Theoretical medicine and bioethics最新文献

In a series of papers in the early 1970s and in his important book Abortion and the Sanctity of Human Life (1975), Baruch Brody offered what remains to this day one of the most philosophically rigorous contributions to the debate concerning the morality of abortion and the ethics of homicide more generally. In this paper I would like to critically examine Brody's argument that abortion is sometimes justifiable in some cases even when (1) one cannot claim self-defense, or (2) diminished responsibility, and (3) the abortion is a 'killing' rather than a 'not saving.' This justification, I argue, is limited to certain cases in which the life of the mother is at stake. The cautious principle which he finally formulates merits serious attention and consideration. While I find a great deal of value in Brody's discussion, I will argue that there are several difficulties with the principle of justifiable homicide he constructs. Accordingly, I will further amend and supplement his final version by offering my own alternative principle.

With the growing application of machine learning models in medicine, principlist bioethics has been put forward as needing revision. This paper reflects on the dominant trope in AI ethics to include a new 'principle of explicability' alongside the traditional four principles of bioethics that make up the theory of principlism. It specifically suggests that these four principles are sufficient and challenges the relevance of explicability as a separate ethical principle by emphasizing the coherentist affinity of principlism. We argue that, through specification, the properties of explicability are already covered by the four bioethical principles. The paper finishes by anticipating an objection that coherent principles could not facilitate technology induced change and are not well-suited to tackle moral differences.

This article first describes the mechanism of any self-fulfilling prophecy through discussion of its four conditions: credibility, employment, employment sensitivity, and realization. Each condition is illustrated with examples specific to the medical context. The descriptive account ends with the definition of self-fulfilling prophecy and an expansion on collective self-fulfilling prophecies. Second, the normative account then discusses the moral relevance of self-fulfilling prophecies in medicine. A self-fulfilling prophecy is typically considered problematic when the prediction itself changes the predicted outcome to match the prediction (transformative self-fulfillment). I argue that also self-fulfilling prophecies that do not change the outcome but change the ways in which the outcome was realized (operative self-fulfillment), have significant ethical and epistemic ramifications. Because it is difficult to distinguish, retrospectively, between a transformative and an operative self-fulfilling prophecy, and thus between a false or true positive, it becomes equally difficult to catch mistakes. Moreover, since the prediction necessarily turns out true, there is never an error signal warning that a mistake might have been made. On the contrary, accuracy is seen as the standard for quality assurance. As such, self-fulfilling prophecies inhibit our ability to learn, inviting repetition and exacerbation of mistakes. With the rise of automated diagnostic and prognostic procedures and the increased use of machine learning and artificial intelligence for the development of predictive algorithms, attention to self-fulfilling feedback loops is especially warranted. This account of self-fulfilling prophecies is practically relevant for medical research and clinical practice. With it, researchers and practitioners can detect and analyze potential self-fulfilling mechanisms in any medical case and take responsibility for their ethical and epistemic implications.

Flourishing is an increasingly common construct employed in the study of human wellbeing. But its appropriateness as a framework of wellbeing at certain stages of life is contested. In this paper, we consider to what extent it is possible for someone to flourish at the end of life. People with terminal illness often experience significant and protracted pain and suffering especially when they opt for treatments that prolong life. Certain aspects of human goods, however, that are plausibly constitutive of flourishing-such as meaning and purpose, deep personal relationships, and character and virtue-can be uniquely realised when life is ending. We argue that there is a qualified sense in which one can flourish at the end of life but that one must make important modifications to the criteria implicit in conventional conceptions of flourishing. We close with a discussion of the empirical assessment of wellbeing at the end of life and explore the possibility of introducing a flourishing measure in palliative care practice.

If Epicurean arguments for the harmlessness of death are successful, then they also successfully undermine a common justification for physician-assisted suicide, euthanasia, and the termination of hopeless pregnancies that I call the 'Mercy Intuition', according to which, by ending the life of a suffering loved one for whom there is little to no chance of recovery, one is relieving that person of her suffering, and thus providing a great benefit to her. For, if death is not a harm to the person who dies, then it cannot be a benefit to her either, even in cases of intense and prolonged suffering. Along these lines, in this paper, I defend the claim that death cannot provide a benefit to those who are suffering. I begin by highlighting the Epicurean foundations of the argument, focusing on three main Epicurean arguments for the harmlessness of death and their no-benefit analogues. I then move on to explore several important limitations of the argument, which make available a number of strategies for avoiding its conclusion. Along the way, I respond to each of these avoidance strategies. I conclude that even granting several of its limitations, the argument still poses a serious challenge to the Mercy Intuition.

Joona Räsänen argues that vegans ought to be anti-natalists and therefore abstain from having children. More precisely, Räsänen claims that vegans who accept a utilitarian or rights-based argument for veganism, ought to, by parity of reasoning, accept an analogous argument for anti-natalism. In this paper, I argue that the reasons vegans have for refraining from purchasing animal products do not commit them to abstaining from having children. I provide novel arguments to the following conclusion: while there is good reason to believe that factory farming results in a net disutility and involves treating non-human animals as mere means, there is not good reason to believe that having children results in a net disutility or involves treating the children as mere means. Subsequently, I respond to what I take to be Räsänen's underlying reasoning-that vegans are committed to abstaining from other practices which cause unnecessary suffering. I respond by arguing that this is plausibly false as various practices which cause unnecessary suffering are likely permissible, whereas factory farming is not.

Family disputes over the diagnosis of brain death have caused much controversy in the bioethics literature over the conceptual validity of the brain death standard. Given the tenuous status of brain death as death, it is pragmatically fruitful to reframe intractable debates about the metaphysical nature of brain death as metalinguistic disputes about its conceptual deployment. This new framework leaves the metaphysical debate open and brings into focus the social functions that are served by deploying the concept of brain death. In doing so, it highlights the epistemic injustice of medicolegal authorities that force people to uniformly accept brain death as a diagnosis of death based on normative considerations of institutional interests, such as saving hospital resources and organ supplies, rather than empirical evidence of brain death as death, which is insufficient at best and nonexistent at worst. In light of this injustice, I propose the rejection of the uniform standard of brain death in favor of a choice-based system that respects families' individualized views of death.

Virtues commonly associated with physicians and other healthcare professionals include empathy, respect, kindness, compassion, trustworthiness, and many more. Building upon the work of Bortolloti, Murphy-Hollies, and others, I suggest that curiosity as a virtue has an integral role to play in healthcare, namely, in helping to make those who are invisible, visible. Practicing the virtue of curiosity enables one to engage with and explore the experiences of patients and contributes toward building a physician-patient relationship of trust. As the perspectives and experiences of patients can be too often dismissed or lost within medical settings, curiosity can allow physicians to deeply know their patients, and thus provide better care. However, caution must be exercised so as to not to venture into inappropriate curiosity, where questions are asked for improper reasons or to help satisfy the personal interest of physicians. Finally, I sketch out two cases-on chronic pain and on vaccine hesitancy-to illustrate where curiosity can play a valuable role.