Medicine Health Care and Philosophy最新文献

Healthcare systems produce significant greenhouse gas emissions, raising an important question: should healthcare be treated like any other polluter when it comes to reducing its emissions, or is healthcare special because of its essential societal role? On one hand, reducing emissions is critical to combat climate change. On the other, healthcare depends on emissions to deliver vital services. The resulting tension surrounds an idea of healthcare exceptionalism and leads to the question I consider in this paper: to what extent (if any) should the valuable goals of healthcare form an exception to the burdens of reducing greenhouse gas emissions? The goals of this paper are twofold. One is to think about how to address the issue of healthcare exceptionalism. Second is to discuss the extent of healthcare's climatic responsibilities. I examine two perspectives on healthcare exceptionalism. The first treats a responsibility to reduce emissions and the delivery of healthcare as separate issues, each governed by its own principle. I reject this view, proposing instead that we consider healthcare's environmental responsibilities in conjunction with its essential functions. I defend an "inability to pay" principle, suggesting that while healthcare should indeed contribute to mitigating climate change, its obligations should be constrained by the necessity of maintaining its core goals like protecting health and preventing disease. Healthcare should be treated differently from other sectors, but not to the extent that it is entirely exempt from efforts to reduce emissions.

The prevalence of non-communicable diseases, the related increased medical costs, and the recent public health emergency bring out more forcefully pre-existing dilemmas of distributive justice in the healthcare context. Under this reality, would it be justified to hold people responsible for their taken lifestyle decisions, or would it constitute an instance of unjustified disrespectful treatment? From a respect-based standpoint, one could argue that a responsibility-sensitive healthcare system morally disrespects the imprudent ones engaging in disadvantageous differential treatment to their detriment. In contrast, however, we might also have luck egalitarian reasons that explain why this differential treatment is not unjust. Luck egalitarianism is a responsibility-sensitive theory of distributive justice, which argues that it is bad if some people are worse off than others through no voluntary fault of their own. In this paper, I clarify the concerns about disrespect raised against the luck egalitarian viewpoint and offer possible respect-based reasons for why this might not be the case grounded in deontological concepts. First, I employ a revised Double-effect case to support responsibility-sensitive rationing. In the last part of the paper, these are further supported through the Kantian Formula of Humanity supplemented by the concept of duties.

Multi-professional teams have become increasingly common in healthcare. Collaboration within such teams aims to enable knowledge amalgamation across specializations and to thereby improve standards of care for patients with complex health issues. However, multi-professional teamwork comes with certain challenges, as it requires successful communication across disciplinary and professional frameworks. In addition, work in multi-professional teams is often characterized by medical dominance, i.e., the perspective of physicians is prioritized over those of nurses, social workers, or other professionals. We argue that medical dominance in multi-professional teams can lead to institutional epistemic injustice, which affects both providers and patients negatively. Firstly, it codifies and promotes a systematic and unfair credibility deflation of the perspectives of professionals other than physicians. Secondly, it indirectly promotes epistemic injustice towards patients via leading to institutional opacity; i.e., via creating an intransparent system of credibility norms that is difficult to navigate. To overcome these problems, multi-professional teamwork requires institutional settings that promote epistemic equity of team members.

Forensic mental health services (FMHS) involve restricting certain individual rights to uphold or promote other ethical values - the restriction of liberty in various forms is justified with reference to health and safety of the individual and the community. The tension that arises from this has been construed as a hallmark of the practice and an ever-present quandary for practitioners. Stating this ethical dilemma upfront is a common point of departure for many texts discussing FMHS. But do we run the risk of missing something important if setting the ethical scene rather than exploring it? This paper draws on interviews with three types of interested parties in mental health law proceedings - patients, psychiatrists and public defenders, and seeks to tease out what values are enacted when they describe and discuss experiences of FMHS and court proceedings. In doing so, we find emphasized values such as acceptance, telling it like it is, atonement, normality, and ensuring the future. We find that well-delineated and separate values are not necessarily the basis for decisions. We also find potential for explanation and guidance in bringing ethical discourse closer to everyday practice.

Laurie A. Paul (2014) developed the concept of transformative experience. In describing transformative experience as an experience that is both epistemically and personally transformative, she argues that transformative experience challenges the traditional model of rational decision making. Her concept of transformative experiences has been expanded to the field of illness. It has been argued that illness is a transformative experience because it fulfills Paul's criteria for a transformative experience (Carel et al. 2016; Carel and Kidd 2020). Conceptualizing illness as a transformative experience would have far-reaching implications for the agency and for the rational decision-making process of ill persons. In considering these implications, this article questions the assumption that illness is a transformative experience and proposes that illness, especially when it is chronic, can be a transformative activity, in the sense that Agnes Callard (2020), introduced us to the concept of transformative activity. The article argues that conceptualizing (chronic) illness as a transformative activity strengthens the ill person's agency and ability to learn to live with the illness.

In 2023, thousands of young Norwegian physicians joined an online movement called #legermåleve (#doctorsmustlive) and shared stories of their own mental and somatic health issues, which they considered to be caused by unacceptable working conditions. This paper discusses this case as an extreme example of physicians' and healthcare workers' suffering in late modern societies, using Vosman and Niemeijer's approach of rethinking care imaginaries by a structured process of thinking along, counter-thinking and rethinking, bringing to bear suffering as a heuristic device. Thinking along, taking the physicians' stories and arguments literally, reveals an image of an unbearable workload. Counter-thinking resituates their suffering within the broader conditions of late modernity, suggesting that the root cause may lie not in the quantity of the workload itself but in its qualities and in its perceived threat to their integrity as caregivers through epistemic and moral injury and an inability to respond to this threat. In rethinking, the ambiguity of suffering- its dual potential as both a constraint and an opening- becomes central. Following the physicians' own interpretations and the solutions emerging from this framing, both their suffering and that of their patients could paradoxically be exacerbated by further decentering physicians and reinforcing utilitarian, data-driven approaches. However, staying with their suffering and reinterpreting its causes opens possibilities to leverage critiques of medicalization at large and of their own suffering in particular, challenging the assumption that the weight of care must always grow heavier. From this reframing, I argue, it is possible to reclaim and reimagine care and the clinical space as a nexus of epistemic and moral privilege, recentering response-ability both relationally and socially.

In an interesting article, Dr Zuzana Parusniková claimed: (i) that Semmelweis' colleagues did not recognise the importance of his animal experiments, (ii) that the resistance to Semmelweis' hypothesis and results was due mainly to applying mono-causality and (iii) Semmelweis inability to communicate, (iv) that the New Vienna Medical School applied evidence-based medicine, and (v) that the philosophy of Karl Popper is the best interpretation of Semmelweis' scientific approach. Here, we present some factual aspects of Semmelweis' text from 1861 and discuss Dr Parusniková's claims against this backdrop. We conclude that Semmelweis might intentionally have abstained from communicating his hypothesis and results between 1847 and 1849 - including the results from his animal experiments - as he thought that they would eventually be understood and accepted. Semmelweis' hypothesis was that cadaveric matters and decaying particles were the cause of childbed fever and increased maternal mortality. This hypothesis might have been controversial, but we claim that the major reason for the resistance was eminence-based and induced by the publication of preliminary and suboptimal results, based on a premature version of his hypothesis. If the New Vienna Medical School had been influenced by evidence-based medicine, we believe that Semmelweis' empirical results would have been accepted - as they were based on an almost randomised controlled trial - and if the results had not been associated with his hypothesis but instead had focused on a black box procedure. We agree that the philosophy of Popper might be appropriate when analysing Semmelweis' scientific approach when abandoning low-level theories. However, to understand the resistance against Semmelweis' hypothesis and results, it is not sufficient to refer to a Pickwickian discussion; a Kuhnian framework is more adequate.

An ethical framework for pandemic healthcare distribution typically encompasses multiple ethical values. However, integrating various ethical values and distributive principles into a single framework raises concerns about their compatibility and the overall coherence of the framework. This issue of value compatibility could lead to moral inconsistencies within the ethical framework, leading to practical indetermination when facing conflicting implications. This paper offers a methodological resolution to the compatibility problem, serving as an effective tool to mitigate the impact of value conflicts where possible. It proposes four pathways: specifying values rather than balancing them, incorporating values rather than weighing them, reinforcing values rather than aggregating them, and seeking scientific evidence. By developing coherent ethical frameworks where values do not contradict each other, this approach also enhances practical ethical decision-making. Using the COVID-19 vaccine distribution as a case study, this approach demonstrates how conflicting values can yield practical prioritization strategies, such as allocating vaccines to healthcare and essential workers, addressing multiple layers of disadvantage, and assessing age-related prioritization. Reflecting on the compatibility of values within ethical frameworks offers crucial insights beyond COVID-19, contributing to the development of robust ethical frameworks for future public health crises.

The structural scarcity of healthcare resources has deeply challenged their fair distribution, prompting the need for allocation criteria. Long under the spotlight of the bioethical debate with an extraordinary peak during the recent COVID-19 pandemic, micro-allocation of healthcare has been extensively discussed in the literature with regard to issues of substantive and formal justice. This paper addresses a relatively underdiscussed question within the field of formal justice: who should define micro-allocation criteria in healthcare? To explore this issue, we first establish formal requirements that must be met for allocation criteria to be considered fair and legitimate. Then, we introduce three possible answers to the research question: the attending physician, the team of physicians, and the team of experts. We discuss and then reject all of them, arguing that the task of defining allocation criteria should be assigned to a political representative, supported by a cross-disciplinary team of experts. This proposal is based on the need to take democracy seriously as a tool for making substantive allocative decisions in light of the inevitable disagreement on such matters within a community. To support this claim, we present two key arguments-the democracy argument and the consistency argument. We also pre-emptively respond to two significant critiques: the too-specificity of the decision critique and the catastrophic outcomes critique. In conclusion, we argue that our proposal offers the fairest and most legitimate decision-making process for healthcare micro-allocation.

There are an increasing number of ways to enhance human abilities, characteristics, and performance. In recent years, the ethical debate on enhancement has focused mainly on the ethical evaluation of new enhancement technologies. Yet, the search for an adequate and shared understanding of enhancement has always remained an important part of the debate. It was initially undertaken with the intention of defining the ethical boundaries of enhancement, often by attempting to distinguish enhancements from medical treatments. One of the more recent approaches comes from Julian Savulescu, Anders Sandberg, and Guy Kahane. With their welfarist account, they define enhancement in terms of its contribution to individual well-being: as any state of a person that increases the chances of living a good life in the given set of circumstances. The account aims to contribute both to a shared and clear understanding of enhancement and to answering the question of whether we should enhance in certain ways or not. I will argue that it cannot live up to either claim, in particular because of its inherent normativity and its failure to adequately define well-being. Nevertheless, it can make a valuable contribution to an ethics of enhancement. As I will show, the welfarist account refocuses the debate on a central value in health care: well-being, which can be a relevant aspect in assessing the permissibility of biomedical interventions - especially against the background of new bioethical challenges. To fulfil this function, however, a more differentiated understanding of well-being is needed.