The harm of medical disorder as harm in the damage sense
AbstractJerome Wakefield has argued that a disorder is a harmful dysfunction. This paper develops how Wakefield should construeharmful in his harmful dysfunction analysis (HDA). Recently, Neil Feit has argued that classic puzzles involved in analyzing harm render Wakefield ’s HDA better off without harm as a necessary condition. Whether or not one conceives of harm as comparative or non-comparative, the concern is that the HDA forces people to classify as mere dysfunction what they know to be a disorder. For instance, one can conceive of cases where simultaneous dis orders prevent each other from being, in any traditiona...
Source: Theoretical Medicine and Bioethics - March 1, 2019 Category: Medical Ethics Source Type: research
Outcome-adaptive randomization in clinical trials: issues of participant welfare and autonomy
AbstractOutcome-adaptive randomization (OAR) has been proposed as a corrective to certain ethical difficulties inherent in the traditional randomized clinical trial (RCT) using fixed-ratio randomization. In particular, it has been suggested that OAR redresses the balance between individual and collective ethics in favour of the former. In this paper, I examine issues of welfare and autonomy arising in relation to OAR. A central issue in discussions of welfare in OAR is equipoise, and the moral status of OAR is crucially influenced by the way in which this concept is construed. If OAR is based on a model of equipoise that d...
Source: Theoretical Medicine and Bioethics - February 18, 2019 Category: Medical Ethics Source Type: research
Evidence for personalised medicine: mechanisms, correlation, and new kinds of black box
AbstractPersonalised medicine (PM) has been discussed as a medical paradigm shift that will improve health while reducing inefficiency and waste. At the same time, it raises new practical, regulatory, and ethical challenges. In this paper, we examine PM strategies epistemologically in order to develop capacities to address these challenges, focusing on a recently proposed strategy for developing patient-specific models from induced pluripotent stem cells (iPSCs) so as to make individualised treatment predictions. We compare this strategy to two main PM strategies —stratified medicine and computational models. Drawing on ...
Source: Theoretical Medicine and Bioethics - February 15, 2019 Category: Medical Ethics Source Type: research
Beyond the Equivalence Thesis: how to think about the ethics of withdrawing and withholding life-saving medical treatment
AbstractWith few exceptions, the literature on withdrawing and withholding life-saving treatment considers the bare fact of withdrawing or withholding to lack any ethical significance. If anything, the professional guidelines on this matter are even more uniform. However, while no small degree of progress has been made toward persuading healthcare profe ssionals to withhold treatments that are unlikely to provide significant benefit, it is clear that a certain level of ambivalence remains with regard to withdrawing treatment. Given that the absence of clinical benefit means treating patients is not only ethically ques...
Source: Theoretical Medicine and Bioethics - February 13, 2019 Category: Medical Ethics Source Type: research
Whose harm? Which metaphysic?
AbstractDouglas Diekema has argued that it is not the best interest standard, but the harm principle that serves as the moral basis for ethicists, clinicians, and the courts to trigger state intervention to limit parental authority in the clinic. Diekema claims the harm principle is especially effective in justifying state intervention in cases of religiously motivated medical neglect in pediatrics involving Jehovah ’s Witnesses and Christian Scientists. I argue that Diekema has not articulated a harm principle that is capable of justifying state intervention in these cases. Where disagreements over appropriate care are ...
Source: Theoretical Medicine and Bioethics - February 12, 2019 Category: Medical Ethics Source Type: research
Akira Akabayashi (ed): The future of bioethics: international dialogues
(Source: Theoretical Medicine and Bioethics)
Source: Theoretical Medicine and Bioethics - December 18, 2018 Category: Medical Ethics Source Type: research
Jacob Stegenga: Medical nihilism
(Source: Theoretical Medicine and Bioethics)
Source: Theoretical Medicine and Bioethics - December 10, 2018 Category: Medical Ethics Source Type: research
“Just do your job”: technology, bureaucracy, and the eclipse of conscience in contemporary medicine
AbstractMarket metaphors have come to dominate discourse on medical practice. In this essay, we revisit Peter Berger and colleagues ’ analysis of modernization in their bookThe Homeless Mind and place that analysis in conversation with Max Weber ’s 1917 lecture “Science as a Vocation” to argue that the rise of market metaphors betokens the carry-over to medical practice of various features from the institutions of technological production and bureaucratic administration. We refer to this carry-over as theproduct presumption. The product presumption foregrounds accidental features of medicine while hiding its essent...
Source: Theoretical Medicine and Bioethics - November 20, 2018 Category: Medical Ethics Source Type: research
Enchanted nature, dissected nature: the case of Galen ’s anatomical theology
AbstractThrough the historical portrait of Galen, I argue that even an enchanted nature does not prevent the performance of violence against nature. Galen (129 –c. 216 CE), the great physician-philosopher of antiquity, is best known for his systematization and innovation of the Hippocratic medical tradition, whose thought was the reigning medical orthodoxy from the medieval period into the Renaissance. His works on anatomy were the standard that Vesaliu s’ works on anatomy overturned. What is less known about Galen’s study of anatomy, however, is its philosophical and theological edge. In this paper, I show that it ...
Source: Theoretical Medicine and Bioethics - November 17, 2018 Category: Medical Ethics Source Type: research
Understanding modern, technological medicine: enchanted, disenchanted, or other?
(Source: Theoretical Medicine and Bioethics)
Source: Theoretical Medicine and Bioethics - November 15, 2018 Category: Medical Ethics Source Type: research
On the disenchantment of medicine: Abraham Joshua Heschel ’s 1964 address to the American Medical Association
AbstractIn 1964, the American Medical Association invited liberal theologian Abraham Joshua Heschel (1907 –1972) to address its annual meeting in a program entitled “The Patient as a Person” (Heschel, in: Heschel (ed) The insecurity of freedom: essays on human existence, Noonday, New York, pp 24–38,1967). Unsurprisingly, in light of Heschel ’s reputation for outspokenness, he launched a jeremiad against physicians, claiming: “The admiration for medical science is increasing, the respect for its practitioners is decreasing. The depreciation of the image of the doctor is bound to disseminate disenchantment and to...
Source: Theoretical Medicine and Bioethics - November 8, 2018 Category: Medical Ethics Source Type: research
Re-enchanting the body: overcoming the melancholy of anatomy
AbstractI argue here that Weberian disenchantment is manifest in the triumph of instrumental reason and the expansion of analytic enquiry, which now dominates not simply those sciences upon which medicine depends, but medical practice itself. I suggest ways that analytic enquiry, also referred to here as anatomical reasoning, are part of a particular ideology —a way of seeing, speaking about, and inhabiting the world—that often fails to serve the health of patients because it is incapable of “seeing” them in the moral sense described by Iris Murdoch and others. I use the work of James Elkins and Wendell Berry to ca...
Source: Theoretical Medicine and Bioethics - November 8, 2018 Category: Medical Ethics Source Type: research
Patient reflections on the disenchantment of techno-medicine
AbstractOver one hundred years after Max Weber delivered his lecture “Science as a Vocation,” his description of the work of the physician in a disenchanted world still resonates. As a chronically ill patient who interacts with physicians frequently, I struggle with reconciling my understanding of my ill body with how my physician makes sense of my illness. My diagnosis created an existential crisis that caused me to search for meaning in my embodied experience, but I soon learned there is little room for such a search within modern biomedicine. Instead, I turned to fine art to help me make sense of my ill body and i...
Source: Theoretical Medicine and Bioethics - November 1, 2018 Category: Medical Ethics Source Type: research
The worthless remains of a physician ’s calling: Max Weber, William Osler, and the last virtue of physicians
AbstractOn the centenary of Max Weber ’s “Science as a Vocation,” his essay still performs interpretative work. In it, Weber argues that the vocation of a scientist is to produce specialized, rationalized knowledge that will be superseded. Weber says this vocation is a rationalized version of the Protestant conception of calling o r vocation (Beruf), tragically disenchanting the world and leaving the idea of calling as a worthless remains (caput mortuum). A similar trajectory can be seen in the physician William Osler ’s writings, especially his essay “Internal Medicine as a Vocation,” in which the calling of a...
Source: Theoretical Medicine and Bioethics - November 1, 2018 Category: Medical Ethics Source Type: research
Rivka Weinberg: The risk of a lifetime: how, when, and why procreation may be permissible
(Source: Theoretical Medicine and Bioethics)
Source: Theoretical Medicine and Bioethics - October 24, 2018 Category: Medical Ethics Source Type: research
