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Journal of Medicine and Philosophy

Niels Lynøe, Niklas Juth, Anders Eriksson
A scientific paradigm typically embraces research norms and values, such as truth-seeking, critical thinking, disinterestedness, and good scientific practice. These values should prevent a paradigm from introducing defective assumptions. But sometimes, scientists who are also physicians develop clinical norms that are in conflict with the scientific enterprise. As an example of such a conflict, we have analyzed the genesis and development of the shaken baby syndrome (SBS) paradigm. The point of departure of the analysis is a recently conducted systematic literature review, which concluded that there is very low scientific evidence for the basic assumption held by Child Protection Teams: when certain signs are present (and no other "acceptable" explanations are provided) the infant has been violently shaken...
September 3, 2018: Journal of Medicine and Philosophy
Mohammed Abouelleil Rashed
At a time when different groups in society are achieving notable gains in respect and rights, activists in mental health and proponents of mad positive approaches, such as Mad Pride, are coming up against considerable challenges. A particular issue is the commonly held view that madness is inherently disabling and cannot form the grounds for identity or culture. This paper responds to the challenge by developing two bulwarks against the tendency to assume too readily the view that madness is inherently disabling: the first arises from the normative nature of disability judgments, and the second arises from the implications of political activism in terms of being a social subject...
August 18, 2018: Journal of Medicine and Philosophy
Jason T Eberl
Some bioethicists have argued that moral bioenhancement, complementing traditional means of enhancing individuals' moral dispositions, is essential if we are to survive as a species. Traditional means of moral enhancement have historically included civil legislation, socially recognized moral exemplars, religious teachings and disciplines, and familial upbringing. I explore the necessity and feasibility of pursuing methods of moral bioenhancement as a complement to such traditional means, grounding my analysis within a virtue-theoretic framework...
September 5, 2018: Journal of Medicine and Philosophy
Valerie Gray Hardcastle
In this article, I argue that as we learn more about how we might intervene in the brain in ways that impact human behavior, the scope of what counts as "moral behavior" becomes smaller and smaller because things we successfully manipulate using evidence-based science are often things that fall outside the sphere of morality. Consequently, the argument that we are morally obligated to morally enhance our neighbors starts to fall apart, not because humans should be free to make terrible choices, but because morality is not something subject to such manipulation...
September 5, 2018: Journal of Medicine and Philosophy
Alfred Archer
Suppose, we could take a pill that would turn us into morally better people. Would we have a duty to take such a pill? In recent years, a number of philosophers have discussed this issue. Most prominently, Ingmar Persson and Julian Savulescu have argued that we would have a duty to take such a pill. In this article, I wish to investigate the possible limits of a duty to take moral enhancement drugs through investigating the related question of whether it would be desirable to create a world populated entirely with morally perfect people...
September 5, 2018: Journal of Medicine and Philosophy
Michael Bess
Over the coming century, the accelerating advance of bioenhancement technologies, robotics, and artificial intelligence (AI) may significantly broaden the qualitative range of sentient and intelligent beings. This article proposes a taxonomy of such beings, ranging from modified animals to bioenhanced humans to advanced forms of robots and AI. It divides these diverse beings into three moral and legal categories-animals, persons, and presumed persons-describing the moral attributes and legal rights of each category...
September 5, 2018: Journal of Medicine and Philosophy
Pei-Hua Huang
John Harris recently argued that the moral bioenhancement proposed by Persson and Savulescu can damage moral agency by depriving recipients of their freedom to fall (freedom to make wrongful choices) and therefore should not be pursued. The link Harris makes between moral agency and the freedom to fall, however, implies that all forms of moral enhancement that aim to make the enhancement recipients less likely to "fall," including moral education, are detrimental to moral agency. In this article, I present a new moral agency-based critique against the moral bioenhancement program envisaged by Persson and Savulescu...
September 5, 2018: Journal of Medicine and Philosophy
Parker Crutchfield
There is recent empirical evidence that personal identity is constituted by one's moral traits. If true, this poses a problem for those who advocate for moral enhancement, or the manipulation of a person's moral traits through pharmaceutical or other biological means. Specifically, if moral enhancement manipulates a person's moral traits, and those moral traits constitute personal identity, then it is possible that moral enhancement could alter a person's identity. I go a step further and argue that under the right conditions, moral enhancement can kill the subject of the enhancement...
September 5, 2018: Journal of Medicine and Philosophy
Black Hawk Hancock
This article explores Foucault's two different notions of power: one where the subject is constituted by power-knowledge relations and another that emphasizes how power is a central feature of human action. By drawing out these two conceptualizations of power, Foucault's work contributes three critical points to the formation of medicalized subjectivities: (1) the issue of medicalization needs to be discussed both in terms of both specific practices and holistically (within the carceral archipelago); (2) we need to think how we as human beings are "disciplined" and "subjectivated" through medicalization, as discourses, practices, and institutions are all crystallizations of power relations; and (3) we need to reflect on how we can "resist" this process of subjectification, since "power comes from below" and patients shape themselves through "technologies of the self...
July 9, 2018: Journal of Medicine and Philosophy
Brent M Kious
There has been much debate about whether the concept of disease articulated in Boorse's biostatistical theory is value-neutral or value-laden. Here, I want to examine whether this debate matters. I suggest that there are two basic respects in which value-ladenness might be important: it could threaten either scientific legitimacy or moral permissibility. I argue that value-ladenness does not threaten the scientific legitimacy of our disease-concept because the concept makes little difference to the formulation and testing of scientific hypotheses...
July 9, 2018: Journal of Medicine and Philosophy
Mary Jean Walker, Wendy A Rogers
In this paper, we examine recent critiques of the debate about defining disease, which claim that its use of conceptual analysis embeds the problematic assumption that the concept is classically structured. These critiques suggest, instead, developing plural stipulative definitions. Although we substantially agree with these critiques, we resist their implication that no general definition of "disease" is possible. We offer an alternative, inductive argument that disease cannot be classically defined and that the best explanation for this is that the concept is structured as a cluster...
July 9, 2018: Journal of Medicine and Philosophy
Beatrijs Haverkamp, Bernice Bovenkerk, Marcel F Verweij
Whereas theories on health generally argue in favor of one specific concept, we argue that, given the variety of health practices, we need different concepts of health. We thus approach health concepts as a Wittgensteinian family of thick concepts. By discussing five concepts of health offered by (philosophical) theory, we argue that all capture something that seems relevant when we talk and think about health. Classifying these concepts reveals their family resemblances: each of these concepts differs from the others in at least one respect and resembles the others in several respects...
July 9, 2018: Journal of Medicine and Philosophy
Robyn Bluhm, Kirstin Borgerson
Arguments in favor of greater research-practice integration in medicine have tended to be ethical, political, or pragmatic. There are good epistemic reasons to pursue greater integration, and it is important to think through these reasons in order to avoid inadvertently designing new systems in ways that replicate the epistemic elitism common within current systems. Meaningful transformation within health care is possible with close attention to all reasons in favor of greater research-practice integration, including epistemic reasons...
July 9, 2018: Journal of Medicine and Philosophy
M Cristina Amoretti, Elisabetta Lalumera
The general concept of mental disorder specified in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders is definitional in character: a mental disorder might be identified with a harmful dysfunction. The manual also contains the explicit claim that each individual mental disorder should meet the requirements posed by the definition. The aim of this article is two-fold. First, we shall analyze the definition of the superordinate concept of mental disorder to better understand what necessary (and sufficient) criteria actually characterize such a concept...
May 30, 2018: Journal of Medicine and Philosophy
Thaddeus Metz
In his article "Prediction, Understanding, and Medicine," Alex Broadbent argues that the nature of medicine is determined by its competences, that is, which things it can do well. He argues that although medicine cannot cure well, it can do a good job of enabling people not only to understand states of the human organism and of what has caused them, but also to predict future states of it. From this, Broadbent concludes that medicine is (at least in part) essentially a practice of understanding and predicting, not curing...
May 9, 2018: Journal of Medicine and Philosophy
Lynn A Jansen
There is broad agreement among research ethicists that investigators have a duty to obtain the informed consent of all subjects who participate in their research trials. On a common view, the duty to obtain this informed consent follows from the need to respect persons and their autonomous decisions. However, the nature of informed consent and the demands it places on investigators are open to dispute and recently have been challenged. Respect for persons, it has been claimed, does not require investigators to guarantee that the subjects enrolled in their trials comprehend the risk/benefit information disclosed to them or even that they appreciate the difference between research and therapy...
May 9, 2018: Journal of Medicine and Philosophy
Chadwin Harris
In "Prediction, Understanding, and Medicine," Alex Broadbent rejects the curative thesis, the view that the core medical competence is to cure, in favor of his predictive thesis that the main intellectual medical competence is to explain and the main practical medical competence is to predict. Broadbent thinks his account explains the phenomenon of multiple consultation, which is the fact that people persist in consulting alternative medical traditions despite having access to mainstream medicine...
May 9, 2018: Journal of Medicine and Philosophy
Alex Broadbent
What is medicine? One obvious answer in the context of the contemporary clinical tradition is that medicine is the process of curing sick people. However, this "curative thesis" is not satisfactory, even when "cure" is defined generously and even when exceptions such as cosmetic surgery are set aside. Historian of medicine Roy Porter argues that the position of medicine in society has had, and still has, little to do with its ability to make people better. Moreover, the efficacy of medicine for improving population health has been famously doubted by historians and epidemiologists...
May 9, 2018: Journal of Medicine and Philosophy
Alex Broadbent
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.
May 9, 2018: Journal of Medicine and Philosophy
Somogy Varga
Often drawing on the phenomenological tradition, a number of philosophers and cognitive scientists working in the field of "embodied cognition" subscribe to the general view that cognition is grounded in aspects of its sensorimotor embodiment and should be comprehended as the result of a dynamic interaction of nonneural and neural processes. After a brief introduction, the paper critically engages Lakoff and Johnson's "conceptual metaphor theory" (CMT), and provides a review of recent empirical evidence that appears to support it...
March 13, 2018: Journal of Medicine and Philosophy
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