Philosophy of Medicine, Misc

This article is an introduction to the special issue on philosophy of medicine. Philosophy of medicine is a field that has flourished in the last couple of decades and has become increasingly institutionalized. The introduction begins with a brief overview of some of the most central recent developments in the field. It then describes the six articles that comprise this issue.

In the past few years, the ethical ramifications of AI technologies have been at the center of intense debates. Considerable attention has been devoted to understanding how a morally responsible practice of data science can be promoted and which values have to shape it. In this context, ethics and moral responsibility have been mainly conceptualized as compliance to widely shared principles. However, several scholars have highlighted the limitations of such a principled approach. Drawing from microethics and the virtue theory tradition, (...) in this paper, we formulate a different approach to ethics in data science which is based on a different conception of “being ethical” and, ultimately, of what it means to promote a morally responsible data science. First, we develop the idea that, rather than only compliance, ethical decision-making consists in using certain moral abilities, which are cultivated by practicing and exercising them in the data science process. An aspect of virtue development that we discuss here is moral attention, which is the ability of data scientists to identify the ethical relevance of their own technical decisions in data science activities. Next, by elaborating on the capability approach, we define a technical act as ethically relevant when it impacts one or more of the basic human capabilities of data subjects. Therefore, rather than “applying ethics”, data scientists should cultivate ethics as a form of reflection on how technical choices and ethical impacts shape one another. Finally, we show how this microethical framework concretely works, by dissecting the ethical dimension of the technical procedures involved in data understanding and preparation of electronic health records. (shrink)

[1st paragraph] A philosophical discussion on evidence-based medicine (EBM) can be probably perceived almost as an oxymoron. How can “the process of systematically finding, appraising, and using contemporaneous research findings as the basis for clinical decisions” (Jenicek 2012: 23) be compatible with the critical and systematic examination of fundamental problems such as the nature of being, reality, thinking, values and perception? How can a scientific field focused mainly on the search and evaluation of evidence and aimed at solid quantifications of (...) hypotheses (Jenicek 2003: 70) be approachable from a perspective that is characterized by probable or defeasible arguments? The challenge of this special issue is to show how a philosophical perspective on evidence is not opposed to, but rather at the grounds of evidence-based medicine. (shrink)

A large part of contemporary phenomenology of medicine has been devoted to accounts of health and illness, arguing that they contribute to the improvement of healthcare. Less focus has been paid to the issue of prevention of disease and the associated difficulty of adhering to health-promoting behaviours, which is arguably of equal importance. This article offers a phenomenological account of this disease prevention, focusing on how we – as embodied beings – engage with health-promoting behaviours. It specifically considers how we (...) engage with oral hygiene regimes to prevent periodontitis and why we are not good at it. The article suggests that poor adherence to health-promoting behaviours can be explained with reference to the concept of the absent body, as prevention of disease is generally concerned with pre-symptomatic illness experience. The final section contains a discussion of some strategies for the improvement of disease prevention based on this viewpoint. (shrink)

This paper analyses the ethics of routine measurement for healthcare improvement. Routine measurement is an increasingly central part of healthcare system design and is taken to be necessary for successful healthcare improvement efforts. It is widely recognised that the effectiveness of routine measurement in bringing about improvement is limited—it often produces only modest effects or fails to generate anticipated improvements at all. We seek to show that these concerns do not exhaust the ethics of routine measurement. Even if routine measurement (...) does lead to healthcare improvements, it has associated ethical costs which are not necessarily justified by its benefits. We argue that the practice of routine measurement changes the function of the healthcare system, resulting in an unintended and ethically significant transformation of the sector. It is difficult to determine whether such changes are justified or offset by the benefits of routine measurement because there may be no shared understanding of what is ‘good’ in healthcare by which to compare the benefits of routine measurement with the goods that are precluded by it. We counsel that the practice of routine measurement should proceed with caution and should be recognised to be an ethically significant choice, rather than an inevitability. (shrink)

Empathy is often described as a virtue which that could help in making medicine more humanistic. This paper argues that there are two limits to this thesis. First, it is unclear whether a lack of empathy can be attributed to the biomedical education. Second, empathy itself is not without issues, and another concept, compassion, can be put forward instead. Humanism based on compassion is more minimalist, but integrated with an approach focused on health systems, it makes humanism more tangible and (...) radical. -/- . (shrink)

The article examines the theological and philosophical origins of Jewish and early Christian medicine. We have shown that the basis of the medical practice of the ancient Jews and early Christians were the books of the Old Testament. The principles of nutrition, sanitation and hygiene have been considered in detail in the context of the topic. We also have analyzed the rules of care for sick people and the means used by the Jewish people in the treatment of infectious diseases. (...) It has been shown that in order to prevent the spread of an infectious disease, Jews isolated an infected person from close contact with other people, thus avoiding the spread of various diseases and epidemics. Some Jewish works of the post-biblical period contain a description of the development of philosophy and ethics in medicine; the main ones are the Midrash, the Mishnah and the Talmud. In the article we also have analyzed conceptual medical foundations set forth in the Pentateuch of the Moses and the Talmud. It has been shown that the main attention of Jewish treatment practitioners was focused on disease prevention, as they attached great importance to the principles of ritual purity, which in turn was directly related to public hygiene. We also have studied a number of works of the early church fathers, who initiated the practice of caring for the physically ill. As a result, it was found that in the writings of the church fathers there are many mentions of surgery and treatment of mental illness. (shrink)

The Astronomia Olympi novi and the Theologia Cabalistica were published as part of the Philosophia Mystica. This influential collection of Paracelsian and Weigelian texts was among the first to include a publication of the theologica of Paracelsus. Both of these short pseudo-Paracelsian works were written by Adam Haslmayr, the propagator of the “Theophrastia Sancta,” a philosophical theology of Paracelsus mixed with Weigelian and alchemical influences. These works, taken in the Philosophia Mystica, are among the very few of his texts that (...) appeared in print in his lifetime. In this paper, the content of both pseudepigrapha is analyzed and related to ideas found in both the authentic and the pseudepigraphic works of Paracelsus, as well as in relevant works of some Paracelsians. Specifically, the notions of the “Olympus novus” and the “cabalistic principles” are discussed in a wider context. (shrink)

Practical and evidence-based, this unique book is the first comprehensive text focused on person-centered approaches to people with serious mental illness such as schizophrenia and bipolar disorder. It reflects a range of views and findings regarding assessment, treatment, rehabilitation, self-help, policy-making, education and research. It is highly recommended for all healthcare professionals, students, researchers and educators involved in general practice, psychiatry, nursing, social work, clinical psychology and therapy. Healthcare service providers, and policy makers and shapers, will find the book's wide-ranging, (...) multi-professional approach enlightening. 'Serious Mental Illness reflects a continued distancing from the outmoded and unsubstantiated belief that people with severe mental illnesses could not recover, and that they would respond positively only to goals and treatment plans chosen, designed and implemented by providers in order to prevent their further deterioration. Anyone with an interest in the concept of person-centered approaches will discover new ideas in this book. Indeed, anyone with an interest in person-centered approaches has to read this book. Not only is it the first such book on person-centered approaches, but it will serve as the gold standard in this topic area for years to come.' William A Anthony, in the Foreword. (shrink)

In this commentary, I discuss the scientific changes brought by the exposome, asking what is new about this approach and line of research. I place the exposome in a historical perspective, by analyzing the conditions under which the exposome has been conceived, developed and established in the context of contemporary epidemiological research. I argue that the exposome has been developed by transferring approaches, methods and conceptualizations from other lines of research in the life and health sciences. I thus discuss the (...) conceptual and methodological innovations of the exposome as a result of the merging and adaptation of these elements for new uses and purposes. On this basis, I argue that the novelty of the exposome should be seen in incremental rather than revolutionary terms and, in this sense, the exposome shares significant elements with other projects and repertoires in postgenomics. I conclude by discussing the consequences of this analysis for the potential limitations and future development of exposome research. (shrink)

A very basic form of experience consists in feeling energetic, vital, alive, tired, dispirited, vigorous and so on. These feelings – which I call feelings of vitality or vital feelings – constitute the main concern of this paper. My aim is to argue that these feelings exhibit a distinctive form of affectivity which cannot be explained in terms of emotions, moods, background feelings or existential feelings and to explore different paths for their conceptualization. The paper proceeds as follows. After introducing (...) the topic (sect. 1), I show that these feelings cannot be subsumed under any of the current categories of the affective mind (sect. 2). Against this backdrop, I present and critically assess Scheler’s notion of vital feelings as an alternative model for capturing their distinctive nature (sect. 3). Next, I explore varieties of vital feelings by focusing on different levels of the bodily-felt experience (sect. 4) and analyze their specific form of self-involvement (sect. 5). Finally, I conclude by showing how the study of vital feelings might contribute to phenomenological bioethics (sect. 6). (shrink)

This article offers an assessment of Henricus Regius’s pre-Cartesian sources and their role in his appropriation of Descartes’s ideas, via two main questions: 1) Who was Regius, doctrinally speaking, before his exposure to Cartesianism? And 2) how did he use Descartes’s theories before his quarrel with Descartes himself in the mid-1640s? These questions are addressed by means of a textual analysis that concerns his theory of matter. In this article, I will show that 1) Regius started out with a scientific (...) program he had found in Ramism and the medical theories of Heurnius and Santorio. 2) On this basis, he developed a physiology encompassing Descartes’s theory of blood circulation and sensory perception. 3) Regius completed the resulting physiology with a theory of matter more developed than Descartes’s, and which he appropriated from Santorio, Basson, and Gorlaeus. (shrink)

Das Ziel einer so genannten Personalisierten Medizin ist es, verfügbare oder neue Interventionen zielgerichteter einzusetzen, um so ihren Nutzen zu optimieren. Mit dieser Zielsetzung sind an eine Prüfung der Zielerreichung die gleichen Anforderungen zu stellen wie an jede andere Intervention. Der Nutzen ist durch aussagefähige Studien, typischerweise also prospektive, kontrollierte Interventionsstudien, zu belegen. Dort, wo es um den Kern personalisierter Medizin, nämlich die Verbindung von Diagnostik und Behandlung geht, ist genau diese Verbindung in Form einer statistischen Wechselwirkung zu belegen. Enrichment-Designs (...) allein beantworten diese Frage nicht. Die Bewertung von Methoden der personalisierten Medizin ist problemlos in das Konzept evidenzbasierter Medizin einzubinden. (shrink)

We raise a problem of applicability of RCTs to validate nuclear diagnostic imaging tests. In spite of the wide application of PET and other similar techniques that use radiopharmaceuticals for diagnostic purposes, RCT-based evidence on their validity is sparse. We claim that this is due to a general conceptual problem that we call Prevalence of Treatment, which arises in connection with designing RCTs for testing any diagnostic procedure in the present context of medical research, and is particularly apparent in this (...) case. We also identify three practical reasons why RCTs do not qualify as the best option for PET validation, which have to do with specific characteristics of nuclear diagnostic imaging, and of radiopharmaceuticals. The paper is meant to contribute both to the philosophical discussion on the EBM hierarchy of evidence, and on the specific debate on radiopharmaceuticals in nuclear medicine. (shrink)

This paper contends, following Plato and Broekman, that seeing images as images is crucial to theorizing medicine and that considering clinical pictures as images of images is a much-needed epistemic complement to the domineering view that sees clinical pictures as mirrors of disease. This does not only offer epistemic, but also ethical benefits to individual patients, especially in those cases where patients suffer from chronic, debilitating, and terminal illnesses and where medicine provides no, or limited, answers in terms of treatment, (...) intervention, and meaning. By creating room for a theory of clinical pictures that rightfully emphasizes its pictorial nature, patients and doctors alike may be encouraged to consider under what authorship, and with which epistemic tools, alternative, supplemental images may be produced to get at the existential reality of disease and suffering. Ultimately, this paper argues that the epistemic tools provided by aesthetics may offer such glimpses into the reality of disease and suffering, and I conclude by discussing a few artistic renditions of breast cancer to illustrate my point. (shrink)

A new therapeutic strategy could break the stalemate in the war on cancer by targeting not all cancerous cells but the small fraction that lie at the root of cancers. Lucie Laplane offers a comprehensive analysis of cancer stem cell theory, based on an original interdisciplinary approach that combines biology, biomedical history, and philosophy.

Business models for biomedical research prescribe decentralization due to market selection pressures. I argue that decentralized biomedical research does not match four normative philosophical models of the role of values in science. Non-epistemic values affect the internal stages of for-profit biomedical science. Publication planning, effected by Contract Research Organizations, inhibits mechanisms for transformative criticism. The structure of contracted research precludes attribution of responsibility for foreseeable harm resulting from methodological choices. The effectiveness of business strategies leads to overrepresentation of profit values (...) versus the values of the general public. These disconnects in respect to the proper role of values in science results from structural issues ultimately linked to the distinct goals of business versus applied science, and so it seems likely that disconnects will also be found in other dimensions of attempts to combine business and science. The volume and integration in the publishing community of decentralized biomedical research imply that the entire community of biomedical research science cannot match the normative criteria of community-focused models of values in science. Several proposals for changing research funding structure might successfully relieve market pressures that drive decentralization. (shrink)

In some quarters within philosophy of medicine, more particularly in the phenomenological approaches, naturalism is looked upon with suspicion. This paper argues, first, that it is necessary to distinguish between two expressions of this attitude towards naturalism: phenomenological approaches to illness disagree with naturalism regarding various theoretical claims and they disapprove of naturalism on an ethical level. Second, this paper argues that both the disagreement with and the disapproval of naturalism are to a large extent confused. It then offers some (...) proposals to set up an agenda for future collaboration. (shrink)

Ill persons suffer from a variety of epistemically-inflected harms and wrongs. Many of these are interpretable as specific forms of what we dub pathocentric epistemic injustices, these being ones that target and track ill persons. We sketch the general forms of pathocentric testimonial and hermeneutical injustice, each of which are pervasive within the experiences of ill persons during their encounters in healthcare contexts and the social world. What’s epistemically unjust might not be only agents, communities and institutions, but the theoretical (...) conceptions of health that structure our responses to illness. Thus, we suggest that although such pathocentric epistemic injustices have a variety of interpersonal and structural causes, they are also sustained by a deeper naturalistic conception of the nature of illness. (shrink)

Modern health care relies extensively on the use of technologies for assessing and treating patients, so it is important to be certain that health care technologies perform their professed functions in an effective and safe manner. Philosophers of technology have developed methods to assign and evaluate the functions of technological products, the major elements of which are described in the ICE theory. This paper questions whether the standard of evidence advocated by the ICE theory is adequate for ascribing and assessing (...) technologies employed in health care. The paper proposes that the general problem with the standard of evidence embodied in the ICE theory is too permissive for assessing medical technologies, in that it does not take into account the relative benefit and harm of medical technologies in ensuring safe functional performance in patients. The paper illustrates how evidence-based medicine has demonstrated the value of clinical research methods, including observational studies, randomized and non-randomized clinical trials, and formal techniques, such as meta-analysis, to measure therapeutic effectiveness. I argue, therefore, that evidence from clinical research studies should take precedence over the testimonial evidence and other types of non-clinical evidence, in providing justification for health technologies. (shrink)

In general, current biomedical models of schizophrenia focus on distinguishing discrete elements that, on their own or in combination with others, might lead to some form of disability. These different and potentially autonomous aspects of the disorder that might disrupt daily activities include positive and negative symptoms as well as disturbances in neurocognitive and psychobiological processes. Such disturbances include genetic vulnerabilities that increase the risk of abnormalities in brain development, and resultant neurocognitive deficits which interfere with the ability to carry (...) out specific tasks.These approaches to schizophrenia, which have... (shrink)

The myriad controversies embroiling the mental health field—heightened in the lead-up to the release of DSM-5 —merit a close analysis of the field and its epistemological underpinnings. By using DSM as a starting point, this paper develops to overview the entire mental health field. Beginning with a history of the field and its recent crises, the troubles of the past “external crisis” are compared to the contemporary “internal crisis.” In an effort to examine why crises have recurred, the internal dynamics (...) of the field are assessed: applying Kuhn’s paradigmatic framework, crises are appraised to situate the differences between the natural sciences and the mental health field. Next, a Foucauldian analysis examines the functioning of the field’s power over the body, which is disproportionate in comparison to its scientific grounding. This is followed by investigating the field’s combination of contested scientific grounding and significant power, through a Latourian consideration of the assumptions and meaning behind the mental health field’s deployment of science. This includes scrutinizing the history of the classification of Post-Traumatic Stress Disorder. The paper closes by assessing the field’s potential to address these issues effectively. (shrink)

Causality in 19th and Early 20th Century Medicine 3 A Lakatosian Approach to the History of Medicine.

The principal argument of the present paper is that the human body is as much a reflective formation of multiple discourses as it is an effect of natural and environmental processes. This paper examines the implications of this argument, and suggests that recognizing the body in this light can be illuminating, not only for our conception of the body, but also for our understanding of medicine. Since medicine is itself a discursive formation, a science with both a history, and a (...) future, it is argued that much can be learned by reflecting on the progression of models, or “paradigm-shifts,”, in terms of which modern medicine has articulated the human body that figures at the heart of its discourse. Four historical periods of medicine will be considered, each one governed by its own distinctive paradigm. It is argued, finally, that, with the emergence of behavioural medicine, and, more particularly, psychoneuroimmunology, a new discursive formation in medicine, one can see a new conceptualization of the human body beginning to take shape; and that this new figure of the body makes it possible for the very first time to conceive the construction of testable hypotheses regarding correlations between the objective body of science and the phenomenological body of experienced meaning. (shrink)

In Unfit for the Future, Ingmar Persson and Julian Savulescu present a sophisticated argument in defense of the imperative of moral enhancement. They claim that without moral enhancement, the future of humanity is seriously compromised. The possibility of ultimate harm, caused by a dreadful terrorist attack or by a final unpreventable escalation of the present environmental crisis aggravated by the availability of cognitive enhancement, makes moral enhancement a top priority. It may be considered optimistic to think that our present moral (...) capabilities can be successfully improved by means of moral education, moral persuasion, and fear of punishment. So, without moral enhancement, drastic restrictions on human freedom would become the only alternative to prevent those dramatic potential outcomes. In this article, I will try to show that we still have reason to be less pessimistic and that Persson & Savulescu’s arguments are fortunately unconvincing. (shrink)

This work brings together Philip van der Eijk's previously published essays on the close connections that existed between medicine and philosophy throughout antiquity. Medical authors such as the Hippocratic writers, Diocles, Galen, Soranus and Caelius Aurelianus elaborated on philosophical methods such as causal explanation, definition and division and applied key concepts such as the notion of nature to their understanding of the human body. Similarly, philosophers such as Plato and Aristotle were highly valued for their contributions to medicine. This interaction (...) was particularly striking in the study of the human soul in its relation to the body, as illustrated by approaches to specific topics such as intellect, sleep and dreams, and diet and drugs. With a detailed introduction surveying the subject as a whole and an essay on Aristotle's treatment of sleep, this wide-ranging and accessible collection is essential reading for the student of ancient philosophy and science. (shrink)

"All ravens are black" is logically but not confirmationally equivalent with "all non-black things are non-ravens." But this is impossible, given that logical equivalence guarantees confirmational equivalence. In this paper, this paradox is solved.