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  Subjects -> PHILOSOPHY (Total: 762 journals)
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Medicine, Health Care and Philosophy
Journal Prestige (SJR): 0.479
Citation Impact (citeScore): 1
Number of Followers: 7  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1386-7423 - ISSN (Online) 1572-8633
Published by Springer-Verlag Homepage  [2467 journals]
  • ChatGPT: evolution or revolution'

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      PubDate: 2023-01-19
       
  • Towards trust-based governance of health data research

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      Abstract: Abstract Developments in medical big data analytics may bring societal benefits but are also challenging privacy and other ethical values. At the same time, an overly restrictive data protection regime can form a serious threat to valuable observational studies. Discussions about whether data privacy or data solidarity should be the foundational value of research policies, have remained unresolved. We add to this debate with an empirically informed ethical analysis. First, experiences with the implementation of the General Data Protection Regulation (GDPR) within a European research consortium demonstrate a gap between the aims of the regulation and its effects in practice. Namely, strictly formalised data protection requirements may cause routinisation among researchers instead of substantive ethical reflection, and may crowd out trust between actors in the health data research ecosystem; while harmonisation across Europe and data sharing between countries is hampered by different interpretations of the law, which partly stem from different views about ethical values. Then, building on these observations, we use theory to argue that the concept of trust provides an escape from the privacy-solidarity debate. Lastly, the paper details three aspects of trust that can help to create a responsible research environment and to mitigate the encountered challenges: trust as multi-agent concept; trust as a rational and democratic value; and trust as method for priority setting. Mutual cooperation in research—among researchers and with data subjects—is grounded in trust, which should be more explicitly recognised in the governance of health data research.
      PubDate: 2023-01-12
       
  • Empowerment through health self-testing apps' Revisiting empowerment
           as a process

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      Abstract: Abstract Empowerment, an already central concept in public health, has gained additional relevance through the expansion of mobile health (mHealth). Especially direct-to-consumer self-testing app companies mobilise the term to advertise their products, which allow users to self-test for various medical conditions independent of healthcare professionals. This article first demonstrates the absence of empowerment conceptualisations in the context of self-testing apps by engaging with empowerment literature. It then contrasts the service these apps provide with two widely cited empowerment definitions by the WHO, which describe the term as a process that, broadly, leads to knowledge and control of health decisions. We conclude that self-testing apps can only partly empower their users, as they, we argue, do not provide the type of knowledge and control the WHO definitions describe. More importantly, we observe that this shortcoming stems from the fact that in the literature on mHealth and in self-testing marketing, empowerment is understood as a goal rather than a process. This characterises a shift in the meaning of empowerment in the context of self-testing and mHealth, one that reveals a lack of awareness for relational and contextual factors that contribute to empowerment. We argue that returning to a process-understanding of empowerment helps to identify these apps’ deficits, and we conclude the article by briefly suggesting several strategies to increase self-testing apps’ empowerment function.
      PubDate: 2023-01-02
       
  • Social inclusion revisited: sheltered living institutions for people with
           intellectual disabilities as communities of difference

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      Abstract: Abstract The dominant idea in debates on social inclusion of people with intellectual disabilities is that social inclusion requires recognition of their ‘sameness’. As a result, most care providers try to enable people with intellectual disabilities to live and participate in ‘normal’ society, ‘in the community’. In this paper, we draw on (Pols, Medicine Health Care and Philosophy 18:81–90, 2015) empirical ethics of care approach to give an in-depth picture of places that have a radically different take on what social inclusion for people with intellectual disabilities looks like: places known as ‘sheltered living institutions’. We argue these places can be seen as ‘communities of difference’ catered to the specific needs and capacities of the residents. We then contend that these communities raise questions about what a good life for people with intellectual disabilities looks like and where and how it ought to be realised; questions not posed very often, as they get muzzled by the dominant rhetoric of normalisation and the emphasis on sameness.
      PubDate: 2022-12-30
       
  • How to derive ethically appropriate recommendations for action' A
           methodology for applied ethics

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      Abstract: Researchers in applied ethics, and some areas of bioethics particularly, aim to develop concrete and appropriate recommendations for action in morally relevant real-world situations. When proceeding from more abstract levels of ethical reasoning to such concrete recommendations, however, even with regard to the very same normative principle or norm, it seems possible to develop divergent or even contradictory recommendations for action regarding a certain situation. This may give the impression that such recommendations would be arbitrary and, hence, not well justified. Against this background, we, first, aim at showing that ethical recommendations for action, although being contingent in some sense, are not arbitrary if developed appropriately. For this purpose, we examine two types of contingencies arising in applied ethics reasoning based on recent examples of recommendations for action in the context of the COVID-19 pandemic. In doing so, we refer to a three-step model of ethical reasoning towards recommendations for actions. This, however, leaves open the question of how applied ethics may cope with contingent recommendations for action. Therefore, in a second step, we analyze the role of bridge principles for developing ethically appropriate recommendations for action, i.e., principles which connect normative claims with relevant empirical information to justify certain recommendations for action in a given morally relevant situation. Finally, we discuss some implications for reasoning and reporting in empirically informed ethics.
      PubDate: 2022-12-15
       
  • Correction to: On the relation between decision quality and autonomy in
           times of patient‑centered care: a case study

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      PubDate: 2022-12-05
       
  • The continuing formation of relational caring professionals

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      Abstract: Abstract Learning to work as a relational caring professional in healthcare and social welfare, is foremost a process of transformative learning, of Building, of professional subjectification. In this article we contribute to the design of such a process of formation by presenting a structured map of five domains of formational goals. It is mainly informed by many years of care-ethical research and training of professionals in healthcare and social work. The five formational domains are: Relational Caring Approach, Perception, Knowledge, Interpretation, and Practical Wisdom. The formation process, described as the recurring detour of a continuing practice, requires ‘exposure’, in-depth learning and learning communities. Relational caring—care consequently resulting from and structured by relational thinking, exploring, and steering—requires ‘inquiry’ as a continuous learning process in practice. The process is ultimately aimed at fostering mature, competent, and practically wise professional caregivers who are able to relationally connect with and attune to care receivers, and adequately navigate existential, moral, and political-institutional tensions in relational caring in complex organizations in Late-Modern society.
      PubDate: 2022-12-01
      DOI: 10.1007/s11019-022-10104-0
       
  • Chronic pain as a blind spot in the diagnosis of a depressed society. On
           the implications of the connection between depression and chronic pain for
           interpretations of contemporary society

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      Abstract: Abstract One popular description of current society is that it is a depressed society and medical evidence about depression’s prevalence may well make such an estimation plausible. However, such normative-critical assessments surrounding depression have to date usually operated with a one-sided understanding of depression. This understanding widely neglects the various ways depression manifests as well as its comorbidities. This becomes evident at the latest when considering one of depression’s most prominent and well-known comorbidities: chronic pain. Against this background, we aim in this article to substantiate our leading claim that the phenomenal interconnection between depression and chronic pain must be acknowledged in the global diagnosis of a depressive society. Thus, we argue here for a complementation of the dominant interpretation of a depressed society. This would support the overcoming of oversimplified images and estimations about depression in current society and further, help to recognize chronic pain properly on the larger scale of assessments that address society as a whole.
      PubDate: 2022-12-01
      DOI: 10.1007/s11019-022-10109-9
       
  • Patient autonomy, clinical decision making, and the Phenomenological
           reduction

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      Abstract: Abstract Phenomenology gives rise to certain ontological considerations that have far-reaching implications for standard conceptions of patient autonomy in medical ethics, and, as a result, the obligations of and to patients in clinical decision-making contexts. One such consideration is the phenomenological reduction in classical phenomenology, a core feature of which is the characterisation of our primary experiences as immediately and inherently meaningful. This paper builds on and extends the analyses of the phenomenological reduction in the works of Husserl, Heidegger, and Merleau-Ponty in order to identify and explain its implications for our current understanding of the principle of respect for patient autonomy and the norms of clinical decision making.
      PubDate: 2022-12-01
      DOI: 10.1007/s11019-022-10102-2
       
  • Epistemic solidarity in medicine and healthcare

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      Abstract: Abstract In this article, I apply the concept of solidarity to collective knowledge practices in healthcare. Generally, solidarity acknowledges that people are dependent on each other in many respects, and it captures those support practices that people engage in out of concern for others in whom they recognise a relevant similarity. Drawing on the rich literature on solidarity in bioethics and beyond, this article specifically discusses the role that epistemic solidarity can play in healthcare. It thus focuses, in particular, on solidarity’s relationship with justice and injustice. In this regard, it is argued (1) that justice and solidarity are two equally important and complementary values that should both be considered in healthcare practices and institutions and (2) that solidarity often arises in unjust situations and can be a means to bring about justice. I transfer these ‘general’ insights about solidarity to knowledge practices in healthcare and link them to the discussion about epistemic injustices in healthcare and how to overcome them. I argue that epistemic solidarity can play an important role in overcoming epistemic injustices as well as—and independently from its contribution to justice—in knowledge production in medicine more generally. To demonstrate how epistemic solidarity can add to our understanding of collective knowledge practices, I discuss two examples: patients sharing their medical data for research purposes and healthcare professionals’ engagement with patients to better understand their afflictions.
      PubDate: 2022-12-01
      DOI: 10.1007/s11019-022-10112-0
       
  • Issues for a phenomenology of illness – transgressing
           psychologizations

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      Abstract: Abstract Phenomenology of illness has grown increasingly popular in recent times. However, the most prominent phenomenologists of illness defend a psychologizing notion of phenomenology, which argues that illness is primarily constituted by embodied experiences, feelings, and emotions of suffering, alienation etc. The article argues that this gives rise to three issues that need to be addressed. (1) How is the theory of embodiment compatible with the strong distinction between disease and illness' (2) What is the difference between problematic embodiment and illness' (3) How is existential edification, that illness can give rise to according to the phenomenologists, to be understood' The article then engages in an analysis of Heidegger’s and Waldenfels’ phenomenology with the ambition of developing a notion of existence, which can transgress the psychologization of illness. Rather than arguing that illness is constituted by experiences of suffering and alienation, it emphasizes that broaches upon conatively guided activities constitute illness.
      PubDate: 2022-12-01
      DOI: 10.1007/s11019-022-10100-4
       
  • Suicide and Homicide: Symmetries and Asymmetries in Kant’s
           Ethics

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      Abstract: Abstract Kant formulated a secular argument against suicide’s permissibility based on what he regarded as the intrinsic value of humanity. In this paper, I first show that Kant’s moral framework entails that some types of suicide are morally permissible. Just as some homicides are morally permissible, according to Kant, so are suicides that are performed according to equivalent maxims. Intention, foreseeability, voluntariness, diminished responsibility, and mental capacity determine the moral characterization of the killing. I argue that a suicide taxonomy that differentiates types of suicide according to morally relevant criteria is compatible with Kantian ethics; it establishes that even where we hold a robust deontological sanctity of life position, we are not obligated to preserve the lives of people whose future life only offers profound suffering, and helping them to die may be justifiable if doing so honors their dignity and autonomy. Nevertheless, homicide and suicide are only weakly morally symmetrical in that even if a given suicide is morally impermissible, we do not normally have the right to prevent it forcibly, though this may be altered by juridical laws under some circumstances.
      PubDate: 2022-12-01
      DOI: 10.1007/s11019-022-10105-z
       
  • Moralization and Mismoralization in Public Health

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      Abstract: Abstract Moralization is a social-psychological process through which morally neutral issues take on moral significance. Often linked to health and disease, moralization may sometimes lead to good outcomes; yet moralization is often detrimental to individuals and to society as a whole. It is therefore important to be able to identify when moralization is inappropriate. In this paper, we offer a systematic normative approach to the evaluation of moralization. We introduce and develop the concept of ‘mismoralization’, which is when moralization is metaethically unjustified. In order to identify mismoralization, we argue that one must engage in metaethical analysis of moralization processes while paying close attention to the relevant facts. We briefly discuss one historical example (tuberculosis) and two contemporary cases related to COVID-19 (infection and vaccination status) that we contend to have been mismoralized in public health. We propose a remedy of de-moralization that begins by identifying mismoralization and that proceeds by neutralizing inapt moral content. De-moralization calls for epistemic and moral humility. It should lead us to pull away from our tendency to moralize—as individuals and as social groups—whenever and wherever moralization is unjustified.
      PubDate: 2022-12-01
      DOI: 10.1007/s11019-022-10103-1
       
  • On the relation between decision quality and autonomy in times of
           patient-centered care: a case study

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      Abstract: Abstract It is commonplace that care should be patient-centered. Nevertheless, no universally agreed-upon definition of patient-centered care exists. By consequence, the relation between patient-centered care as such and ethical principles cannot be investigated. However, some research has been performed on the relation between specific models of patient-centered care and ethical principles such as respect for autonomy and beneficence. In this article, I offer a detailed case study on the relationship between specific measures of patient-centered care and the ethical principle of respect for autonomy. Decision Quality Instruments (DQIs) are patient-centered care measures that were developed by Karen Sepucha and colleagues. The model of patient-centered care that guided the development of these DQIs pays special attention to the ethical principle of respect for autonomy. Using Jonathan Pugh’s theory of rational autonomy, I will investigate how the DQIs relate to patient autonomy. After outlining Pugh’s theory of rational autonomy and framing the DQIs accordingly (Part I), I will investigate whether the methodological choices made while developing these DQIs align with respect for autonomy (Part II). My analysis will indicate several tensions between DQIs and patient autonomy that could result in what I call “structural paternalism.” These tensions offer us sufficient reasons, especially given the importance of the ethical principle of respect for autonomy, to initiate a more encompassing debate on the normative validity of Decision Quality Instruments. The aim of the present paper is to highlight the need for, and to offer a roadmap to, this debate.
      PubDate: 2022-12-01
      DOI: 10.1007/s11019-022-10108-w
       
  • Systemising triage: COVID-19 guidelines and their underlying theories of
           distributive justice

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      Abstract: Abstract The COVID-19 pandemic has been overwhelming public health-care systems around the world. With demand exceeding the availability of medical resources in several regions, hospitals have been forced to invoke triage. To ensure that this difficult task proceeds in a fair and organised manner, governments scrambled experts to draft triage guidelines under enormous time pressure. Although there are similarities between the documents, they vary considerably in how much weight their respective authors place on the different criteria that they propose. Since most of the recommendations do not come with ethical justifications, analysing them requires that one traces back these criteria to their underlying theories of distributive justice. In the literature, COVID-19 triage has been portrayed as a value conflict solely between utilitarian and egalitarian elements. While these two accounts are indeed the main antipodes, I shall show that in fact all four classic theories of distributive justice are involved: utilitarianism, egalitarianism, libertarianism, and communitarianism. Detecting these in the documents and classifying the suggested criteria accordingly enables one to understand the balancing between the different approaches to distributive justice—which is crucial for both managing the current pandemic and in preparation for the next global health crisis.
      PubDate: 2022-12-01
      DOI: 10.1007/s11019-022-10101-3
       
  • Pathologies and the Healing of the soul: medical terms as metaphors in
           philosophy

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      Abstract: Abstract This paper critically examines the metaphorical use of medical terms in philosophy. Three examples selected from distinct philosophical contexts demonstrate that such terms have been employed as metaphors both to describe the practice of philosophising and historically to diagnose philosophical positions. The selected examples are (i) the title of Avicenna’s main philosophical work, The Book of Healing, (ii) the criticism of medical metaphors in Enlightenment philosophy, and (iii) recent historical diagnoses in philosophy. The underlying epistemological assumptions of all three contexts are reconstructed to critically analyse the medical metaphors. Through this tripartite synopsis, I arrive at a normative conclusions medical metaphors, such as the “healing of the soul” or “pathology of reason”, do not stand up to the critique of Enlightenment and are obsolete against the theoretical background of my reference texts.
      PubDate: 2022-12-01
      DOI: 10.1007/s11019-022-10099-8
       
  • Metaphors in medicine

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      PubDate: 2022-10-20
      DOI: 10.1007/s11019-022-10117-9
       
  • Autonomy, procedural and substantive: a discussion of the ethics of
           cognitive enhancement

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      Abstract: Abstract As cognitive enhancement research advances, important ethical questions regarding individual autonomy and freedom are raised. Advocates of cognitive enhancement frequently adopt a procedural approach to autonomy, arguing that enhancers improve an individual’s reasoning capabilities, which are quintessential to being an autonomous agent. On the other hand, critics adopt a more nuanced approach by considering matters of authenticity and self-identity, which go beyond the mere assessment of one’s reasoning capacities. Both positions, nevertheless, require further philosophical scrutiny. In this paper, we investigate the ethics of cognitive enhancement through the lenses of political and philosophical arguments about autonomy and freedom. In so doing, we contend that a substantive, relational account of individual autonomy offers a more holistic understanding of the ethical concerns of cognitive enhancement.
      PubDate: 2022-10-19
      DOI: 10.1007/s11019-022-10110-2
       
  • Ethical, legal, and social aspects of symptom checker applications: a
           scoping review

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      Abstract: Abstract Symptom Checker Applications (SCA) are mobile applications often designed for the end-user to assist with symptom assessment and self-triage. SCA are meant to provide the user with easily accessible information about their own health conditions. However, SCA raise questions regarding ethical, legal, and social aspects (ELSA), for example, regarding fair access to this new technology. The aim of this scoping review is to identify the ELSA of SCA in the scientific literature. A scoping review was conducted to identify the ELSA of SCA. Ten databases (e.g., Web of Science and PubMed) were used. Studies on SCA that address ELSA, written in English or German, were included in the review. The ELSA of SCA were extracted and synthesized using qualitative content analysis. A total of 25,061 references were identified, of which 39 were included in the analysis. The identified aspects were allotted to three main categories: (1) Technology; (2) Individual Level; and (3) Healthcare system. The results show that there are controversial debates in the literature on the ethical and social challenges of SCA usage. Furthermore, the debates are characterised by a lack of a specific legal perspective and empirical data. The review provides an overview on the spectrum of ELSA regarding SCA. It offers guidance to stakeholders in the healthcare system, for example, patients, healthcare professionals, and insurance providers and could be used in future empirical research to investigate the perspectives of those affected, such as users.
      PubDate: 2022-10-01
      DOI: 10.1007/s11019-022-10114-y
       
  • Disclosing the person in renal care coordination: why unpredictability,
           uncertainty, and irreversibility are inherent in person-centred care

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      Abstract: Abstract This article explores an example of person-centred care: the work of so-called renal care coordinators. The empirical basis of the article consists of qualitative interviews with renal care coordinators, alongside participant observations of their patient interactions. During the analyses of the empirical material, I found that that one of the coordinators’ most fundamental ambitions is to get to know who the patient is. This is also a central tenet of person-centred care. The aim of the article is not only to argue for the plausibility of this tenet, but also, and more importantly, to highlight and explore its implications in the context of healthcare, through the example of renal care coordination. By drawing on the philosophy of Hannah Arendt, the article shows that the disclosure of who the patient is that takes place in person-centred care requires speech and action, which are modes of human activity that initiate processes characterized by unpredictability, uncertainty, and irreversibility. This unpredictability, uncertainty, and irreversibility, found to be inherent in person-centred care, is then discussed in relation to the pursuit of certainty characterizing contemporary evidence-based medicine. At the end of the article the conclusion is drawn that, if healthcare is to be person-centred, it must find ways of accommodating the contradictory pursuits of certainty and uncertainty found in evidence-based medicine and person-centred care respectively.
      PubDate: 2022-09-20
      DOI: 10.1007/s11019-022-10113-z
       
 
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