples has received little attention to date. This article applies Beauchamp and Childress' bioethical framework to identify, assess and systematically discuss ethical issues associated with the use of clinical foetal autopsy in reproductive healthcare within the German legal context. In the format of a clinical ethics consultation, the article examines the current policy on perinatal post-mortem examinations in Germany, and asks whether the clinical foetal autopsy for reproductive health purposes should be part of standard clinical examinations offered to bereaved parents. The conclusion of our research recommends clinical foetal autopsy as ethically acceptable, provided that the necessary resources are available. This recommendation is based on the ethical obligation towards the mother as the patient, which is grounded in the bioethical principles of autonomy and beneficence.

Burnout is generally conceived as a condition resulting from external stressors in one's work environment, but its precise definition is contested. In line with recent empirical studies, we suggest an existential-phenomenological approach to avoid the dualisms that characterize the present understanding of burnout. Drawing on Merleau-Ponty's phenomenology, we do not consider burnout in terms of a psychological syndrome with physiological aspects, but rather suggest that these syndromes are expressions of the same problem. Burnout is not caused by an individual's inability to cope with external demands, nor by a too demanding work environment, but it is a mismatch between the two. Furthermore, we conceive of 'world' in Arendtian terms and situate burnout within the social context of vita activa. We argue that burnout can be understood in terms of 'world alienation,' and discuss the extent to which Arendt's diagnosis of the shifts in human activity in modernity from 'work' to 'labor' may provide a social context for the existential breakdown that burnout entails. We conclude the paper by outlining some implications for diagnosis and treatment based on our definition of burnout.