Medicine Health Care and Philosophy最新文献

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.

Some philosophical and metaethical theories have tried to provide a fundamental background for bioethics but miss the fundamental question about what medicine is, its nature and its end. We argue that the philosophy of medicine, through the development that Edmund Pellegrino and David Thomasma gave to this field of study, allied with Aristotle's practical and teleological ethics, can provide an ontological background for bioethics beyond the tradition of principles and deontology, with particular emphasis on the uniqueness of the doctor-patient encounter. Some difficulties and criticisms of this ontological model are also examined.

In addressing the question of what mental health is we might proceed as if there is a single phenomenon-mental health-denoted by a single overarching concept. The task, then, is to provide an informative analysis of this concept which applies to all and only instances of mental health, and which illuminates what it is to be mentally healthy. In contrast, mental health pluralism is the idea that there are multiple mental health phenomena denoted by multiple concepts of mental health. Analysis and illumination of mental health may still be possible, but there isn't a single phenomenon or concept to be analysed in addressing the question of what mental health is. The question of pluralism has been overlooked in the philosophy of mental health. The discussion to follow is an attempt to get us to take mental health pluralism seriously. To that end, in this essay I have three primary goals: (1) to give a precise account of what mental health pluralism is, (2) to show that the question of pluralism should not be neglected in debate about what mental health is, and (3) to argue for mental health pluralism. I also draw out some implications of this discussion for philosophy, science, and psychotherapy.

False hope is costly for individuals, their loved ones, and society. Scholars have defined false hope as one that involves an epistemically unjustified belief. In this paper, I argue that this account of false hope is incomplete and that false hope should be conceptualized in terms of the way in which the agent attends to or focuses on a highly desired but unlikely outcome. I explain how this account better captures the distinctiveness of false hope.

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.

Recent publications on digital health technologies highlight the importance of 'responsible' use. References to the concept of responsibility are, however, frequently made without providing clear definitions of responsibility, thus leaving room for ambiguities. Addressing these uncertainties is critical since they might lead to misunderstandings, impacting the quality and safety of healthcare delivery. Therefore, this study investigates how responsibility is interpreted in the context of using digital health technologies, including artificial intelligence (AI), telemonitoring, wearables and mobile apps. We conducted a scoping review with a systematic search in PubMed, Web of Science, Embase, CINAHL and Philosopher's Index. A total of 34 articles were included and categorized using a theoretical framework of responsibility aspects, and revealed two main findings. First, we found that digital health technologies can expand and shift existing 'role responsibilities' among caregivers, patients and technology. Second, moral responsibility is often equated with liability or accountability, without clear justification. Articles describe new ways in which physicians can be held accountable, particularly in the context of AI, and discuss the emergence of a 'responsibility gap' where no-one can be fully responsible for AI-generated outcomes. The literature also shows that m-Health technologies can increase patients' accountability for their own health. However, there was limited discussion in the reviewed literature on whether these attributions of accountability are appropriate. We conclude with implications for practice and suggestions for expanding the theoretical framework of moral responsibility, recommending further study on responsibility of collectives and artificial entities, and on the role of virtue in digital health.

In recent years, data-driven approaches to chronic pain care have increased dramatically. However, people living with chronic pain are ambivalent about datafication practices. Drawing on in-depth interviews with individuals living with chronic pain, I discuss and analyze this ambivalence. On the one hand, participants imbibe the promissory rhetoric of data as that which may organize and control the body in pain. On the other hand, they dismiss and critique the type of data collected. This micro-level analysis of the pain tracking experience illuminates a tension between datafication and chronic pain. Datafication demands that the patient relay information about their body that is free of ambiguity. However, chronic pain is ambiguous and full of paradox. This article illuminates the emotional chasm between datafication enthusiasts and chronic pain patients who track their pain and suggests that such enthusiasm may lead to bad faith.

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.