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Theoretical Medicine and Bioethics

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https://www.readbyqxmd.com/read/30411181/on-the-disenchantment-of-medicine-abraham-joshua-heschel-s-1964-address-to-the-american-medical-association
#1
Alan B Astrow
In 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...
November 8, 2018: Theoretical Medicine and Bioethics
https://www.readbyqxmd.com/read/30406878/re-enchanting-the-body-overcoming-the-melancholy-of-anatomy
#2
Joel James Shuman
I 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...
November 8, 2018: Theoretical Medicine and Bioethics
https://www.readbyqxmd.com/read/30387036/the-worthless-remains-of-a-physician-s-calling-max-weber-william-osler-and-the-last-virtue-of-physicians
#3
Abraham M Nussbaum
On 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 In it, Weber argues that the vocation of a scientist is to produce specialized, rationalized knowledge that will be superseded.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 or 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 physician is described as both rational and noble...
November 1, 2018: Theoretical Medicine and Bioethics
https://www.readbyqxmd.com/read/30387035/patient-reflections-on-the-disenchantment-of-techno-medicine
#4
Devan Stahl
Over 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...
November 1, 2018: Theoretical Medicine and Bioethics
https://www.readbyqxmd.com/read/30291499/the-dramatic-essence-of-the-narrative-approach
#5
Oscar Vergara
Even though it is not a methodology on the level of principlism or casuistry, narrative bioethics nonetheless contributes to and guides decision-making in the field of biomedical ethics. However, unlike other methodologies, the narrative approach lacks a set of specific patterns and formal rules for doing so. This deficiency leaves this approach more vulnerable to the influence of historical factors; in fact, the vital history of a person is made up of thousands of scenes, which one must select and group under different norms...
October 2018: Theoretical Medicine and Bioethics
https://www.readbyqxmd.com/read/30238181/should-physicians-be-empathetic-rethinking-clinical-empathy
#6
David Schwan
The role and importance of empathy in clinical practice has been widely discussed. This paper focuses on the ideal of clinical empathy, as involving both cognitive understanding and affective resonance. I argue that this account is subject to a number of objections. Affective resonance may serve more as a liability than as a benefit in clinical settings, and utilizing this capacity is not clearly supported by the relevant empirical literature. Instead, I argue that the ideal account of empathy in medicine remains cognitive, though there is a central role for expressing empathic concern toward patients...
October 2018: Theoretical Medicine and Bioethics
https://www.readbyqxmd.com/read/30159800/birth-with-dignity-from-the-confucian-perspective
#7
Jianhui Li, Yaming Li
The development of biotechnologies has broadly interfered with a number of life processes, including human birth. An important moral question arises from the application of such medical technologies to birth: do biotechnological advancements violate human dignity? Many valid arguments have been raised. Yet bioethicists are still far from reaching a consensus on how best to protect the dignity of human birth. Confucianism is an influential ethical theory in China and presents a distinctive understanding of human dignity...
October 2018: Theoretical Medicine and Bioethics
https://www.readbyqxmd.com/read/30167942/twin-inc
#8
Rose Hershenov, Derek Doroski
This paper presents an account of how human spontaneous embryonic chimeras are formed. On the prevalent view in the philosophical literature, it is said that chimeras are the product of two embryos that fuse to form a new third embryo. We call this version of fusion synthesis. In contrast to synthesis, we present an alternative mechanism for chimera formation called incorporation, wherein one embryo incorporates the cells of a second embryo into its body. We argue that the incorporation thesis explains other types of chimera formation, which are better understood, and is more consistent than synthesis with what is known about embryological development...
August 2018: Theoretical Medicine and Bioethics
https://www.readbyqxmd.com/read/30120696/violence-research-and-non-identity-in-the-psychiatric-clinic
#9
Michelle Bach
Violence in psychiatric clinics has been a consistent problem since the birth of modern psychiatry. In this paper, I examine current efforts to understand and reduce both violence and coercive responses to violence in psychiatry, arguing that these efforts are destined to fall short. By and large, scholarship on psychiatric violence reduction has focused on identifying discrete factors that are statistically associated with violence, such as patient demographics and clinical qualities, in an effort to quantify risk and predict violent acts before they happen...
August 2018: Theoretical Medicine and Bioethics
https://www.readbyqxmd.com/read/30109541/letter-to-the-editor
#10
LETTER
Michael L Gross
No abstract text is available yet for this article.
August 2018: Theoretical Medicine and Bioethics
https://www.readbyqxmd.com/read/30094768/the-discourse-on-faith-and-medicine-a-tale-of-two-literatures
#11
Jeff Levin
Research and writing at the intersection of faith and medicine by now include thousands of published studies, review articles, books, chapters, and essays. Yet this emerging field has been described, from within, as disheveled on account of imprecision and lack of careful attention to conceptual and theoretical concerns. An important source of confusion is the fact that scholarship in this field constitutes two distinct literatures, or rather meta-literatures, which can be termed (a) faith as a problematic for medicine and (b) medicine as a problematic for faith...
August 2018: Theoretical Medicine and Bioethics
https://www.readbyqxmd.com/read/29948503/prisoners-competence-to-die-hunger-strike-and-cognitive-competence
#12
Zohar Lederman
Several bioethicists have recently advocated the force-feeding of prisoners, based on the assumption that prisoners have reduced or no autonomy. This assumed lack of autonomy follows from a decrease in cognitive competence, which, in turn, supposedly derives from imprisonment and/or being on hunger strike. In brief, causal links are made between imprisonment or voluntary total fasting (VTF) and mental disorders and between mental disorders and lack of cognitive competence. I engage the bioethicists that support force-feeding by severing both of these causal links...
August 2018: Theoretical Medicine and Bioethics
https://www.readbyqxmd.com/read/29992371/against-the-idoctor-why-artificial-intelligence-should-not-replace-physician-judgment
#13
Kyle E Karches
Experts in medical informatics have argued for the incorporation of ever more machine-learning algorithms into medical care. As artificial intelligence (AI) research advances, such technologies raise the possibility of an "iDoctor," a machine theoretically capable of replacing the judgment of primary care physicians. In this article, I draw on Martin Heidegger's critique of technology to show how an algorithmic approach to medicine distorts the physician-patient relationship. Among other problems, AI cannot adapt guidelines according to the individual patient's needs...
July 10, 2018: Theoretical Medicine and Bioethics
https://www.readbyqxmd.com/read/30136127/palliative-sedation-clinical-context-and-ethical-questions
#14
Farr A Curlin
Practitioners of palliative medicine frequently encounter patients suffering distress caused by uncontrolled pain or other symptoms. To relieve such distress, palliative medicine clinicians often use measures that result in sedation of the patient. Often such sedation is experienced as a loss by patients and their family members, but sometimes such sedation is sought as the desired outcome. Peace is wanted. Comfort is needed. Sedation appears to bring both. Yet to be sedated is to be cut off existentially from human experience, to be made incapable of engaging self-consciously in any human action...
June 2018: Theoretical Medicine and Bioethics
https://www.readbyqxmd.com/read/30132300/the-last-low-whispers-of-our-dead-when-is-it-ethically-justifiable-to-render-a-patient-unconscious-until-death
#15
Daniel P Sulmasy
A number of practices at the end of life can causally contribute to diminished consciousness in dying patients. Despite overlapping meanings and a confusing plethora of names in the published literature, this article distinguishes three types of clinically and ethically distinct practices: (1) double-effect sedation, (2) parsimonious direct sedation, and (3) sedation to unconsciousness and death. After exploring the concept of suffering, the value of consciousness, the philosophy of therapy, the ethical importance of intention, and the rule of double effect, these three practices are defined clearly and evaluated ethically...
June 2018: Theoretical Medicine and Bioethics
https://www.readbyqxmd.com/read/30120697/proportionate-palliative-sedation-and-the-giving-of-a-deadly-drug-the-conundrum
#16
Thomas A Cavanaugh
Among the oldest extant medical ethics, the Hippocratic Oath prohibits the giving of a deadly drug, regarding this act as an egregious violation of a medical ethic that is exclusively therapeutic. Proportionate palliative sedation involves the administration of a deadly drug. Hence it seems to violate the venerable Hippocratic promise associated with the dawn of Western medicine not to give a deadly drug. Relying on distinctions commonly employed in the analysis and evaluation of human actions, this article distinguishes physician-assisted suicide and euthanasia, as acts that necessarily violate the prohibition against giving a deadly drug, from proportionate palliative sedation, as an act that does not...
June 2018: Theoretical Medicine and Bioethics
https://www.readbyqxmd.com/read/30097763/reckoning-with-the-last-enemy
#17
Douglas Farrow
Developing the ethics of palliative sedation, particularly in contrast to terminal sedation, requires consideration of the relation between body and soul and of the nature of death and dying. Christianly considered, it also requires attention to the human vocation to immortality and hence to the relation between medicine (as aid for the body) and discipline (as aid to the soul). Leaning on Augustine's rendering of the latter, this paper provides a larger anthropological and soteriological frame of reference for the ethics of palliative sedation, organized by way of nine briefly expounded theses...
June 2018: Theoretical Medicine and Bioethics
https://www.readbyqxmd.com/read/30078061/comforting-when-we-cannot-heal-the-ethics-of-palliative-sedation
#18
Gilbert Meilaender
This essay considers whether palliative sedation is or is not appropriate medical care. This requires one to consider (a) whether, in addition to the good of health, relief of suffering is also a proper end of medicine; (b) whether unconsciousness can ever be a good for a human being; and (c) how double-effect reasoning can help us think about difficult cases. The author concludes that palliative sedation may be proper medical care, but only in a limited range of cases.
June 2018: Theoretical Medicine and Bioethics
https://www.readbyqxmd.com/read/29967981/sedation-and-care-at-the-end-of-life
#19
Daniel P Sulmasy
This special issue of Theoretical Medicine and Bioethics takes up the question of palliative sedation as a source of potential concern or controversy among Christian clinicians and thinkers. Christianity affirms a duty to relieve unnecessary suffering yet also proscribes euthanasia. Accordingly, the question arises as to whether it is ever morally permissible to render dying patients unconscious in order to relieve their suffering. If so, under what conditions? Is this practice genuinely morally distinguishable from euthanasia? Can one ever aim directly at making a dying person unconscious, or is it only permissible to tolerate unconsciousness as an unintended side effect of treating specific symptoms? What role does the rule of double effect play in making such decisions? Does spiritual or psychological suffering ever justify sedation to unconsciousness? What are the theological and spiritual aspects of such care? This introduction describes how the authors in this special issue wrestle with such questions and shows how each essay relates to the author's individual position on palliative sedation, as developed in greater detail within his contribution...
June 2018: Theoretical Medicine and Bioethics
https://www.readbyqxmd.com/read/30056624/taking-responsibility-for-health-in-an-epistemically-polluted-environment
#20
Neil Levy
Proposals for regulating or nudging healthy choices are controversial. Opponents often argue that individuals should take responsibility for their own health, rather than be paternalistically manipulated for their own good. In this paper, I argue that people can take responsibility for their own health only if they satisfy certain epistemic conditions, but we live in an epistemic environment in which these conditions are not satisfied. Satisfying the epistemic conditions for taking responsibility, I argue, requires regulation of this environment...
April 2018: Theoretical Medicine and Bioethics
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