Research question and aim Clinical Ethics Committees (CECs) aim to support healthcare professionals (HPs) and healthcare organizations to deal with the ethical issues of clinical practice. In 2020, a CEC was established in an Oncology Research Hospital in the North of Italy. This paper describes the development process and the activities performed 20 months from the CEC’s implementation, to increase knowledge about CEC’s implementation strategy. Research design We collected quantitative data related to number and characteristics of CEC activities carried out (...) from October 2020 to June 2022 using the CEC internal database. Data were reported descriptively and compared with data from the literature to provide a complete overview of the CEC’s development and implementation process. Participants and research context The study has been conducted at the local health authority (LHA) of Reggio Emilia. It is a report of the activities provided by the CEC, where no HPs or patients were involved. Ethical Considerations The report is part of a larger study named EVAluating a Clinical Ethics Committee implementation process (EvaCEC), which has been approved by the Local Ethics Committee (AUSLRE Protocollo n° 2022/0026554 of 24/02/2022). EvaCEC is also the first author's PhD project. Findings In total, the CEC performed 7 ethics consultations (EC), published three policies related to particular ethical questions of clinical and organizational practice, provided one educational online course on ethics consultation targeting employed HPs, and promoted a specific dissemination process among the different departments of the LHA. According to our results, the CEC widely fulfilled the standard threefold set of clinical ethics support services tasks (namely, ethics consultation, ethics education, and policy development), but further investigations are needed to evaluate the CEC’s impact on clinical practice. Conclusion Our findings may increase knowledge regarding the composition, role, and tasks of a CEC in an Italian setting, informing future strategies and efforts to regulate these institutions officially. (shrink)

Volume 25, Issue 2, February 2025, Page 87-90.

Volume 25, Issue 2, February 2025, Page 36-38.

In this remarkable book Michel Foucault, one of the most influential thinkers of recent times, calls us to look critically at specific historical events in order to uncover new layers of significance.

There is a palpable malaise in American medicine as clinical practice veers off its moorings, swept along by a new commercialism that is displacing medical professionalism and its attendant moral obligations. Although the sociology of this phenomenon is complex and multifactorial, I argue that this move toward medical commercialism was accelerated by the abortive efforts of the Clinton Administration's Health Security Act. Through an analysis of performative speech I show that, although the Clinton plan drew on many strands of speech (...) about healthcare, it favored the discourse of health policy and health economics over that of clinical practice and professionalism. Though the Clinton plan failed, this new vocabulary of health economics has led us to imagine a new descriptive framework, which has commodified healthcare and commercialized the clinic. (shrink)

The article reconsiders the nature and location of science in the development of genetic classification. Drawing on field studies of medical genetics, we explore how patient categorization is accomplished in between the clinic and laboratory. We focus on dysmorphology, a specialism concerned with complex syndromes that impair physical development. We show that dys-morphology is about more than fitting patients into prefixed diagnostic categories and that diagnostic process is marked by moments of uncertainty, ambiguity, and deferral. We describe how different (...) forms of evidence are brought into play and how patterns of physical features are identified as genetic or not. We suggest that clinical categorical work helps articulate the genetic as an emergent domain of medical classification and that moments of ambiguity and deferral create an imperative space that helps legitimate the need for more technoscience, and consequently, more clinical judgment with which to fix the genetic future. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Talking Cures, the Clinic, and the Value of the IneffableDaniel Berthold (bio)KeywordsMadness, disease, the normal, the abnormal, the ineffable, Hegel, Kierkegaard, LacanI am most grateful to my readers, James Phillips and Louis Sass, who have led me to several new insights by suggesting ways of complicating my reading of a Lacanian approach to Hegel's and Kierkegaard's conceptions of madness. I am a Kierkegaard and Hegel scholar, with very (...) little pretense to expertise about Lacan and regrettably even less about the theory and practice of psychiatry. In submitting my essay to Philosophy, Psychiatry, & Philosophy, I was hoping to entice a community of practitioners and theoreticians I have great respect for to consider the musings of a philosopher on topics which engage them as thinkers and actors in their professions. I could not possibly have hoped for more intelligent and provocative replies than I have been given by my two respondents.Phillips' framing of his response in terms of the distinction between the "madness of the philosophers" and the "madness of the clinic" is very helpful. It is a distinction that is indeed central to the question of the possibility of dialogue between philosophers and clinicians—so central, in fact, that it is generous of Phillips not to reproach me for failing to mention it. On the one hand, the challenge for philosophers is to show that their descriptions are not merely metaphoric and that their preoccupation with the dark side of human experience connects in some way with the reality of disease, so that there is some way for clinicians to translate their language into the language of psychiatry. Otherwise, philosophers will have only poetic or literary interest for the psychiatrist or psychologist.On the other hand, the challenge for clinicians is the extent to which they are open to moving beyond a reduction of "mental illness" to a purely biological conception of disease. One needn't go so far—nor should we—as Thomas Szasz or Michel Foucault in seeing "mental disease" as itself merely a metaphor. But granting the evidence of underlying organic disorder, symptoms nevertheless display themselves as mental and behavioral states (what Hegel calls "shapes of consciousness") that, as Hegel argued, are paralleled in "normal" experience, so that the distinction between disease and normality (and hence illness and metaphor) is often elusive. Madness "has the healthy consciousness for its presupposition," Hegel writes, because the healthy mind is still grappling with the same sorts of contradictions and feelings of alienation, the same "infinite pain" which characterizes insanity. Madness is not the absolute "other" of rationality, but an echo of it (1978, 3:382, 408).Hegel himself accepted the medicalization of madness that began to occur in the late eighteenth [End Page 325] century, and rejected the metaphysical and theological categories of what was called "romantic medicine." But he also cautioned against the narrowness of the "somatic" school which he felt lacked sufficient explanatory value if not connected to a "speculative" (i.e., philosophic) framework (see Berthold-Bond 1995, ch. 2).It might even be argued that every person seeking therapy is first of all suffering from "philosophic" madness, at least in the sense that initially she does not understand her own suffering as "disease," but experiences her torment in the vocabulary of the philosopher. Thus the philosopher's descriptions are the closest to the subject's own self-understanding, and while the therapist must seek to rephrase these descriptions into the vocabulary of the clinic (just as Hegel, for example, translated his own philosophic description of the madness of his friend Hölderlin in the Phenomenology as the "lost soul" whose "light dies away within it" into the medical category of Wahnsinn—mania or frenzy, which today we would call schizophrenia—in the classificatory scheme of mental disorder he gives in the Encyclopaedia; 1977, 400; 1978, 408)—there is a real question about which vocabulary is a metaphor for the other.The second main point Phillips addresses, which is taken up in different ways by Sass as well, has to do with the relation between speech and silence in madness. Phillips finds that Kierkegaard offers a more complex and subtle view than... (shrink)

In conjunction with the growing feminist literature on pregnancy and visualization, this paper uses Foucault’s The Birth of the Clinic to demonstrate how the effort to make the interior of the pregnant body visible in medical discourse was a crucial part of the development of the modern medical gaze. In doing so I develop two concurrent arguments. First, I argue that the pathological corpse of the Clinic can conceptually serve as a double for the pregnant body as it (...) emerged in modern medicine in the 20th century. At the same time I use the insights of the Clinic to illustrate changes in pregnancy from early modernity to the 20th century. In early modernity, the pregnant body was understood in terms of generation, as a tree that bears fruit; by the 19th century, the pregnant body was a machine that reproduced the species. This transition can be seen in the overlap of pathology and pregnancy in early modernity, an overlap that continued throughout the 19 century and is inadvertently reinforced through the practice of ultrasound. (shrink)

Mental disorders in university students are very frequent, therefore higher education institutions have established in-campus mental healthcare centres. These clinics have particular characteristics that differ from other mental health centres, as they report to and represent an educational institution, while at the same time looking after the interests and well-being of patients requesting assistance, thus generating unique bioethical conflicts. Ethics Committees are useful tools to offer support to mental health professionals in making ethical decisions. In order to respond to these (...) issues, it was decided that an Ethics Committee would be created in the mental health clinic of a private university in Mexico City. This article describes the implementation process for this Committee, its duties and scope, as well as the case work and review methodology. A list of the most frequent ethical conflicts is attached, jointly with the ethical analysis of the cases treated throughout the year and a half or work by the Committee. (shrink)

Using the theoretical constructs “biographical disruption” and “limit experience” and also methodological frameworks from autoethnography and discourse analysis, we discuss the divergent ways in which language and healing are conceptualized and performed, first in an American medical clinic and then by traditional healers in Kwara‘ae (Solomon Islands). Discourses at the Dallas clinic draw on allopathic and complementary medicine and in emphasizing a scientific approach to talk about illness and treatment, were found to create ambiguity in patients’ sense of (...) their physical and metaphysical identities. In contrast, Kwara‘ae healing involves disappearing into silence, in which the physical and metaphysical are never separated, and where healing occurs. (shrink)

Mayo Clinic is recognized as a worldwide leader in innovative, high-quality health care. However, the Catholic mission and ideals from which this organization was formed are not widely recognized or known. From partnership with the Sisters of St. Francis in 1883, through restructuring of the Sponsorship Agreement in 1986 and current advancements, this Catholic mission remains vital today at Saint Marys Hospital. This manuscript explores the evolution and growth of sponsorship at Mayo Clinic, defined as “a collaboration between (...) the Sisters of St. Francis and Mayo Clinic to preserve and promote key values that the founding Franciscan sisters and Mayo physicians embrace as basic to their mission, and to assure the Catholic identity of Saint Marys Hospital.” Historical context will be used to frame the evolution and preservation of Catholic identity at Saint Marys Hospital; and the shift from a “sponsorship-by-governance” to a “sponsorship-by-influence” model will be highlighted. Lastly, using the externally-developed Catholic Identity Matrix (developed by Ascension Health and the University of St. Thomas, Minnesota), specific examples of Catholic identity will be explored in this joint venture of Catholic health care institution and a secular, nonprofit corporation (Mayo Clinic). (shrink)

Due to their financial incentive, clinicians who earn income from a firm that markets medical devices, pharmaceuticals, tests, etc. might inappropriately prescribe their products or services. The Cleveland Clinic’s conflict of interest (CI) policy creates rules governing clinicians who accept compensation from outside firms that market products they prescribe or use in their practice (hereafter, covered financial relationships). The CI policy is implemented by the Innovation Management and Conflict of Interest Program (IM&COI) (hereafter the Committee).

Death in the Clinic fills a gap in contemporary medical education by explicitly addressing the concrete clinical realities about death with which practitioners, patients, and their families continue to wrestle. Visit our website for sample chapters!

This article reflects on the assumption underlying the argument of Little et al. that "contested understandings" in the clinic are susceptible to reconciliation within a liberal framework described as "pragmatic pluralism". It is argued that no such reconciliation is possible or desirable because it is of the nature of the clinic that it provides a forum for multiple voices, ethical and cultural perspectives, and conceptual frameworks, and this is the source of its fecundity and creativity. Medicine itself cannot (...) be represented by a single discourse, precisely because it is itself an unruly collection of practices that, despite their heterogeneity, are able to engage in productive dialogues with each other. The heteroglossia of the clinic, therefore, is not a problem to be overcome. Rather, it is a rich resource to be mobilized in accordance with its multiple inherent purposes. (shrink)

The programme of physicians and surgeons during the ‘late’ phase of the Paris Hospital incorporated efforts to codify the most efficient ways of defining disease. Those efforts involved reckoning the probability, the specificity, and most consistently, the localization of disease entities. One of the most frequently encountered of such entities was pleuritis. Pleuritis is therefore used here as a ‘marker’ through which to investigate how Auguste Chomel and others carried forward the programme of codification. A conspicuous feature of that programme (...) was a highly ritualized system of pedagogical organization in the clinique médicale. (shrink)

Death in the Clinic fills a gap in contemporary medical education by explicitly addressing the concrete clinical realities about death with which practitioners, patients, and their families continue to wrestle. Visit our website for sample chapters!

The social interface between reproductive medicine and embryonic stem cell research has been investigated in a pilot study at a large IVF clinic in central China. Methods included observation, interviews with hospital personnel, and five in-depth qualitative interviews with women who underwent IVF and who were asked for their consent to the donation of embryos for use in medical (in fact human embryonic stem cell) research. This paper reports, and discusses from an ethical perspective, the results of an analysis (...) of these interviews. The participants talked of extreme social pressure to become pregnant. Once they had a baby, ‘spare’ embryos lost practical significance due to the Chinese one-child policy. In the context of decision making about donating embryos to research, the women used the clinical distinctions between ‘good and bad quality’ embryos and also between frozen and transferred embryos, as guiding moral distinctions. In the absence of concrete information about what sort of research their embryos should be used for, the women interviewed either refused consent (for fear that the embryo would be given to another couple) or accepted, expressing motives of solidarity with other women in a similar situation. This reveals that they filled the knowledge gap with an image of research improving fertility treatment. (shrink)

A traditional approach to teaching medical ethics aims to provide knowledge about ethics. This is in line with an epistemological view on ethics in which moral expertise is assumed to be located in theoretical knowledge and not in the moral experience of healthcare professionals. The aim of this paper is to present an alternative, contextual approach to teaching ethics, which is grounded in a pragmatic-hermeneutical and dialogical ethics. This approach is called moral case deliberation. Within moral case deliberation, healthcare professionals (...) bring in their actual moral questions during a structured dialogue. The ethicist facilitates the learning process by using various conversation methods in order to find answers to the case and to develop moral competencies. The case deliberations are not unique events, but are a structural part of the professional training on the work floor within healthcare institutions. This article presents the underlying theory on ethics and illustrates this approach with an example of a moral case deliberation project in a Dutch psychiatric hospital. The project was evaluated using the method of responsive evaluation. This method provided us with rich information about the implementation process and effects the research process itself also lent support to the process of implementation. (shrink)

Russell articulates compelling reasons that bioethicists and health care professionals should take individual responsibility for deconstructing structural injustices in healthcare through in...

Philosophers and others have questioned whether or not expertise in morality is possible. This debate is not only theoretical, but also affects the perceived legitimacy of clinical ethicists. One argument against moral expertise is that in a pluralistic society with competing moral theories no one can claim expertise regarding what another ought morally to do. There are simply too many reasonable moral values and intuitions that affect theory choice and its application; expertise is epistemically uniform. In this article, we discuss (...) how similar concerns have recently threatened to undermine expertise in medicine and science. In contrast, we argue that the application of values is needed to exercise medical, scientific, and moral expertise. As long as these values are made explicit, worries about a pretense to authority in the context of a liberal democracy are ill-conceived. In conclusion, we argue for an expertise that is epistemically diverse. (shrink)

This paper explores the wartime creation of veterinary expertise in cattle breeding, and its contribution to the transition between two very different types of agriculture. During the interwar period, falling prices and steep competition from imports caused farmers to adopt a ‘low input, low output’ approach. To cut costs, they usually butchered, marketed or doctored diseased cows in preference to seeking veterinary aid. World War II forced a greater dependence on domestic food production, and inspired wide-ranging state-directed attempts to increase (...) agricultural output. However, the weak connection between veterinary services and livestock productivity meant that the drive for greater milk yields did not automatically translate into a demand for improved veterinary health care. Rather veterinary expertise had to be actively created and made relevant to the new context. Leaders of the profession secured this goal through establishing a government-backed ‘scheme for the control of certain diseases of dairy cows’. Drawing on pre-existing but rarely applied reproductive technologies, the scheme provided the opportunities and education necessary for more extensive veterinary interventions in cattle breeding. I show how its operation transformed understandings of fertility, raised veterinarians to the status of experts, won them the patronage of farmers and the state, and facilitated the shift to a productivity-oriented agriculture. (shrink)

Contemporary debate suggests that the new genetics may be changing ideas about the body and what it is to be human. Specifically, there are notions that the new genetics seems to erode the ideas that underpin modernity, such as the figure of the integrated, discrete, conscious individual body-self. Holding these ideas against the practices of genetic medicine, however, this article suggests a quite different picture; one that does not erase, but helps to keep in play, some crucial tenets of humanism. (...) The article examines how the genetic clinic constructs clinical pictures as new forms of portraiture: assemblages in which multiple and heterogeneous images of bodies and their parts are juxtaposed. Rather than these portraits just making the distributed and hybrid nature of personhood explicit, shifts in ground mean that what is being portrayed is the possibility of a ‘syndrome–genotype’ relation. At first sight this appears as a straightforward geneticization of the body and the unravelling of the figure of the individual. But the article illustrates how, at the same time as the portraits of syndrome–genotypes are made up of many heterogeneous parts, the clinic still keeps in play an idea of persons that remains, unlike their bodies, much more than the sum of their parts. All the parts that make up the body of the person can still, at moments, be transcended, to refigure the human: the complex individual of humanist thought. (shrink)

Drawing on a historical ethnography of how Brazil’s post-dictatorial psychiatric reforms have shaped young people’s lives, this paper builds on Eve Sedgwick’s analysis of the hermeneutics of suspicion to show that narrow applications of Foucault’s biopower concept nurture forms of resistance to bio-reductionism centred primarily on epistemic deconstruction. To unsettle this hermeneutic, I put young people’s theories of power into conversation with Georges Canguilhem’s concept of the milieu and with feminist scholars’ work on prefigurative politics. I introduce the concepts of (...) threading and unthreading to consider how one subject of biopower, the child-like biobehavioural figure, was continuously being threaded within a specific milieu and in relation to another key figure: the elite angst-ridden ‘storm-and-stress’ adolescent. Young people’s subsequent unthreading and reweaving politics, flourishing in co-construction with what I call the politicizing clinic, illustrate how decolonial pedagogies can incrementally change the patterning of social life. (shrink)

Beginning with a rumination on the AIDS-inspired poetry of Thom Gunn, this article by the guest editors introduces the special issue of the Journal of Medical Humanities titled “Queer in the Clinic.” After providing an overview of the historical legacy and contemporary dilemmas of LGBTQ persons in biomedical practice, the authors describe the rationale of the issue and the contributions included.

Negrete brings together women writers and artists known for their formal experimentation to show that "the aesthetic experiences afforded by their work are underwritten by a tenacious and uniquely feminine ethics of desire."-- taken from back cover.

This commentary examines the experiences of medical interpreters through a collection of narratives exploring the complex interplay of language, culture, and power dynamics within the healthcare setting reported by medical interpreters. By analyzing themes of power differentials, language barriers, and vulnerability, this commentary highlights the critical role of interpreters in bridging communication gaps and advocating for patient needs. In addition, this commentary explores the personal and professional challenges faced by interpreters, emphasizing the impact of working conditions on interpretation quality. This (...) commentary contributes to a deeper understanding of the experiences of medical interpreters and underscores the importance of supporting their work to improve patient care and health outcomes. (shrink)

Put relationship-centered communication at the forefront of care Today, physicians face a hypercompetitive marketplace in which they must meet unique and complex patient needs as efficiently as possible. But in a culture prioritizing clinical outcomes above all, there can be a tendency to lose sight of one of the most critical aspects of providing effective care: the communication skills that build and foster physician-patient relationships. Studies have shown that good communication between doctors and patients and among all caregivers who interface (...) with patients directly results in better clinical outcomes, reduced costs, greater patient satisfaction, and lower rates of physician burnout. In Communication the Cleveland Clinic Way, Dr. Adrienne Boissy and her team tell the story of how Cleveland Clinic created and applied the R.E.D.E. to Communicate: Foundations of Healthcare program, making the world-renowned hospital system a leader in relationship-centered care. They provide a step-by-step guide for healthcare leaders and decision-makers to design, develop, and implement communication skills training in their own institutions. Learn how to: • Craft an effective, colleague-supported communication skills program to include veteran physicians, residents, and medical students • Leverage creative program design and data transparency to engage and facilitate staff physicians and advanced care providers • Identify common misperceptions and myths in healthcare communication and respond to them successfully • Cultivate a true sense of empathy—with patients and fellow caregivers alike—while maintaining professionalism In a field where difficult conversations and stressful relationships are commonplace, clinicians need a structured approach to enable them to deliver the best care possible. Communication the Cleveland Clinic Way is the blueprint for establishing a relationship-centered program that will improve patient experience, reinvigorate doctors’ passion for their work, and elevate any organization. (shrink)

Since its foundation in 2010, the annual philosophy thematic edition of this journal has been a forum for authors from a wide range of disciplines and backgrounds, enabling contributors to raise questions of an urgent and fundamental nature regarding the most pressing problems facing the delivery and organization of healthcare. Authors have successfully exposed and challenged underlying assumptions that framed professional and policy discourse in diverse areas, generating productive and insightful dialogue regarding the relationship between evidence, value, clinical research and (...) practice. These lively debates continue in this thematic edition, which includes a special section on stigma, shame and respect in healthcare. Authors address the problems with identifying and overcoming stigma in the clinic, interactional, structural and phenomenological accounts of stigma and the ‘stigma-shame nexus’. Papers examine the lived experience of discreditation, discrimination and degradation in a range of contexts, from the labour room to mental healthcare and the treatment of ‘deviancy’ and ‘looked-after children’. Authors raise challenging questions about the development of our uses of language in the context of care, and the relationship between stigma, disrespect and important analyses of power asymmetry and epistemic injustice. The relationship between respect, autonomy and personhood is explored with reference to contributions from an important conference series, which includes analyses of shame in the context of medically unexplained illness, humour, humiliation and obstetric violence. (shrink)

Studies of drug development have described the role of clinical trials in the selection of drug profiles. This article presents a case study of the development of hormonal drugs in the 1920s and 1930s to illustrate that clinical trials have a more extensive role than is assumed. Clinical trials are instrumental in mediating the relationships between the pharmaceutical industry, the laboratory, and the clinic, resulting in a network of actors collectively creating medical knowledge, drugs, and markets for these drugs.

This paper challenges the presumed triumph of laboratory life in the history of twentieth-century biomedical research through an exploration of the relationships between laboratory, clinic, and field in the regional understanding and treatment of allergy in America. In the early establishment of allergy clinics, many physicians opted to work closely with botanists knowledgeable about the local flora in the region to develop pollen extracts in desensitization treatments, rather than rely upon pharmaceutical companies that had adopted a principle of standardized (...) vaccines beholden to bacteriology that gave no thought to the particularities of place where their products were to be sold. Natural historical sciences like plant ecology and systematics furnished important knowledge, resources, and practices in establishing a medical marketplace for allergy in America. And botanists similarly profited from biomedicine and allergic bodies in extending their network of knowledge about the plant world. (shrink)

Paltrow, Harris, and Marshall argue that the reversal of Roe will impact all pregnant persons, not only those who wish to terminate a pregnancy. I agree that these consequences ar...

In the last fifteen years, testing has attracted much attention in science and technology studies. Most researchers have focused almost exclusively on testing in the laboratory, specifically designed test locations, and, for medical technologies, the clinic. What counts as testing has largely been described in terms of the activities of scientific experts. This is not to say that science and technology studies have completely neglected other institutional discourses. Journalistic texts have been a favorite research site for scholars in science (...) and technology studies, particularly those seeking to understand the dynamics of public controversies on science and technology. Although most constructivist studies of science and media relations have treated journalistic texts as secondary to scientific texts, other scholars have dismissed this hierarchy. In this article, scientific texts and journalistic texts are considered equally important locations in which to analyze the testing of technologies. Based on a case study on the testing of a new contraceptive technology for men, the article shows that what counts as successful testing is not solely in the hands of scientific experts. In the case of male contraceptive technologies, journalists have contested the claims of scientific experts, particularly their claims about the cultural feasibility of the new technology. (shrink)

Background It has been well documented that patients can feel abused in health care and that many patients suffer from these experiences. Insight lacks into contributing factors behind such events. Silence surrounding the abuse has been suggested as a possible mechanism. The present study explores silence surrounding the abuse as a possible contributing factor. We have explored whether this silence is connected with the staff’s hierarchical position and with the staff’s own experiences as patients abused in health care. Methods During (...) January 2008, a paper questionnaire was sent to all staff members at a Swedish women’s clinic. The questionnaire included questions on sociodemography and profession and multiple questions about abuse in health care. After univariate testing, a binary logistic regression model including variables concerning profession and staff’s own experiences of abuse was built. Results Our data show that in contrast to midwives and gynaecologists, auxiliary nurses seldom report hearing about cases of abuse in health care. Staff who themselves experienced abuse in health care as patients, so-called wounded healers, were more likely to have heard about abuse in health care during the last 12 months. Conclusions This study suggests that a form of silence reigns over events of abuse in health care that is not randomly distributed over staff. Professional hierarchies and staff’s own experiences of abuse as patients could be considered in the design of interventions to break the silence surrounding patients’ experiences of abuse in health care. (shrink)

Making good decisions in extremely complex and difficult processes and situations has always been both a key task as well as a challenge in the clinic and has led to a large amount of clinical, legal and ethical routines, protocols and reflections in order to guarantee fair, participatory and up-to-date pathways for clinical decision-making. Nevertheless, the complexity of processes and physical phenomena, time as well as economic constraints and not least further endeavours as well as achievements in medicine and (...) healthcare continuously raise the need to evaluate and to improve clinical decision-making. This article scrutinises if and how clinical decision-making processes are challenged by the rise of so-called artificial intelligence-driven decision support systems (AI-DSS). In a first step, this article analyses how the rise of AI-DSS will affect and transform the modes of interaction between different agents in the clinic. In a second step, we point out how these changing modes of interaction also imply shifts in the conditions of trustworthiness, epistemic challenges regarding transparency, the underlying normative concepts of agency and its embedding into concrete contexts of deployment and, finally, the consequences for (possible) ascriptions of responsibility. Third, we draw first conclusions for further steps regarding a ‘meaningful human control’ of clinical AI-DSS. (shrink)

American Academy of Pediatrics (AAP) and American College of Medical Genetics (ACMG) recently provided two recommendations about predictive genetic testing of children. The Clinical Sequencing Exploratory Research Consortium's Pediatrics Working Group compared these recommendations, focusing on operational and ethical issues specific to decision making for children. Content analysis of the statements addresses two issues: (1) how these recommendations characterize and analyze locus of decision making, as well as the risks and benefits of testing, and (2) whether the guidelines conflict or (...) come to different but compatible conclusions because they consider different testing scenarios. These statements differ in ethically significant ways. AAP/ACMG analyzes risks and benefits using best interests of the child and recommends that, absent ameliorative interventions available during childhood, clinicians should generally decline to order testing. Parents authorize focused tests. ACMG analyzes risks and benefits using the interests of the child and other family members and recommends that sequencing results be examined for additional variants that can lead to ameliorative interventions, regardless of age, which laboratories should report to clinicians who should contextualize the results. Parents must accept additional analysis. The ethical arguments in these statements appear to be in tension with each other. (shrink)

This paper develops previous work on theories of embodiment by drawing on empirical data from a study into the experiences of infertile women in the UK. I suggest experiences of embodiment shape the preferences of infertile women for a female nurse as chaperone during intimate medical procedures. I explore the impact of this role on the understandings and meanings of nursing in a highly gendered field of practice. I present data from an ethnographic study of infertile women who chose to (...) attend a British infertility clinic for investigation and fertility treatment cycles. Data were collected over 2 years using participant observation and semistructured interviews with 15 women and 20 members of staff in a British fertility unit. Data analysis was completed using a modified thematic analysis following Boyle and McEvoy. I discuss women's experiences of intimacy and bodily care and how these experiences might be understood by exploring the phenomenological concept of embodiment. I argue that women benefit from having a female nurse as chaperone because of their expectations of gender, nursing and caring. Women's expectations reinforce both notions of gendered caring and the gendered role of nursing. These data challenge notions of patriarchal professionalism prevalent in nursing, which seek to move away from the gendered role of the nurse (which traditionally included a chaperone role) towards a model of professional development based on a mind–body split. I suggest that these data offer a way of understanding the female embodied subject in the field of gendered caring, which is potentially transgressive because they suggest ways in which both mind and body can be integrated through the role of the female chaperone. (shrink)

This short essay provides an overview of the Visual Studies section of the special issue “Queer in the Clinic.” Addressing the impact of visual culture on queer experiences in the clinic, the author offers thoughts on the graphic artwork of Edie Fake and Brain Cremins’s essay included in this issue. Arguing that contemporary and historical visual assessments of the LGBTQ clinical subject are vital contributors to queer bioethical debates, she explains relevant concepts such as “radical somatic transformation,” “the (...) nature of bodily possibility,” and Walter Benjamin’s “world of secret affinities.”. (shrink)