Theoretical medicine and bioethics最新文献

In this paper I present a novel understanding of diagnostic hypothesis that draws ideas from Walter Benjamin's work on translation. My framework originates from previous literature that aligns diagnostic hypothesis with Peircean 'abduction.' I argue that the abductive step, rather than being an inference to the best explanation, is a strategic conjecture that is simultaneously interrogative and interpretive. While Peirce places the burden of interpretation solely on semiotic analysis, I develop a form of dialectical abduction that draws on Benjamin's distinction between semiotic and mimetic faculties of language. I further argue that while all abduction functions through language interpretation, diagnostic abduction works not simply as interpretation but is more accurately described as the translation of patient narrative and clinician investigation into the language of clinical medicine. I then analyze diagnostic translation within the dialectical framework for translation described by Benjamin, and use this model to develop suggestions for a methodology of clinical abduction.

Predictions that artificial intelligence (AI) will become capable of replacing human beings in domains such as medicine rest implicitly on a theory of mind according to which knowledge can be captured propositionally without loss of meaning. Generative AIs, for example, draw upon billions of written sources to produce text that most likely responds to a user's query, according to its probability heuristic. Such programs can only replace human beings in practices such as medicine if human language functions similarly and, like AI, does not rely on meta-textual resources to convey meaning. In this essay, I draw on the hermeneutic philosophy of Hans-Georg Gadamer to challenge this conception of human knowledge. I follow Gadamer in arguing that human understanding of texts is an interpretive process relying on previously received judgments that derive from the human person's situatedness in history, and these judgments differ from the rules guiding generative AI. Human understanding is also dialogical, as it depends on the 'fusion of horizons' with another person to the extent that one's own prejudices may come under question, something AI cannot achieve. Furthermore, artificial intelligence lacks a human body, which conditions human perception and understanding. I contend that these non-textual sources of meaning, which must remain obscure to AI, are important in moral practices such as medicine, particularly in history-taking, physical examination, diagnostic reasoning, and negotiating a treatment plan. Although AI can undoubtedly aid physicians in certain ways, it faces inherent limitations in replicating these core tasks of the physician-patient relationship.

This essay considers the idea of 'representation' and pain in neuroscience, continental philosophy, and analytic philosophy. To do so, it considers two forms of representation: linguistic representation refers to how words stand in for experiences or things, while mental representation involves the mind's internal depiction of external reality. First, I consider how the question of pain may be conveyed as a question of representation through the McGill Pain Quotient. I then turn to phenomenology to consider how pain cuts straight through representation. Pain is simultaneously an extra-mental experience and an introspective phenomenal experience involving the affect of pain and the social expression of that affect. But to illustrate how pain lacks intention, I consider how the term 'representation' in the neuroscience on cognitive empathy for pain obfuscates the affective ontology of pain experiences. Linguistic expression of pain may suggest belief and representational data, while the phenomenological experience centers around the affective and embodied. Ultimately, the response to pain plays out in social acknowledgement, and both linguistic and mental representation offer necessary but insufficient understandings of ethical acknowledgement. To that end, neuroethics can offer naturalist, physicalist grounds to affirm both the analytic and continental theses about pain and language.

Public bioethics aims to provide moral guidance on questions of public policy, research, and clinical ethics. However, Alasdair MacIntyre famously opened his seminal work, After Virtue, with a 'disquieting suggestion' that contemporary moral language is in such a state of disorder that securing authoritative moral guidance will not be possible. In Ethics After Babel, Jeffrey Stout responds to MacIntyre's pessimistic description of contemporary moral discourse by developing the idea of moral bricolage, which involves taking stock of the ethical questions that need answering, the available conceptual resources at hand from a variety of traditions (e.g., philosophies, theologies, law), and then reworking them to create a solution. In this essay, we draw upon MacIntyre's insight about tradition and Stout's metaphor of moral bricolage to argue that some works of bioethical consensus are appropriately described as works of moral bricolage that, when analyzed, reveal theoretical insights about an emerging tradition of secular bioethics.

The prospect of shared decision-making with animals is an elusive one. Its elusiveness comes largely from how difficult it is to assess the linguistic abilities of animals, whether that be their ability to 'speak' or their ability to maintain propositional values. In this paper, I suggest a path to shared decision-making with animals that attempts to avoid these deadlocks by using resources from biosemiotics and Umwelt theory. I begin with an examination of the general structure of decision-making, demonstrating its future-orientation, comparison of imagined futures, and assessment of what things matter to participants in decision-making. Animals' capability of having things matter to them, due to their residence in Umwelten, offers a means to shared decision-making with animals via a process I call 'imaginative adjuncting.'

This essay asks what quality of moral guidance is offered via the language of principlism, the lingua franca of bioethics. In particular, I suggest three approaches to principlist language via Kant, Rawls, and Wittgenstein. A 'top down' Kantian view of language would seem to offer 'pure' or 'crystalline' moral guidance as autonomy, beneficence, non-maleficence, and justice function as linguistic links to draw us towards universal values up or out there to engage. While drawing upon Rawls, Beauchamp and Childress differ importantly by citing a universal morality grounded in reflective equilibrium amongst citizens. Principlism, hence, possesses a democratic form where the common morality depends upon a historically consistent majority position; what is 'universal' arises from political 'bottom up' discourses and processes. Wittgenstein, however, offers a notably different view of language that embraces the mystical and aesthetic realities of 'the ethical' while also affirming the grounding of language in everyday contexts. Not unlike the Stoics, language for Wittgenstein is ascetic in that it is a practice, a formative exercise that reveals the humility of language as an immanent 'game' that should nevertheless inspire one towards 'the ethical.'

The language of principlism seems to have emerged as the predominant guiding framework in teaching, research and even legislation within contemporary Chinese bioethics. This essay reveals the dissonance between the individualistic orientation of this theoretical language and the familist features of Chinese clinical practice by considering the principle of respect for autonomy and its discordance with the Confucian tradition of virtue ethics and medical rituals. Several representative clinical cases in mainland China are presented to illustrate the incongruity between the current state of Confucian medical rituals and the language game of the principle of respect for autonomy. While there is a recognized need in contemporary Chinese medical practice to promote patient involvement in decision-making in the cases of terminal illness, we argue that this approach should be implemented in alignment with Confucian virtue ethics and medical rituals. Resolving the linguistic discordance between Chinese bioethics and principlism should not entail a shift towards principlism.