Theoretical medicine and bioethics最新文献

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.

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.

Virtue-based ethics prioritizes phronesis (practical wisdom) because, as rules have become less action-guiding, good judgment (phronesis) becomes more necessary as a guiding meta-virtue. The view of phronesis that MacIntyre proposed in After Virtue (hereafter, AV phronesis) has been applied in medical ethics despite his substantial deviations from his source (Aristotle) in After Virtue. In this paper, we clarify the differences between the neo-Aristotelian and AV phronesis views and argue for a neo-Aristotelian phronesis with four functions (constitutive, adjudicative, emotion regulative, and blueprint). In referring to neo-Aristotelians, we refer to the recent scholars that who hark back strongly to Aristotle and have amended some of Aristotle's less palatable views by adding insights from current empirical science to the domains that he left vague. Then we discuss how AV phronesis and neo-Aristotelian phronesis differ, focusing on the distinction between technical (i.e., alterable means toward patient health such as medication choices) and phronetic (i.e., actions that are inseparable from patient health) actions in medicine. This distinction is understated in AV phronesis, but central to neo-Aristotelian phronesis. Accordingly, the neo-Aristotelian approach makes an important and unique contribution to physician ethical development.

In Dobbs v. Jackson, the Supreme Court found that 'the Constitution does not confer a right to abortion.' Rather, individual states must determine whether a right to abortion exists. Following Dobbs, state abortion laws have diverged significantly. This has generated confusion over what the law permits. Consequently, some pregnant women reportedly have not received timely treatment for life-threatening conditions. Clear guidance on abortion policy is essential, therefore, since continued confusion risks lives. Sweeping calls to improve patient access to abortion will not provide clear guidance, however, since 'abortion' is defined differently across jurisdictions. In fact, there are six variables to consider when defining 'abortion': (1) the definition of 'pregnancy,' (2) whether prescribing abortifacients counts as an abortion, (3) whether abortion successfully terminates pregnancy, (4) whether abortion has some characteristic intention, (5) whether providers must know that they likely will harm fetuses, and (6) whether providers must know that their patients are pregnant. States address each variable differently, so 'abortion' means different things across jurisdictions. One may respond that legislators are solely to blame for confusion here, since medical experts, by contrast, possesses a clear definition of 'abortion.' Not so. 'Abortion' is defined inconsistently throughout the medical literature too. As such, both legal and medical domains would benefit from careful discussions of 'abortion.' Attending to the six variables identified here is a good starting place. In this essay, I suggest how best to think about each and propose a definition of 'abortion' well-suited for developing clear abortion policy in a polarized society.