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Theoretical Medicine and Bioethics

J K Miles
Virtue theory in philosophical bioethics has influenced clinical ethics with depictions of the virtuous doctor or nurse. Comparatively little has been done with the concept of the virtuous patient, however. Bioethicists should correct the asymmetry in virtue theory between physician virtues and patient virtues in a way that provides a practical theory for the new patient-centered medicine-something clinicians and administrators can take seriously.
April 10, 2019: Theoretical Medicine and Bioethics
Philip Reed
The practice whereby terminally ill patients choose to end their own lives painlessly by ingesting a drug prescribed by a physician has commonly been referred to as physician-assisted suicide. There is, however, a strong trend forming that seeks to deny that this act should properly be termed suicide. The purpose of this paper is to examine and reject the view that the term suicide should be abandoned in reference to what has been called physician-assisted suicide. I argue that there are no good conceptual or philosophical reasons to avoid the suicide label...
April 6, 2019: Theoretical Medicine and Bioethics
David S Oderberg
The dead donor rule holds that removing organs from living human beings without their consent is wrongful killing. The rule still prevails in most countries, and I assume it without argument in order to pose the question: is it possible to have a metaphysically correct, clinically relevant analysis of human death that makes organ donation ethically permissible? I argue that the two dominant criteria of death-brain death and circulatory death-are both empirically and metaphysically inadequate as definitions of human death and therefore hold no epistemic value in themselves...
April 3, 2019: Theoretical Medicine and Bioethics
David G Limbaugh
Jerome Wakefield has argued that a disorder is a harmful dysfunction. This paper develops how Wakefield should construe harmful 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 disorders prevent each other from being, in any traditional sense, actually harmful; in such cases, according to the HDA, neither would be a disorder...
March 2, 2019: Theoretical Medicine and Bioethics
Julius Sim
Outcome-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...
February 18, 2019: Theoretical Medicine and Bioethics
Mary Jean Walker, Justin Bourke, Katrina Hutchison
Personalised 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...
February 15, 2019: Theoretical Medicine and Bioethics
Nathan Emmerich, Bert Gordijn
With 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 professionals 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...
February 13, 2019: Theoretical Medicine and Bioethics
Abram Brummett
Douglas 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...
February 2019: Theoretical Medicine and Bioethics
James A Marcum
No abstract text is available yet for this article.
December 10, 2018: Theoretical Medicine and Bioethics
Kimbell Kornu
Through 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 Vesalius' works on anatomy overturned. What is less known about Galen's study of anatomy, however, is its philosophical and theological edge...
December 2018: Theoretical Medicine and Bioethics
Matthew Vest, Ashley Moyse
No abstract text is available yet for this article.
December 2018: Theoretical Medicine and Bioethics
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...
December 2018: Theoretical Medicine and Bioethics
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...
December 2018: Theoretical Medicine and Bioethics
Jacob A Blythe, Farr A Curlin
Market metaphors have come to dominate discourse on medical practice. In this essay, we revisit Peter Berger and colleagues' analysis of modernization in their book The 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 the product presumption...
November 20, 2018: Theoretical Medicine and Bioethics
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
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
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
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
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
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
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