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Theoretical Medicine and Bioethics

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
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...
July 2, 2018: Theoretical Medicine and Bioethics
Lantz Fleming Miller
No abstract text is available yet for this article.
June 29, 2018: Theoretical Medicine and Bioethics
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...
June 14, 2018: Theoretical Medicine and Bioethics
Claudia Bozzaro
Physician-assisted dying (assisted suicide and euthanasia) is currently an intensely discussed topic in several countries. Despite differences in legislation and application, countries with end-of-life laws have similar eligibility criteria for assistance in dying: individuals must be in a hopeless situation and experience unbearable suffering. Hopelessness, as a basic aspect of the human condition, is a central topic in Albert Camus' philosophical work The Myth of Sisyphus, which addresses the question of suicide...
March 20, 2018: Theoretical Medicine and Bioethics
Luke Kallberg
I argue that the separation of conjoined twins in infancy or early childhood is unethical (rare exceptions aside). Cases may be divided into three types: both twins suffer from lethal abnormalities, only one twin has a lethal abnormality, or neither twin does. In the first kind of case, there is no reason to separate, since both twins will die regardless of treatment. In the third kind of case, I argue that separation at an early age is unethical because the twins are likely to achieve an irreplaceably good quality of life-the goods of conjoinment-that separation takes away...
February 2018: Theoretical Medicine and Bioethics
Juliette Ferry-Danini
According to recent approaches in the philosophy of medicine, biomedicine should be replaced or complemented by a humanistic medical model. Two humanistic approaches, narrative medicine and the phenomenology of medicine, have grown particularly popular in recent decades. This paper first suggests that these humanistic criticisms of biomedicine are insufficient. A central problem is that both approaches seem to offer a straw man definition of biomedicine. It then argues that the subsequent definition of humanism found in these approaches is problematically reduced to a compassionate or psychological understanding...
February 2018: Theoretical Medicine and Bioethics
Adam Omelianchuk
Although much has been written on the dead-donor rule (DDR) in the last twenty-five years, scant attention has been paid to how it should be formulated, what its rationale is, and why it was accepted. The DDR can be formulated in terms of either a Don't Kill rule or a Death Requirement, the former being historically rooted in absolutist ethics and the latter in a prudential policy aimed at securing trust in the transplant enterprise. I contend that the moral core of the rule is the Don't Kill rule, not the Death Requirement...
February 2018: Theoretical Medicine and Bioethics
Patrick Daly
In this introduction to a special subsection of Theoretical Medicine and Bioethics comprising separate reviews of the Springer Handbook of the Philosophy of Medicine, The Routledge Companion to Philosophy of Medicine, and The Bloomsbury Companion to Contemporary Philosophy of Medicine, I compare the three texts with respect to their overall organization and their approach to the relation between the science and the art of medicine. I then indicate two areas that merit more explicit attention in developing a comprehensive philosophy of medicine going forward: health economics and systematic relations within the field as a whole...
December 2017: Theoretical Medicine and Bioethics
Thomas S Huddle
The dispute over professional conscientious objection presumes a picture of medicine as a practice governed by rules. This rule-based conception of medical practice is identifiable with John Rawls's conception of social practices. This conception does not capture the character of medical practice as experienced by practitioners, for whom it is a sensibility or "form of life" rather than rules. Moreover, the sensibility of medical practice as experienced by physicians is at best neutral, and at worst hostile, to the demands of those who would override physician conscientious objection to the provision of currently contested services...
December 2017: Theoretical Medicine and Bioethics
Lauren L Baker
This article explores the relationship between gender, technology, language, and how infants and children born with disorders of sexual development are shaped into intelligible members of the community. The contemporary medical model maintains that children ought to be both socially and surgically assigned and reared as one particular gender. Gender scholar Suzanne Kessler rejects this position and argues for the acceptance of greater genital variability through the use of language. Using a Heideggerian lens, the main question I seek to answer in this article is: does Kessler's approach succeed in its aim to better treat individuals born with disorders of sexual development? I argue that Kessler is successful in offering practical solutions for persons with intersexed conditions to exist and flourish as intelligible members of the community, but that her project ultimately relies on power to "challenge forth" greater acceptance of genital variance...
December 2017: Theoretical Medicine and Bioethics
Allan Køster
It is often emphasised that persons diagnosed with borderline personality disorder (BPD) show difficulties in understanding their own psychological states. In this article, I argue that from a phenomenological perspective, BPD can be understood as an existential modality in which the embodied self is profoundly saturated by an alienness regarding the person's own affects and responses. However, the balance of familiarity and alienness is not static, but can be cultivated through, e.g., psychotherapy. Following this line of thought, I present the idea that narrativising experiences can play an important role in processes of appropriating such embodied self-alienness...
December 2017: Theoretical Medicine and Bioethics
Sally Markowitz
No abstract text is available yet for this article.
October 2017: Theoretical Medicine and Bioethics
David Hershenov, Rose Joanna Hershenov
No abstract text is available yet for this article.
October 2017: Theoretical Medicine and Bioethics
David B Hershenov, Rose J Hershenov
Our contention is that all of the major arguments for abortion are also arguments for permitting infanticide. One cannot distinguish the fetus from the infant in terms of a morally significant intrinsic property, nor are they morally discernible in terms of standing in different relationships to others. The logic of our position is that if such arguments justify abortion, then they also justify infanticide. If we are right that infanticide is not justified, then such arguments will fail to justify abortion...
October 2017: Theoretical Medicine and Bioethics
Neil Feit
According to Jerome Wakefield's harmful dysfunction analysis (HDA) of medical disorder, the inability of some internal part or mechanism to perform its natural function is necessary, but not sufficient, for disorder. HDA also requires that the part dysfunction be harmful to the individual. I consider several problems for HDA's harm criterion in this article. Other accounts on which harm is necessary for disorder will suffer from all or almost all of these problems. Comparative accounts of harm imply that one is harmed when one is made worse off, that is, worse off than one otherwise would have been...
October 2017: Theoretical Medicine and Bioethics
Nikk Effingham, Malcolm J Price
When a study shows statistically significant correlation between an exposure and an outcome, the credence of a real connection between the two increases. Should that credence remain the same when it is discovered that further independent studies between the exposure and other independent outcomes were conducted? Matthew Kotzen argues that it should remain the same, even if the results of those further studies are discovered. However, we argue that it can differ dependent upon the results of the studies.
October 2017: Theoretical Medicine and Bioethics
Ian James Kidd
Many people report that reading first-person narratives of the experience of illness can be morally instructive or educative. But although they are ubiquitous and typically sincere, the precise nature of such educative experiences is puzzling, for those narratives typically lack the features that modern philosophers regard as constitutive of moral reason. I argue that such puzzlement should disappear, and the morally educative power of illness narratives explained, if one distinguishes two different styles of moral reasoning: an inferentialist style that generates the puzzlement and an alternative exemplarist style that offers a compelling explanation of the morally educative power of pathographic literature...
August 2017: Theoretical Medicine and Bioethics
Jeremy R Simon, Havi Carel, Alexander Bird
No abstract text is available yet for this article.
August 2017: Theoretical Medicine and Bioethics
Sam Fellowes
Psychiatric researchers typically assume that the modelling of psychiatric symptoms is not influenced by psychiatric categories; symptoms are modelled and then grouped into a psychiatric category. I highlight this primarily through analysing research domain criteria (RDoC). RDoC's importance makes it worth scrutinizing, and this assessment also serves as a case study with relevance for other areas of psychiatry. RDoC takes inadequacies of existing psychiatric categories as holding back causal investigation...
August 2017: Theoretical Medicine and Bioethics
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