In their article, Nielsen Busch and Mjaaland defend the moral permissibility of cDCD, suggesting that much of the controversy around this donation practice has been the result of a misinterpretatio...

Experts in medical informatics have argued for the incorporation of ever more machine-learning algorithms into medical care. As artificial intelligence research advances, such technologies raise the possibility of an “iDoctor,” a machine theoretically capable of replacing the judgment of primary care physicians. In this article, I draw on Martin Heidegger’s critique of technology to show how an algorithmic approach to medicine distorts the physician–patient relationship. Among other problems, AI cannot adapt guidelines according to the individual patient’s needs. In response to (...) the objection that AI could develop this capacity, I use Hubert Dreyfus’s analysis of AI to argue that attention to the needs of each patient requires the physician to attune his or her perception to the patient’s history and physical exam, an ability that seems uniquely human. Human physician judgment will remain better suited to the practice of primary care despite anticipated advances in AI technology. (shrink)

Pellegrino and Thomasma have proposed a normative medical ethics founded on a conception of the end of medicine detached from any broader notion of the telos of human life. In this essay, I question whether such a narrow teleological account of medicine can be sustained, taking as a starting point Pellegrino and Thomasma’s own contention that the end of medicine projects itself onto the intermediate acts that aim at that end. In order to show how the final end of human (...) life similarly alters intermediate ends, such as the end of medicine, I describe Thomas Aquinas’s concept of pain and explain how his remedies for pain derive from his account of the telos of human life. In turn, this account has implications for the way in which physicians who accept such a telos would manage their patients’ pain. If a comprehensive telos for human life is necessary to make sense of even such a routine aspect of medical care, then medical ethicists may not be able to sidestep questions about the good life for human beings. (shrink)

Whereas bioethicists generally consider medicine a practice aimed at the individual good of each patient, in this paper I present an alternative conception of the goods of medicine. I first explain how modern liberal political theory gives rise to the predominant view of the medical good and then contrast this understanding of politics with that of Thomas Aquinas, informed by Aristotle. I then show how this Christian politics is implicit in certain aspects of contemporary medical practice and argue that Christians (...) ought to draw more attention to this point in order to direct medicine toward the common good. (shrink)

The predominant approach of public health experts to cigarette smoking might be described as behaviorist, for it aims to eliminate this behavior without attending to human agency and intention. The requirement that physicians address smoking cessation at every patient visit also constitutes physicians as “managers” who focus narrowly on technical means to achieve predetermined ends. In this paper, I contrast such an approach with the Aristotelian tradition, according to which physician and patient ought to develop the virtue of temperance that (...) would allow the patient to quit smoking. Although this model could potentially mitigate medicine’s behaviorist-managerial tendencies, I follow Aristotle to argue that it requires a moral friendship in which participants share a conception of the human good and pursue that good together. Due to the intractable moral pluralism that characterizes contemporary life, physicians and patients are unlikely to achieve this sort of friendship, making Aristotelian medicine impracticable at present. (shrink)

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. (shrink)