Theoretical medicine and bioethics最新文献

Orthorexia nervosa is defined as an exaggerated and obsessive fixation on healthy eating. In recent years, there has been growing debate over whether orthorexia nervosa should be considered a new psychiatric disorder. This paper discusses the conceptual issues that emerge from the attempt to identify the diagnostic criteria for orthorexia nervosa as opposed to non-pathological cases of healthy eating or 'healthy orthorexia'. The analysis focuses on two main strategies that have been proposed in the literature: using physical impairment (malnutrition) and having recourse to the presence of psychological and psychosocial distress. The first strategy requires fundamental changes in the conceptualization of orthorexia nervosa, while the second risks unacceptably pathologizing uncommon lifestyles devoted to pursuing one specific activity, interest, or plan. Thus, substantial problems undermine the possibility of considering orthorexia nervosa, as it currently stands, as a plausible nosographic category. By proposing an analogy with eco-anxiety, the paper lastly shows that, if one accepts the widespread conceptualization of orthorexia nervosa, this behavior is better interpreted as an adaptive response than as a form of mental disorder.

In response to the increasingly acknowledged physical, emotional, and psychological challenges of medical education, 'wellness' initiatives have been widely instituted. While the idea of 'wellness' represents a well-intentioned effort to mitigate these stressors, we argue that this notion lacks the moral and philosophical grounding to allow students and trainees to thrive and, on its own, cannot serve as a sufficient goal for medical education reform efforts. We propose the neo-Aristotelian concept of 'flourishing' as a better overarching goal for undergraduate and graduate medical education to pursue in their efforts to better equip their students amidst the challenges of medical school and residency training.

Buford first criticizes my 2019 paper by relying upon a view about the permanence of death that no one should hold as it makes death due to extrinsic features. The second criticism involves a description of cerebrum transplants that I don't accept. The continued existence of a transplanted cerebrum doesn't show that the whole brain death criterion hasn't been met as the brainstem-less person has gone out of existence and so no longer has a brain and thus trivially meets the whole brain criterion. Buford's third criticism is that a criterion should be helpful, doctors can make use of it, and legislators can enshrine it in law. I admit that criterion for the death of the person won't be useful when the person dies but animal remains. But the criterion of existence for the person will be met and one can infer from that the death criterion has been met.

When a patient lacks capacity, medical decisions on their behalf are made according to an advance directive or by surrogate decision making. Often, however, patients' previously expressed wishes are ambiguous, vague, inconsistent, or fail to anticipate the patient's current condition. In this paper, we argue that when patient's wishes are not clear, surrogates must utilize interpretative principles to reach a decision regarding treatment. We identify three such principles: the value-substitution, value-coherence, and volitional principles. We argue that the volitional principle is the most reliable way of capturing what the patient would have wanted when they no longer possess decisional capacity. This approach tasks the surrogate with identifying a medical choice close to what the patient would have agreed to based on previously expressed wishes without attributing the surrogate's own values to the patient or attempting to provide an interpretation consistent with the patient's other values. This approach is best positioned to support patients' sovereignty for those who were previously able to express wishes for or against life-sustaining treatment.

The ethics of anti-love drugs - pharmaceutical interventions to dampen one's feelings of love for, say, a former partner - have been the subject of a growing body of research. Scientific research on these drugs is fairly nascent and ethical debates about their implications are therefore by necessity largely speculative. Nonetheless, insofar as future developments in anti-love drugs propose to affect a value as personal and important as love, these ethical debates are imperative. In this article, I propose to add a new dimension to ethical discourse on anti-love drugs by contextualising it within existing ethical debates on precommitment. An agent who consumes an anti-love drug does so to limit their future behavior - i.e. preventing themselves from reigniting their former relationship-based on their present preferences. The use of anti-love drugs is therefore an unambiguous example of a precommitment strategy. This recognition therefore allows one to draw on existing ethical research on precommitment to invigorate ethical discourse on anti-love drugs.

It is often believed that withholding or withdrawing life-sustaining treatment is justifiable only when the patient's death is not intended. Also, in accordance with this belief, many argue that the justification of withholding/withdrawing life-sustaining treatment is an application of the doctrine of double effect (hereafter DDE). This paper aims to defend these accounts from some important criticisms. Baruch Brody maintains that most people intend the patient's death when they withhold/withdraw such treatments and that therefore, there are many cases of withholding/withdrawing treatment that are clearly justifiable but rendered unjustifiable by the accounts. Daniel P. Sulmasy asserts that withholding/withdrawing treatment rarely satisfies DDE's fourth condition (that the good effect of the act is proportionately greater than its bad effect) because the goodness of avoiding treatment burden seldom compares to the badness of shortening life. I examine these claims and show that they are mistaken. Central to the discussion in this paper is the idea that those who withhold/withdraw life-sustaining treatment often only intend to avoid the burdens posed by the treatment itself and not to shorten the patient's life. It will be argued that both Brody and Sulmasy are led to an erroneous conclusion because they fail to have an accurate understanding of this idea and its implications.

Narrative medicine has emerged over the past few decades as an exciting approach to medical practice, interweaving the practice of medicine with the practices of literary analysis and reflective writing. It is often claimed that narrative medicine enables practitioners to understand and empathize with patient stories, effectively 'joining' patients in illness. However, I argue that there are reasons to be suspicious of narrative medicine's ability to promote patient-centered care. I begin by questioning the distinctiveness of narrative knowledge, suggesting that it is neither able to be propositional knowledge ('knowledge-that') nor phenomenal/experiential knowledge ('knowledge-what-it's-like'). Then, I consider an alternative reading of narrative medicine, by which narratives are simply ways to structure patient information so that a physician can more readily empathize with the patient. I dismiss this alternative as unsatisfactory given that it depends on either all patients building narratives or physicians imposing narrative structure(s) where one does not inherently exist, thus overriding patients. Finally, I provide possible supplements and alternatives to narrative medicine, proposing that active listening and the removal of systemic barriers to physicians' abilities to provide humanistic care (e.g., lower administrative, profit, and documentation burdens) may be a first step to putting empathetic patient care on the forefront. Ultimately, I think that these efforts (while their fruition may present difficulty), rather than sifting through patient information to construct and elevate narratives, present the opportunity to accurately refocus patient-centered care.

The Exception from Informed Consent (EFIC) permits patient enrolment into therapeutic emergency research where obtaining informed consent is challenging. Yet this fails to resolve a core ethical conflict in the research and has generated controversy. This is because existing justification and practice has relied on applying EFIC per study-a wholesale permission to enroll irrespective of circumstance-instead of per patient. Our novel justification for enrolment centers on applying EFIC per patient, which empowers the enrolling clinician to judge whether to enroll patients with an Exception. This contrasts with the idea that clinician judgment is surplus to the judgements already made by institutions in deciding the research may proceed. Instead, we show that enrolling clinician's judgment is ethically significant and should not be overlooked: attending to this strengthens the research ethically and reduces controversy. There should be a bigger role for the clinician in the research enrolment space.