 Subjects -> PHILOSOPHY (Total: 762 journals)
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- Foucault and medicine: challenging normative claims
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Abstract: Abstract Some of Michel Foucault’s work focusses on an archeological and genealogical analysis of certain aspects of the medical episteme, such as ‘Madness and Civilization’ (1964/2001), ‘The Birth of the Clinic’ (1973) and ‘The History of Sexuality’ (1978/2020a). These and other Foucauldian works have often been invoked to characterize, but also to normatively interpret mechanisms of the currently existing medical episteme. Writers conclude that processes of patient objectification, power, medicalization, observation and discipline are widespread in various areas where the medical specialty operates and that these aspects have certain normative implications for how our society operates or should operate. The Foucauldian concepts used to describe the medical episteme and the normative statements surrounding these concepts will be critically analyzed in this paper. By using Foucault’s work and several of his interpreters, I will focus on the balance between processes of subjectification and objectification and the normative implications of these processes by relating Foucault’s work and the work of his interpreters to the current medical discipline. Additionally, by focusing on the discussion of death and biopower, the role of physicians in the negation and stigmatization of death is being discussed, mainly through the concept of biopower. Lastly, based on the discussion of panopticism in the medical discipline, this paper treats negative and positive forms power, and a focus will be laid upon forms of resistance against power. The discussed aspects will hopefully shed a different and critical light on the relationship between Foucault’s work and medicine, something that eventually can also be deduced from Foucault’s later work itself.
PubDate: 2023-09-25
- First-person disavowals of digital phenotyping and epistemic injustice in
psychiatry-
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Abstract: Abstract Digital phenotyping will potentially enable earlier detection and prediction of mental illness by monitoring human interaction with and through digital devices. Notwithstanding its promises, it is certain that a person’s digital phenotype will at times be at odds with their first-person testimony of their psychological states. In this paper, we argue that there are features of digital phenotyping in the context of psychiatry which have the potential to exacerbate the tendency to dismiss patients’ testimony and treatment preferences, which can be instances of epistemic injustice. We first explain what epistemic injustice is, and why it is argued to be an extensive problem in health and disability settings. We then explain why epistemic injustice is more likely to apply with even greater force in psychiatric contexts, and especially where digital phenotyping may be involved. Finally, we offer some tentative suggestions of how epistemic injustice can be minimised in digital psychiatry.
PubDate: 2023-09-19
- Rethinking advanced motherhood: a new ethical narrative
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Abstract: Abstract The aim of the study is to rethink the ethics of advanced motherhood. In the literature, delayed childbearing is usually discussed in the context of reproductive justice, and in relationship to ethical issues associated with the use and risk of assisted reproductive technologies. We aim to go beyond these more “traditional” ways in which reproductive ethics is framed by revisiting ethics itself through the lens of the figure of the so-called “older” mother. For this purpose, we start by exploring some of the deep seated socio-cultural discourses in the context of procreation: ageism, ableism and the widespread bias towards geneticism and pronatalism. Afterwards, we provide a critical overview of the key arguments against or in support of advanced motherhood. We then briefly discuss how entrenchment by both sides has produced an impasse in the debate on the ethics of advanced motherhood and proceed by arguing that it is fundamental to bring about a change in this narrative. For this purpose, we will revisit the feminist usage of the concept of vulnerability which will allow us both to criticize culturally prescribed norms about motherhood and to address the painful reality of age-related fertility decline. In the last section, we argue that instead of defining “older” motherhood as an ethical problem, we should problematize the fact that female reproductive ageing is an understudied and ill-sourced topic. We believe that allocating resources to research to better understand female reproductive ageing is not only ethically permissible, but might even be ethically desirable.
PubDate: 2023-09-03
- What does it mean to call a medical device invasive'
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Abstract: Abstract Medical devices are often referred to as being invasive or non-invasive. Though invasiveness is relevant, and central, to how devices are understood and regarded in medicine and bioethics, a consensus concept or definition of invasiveness is lacking. To begin to address this problem, this essay explores four possible descriptive meanings of invasiveness: how devices are introduced to the body, where they are located in the body, whether they are foreign to the body, and how they change the body. An argument is offered that invasiveness is not purely descriptive, but implicates normative concepts of danger, intrusion, and disruption. In light of this, a proposal is offered for how to understand use of the concept of invasiveness in discussions of medical devices.
PubDate: 2023-09-01
- Temporal uncertainty in disease diagnosis
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Abstract: Abstract There is a profound paradox in modern medical knowledge production: The more we know, the more we know that we (still) do not know. Nowhere is this more visible than in diagnostics and early detection of disease. As we identify ever more markers, predictors, precursors, and risk factors of disease ever earlier, we realize that we need knowledge about whether they develop into something experienced by the person and threatening to the person’s health. This study investigates how advancements in science and technology alter one type of uncertainty, i.e., temporal uncertainty of disease diagnosis. As diagnosis is related to anamnesis and prognosis it identifies how uncertainties in all these fields are interconnected. In particular, the study finds that uncertainty in disease diagnosis has become more subject to prognostic uncertainty because diagnosis is more connected to technologically detected indicators and less closely connected to manifest and experienced disease. These temporal uncertainties pose basic epistemological and ethical challenges as they can result in overdiagnosis, overtreatment, unnecessary anxiety and fear, useless and even harmful diagnostic odysseys, as well as vast opportunity costs. The point is not to stop our quest for knowledge about disease but to encourage real diagnostic improvements that help more people in ever better manner as early as possible. To do so, we need to pay careful attention to specific types of temporal uncertainty in modern diagnostics.
PubDate: 2023-09-01
- Engaging otherness: care ethics radical perspectives on empathy
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Abstract: Abstract Throughout the years, care ethicists have raised concerns that prevalent definitions of empathy fail to adequately address the problem of otherness. They have proposed alternative conceptualizations of empathy that aim to acknowledge individual differences, help to extend care beyond one’s inner circle, and develop a critical awareness of biases and prejudices. We explore three such alternatives: Noddings’ concept of engrossment, Meyers’ account of broad empathy, and Baart’s concept of perspective-shifting. Based on these accounts, we explain that care ethics promotes a conceptualization of empathy that is radical in its commitment to engage otherness and that is characterized by being: (1) receptive and open, (2) broad and deep in scope, (3) relational and interactive, (4) mature and multifaceted, (5) critical and reflective, (6) disruptive and transformative. This type of empathy is both demanding and rewarding, as it may inspire health professionals to rethink empathy, its challenges, and its contribution to good care and as it may enrich empathy education and professional empathy practices in health care.
PubDate: 2023-09-01
- Empowerment: Freud, Canguilhem and Lacan on the ideal of health promotion
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Abstract: Abstract Empowerment is a prominent ideal in health promotion. However, the exact meaning of this ideal is often not made explicit. In this paper, we outline an account of empowerment grounded in the human capacity to adapt and adjust to environmental and societal norms without being completely determined by those norms. Our account reveals a tension at the heart of empowerment between (a) the ability of self-governance and (b) the need to adapt and adjust to environmental and societal norms. We address this tension by drawing from the work of Freud, Canguilhem, and Lacan. First, we clarify through a discussion of Freud’s notion of sublimation that it is difficult to assess empowerment independent of any social valuations, but also that it is no less problematic to make it dependent on social valuations alone. Second, we draw from the work of Canguilhem to show how empowerment can be understood in terms of the individual’s capacity to tolerate the aggressions of a multiplicity of environments. Third, using Lacan, we show how empowerment requires incorporation of social and symbolic norms, without necessarily rendering ourselves a mere product of these norms. Finally, we demonstrate how the views of these authors can complement one another, resulting in a more sophisticated understanding of empowerment.
PubDate: 2023-09-01
- Body objectified' Phenomenological perspective on patient
objectification in teleconsultation-
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Abstract: Abstract The global crisis of COVID-19 pandemic has considerably accelerated the use of teleconsultation (consultation between the patient and the doctor via video platforms). While it has some obvious benefits and drawbacks for both the patient and the doctor, it is important to consider—how teleconsultation impacts the quality of the patient-doctor relationship' I will approach this question through the lens of phenomenology of the body, focusing on the question—what happens to the patient objectification in teleconsultation' To answer this question I will adopt a phenomenological approach combining both insights drawn from the phenomenological tradition, i.e., the concepts of the lived body and the object body, and the results from the phenomenologically informed qualitative research study on the patient experience of teleconsultation. The theoretical background against which I have developed this study comprises discussions within the field of phenomenology of medicine regarding the different sources of patient objectification within clinical encounter and the arguments concerning the negative impact that objectification has on the quality of care. I will argue that a factor that has frequently been identified within phenomenology of medicine as the main source of patient objectification in clinical encounters, namely, the internalized gaze of the clinician, is diminished during teleconsultation, increasing patient’s sense of agency, decreasing her sense of alienation and opening up the possibility for a closer relationship between the patient and the health care provider, all of which lead to the transformation of the hierarchical patient-health care professional relationship.
PubDate: 2023-09-01
- The biopsychosocial model: Its use and abuse
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Abstract: Abstract The biopsychosocial model (BPSM) is increasingly influential in medical research and practice. Several philosophers and scholars of health have criticized the BPSM for lacking meaningful scientific content. This article extends those critiques by showing how the BPSM’s epistemic weaknesses have led to certain problems in medical discourse. Despite its lack of content, many researchers have mistaken the BPSM for a scientific model with explanatory power. This misapprehension has placed researchers in an implicit bind. There is an expectation that applications of the BPSM will deliver insights about disease; yet the model offers no tools for producing valid (or probabilistically true) knowledge claims. I argue that many researchers have, unwittingly, responded to this predicament by developing certain patterns of specious argumentation I call “wayward BPSM discourse.” The arguments of wayward discourse share a common form: They appear to deliver insights about disease gleaned through applications of the BPSM; on closer inspection, however, we find that the putative conclusions presented are actually assertions resting on question-begging arguments, appeals to authority, and conceptual errors. Through several case studies of BPSM articles and literatures, this article describes wayward discourse and its effects. Wayward discourse has introduced into medicine forms of conceptual instability that threaten to undermine various lines of research. It has also created a potentially potent vector of medicalization. Fixing these problems will likely require reimposing conceptual rigor on BPSM discourse.
PubDate: 2023-09-01
- Adaptation and illness severity: the significance of suffering
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Abstract: Abstract Adaptation to illness, and its relevance for distribution in health care, has been the subject of vigorous debate. In this paper I examine an aspect of this discussion that seems so far to have been overlooked: that some illnesses are difficult, or even impossible, to adapt to. This matters because adaptation reduces suffering. Illness severity is a priority setting criterion in several countries. When considering severity, we are interested in the extent to which an illness makes a person worse-off. I argue that no plausible theory of well-being can disregard suffering when determining to what extent someone is worse-off in terms of health. We should accept, all else equal, that adapting to an illness makes the illness less severe by reducing suffering. Accepting a pluralist theory of well-being allows us to accept my argument, while still making room for the possibility that adaptation is sometimes, all things considered, bad. Finally, I argue that we should conceptualize adaptability as a feature of illness, and thereby account for adaptation on a group level for the purposes of priority setting.
PubDate: 2023-09-01
- 'You have to put a lot of trust in me': autonomy, trust, and
trustworthiness in the context of mobile apps for mental health-
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Abstract: Abstract Trust and trustworthiness are essential for good healthcare, especially in mental healthcare. New technologies, such as mobile health apps, can affect trust relationships. In mental health, some apps need the trust of their users for therapeutic efficacy and explicitly ask for it, for example, through an avatar. Suppose an artificial character in an app delivers healthcare. In that case, the following questions arise: Whom does the user direct their trust to' Whether and when can an avatar be considered trustworthy' Our study aims to analyze different dimensions of trustworthiness in the context of mobile health app use. We integrate O'Neill's account of autonomy, trust, and trustworthiness into a model of trustworthiness as a relational concept with four relata: B is trustworthy with respect to A regarding the performance of Z because of C. Together with O'Neill's criteria of trustworthiness (honesty, competence, and reliability), this four-sided model is used to analyze different dimensions of trustworthiness in an exemplary case of mobile health app use. Our example focuses on an app that uses an avatar and is intended to treat sleep difficulties. The conceptual analysis shows that interpreting trust and trustworthiness in health app use is multi-layered and involves a net of interwoven universal obligations. At the same time, O'Neill's approach to autonomy, trust, and trustworthiness offers a normative account to structure and analyze these complex relations of trust and trustworthiness using mobile health apps.
PubDate: 2023-09-01
- Relating to foetal persons: why women’s Voices come first and last, but
not alone in Abortion debates-
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Abstract: Abstract Abortion remains a controversial topic, with pro-life and pro-choice advocates clashing fiercely. However, public polling demonstrates that the vast majority of the Western public holds a middle position: being in favour of abortion but not in all circumstances nor at any time. The intuitions held by the majority seem to imply a contradiction: two early foetuses at the same point in development have different moral statuses. Providing coherent philosophical grounding for this intuition has proved challenging. Solutions given by philosophers such as Feinberg, Harman and Räsänen are complex and do not fully account for the lived experience of pregnancy loss. This article argues for a relational ontological construction of human personhood as the basis of foetal personhood. This approach takes seriously the literature of pregnancy loss and the lived experiences of pregnant persons. Focusing on the manner in which persons relate to early foetuses (especially pregnant persons), provides a coherent ground for distinct foetal value. Importantly, this approach is both simple and intuitive. Therefore, it can be more easily adopted by middle. To counter an implied equality of human relationality, the article argues for a clear hierarchy based on relational proximity that affirms pregnant persons' primary role in deciding the moral significance of foetal termination.
PubDate: 2023-09-01
- Precision medicine and the problem of structural injustice
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Abstract: Abstract Many countries currently invest in technologies and data infrastructures to foster precision medicine (PM), which is hoped to better tailor disease treatment and prevention to individual patients. But who can expect to benefit from PM' The answer depends not only on scientific developments but also on the willingness to address the problem of structural injustice. One important step is to confront the problem of underrepresentation of certain populations in PM cohorts via improved research inclusivity. Yet, we argue that the perspective needs to be broadened because the (in)equitable effects of PM are also strongly contingent on wider structural factors and prioritization of healthcare strategies and resources. When (and before) implementing PM, it is crucial to attend to how the organisation of healthcare systems influences who will benefit, as well as whether PM may present challenges for a solidaristic sharing of costs and risks. We discuss these issues through a comparative lens of healthcare models and PM-initiatives in the United States, Austria, and Denmark. The analysis draws attention to how PM hinges on—and simultaneously affects—access to healthcare services, public trust in data handling, and prioritization of healthcare resources. Finally, we provide suggestions for how to mitigate foreseeable negative effects.
PubDate: 2023-09-01
- From biocolonialism to emancipation: considerations on ethical and
culturally respectful omics research with indigenous Australians-
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Abstract: Abstract As part of a (bio)colonial project, the biological information of Indigenous Peoples has historically been under scientific scrutiny, with very limited benefits for communities and donors. Negative past experiences have contributed to further exclude Indigenous communities from novel developments in the field of omics research. Over the past decade, new guidelines, reflections, and projects of genetic research with Indigenous Peoples have flourished in Australia, providing opportunities to move the field into a place of respect and ethical relationships. This review explores the ethical and cultural implications of the use of biological samples from Indigenous communities in biomedical research. A structured framework outlining emerging topics of interest for the development of respectful omics research partnerships with Indigenous Australians is presented. This paper highlights aspects related to Indigenous governance, community and individual consent, respectful handling of biological samples, data management, and communication in order to protect Indigenous interests and rights and to promote communities’ autonomy.
PubDate: 2023-09-01
- What’s wrong with medical black box AI'
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PubDate: 2023-07-30
- Ontological insecurity in the post-covid-19 fallout: using existentialism
as a method to develop a psychosocial understanding to a mental health
crisis-
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Abstract: Abstract In the wake of the Covid-19 pandemic we are witnessing a significant rise in mental illness diagnosis and corresponding anti-depressant prescription uptake. The drug response to this situation is unsurprising and reinforces the dominant role (neuro)biology continues to undertake within modern psychiatry. In contrast to this biologically informed, medicalised approach, the World Health Organisation (WHO) issued a statement stressing the causal role of psychological and social factors. Using the concept of ontological insecurity, contextualised within the WHO guidance, the interrelation of psychological and social factors is illuminated, and a psychosocial framework is produced as a means of understanding the mental health consequence of the post-Covid-19 fallout. The psychosocial framework generated provides a rationale to revise and reprioritise how we engage with the biopsychosocial model that is intended to underpin modern psychiatry. This framework establishes a connection between psychological and social theory which are too often addressed as disparate terrains within mental health services and policy creation.
PubDate: 2023-06-30
DOI: 10.1007/s11019-023-10157-9
- Intentional presence and the accompaniment of dying patients
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Abstract: Abstract In this paper, we offer a phenomenological and hermeneutical perspective on the presence of clinicians who care for the suffering and dying patients in the context of end-of-life care. Clinician presence is described as a way of (1) being present to the patient and to oneself, (2) being in the present moment, and (3) receiving and giving a presence (in the sense of a gift). We discuss how presence is a way of restoring human beings’ relational and dialogical nature. To inform a different perspective on relational ethics, we also discuss how accompaniment refers to the clinician’s awareness of the human condition and its existential limits.
PubDate: 2023-06-20
DOI: 10.1007/s11019-023-10161-z
- Towards a concept of embodied autonomy: In what ways can a patient’s
body contribute to the autonomy of medical decisions'-
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Abstract: Abstract “Bodily autonomy” has received significant attention in bioethics, medical ethics, and medical law in terms of the general inviolability of a patient’s bodily sovereignty and the rights of patients to make choices (e.g., reproductive choices) that concern their own body. However, the role of the body in terms of how it can or does contribute to a patient’s capacity for, or exercises of their autonomy in clinical decision-making situations has not been explicitly addressed. The approach to autonomy in this paper is aligned with traditional theories that conceive autonomy in terms of an individual’s capacities for, and exercises of rational reflection. However, at the same time, this paper extends these accounts by arguing that autonomy is, in part, embodied. Specifically, by drawing on phenomenological conceptions of the experience of autonomy, we argue that, in principle, the body is a necessary component of the capacity for autonomy. Secondly, through the presentation of two different cases, we highlight ways in which a patient’s body can contribute to the autonomy of treatment choices. Ultimately, we hope to encourage others to explore additional conditions under which a concept of embodied autonomy should be employed in medical decision making, how its underlying principles might be operationalised in clinical situations, and its consequences for approaches to patient autonomy in healthcare practice, policy, and law.
PubDate: 2023-06-09
DOI: 10.1007/s11019-023-10159-7
- The fertility of moral ambiguity in precision medicine
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Abstract: Abstract Although precision medicine cuts across a large spectrum of professions, interdisciplinary and cross-sectorial moral deliberation has yet to be widely enacted, let alone formalized in this field. In a recent research project on precision medicine, we designed a dialogical forum (i.e. ‘the Ethics Laboratory’) giving interdisciplinary and cross-sectorial stakeholders an opportunity to discuss their moral conundrums in concert. We organized and carried out four Ethics Laboratories. In this article, we use Simone de Beauvoir’s concept of moral ambiguity as a lens to frame the participants’ experience with fluid moral boundaries. By framing our approach through this concept we are able to elucidate irremediable moral issues that are collectively underexplored in the practice of precision medicine. Moral ambiguity accentuates an open and free space where different types of perspectives converge and can inform each other. Based on our study, we identified two dilemmas, or thematic interfaces, in the interdisciplinary moral deliberations which unfolded in the Ethics Laboratories: (1) the dilemma between the individual and the collective good; and (2) the dilemma between care and choice. Through our investigation of these dilemmas, we show how Beauvoir’s concept of moral ambiquity not only serves as a fertile catalyst for greater moral awareness but, furthermore, how the concept can become an indispensable part of the practices of and the discourse about precision medicine.
PubDate: 2023-06-06
DOI: 10.1007/s11019-023-10160-0
- Black-box assisted medical decisions: AI power vs. ethical physician care
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Abstract: Abstract I raise an ethical problem with physicians using “black box” medical AI algorithms, arguing that its use would compromise proper patient care. Even if AI results are reliable, my contention is that without being able to explain medical decisions to patients, physicians’ use of black box AIs would erode the effective and respectful care they provide patients. In addition, I argue that physicians should use AI black boxes only for patients in dire straits, or when physicians use AI as a “co-pilot” (analogous to a spellchecker) but can independently confirm its accuracy. My argument will be further sharpened when, lastly, I give important attention to Alex John London’s objection that physicians already sometimes prescribe treatment, such as lithium drugs, even though neither researchers nor doctors can explain why the treatment works.
PubDate: 2023-06-05
DOI: 10.1007/s11019-023-10153-z
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