Darwin's Hypothesis Nonviolence Samsara The Noble Road to the Eight Virtues Respect for Life The Infinite, the Absolute, the Eternal The Will The Narrow Door The Author 127 127 128 130 131 131 132 132 135 ...

Medical trainees should learn from the actions of Nazi physicians to inform a more just contemporary practice by examining the subtle assumptions, or moral orientations, that led to such heinous actions. One important moral orientation that still informs contemporary medical practice is the moral orientation of elimination in response to suffering patients. We propose that the moral orientation of presence, described by theologian Stanley Hauerwas, provides a more fitting response to suffering patients, in spite of the significant barriers to enacting (...) such a moral orientation for contemporary trainees. (shrink)

Speakers of different languages perceive time differently depending on various factors such as age, pace of life, religion, time of day, and even pregnancy. In recent years, studies have shown that...

In her article, Lee vouches for a reciprocity-based approach that supports an ethics of inclusion in precision medicine research and accounts for participants’ values and experiences of the...

Complementary and alternative medicine is becoming increasingly popular in western countries, with estimates of CAM usage as high as 40%. This has prompted a change of attitude of the medical establishment: the initial dismissal of CAM is being replaced by a drive to integrate CAM into the mainstream. Two possible explanations for this integration thrust are considered. Firstly, integration could be motivated largely by cognitive interest in CAM. Secondly, integration could be mainly power-driven, aimed at controlling the alternative movement and (...) exploiting its capacity to make money. The second explanation seems more plausible, and is supported by data showing the paucity of research on CAM. The medical establishment does not sufficiently appreciate the challenge CAM poses, and does not consider its scientific appraisal to be a high priority. Instead, the allopathic community seems preoccupied with the opportunistic desire to protect its authority and social status. Such a discourse can become dogmatic, reluctant to revise critically the ‘accepted’ body of knowledge. Popper's critical rationalism could help to undercut dogmatism and encourage a critical, open-minded orientation of medical science. (shrink)

This study focuses on issues related to living organ donation for transplantation in Bangladesh. The policy and practice of living organ donation for transplantation in Bangladesh is family-oriented: close relatives (legal and genetic) are the only ones allowed to be living donors. Unrelated donors, altruistic donors (directed and non-directed), and paired/pooled or non-directed altruistic living donor chains—as many of these are implemented in other countries—are not legally allowed to serve as living donors in Bangladesh. This paper presents normative arguments explaining (...) why the family-oriented nature of regulations and practices surrounding living organ donation for transplantation is essential for Bangladesh. In this article, I specifically argue that if the Bangladesh government revises the current biomedical policy robustly beyond relatives and allows unrelated donors to donate organs legally, this may foster organ selling due to the poverty and corruption problems in Bangladesh. The family-oriented requirement of the living organ donation policy and practice is defensible and morally justifiable as it preserves common notions of the family unit and family bonding in Bangladesh. Maintaining the current living-donation regulations and promoting deceased donation is the way forward, as this safely preserves the family values, protects against organ selling, and increases access to organ transplantation. (shrink)

This article is a reply to two critics of my “Prediction, Understanding, and Medicine,” published elsewhere in this journal issue. In that essay, I argued that medicine is best understood not as essentially a curative enterprise, but rather as one essentially oriented towards prediction and understanding. Here, I defend this position from several criticisms made of it.

Current societal changes and challenges demand a broader role of technological universities, thus opening the question of how their role evolved over time and how to frame their current responsibility. In response to urgent calls for debating and redefining the identity of contemporary technological universities, this paper has two aims. The first aim is to identify the key characteristics and orientations marking the development of technological universities, as recorded in the history of engineering education. The second aim is to articulate (...) the responsibility of contemporary technological universities given their different orientations and characteristics. For this, we first provide a non-systematic literature review of the key pedagogical orientations of technological universities, grounded in the history of engineering education. The five major orientations of technological universities presented in the paper are technical, economic, social, political, and ecological. We then use this historical survey to articulate the responsibilities of contemporary technological universities reflecting the different orientations. Technological universities can promote and foster the development of scientific, professional, civic, legal, or intra- and inter- generational responsibility. We argue that responsibility is not specific to any particular orientation, such that the concept is broadened to complement each orientation or mix of orientations of a technological university. Our contribution thus serves as a call for technological universities to self-reflect on their mission and identity, by offering a lens for identifying the orientations they currently foster and making explicit the responsibility arising from their current orientation or the ones they strive to cultivate. (shrink)

The move to patient-centered medical practice is important for providing relevant and sustainable health care. Narrative medicine, for example, suggests that patients should be involved significantly in diagnosis and treatment. In order to understand the meaning of symptoms and interventions, therefore, physicians must enter the life worlds of patients. But physicians face high patient loads and limited time for extended consultations. In current medical practice, then, is narrative medicine possible? We argue that engaging patient perspectives in the medical visit does (...) not necessarily require a lengthy interview. Instead, a new orientation to this process that emphasizes dialogue between practitioners and patients should be considered. In this new model, the purpose of the visit is to communicate successfully and develop a mutual understanding of illness and care. (shrink)

The term ‘environment’ is not uniformly defined in the public health sciences, which causes crucial inconsistencies in research, health policy, and practice. As we shall indicate, this is somewhat entangled with diverging pathogenic and salutogenic perspectives (research and policy priorities) concerning environmental health. We emphasise two distinct concepts of environment in use by the World Health Organisation. One significant way these concepts differ concerns whether the social environment is included. Divergence on this matter has profound consequences for the understanding of (...) health and disease, for measures derived from that understanding targeting health promotion and disease prevention, and consequently, for epistemic structures and concept development in scientific practice. We hope to improve the given situation in public health by uncovering these differences and by developing a fruitful way of thinking about environment. Firstly, we side with the salutogenic conception of environment as a _health resource_ (as well as a source of health risks). Secondly, we subdivide the concept of environment into four _health-oriented environmental categories_ (viz., natural, built-material, socio-cultural, and psychosocial) and we link these with other theoretical notions proposed in the health sciences literature. Thirdly, we propose that in public health ‘environment’ should be understood as consisting of all extrinsic factors that influence or are influenced by the health, well-being, and development of an individual. Consequently, none of the four categories should be excluded from the concept of environment. We point out the practical relevance and fruitfulness of the conception of environment as a health source and frame this in causal terms, representing _individual health environments_ as causal networks. Throughout, we side with the view that for the design of human health-promoting settings, increased attention and consideration of environmental resources of salutogenic potential is particularly pressing. (shrink)

Loneliness in medicine is a serious problem not just for patients, for whom illness is intrinsically isolating, but also for physicians in the contemporary condition of medicine. We explore this problem by investigating the ideal physician-patient relationship, whose analogy with friendship has held enduring normative appeal. Drawing from Talbot Brewer and Nir Ben-Moshe, we argue that this appeal lies in a dynamic form of companionship incompatible with static models of friendship-like physician-patient relationships: a mutual refinement of embodied virtue that draws (...) both persons together. The ideal physician-patient relationship has a dialectical character that fosters each member's improvement of phenomenologically recognizing and embodying moral virtues. A key component of this dynamic is a commitment to the common goal of the patient's health, realized through joint interactivities and conversations over time. The physician's presence to the patient's suffering—understood best as an alienating phenomenological condition for the patient—orients and discloses possibilities for virtuous caregiving by structuring the meanings of the goals, conversations, and joint narrative constitutive of their relationship. Presence to suffering, paradoxically, is perhaps an important prerequisite for this dynamic partnership. These activities dialectically build an interpretive horizon of understanding through which moral goods and character refinement—in and for the other—may become revealed for both persons in their shared being-in-the-world. This analysis of suffering, mood, and revealing of (possible) moral goods has implications for addressing the modern problem of loneliness for patients and physicians, who are increasingly inhibited from building flourishing relationships with each other. (shrink)

Definition of the problemThe upcoming reforms according to the specifications of the Master Plan 2020 provide for a competency-oriented restructuring of medical studies. This article aims to develop perspectives on how teaching ethics in medical studies can be more strongly oriented at building competencies. In this way, it pursues the goal of making the concept of competency more tangible for medical ethics and usable for the design of medical ethics education.ArgumentsWe understand competencies as dispositions for actions that enable problem solving. (...) By transferring the concept of moral intelligence to the moral actions of physicians in patient care, we specify five ethical–moral competencies that must be present for morally appropriate, ethically reflected actions by future physicians: (1) the ability to form a professional moral compass, (2) the willingness to align oneself with professional ethical norms and values, (3) the ability to perceive moral dimensions of medical action, (4) the ability to make moral judgments based on ethical considerations about the right action, and (5) the willingness to realize ethically justified action. We illustrate their importance for teaching medical ethics using the example of teaching clinical ethics in medical studies.ConclusionOur conceptualization of moral–ethical competencies can be used to design concrete courses in a competency-oriented way. Our approach could be applied analogously to other areas of teaching ethics in health care. (shrink)

Novel Medicine: Healing, Literature, and Popular Knowledge in Early Modern China. By Andrew Schonebaum. Seattle: University of Washington Press, 2016. Pp. viii + 283. $50.

This paper presents the newly rediscovered ‘Syriac Galen Palimpsest’. The manuscript has been subjected to the latest imaging techniques, which has allowed scholars to identify its undertext as containing a Syriac translation of Galens Book of Simple Drugs. After discussing the history, imaging and identification of the manuscript, we proceed to consider its significance for our understanding of the transmission of Greek medical lore in Syriac and Arabic, for which the Book of Simple Drugs serves as a convenient model. Several (...) common misconceptions,regarding the Syriac medical traditions are addressed, including the assumed inferiority of the Syriac translations, compared to the Arabic ones, and the role of Syriac as an intermediary between Greek and Arabic. (shrink)

This article discusses some aspects of the practice of complementary and traditional medicine in urban Mexico through a transcultural paradigm, hence it focuses on how medical knowledge(s) are commodified as well as how a `travelling' medical knowledge acquires agency in a transculturation process. This study, while analysing different practices of Chinese and Japanese medicine, argues that oriental medicine is translated in at least two ways - a popular and a cosmopolitan form - that shape particular expressions of citizenship. The (...) popular form is carried out in low-income neighbourhoods and it focuses around a `Mexicanization' of oriental medicine and the reaffirmation of the popular as part of the national. Cosmopolitan medicine, on the other hand, is particularly practised in exclusive health spas and seeks to purge the popular out of the national and to incorporate `traditional' medicine as one of the multiple components of cosmopolitan consumption. The article argues that both popular and cosmopolitan expressions are important to understanding how complementary and oriental medicine have become not only part of a global market, but also part of a particular history of national and popular medical systems. (shrink)

How should one think about innovation in medicine and surgery? Increasingly, the answer to this question has involved reference to what might be called the regulatory ethics paradigm (REP). The regulatory ethics paradigm holds that deviations from standard care involve a degree or kind of experimentation that requires the application of a set of procedures designed to assure the protection of the rights and welfare of the subjects of research. In REP, innovative treatments are regarded as questionable until they are (...) framed in a research protocol with formal mechanisms of informed consent. The protocol must be reviewed and approved by an Institutional Review Board (IRB) or equivalent. The regulatory ethics paradigm in effect imposes the condition that clinical innovations be conducted according to scientific research methodologies. It creates the presumption that without review by an IRB, innovation cannot be conducted in an ethically defensible fashion. The regulatory ethics paradigm also requires the preparation of investigational protocols according to sound evidentiary and methodological standards. In so doing, it creates a presumption that innovations that are not rigorously validated are ethically dubious. These assumptions have deep roots. The Belmont Report, for example, articulated the orienting intuition that “radically new procedures... should... be made the object of formal research at an early stage [emphasis added] in order to determine whether they are safe and effective”.1 The Belmont Report takes the view that formal research to establish safety and efficacy of new interventions is usually feasible at an early stage in the development of a novel intervention. It thus establishes a bias that innovative treatments be conducted and evaluated under a research protocol that has passed muster at an IRB review. Given the …. (shrink)

Francis Collins had an impressive track record as a gene hunter (cystic fibrosis, neurofibromatosis, Huntington’s disease) when he was appointed Director of the Human Genome Project (HGP) in 1993. In June 2000, together with Craig Venter and President Bill Clinton, he presented the draft version of the human genome sequence to a worldwide audience during a famous press conference. And in 2009, President Barack Obama nominated him as director of the National Institutes of Health (NIH), the largest Tfunding agency for (...) biomedical research in the world. s The In 2006, Collins published his book The Language of God,3 an autobiographical account of the HGP and its scientific, historical, and societal significance, with special attention paid to the impact of the human sequence on the way we see our world and ourselves.4 Now, by way of a sequel, he has written The Language of Life. Wherea Language of God focused on the genome sequence of mankind in general, and on the HGP as a “revolution” in biomedicine, the new book, as indicated by its subtitle, is oriented towards “the revolution in personalized medicine”, the impact of the genomics revolution on the personal lives of individuals. Before subjecting Collins’ book to a closer reading, I first of all would like to explain how I will read it and from what perspective. Why is genomics in general, and the HGP and its aftermath in particular, a subject of interest to a philosopher like me? Why did I become interested in assessing the HGP and in studying the work and views of some of its key contributors? (shrink)

Karl E. Rothschuh is one of the most important,but, on an international scale, relativelyunknown representatives of German philosophy ofmedicine in the 20th century. This paperpresents and discusses his central conceptssystematically, especially those ofanthropology, theories of health and disease.Rothschuh distinguishes two methodologicalapproaches to anthropology: a causal analysisthat considers human organism as complex causalsystems, and a so-called bionomicalinvestigation that clarifies the meaning orfunction of single processes in respect to thewhole organism. These two perspectivescomplement each other. From a naturalisticpoint of view, Rothschuh conceptualisesdiseases (...) as disorganisatorial or disbionomic processes;nevertheless, he stresses the culturalinterweavement, and, hence, the normativefoundation of diseases. ‘Disease’ is both arelational and a gradual term: It can beexperienced and conceptualised subjectively bypatients (aegritudo), clinically byphysicians (nosos, pathos) and bysociety (insalubritas). Further,Rothschuh differentiates between the verydefinition, a notion and a concept ofdisease. Because of the normative character ofdisease, medicine cannot be a science strivingfor pure theoretical knowledge like physics orchemistry. Medicine is a practical science,oriented towards its goals of healing. Becauseof the societal position of medicine, Rothschuhdescribes it as task (Aufgabe). Withregard to modern developments in philosophy ofmedicine, this paper discusses Rothschuh’stheories critically and offers somestarting points for necessary enhancements. (shrink)

According to recent approaches in the philosophy of medicine, biomedicine should be replaced or complemented by a humanistic medical model. Two humanistic approaches, narrative medicine and the phenomenology of medicine, have grown particularly popular in recent decades. This paper first suggests that these humanistic criticisms of biomedicine are insufficient. A central problem is that both approaches seem to offer a straw man definition of biomedicine. It then argues that the subsequent definition of humanism found in these approaches is problematically reduced (...) to a compassionate or psychological understanding. My main claims are that humanism cannot be sought in the patient–physician relationship alone and that a broad definition of medicine should help to revisit humanism. With this end in view, I defend what I call an outcomes-oriented approach to humanistic medicine, where humanism is set upon the capacity for a health system to produce good health outcomes. (shrink)

Precision medicine promises to develop diagnoses and treatments that take individual variability into account. According to most specialists, turning this promise into reality will require adapting the established framework of clinical research ethics, and paying more attention to participants’ attitudes towards sharing genotypic, phenotypic, lifestyle data and health records, and ultimately to their desire to be engaged as active partners in medical research.Notions such as participation, engagement and partnership have been introduced in bioethics debates concerning genetics and large-scale biobanking to (...) broaden the focus of discussion beyond individual choice and individuals’ moral interests. The uptake of those concepts in precision medicine is to be welcomed. However, as data and medical information from research participants in precision medicine cohorts will be collected on an individual basis, translating a participatory approach in this emerging area may prove cumbersome. Therefore, drawing on Joseph Raz’s perfectionism, we propose a principle of respect for autonomous agents that, we reckon, can address many of the concerns driving recent scholarship on partnership and public participation, while avoiding some of the limitations these concept have in the context of precision medicine. Our approach offers a normative clarification to how becoming partners in precision is compatible with retaining autonomy.Realigning the value of autonomy with ideals of direct engagement, we show, can provide adequate normative orientation to precision medicine; it can do justice to the idea of moral pluralism by stressing the value of moral self-determination: and, finally, it can reconcile the notion of autonomy with other more communitarian values such as participation and solidarity. (shrink)

유교는 인간을 능동적, 주체적 존재로 인식하고, 사회와 대인관계에서 질서와 조화를 유지하는 것도 자신의 문제로 돌린다. 특히 그 유발 조건이 외부 상황에 달려 있어서, 스스로 수양하는 데 방해가 되는 희노애구애오욕(喜怒哀懼愛惡欲)의 칠정(七情)은 적극 억제하고 조절해야 한다고 본다. 한편 에 처음 제시된 사단으로 대표되는, 인의체득 및 실천과 관련된 타인 중심적 정서 또는 규범 중심적 정서들이다. 중용에서는 감정이 드러나지 않은 상태를 중(中)으로 보고, 그것이 드러나 상황에 맞는 것을 화(和)라고 하였다. 이 때 욕(欲)은 중에서 화로 전환하는 추진체가 되며, 호오(好惡)는 본체를 가동시키는 선택적 시스템인 것이다. 인간은 (...) 늘 호오(好惡)의 중간에서 선택을 강요받으며 살아간다. 이러한 정서적 기재가 자신의 지향에 순기능적으로 작용할 때 행복해지고, 역기능적으로 작동할 때 스트레스를 받는 것이다. 스트레스에 반응하는 방어시스템이 있는데 이것이 반복, 공고화되는 과정에서 신경증적 병리현상으로 나타난다. 한의학과 유교 입론의 차이는 한의학이 몸(精,氣)과 마음(精神)의 유기적 조화관계를 추구한다면, 유교는 인간의 마음 속 깊은 혼성(靈性,理性)에 발원한 ‘정신자아(精神自我)’가 ‘육체자신(肉體自身)’으로 연결되는 과정에 사단(四端)이 적연부동(寂然不動)하게 청기(淸氣)를 타고 인격으로 나타난다는 차이가 있다. 이 때 우리가 파악할 수 있는 단서는 측은(惻隱), 수오(羞惡), 사양(辭讓), 시비(是非)의 마음이다. 이 4가지는 각기 내-외,주-객,나-남,보편-특수의 대대(待對)성을 지니고 있다. 유교의 마음수련은 영[魂]-사단과 혼[魄]-칠정의 지속적인 피드백 과정이라고 할 수 있는데, 이 때 칠정은 이미 내장된 감각소여(感覺所與)의 영향 하에 동정(動靜)의 동기(動機)를 수행하게 된다. 그러므로 사단에서 발원한 정서는 도심(道心)적 동기에 편승하여 형상적 이데아(良知,良心)를 드러내게 되는 것이다. 유교철학의 핵심인 중용은 정도(正道)를 향한 철학적 노력으로 지행합일을 지향한다. 학문(學問)과 사변(思辨)을 통해 정리된 인지적 체계가 사건(事件)과 사물(事物)에 진지하게 반영될 때 중용에서 추구하는 성(誠)을 이루는 것이다. ‘성(誠)’은 천명을 일컫지만 인간과 사회의 관계 속에서 다양한 이치로 변모한다. ‘성’은 천리가 인간과 연결되는 법칙, 원칙, 도리로서 유교적 인간이해의 기본이자 수양을 통해 도달하려는 최고의 경지이기도 하다. 유교에서 성인군자가 되려면, 천성을 가리거나 천리에 반하는 점을 지속적인 제거하여 도덕의 영역이 확장되게 하는 자기극복의 노력이 수반되어야 한다.[克己復禮]이런 논리적 틀에서 하늘이 부여한 본연성을 잘 드러내는 것이 근본적 문제해결법으로 본다. 유교의 사단(四端) 중 지(智,知)는 시비지심(是非之心)이라 한다. 이는 판단력과 결정력을 말하는데 인지심리학이 중요시하는 점이다. 현대인은 결정하지 못하는 갈등으로 스트레스가 쌓이고 결국 정신질환으로 확대될 개연성이 높아졌다. 행동의 근거로서의 사고력과 판단력을 기르고, 도덕정서에서 의지를 통해 분출되는 성격과 행동이 건강한 정체성으로 자리매김하는데 철학의 역할이 요구된다. (shrink)

The development of the philosophy of medicine in the Federal Republic of Germany since 1945 is presented in a thematic form. The first two decades were characterized by the evolution of an anthropological school of thought that aimed at relating physician and patient in a more personal and existential form than had hitherto been the case. In the last years, this tendency to demand deeper psychic and broader social involvement with medical problems had increased. Somatic disorders were considered to be (...) fundamentally caused by socially induced mental stress. After a brief period during which the theme of organisms in general and phenomenologically grasped living-body of human beings in particular were discussed, there followed since the mid-seventies an essential preoccupation with the methodology and epistemology of medicine. According to this trend, medicine is to be analyzed in terms of the theory of action, with its conceptual and strategic orientation towards practice and not, as generally believed, towards the standards of scientific truth. The concepts of disease, diagnosis and therapy are therefore relative and their validity is dependent on time, persons and circumstances involved. Thus, the highest criteria of utility for medical actions cannot but be the affected patient and society. (shrink)

In der Diskussion über Ökonomisierung im Gesundheitswesen werden oft wesentliche Begriffsunterscheidungen außer Acht gelassen. Um feststellen zu können, in welchem Fall die Rede von Ökonomisierung oder Ökonomismus im negativen Sinn angemessen ist, muss zwischen dem Gesellschaftsbereich Wirtschaft und der ökonomischen Dimension in allen Gesellschaftsbereichen (wie dem Gesundheitswesen) unterschieden werden. Es muss geklärt werden, wo ökonomische Ziele verfolgt werden sollen und wo andere Ziele mit ökonomischen Mitteln verfolgt werden sollen. Im Blick auf die Frage nach einer Marktsteuerung des Gesundheitswesens ist zu (...) unterscheiden zwischen dem Gut Gesundheit und Gesundheitsgütern sowie zwischen öffentlichen, privaten und meritorischen Gütern. Außerdem ist die Frage nach einer Marktsteuerung des Gesundheitswesens zu unterscheiden von der Frage nach der Verwendung marktwirtschaftlicher Instrumente zur Steuerung des Umgangs mit bestimmten Gesundheitsgütern durch den Staat. Erst diese begrifflichen Differenzierungen können zu einer angemesseneren Beurteilung der komplexen wirtschaftsethischen Fragen jenseits von wirtschaftsfeindlichen oder ökonomistischen, von marktfeindlichen oder marktradikalen Ideologien führen. (shrink)

A growing body of literature explores the intersection of eating disorders and identity formation—an entanglement that makes eating disorders particularly challenging to treat. Narrative medicine is a discipline of the health humanities that is interested in bearing witness to patients’ stories with a closeness and rigor that enhances clinical care. The pedagogy of the field is the narrative medicine workshop, which mobilizes close-reading of works of art and reflective writing to improve our understanding of Self and Other. Narrative medicine workshops (...) can be a compelling tool in enhancing the care of eating disorders by helping patients and their providers embrace uncertainty and challenge a singular narrative of illness. We facilitated parallel workshop series for patients and providers at a residential eating disorder treatment center and conducted qualitative interviews with four patients and three staff participants. Through a close read of participants’ accounts, we constructed three themes: Phenomenology of Illness, Phenomenology of Change, and Orientation to Treatment. Group participants shared how workshops illuminated the embodied experience of eating disorders, fostered agency, and provided a sense of recognition and belonging. Providers particularly expressed newfound allyship with patients. This study highlights the value of narrative medicine workshops in shifting a patient’s perspectives towards treatment and in promoting a patient-as-partner approach in the treatment of eating disorders—outcomes that situate the pedagogy of narrative medicine as a promising supplement to traditional eating disorder treatment. (shrink)

The article provides an overview of important topics in contemporary medical ethics. Methodologically, it is a literature review. The article addresses only a limited selection of the problematic areas, which are, however, related to each other: digitisation of medicine, genome editing, personalised medicine as well as ethical problems and dilemmas of allocation in healthcare. The global COVID-19 pandemic has emerged as a focus and trigger. Reflections on human rights and justice in medicine are fundamental not only on the individual and (...) social level but also on a global scale. The fundamental question is how society as a whole can be involved in the complex biopolitical and bioethical debate. The social and cultural consequences of life increasingly being understood as a technical product rather than a gift are serious.Contribution: The article also reflects on the specific contribution that Christian theology, and in particular the reformed heritage, can make to bioethical debates in modern society. The distinction between instrumental knowledge [Verfügungswissen] and orientational knowledge [Orientierungswissen] is helpful for its better understanding. A crucial result of this article is that medical treatment is repeatedly faced with ethical dilemmas. Moreover, medical progress not only creates new and better solutions to medical problems, it also raises new ethical questions that did not exist before. The purpose of medical ethics lies in identifying such dilemmas and developing ethical decision-making processes that help us to deal with such dilemmas to some extent. (shrink)

In recent years, Confucian ethics has been considered as an alternative to the individual-oriented model of medical decision-making that is dominating in the modern West.

The medical profession’s increasing acceptance of “physician aid-in-dying” indicates the ascendancy of what we call the provider-of-services model for medicine, in which medical “providers” offer services to help patients maximize their “well-being” according to the wishes of the patient. This model contrasts with and contradicts what we call the Way of Medicine, in which medicine is a moral practice oriented to the patient’s health. A steadfast refusal intentionally to harm or kill is a touchstone of the Way of Medicine, one (...) unambiguously affirmed by Christians through the centuries. Moreover, physician aid-in-dying contradicts one of the distinctive contributions that the Christian era brought to medicine, namely, a taken-for-granted solidarity between medical practitioners and those suffering illness and disability. Insofar as medical practitioners cooperate in aid-in-dying, they contradict this solidarity and undermine the trust that patients need to allow themselves to be cared for by physicians when they are sick and debilitated. (shrink)

Mark Geller is well known to everyone in his field and, unsurprisingly, his Festschrift is a bulging volume of contributions—from thirty-four scholars in a variety of different specialties. Like most Festschriften, it is of uneven quality, but there are some very fine articles, including useful text editions and offerings that raise interesting scholarly questions. Although there is nothing here on economics, there are articles that engage historical and/or anthropological questions, exegetical issues, and matters of composition of literary texts, including one (...) offering on Akkadian grammar. None of these would be expected from a volume entitled Mesopotamian Medicine and Magic, but their presence is a testimony to the very broad interests of the honoree. (shrink)

This paper argues that data-driven medicine gives rise to a particular normative challenge. Against the backdrop of a distinction between the good and the right, harnessing personal health data towards the development and refinement of data-driven medicine is to be welcomed from the perspective of the good. Enacting solidarity drives progress in research and clinical practice. At the same time, such acts of sharing could—especially considering current developments in big data and artificial intelligence—compromise the right by leading to injustices and (...) affecting concrete modes of individual self-determination. In order to address this potential tension, two key elements for ethical reflection on data-driven medicine are proposed: the controllability of information flows, including technical infrastructures that are conducive towards controllability, and a paradigm shift towards output-orientation in governance and policy. (shrink)

Accepting as a given that the humanities disciplines are not product or “results” driven, this paper argues that the core of an interdisciplinary field of medicine and humanities, or medical humanities, is an interpretive enterprise that is not readily open to quantitative assessment. A more humanistically oriented medical practice can derive, however, from the process that produces new insights and works toward the development of a new, mutually shared, and humanizing language.

This paper considers the question of whether the explanation of homosexual orientation offered by Sigmund Freud qualifies as a genuine explanation, judged by the criteria of the social sciences. It is argued that the explanation, namely that homosexual orientation is a function of atypical parental influences, is indeed an explanation of the kind found in the social sciences. Nevertheless, it is concluded that to date Freud's hypotheses about homosexuality are no more than unproven speculations. Also considered is the question of (...) whether the very topic of homosexuality falls or ought to fall within the domain of medical inquiry. CiteULike Connotea Del.icio.us What's this? (shrink)

Precision medicine and molecular systems medicine (MSM) are highly utilized and successful approaches to improve understanding, diagnosis, and treatment of many diseases from bench-to-bedside. Especially in the COVID-19 pandemic, molecular techniques and biotechnological innovation have proven to be of utmost importance for rapid developments in disease diagnostics and treatment, including DNA and RNA sequencing technology, treatment with drugs and natural products and vaccine development. The COVID-19 crisis, however, has also demonstrated the need for systemic thinking and transdisciplinarity and the limits (...) of MSM: the neglect of the bio-psycho-social systemic nature of humans and their context as the object of individual therapeutic and population-oriented interventions. COVID-19 illustrates how a medical problem requires a transdisciplinary approach in epidemiology, pathology, internal medicine, public health, environmental medicine, and socio-economic modeling. Regarding the need for conceptual integration of these different kinds of knowledge we suggest the application of general system theory (GST). This approach endorses an organism-centered view on health and disease, which according to Ludwig von Bertalanffy who was the founder of GST, we call Organismal Systems Medicine (OSM). We argue that systems science offers wider applications in the field of pathology and can contribute to an integrative systems medicine by (i) integration of evidence across functional and structural differentially scaled subsystems, (ii) conceptualization of complex multilevel systems, and (iii) suggesting mechanisms and non-linear relationships underlying the observed phenomena. We underline these points with a proposal on multi-level systems pathology including neurophysiology, endocrinology, immune system, genetics, and general metabolism. An integration of these areas is necessary to understand excess mortality rates and polypharmacological treatments. In the pandemic era this multi-level systems pathology is most important to assess potential vaccines, their effectiveness, short-, and long-time adverse effects. We further argue that these conceptual frameworks are not only valid in the COVID-19 era but also important to be integrated in a medicinal curriculum. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Précis of Microaggressions in MedicineLauren Freeman (bio) and Heather Stewart (bio)Microaggressions in Medicine demonstrates that the harms of microaggressions are anything but micro. Guided by diverse patient testimonies and case studies, the book focuses on harms experienced by patients who are marginalized on the basis of race, gender, sexual orientation, body size, and disability. It amplifies their voices, stories, and experiences, which have too often been excluded from mainstream (...) bioethical, medical, and popular discussions. The novel account advanced in Microaggressions in Medicine illustrates that microaggressions in medicine are not rare, but frequent in the healthcare experiences of marginalized patients. Our hope is that the book helps patients better understand and make sense of their experiences. We also hope that it helps current and future healthcare professionals recognize the serious and enduring consequences that microaggressions can have on their patients. Finally, it introduces actionable strategies for healthcare professionals to reduce microaggressions in their practices and institutions.Microaggressions in Medicine argues that healthcare professionals have a moral obligation to prevent microaggressions as much as possible. It aims to make a positive difference in the lives of marginalized patients as they interact with medical practitioners and institutions. It also aims to support healthcare professionals in modifying their practices to ensure that they are always providing high-quality, patient-centered care to all patients. Its ultimate goal is to help increase health equity.More specifically, the book has two broad goals: one theoretical, one practical. The theoretical goal is to reconceptualize how microaggressions have been understood in the literature and to develop this new account within medical contexts. The practical goal is to provide healthcare professionals with a greater understanding of the serious and enduring consequences that microaggressions can have on members of marginalized patient groups and to introduce strategies and tools to help healthcare professionals reduce microaggressions experienced [End Page 142] by patients, thereby diminishing harm caused to patients. To set the context for the critical responses to follow, we briefly summarize each chapter of the book, highlighting the main arguments and novel contributions.Microaggressions can be defined as actions, gestures, or even material environments that subtly and often unintentionally harm members of marginalized groups. They are prevalent in medicine yet often go unnoticed by those who commit them. The introduction outlines the main problem with which the book engages: that there are subtle things that healthcare professionals commonly say and do to patients that do not register as serious to them yet that often cause major harms to patients in the short and long term. To set the stage to unpack this problem, we define what microaggressions are, provide examples of microaggressions in medical contexts, outline the aims and goals of the book, and explain key concepts (e.g., intersectionality, harm, structural oppression) that are necessary for understanding and engaging with the book's arguments. The introduction makes clear how and why a discussion of microaggressions in medicine is valuable to marginalized patients who want to better understand their own experiences interacting with healthcare professionals and institutions. It also underscores the book's value for healthcare professionals who want to improve their clinical interactions with marginalized patients and strategize about how to make their practices more inclusive, welcoming, and just.Chapter 1, "Microaggressions: A Brief History," provides a history of microaggressions. The term was coined in 1970 by a Black Harvard psychologist, Chester Pierce, to describe the "subtle blows" experienced by Black people that are not major or explicit yet that cause real harm. Although little was written about microaggressions for almost four decades, microaggressions gained traction in 2007 through the work of psychologist Derald Sue and his colleagues. We discuss Sue et al.'s work on microaggressions, tracing key revisions and developments the concept has undergone in the last fifteen years. The chapter also summarizes some of the main criticisms that have been launched against microaggressions and considers responses that have been offered. This chapter provides the groundwork for chapter 2, which lays out our novel critique of the dominant understanding of microaggressions. It also motivates our reconceptualization of microaggressions that unfolds over the remainder of the book.Chapter 2, "Microaggressions Reconsidered: A Critique of the Act-Based... (shrink)

The idea of personalised medicine (PM) has gathered momentum recently, attracting funding and generating hopes as well as scepticism. As PM gives rise to differing interpretations, there have been several attempts to clarify the concept. In an influential paper published in this journal, Schleidgen and colleagues have proposed a precise and narrow definition of PM on the basis of a systematic literature review. Given that their conclusion is at odds with those of other recent attempts to understand PM, we consider (...) whether their systematic review gives them an edge over competing interpretations. We have found some methodological weaknesses and questionable assumptions in Schleidgen and colleagues’ attempt to provide a more specific definition of PM. Our perplexities concern the lack of criteria for assessing the epistemic strength of the definitions that they consider, as well as the logical principles used to extract a more precise definition, the narrowness of the pool from which they have drawn their empirical data, and finally their overlooking the fact that definitions depend on the context of use. We are also worried that their ethical assumption that only patients’ interests are legitimate is too simplistic and drives all other stakeholders’ interests—including those that are justifiable—underground, thus compromising any hope of a transparent and fair negotiation among a plurality of actors and interests. As an alternative to the shortcomings of attempting a semantic disciplining of the concept we propose a pragmatic approach. Rather than considering PM to be a scientific concept in need of precise demarcation, we look at it as an open and negotiable concept used in a variety of contexts including at the level of orienting research goals and policy objectives. We believe that since PM is still more an ideal than an achieved reality, a plurality of visions is to be expected and we need to pay attention to the people, reasons and interests behind these alternative conceptions. In other words, the logic and politics of PM cannot be disentangled and disagreements need to be tackled addressing the normative and strategic conflicts behind them. (shrink)

There is a growing tendency for medicine to be used not to prevent or heal illnesses, but to fulfil individual personal wishes such as wishes for enhanced work performance, better social skills, children with specific characteristics, stress relief, a certain appearance or a better sex life. While recognizing that the subject of wish-fulfilling medicine may vary greatly and that it may employ very different techniques, this article argues that wish-fulfilling medicine can be described as a cohesive phenomenon with distinctive features. (...) Following a few examples of well established wish-fulfilling medical practices and a brief definition of the phenomenon, both theoretical aspects and ethical implications of such practices are discussed and the question is raised how wish-fulfilling medicine should be evaluated from an ethical point of view. It is concluded that modern medicine is currently ill equipped to provide reasons why wish-fulfilling medicine should be banned or discouraged. The phenomenon of wish-fulfilling medicine serves as a prime example of the vagueness of the descriptive and the lack of decisive orientation of the normative categories employed in modern medicine. (shrink)

ArgumentIn this article I describe the establishment and early development of an institution that is unique to the history of Chinese medicine – the Imperial Pharmacy (惠 民 藥 局). Established in 1076 during the great reforms of the Song dynasty, the Imperial Pharmacy was a remarkable institution that played different political, social, economic, and medical roles over the years of its existence. Initially it was an economic institution designed to curb the power of plutocrats who were manipulating medicinal drug (...) markets in their favor. A few decades later, I claim, the Imperial Pharmacy became a public-health-oriented institution focusing on selling readymade prescriptions in addition to simples. Various records, including local gazetteers and local maps, indicate that the Imperial Pharmacy expanded about a century after it was established to include dozens of branches throughout the empire. The Pharmacy's impact on the practices of physicians during these years is somewhat vague. It seems, however, to have posed an unwelcome addition to the medical scene, since it enabled uninitiated practitioners who relied on the Pharmacy's formulary to fit patients' symptoms to their own prescriptions and dispense medications with relative ease. (shrink)

It is argued that human needs are not facts (properties, states, processes, relations) about people, but are values. The reasons presented for this position are (1) that needs are goal oriented and goals are things people value, (2) that ‘need’ functions as a basic motivational term, and (3) that disagreements about what people need are disagreements in attitude toward, and emotional attachment to, things variously considered to be valuable. If human needs are not facts, then, of course, health or medical (...) needs are not. Viewing health or medical needs as discoverable facts, rather than values, engenders certain difficulties in the following areas of concern: (a) Deciding when surgery is necessary and when unnecessary; (b) Defining the concepts of health and disease; (c) Evaluating some consequences of the development of medical science and technology; and (d) Understanding the alleged conflict between patients' health needs and their human rights. CiteULike Connotea Del.icio.us What's this? (shrink)

Ethical dissonance arises from conflicts between beliefs or behaviors and affects ethical factors such as normality or conformity. This paper proposes a weak signal-oriented framework to investigate ethical dissonance from experiences linked to human–machine interactions. It is based on a systems engineering principle called human-systems inclusion, which considers any experience feedback of weak signals as beneficial to learn. The framework studies weak signal-based scenarios from testimonies of individual experiences and these scenarios are assessed by other people. For this purpose, the (...) framework proposes several databases as sources of weak signals, formalization tools of experience feedback of weak signals, models of references of conformity, ethical factors, and a list of examples of ethical dissonance. It also includes sequential steps to make the latter credible regarding the results from the experimental protocols. The framework was used to investigate ethical dissonance by analyzing experiences pertaining to achieving inclusive mobility. The first example focuses on ethical dissonance in terms of hindrance that goes against autonomous mobility due to a misunderstanding of how the system functions in terms of negative and positive emotions. Two other examples present possible ethical dissonance when the use of safety systems such as car driver-assistance systems, may create danger. Investigating ethical dissonance can then help system-inclusive design or evaluation processes by taking into account scenarios from weak signal-based experiences and making them credible. (shrink)

According to Aristotle, the medical art aims at health, which is a virtue of the body, and does so in an unlimited way. Consequently, medicine does not determine the extent to which health should be pursued, and “mental health” falls under medicine only via pros hen predication. Because medicine is inherently oriented to its end, it produces health in accordance with its nature and disease contrary to its nature—even when disease is good for the patient. Aristotle’s politician understands that this (...) inherent orientation can be systematically distorted, and so would see the need for something like the Hippocratic Oath. (shrink)

In this paper, I urge that the very real lessons Carol Gilligan's work in moral psychology offer to moral philosophy can best be appreciated if we take seriously the gap between the two disciplines. The care and justice perspectives Gilligan explores are psychological orientations, and orientations are defined as much by matters of emphasis, selectivity of interpretation, and gestalt as they are by propositional commitment. As such, I argue, their contribution to moral theory is best seen as stances from which (...) to do theory, rather than as constituting ready-made theories themselves. In pursuing this train of thought, I examine how Gilligan's work has developed over time and how, in the end, we should understand the juxtaposition between the two orientations. (shrink)

Fifty years ago, in 1961, Feinstein published his first path-breaking articles leading to his seminal work Clinical Judgement and to the establishment of clinical epidemiology. Feinstein had an Aristotelian approach to scientific method: methods must be adapted to the material examined. Feinstein died 10 years ago and few years before his death he concluded that efforts to promote a person-oriented medicine had failed. He criticised medicine for not having recognized that only persons can suitably observe, evaluate and rate their own (...) health status. Feinstein’s position was—as in Clinical Judgement—methodological. He didn’t espouse ethical principles. He pointed to methodological deficiencies in clinical epidemiology and evidence-based medicine. In this article we’ll provide a framework for understanding and justifying Feinstein’s call for a person-oriented medicine which recognizes patients as co-actors in clinical reasoning. It’s argued that craftsmanship and practical wisdom are integrated in clinical judgement and reasoning and that clinical reasoning is not only about means to achieve the end, health. We do also reason and deliberate about ends. The ‘defining end’ of medicine (health) has continuously been negotiated and so been the object of deliberation. For centuries among professionals, in recent years among professionals and patients. These negotiations and deliberations lead to ongoing specifications of health as a ‘guiding end’, i.e. an end guiding clinical reasoning about what to do in particular situations. Feinstein’s self-critical account to clinical epidemiology at the end of his professional career reflects the fact that patients during the last 30–40 years (i.e. in the period after the publication of Clinical Judgement) widely have been recognized as persons with rights to autonomy. Feinstein’s lesson is, however, that espousing and recognizing ethical ideals is not enough. A change of clinical practice and its methods is necessary. His critique also implies that clinical epidemiology and evidence-based medicine as practiced haven’t provided such a turn. (shrink)

Background The German Diagnosis-Related Groups (G-DRG) system has led to a revenue-orientated hospital financing system. This article examines the ethical implications and consequences of this system using the example of reconstructive measures (defect care) in patients with oral cavity carcinoma. At the same time, the interplay between the G‑DRG system and guideline development must also be scrutinized. This is preceded by introductory information on oral cavity carcinoma and the existing treatment options: conventional reconstruction techniques versus cost-intensive high-end surgery. Methods The (...) case scenario “treatment of medium-sized defects after tumor resection” forms the methodological basis and argumentative reference point of the study. Results and discussion The G‑DRG system and the economic incentives lead to far-reaching ethical implications concerning the demand-orientated treatment of patients and lead to multidimensional interactions. The existing tendency towards high-end surgery harbors the risk of overuse and misuse and, therefore, runs counter to the principles of beneficence and nonmaleficence. The one-sided indication in favor of high-end surgery also suggests that patient information is given in a directive manner (violation of respect for patient autonomy). Moreover, costly high-end procedures counteract the principle of economic efficiency and, thus, touch on issues of distributive justice. Finally, the clinical favoring of high-end procedures also affects logic within medicine, namely the publication landscape (publication bias), the design of the relevant guidelines, and surgical expertise. Conclusions There is a need to raise the awareness of all those working in the field of surgery (surgeons, guideline experts, reviewers). (shrink)

The Covid-19 pandemic has challenged both medicine and governments as they have strived to confront the pandemic and its consequences. One major challenge is that evidence-based medicine has struggled to provide timely and necessary evidence to guide medical practice and public policy formulation. We propose an extension of evidence-based corona medicine to an organismic systems corona medicine as a multilevel conceptual framework to develop a robust concept-oriented medical system. The proposed organismic systems corona medicine could help to prevent or mitigate (...) future pandemics by transitioning to a bifocal medicine that extends an empirical evidence-based medicine to a theory-oriented organismic systems medicine. (shrink)