Volume 24, Issue 9, September 2024, Page 48-50.

Volume 24, Issue 12, December 2024, Page 6-7.

Volume 24, Issue 11, November 2024, Page 1-3.

The best things in my Ufe have come to me by accident and this book results from one such accident: my having the opportunity, out of the blue, to go to work as H. Tristram Engelhardt, Jr. 's, research assistant at the Institute for the Medical Humanities in the University of Texas Medi cal Branch at Galveston, Texas, in 1974, on the recommendation of our teacher at the University of Texas at Austin, Irwin C. Lieb. During that summer Tris "lent" (...) me to Chester Bums, who has done important schol arly work over the years on the history of medical ethics. I was just finding out what bioethics was and Chester sent me to the rare book room of the Medical Branch Library to do some work on something called "medical deontology. " I discovered that this new field of bioethics had a history. This string of accidents continued, in 1975, when Warren Reich (who in 1979 made the excellent decisions to hire me to the faculty in bioethics at the Georgetown University School of Medicine and to persuade Andre Hellegers to appoint me to the Kennedy Institute of Ethics) took Tris Engelhardt's word for it that I could write on the history of modem medical ethics for Warren's major new project, the Encyclopedia of Bioethics. Warren then asked me to write on eighteenth-century British medical ethics. (shrink)

In this paper, an argumentative pattern that is prototypical for the communicative practice of over-the-counter medicine advertisements will be discussed. First, a basic argumentative pattern for this type of advertisement will be identified. In addition, an overview of various types of extensions of this basic pattern will be presented. Finally, it will be made clear how combinations of the basic pattern and specific extensions can be analysed as the result of strategic choices made by the advertisers concerning the type (...) of arguments that are advanced, the argumentation structure and the presentation of their arguments. (shrink)

Most proponents of conscientious objection accommodation in medicine acknowledge that not all conscientious beliefs can justify refusing service to a patient. Accordingly, they admit that constraints must be placed on the practice of conscientious objection. I argue that one such constraint must be an assessment of the reasonability of the conscientious claim in question, and that this requires normative justification of the claim. Some advocates of conscientious object protest that, since conscientious claims are a manifestation of personal beliefs, they (...) cannot be subject to this kind of public justification. In order to preserve an element of constraint without requiring normative justification of conscientious beliefs, they shift the justificatory burden from the belief motivating the conscientious claim to the condition of the patient being refused service. This generally involves a claim along the lines that conscientious refusals should be permitted to the extent that they do not cause unwarranted harm to the patient. I argue that explaining what would constitute warranted harm requires an explanation of what it is about the conscientious claim that makes the harm warranted. ‘Warranted’ is a normative operator, and providing this explanation is the same as providing normative justification for the conscientious claim. This shows that resorting to facts about the patient’s condition does not avoid the problem of providing normative justification, and that the onus remains on advocates of conscientious objection to provide normative justification for the practice in the context of medical care. (shrink)

This paper explains Viktor von Weizsäcker’s Gestaltkreis model as a reinterpretation of Jakob von Uexküll’s Funktionskreis. Also derived from the Funktionskreis is Thure von Uexküll’s Situationskreis model. Both Weizsäcker’s Gestaltkreis and Thure von Uexküll’s Situationskreis have evolved in the context of integrated medicine in Germany throughout the twentieth century. Focusing on the role of language in health and medicine, this paper addresses important concepts associated with the project of integrated medicine in Germany, especially the biographical approach practiced (...) by Viktor von Weizsäcker and developed by Thure von Uexküll through the concept of the biographical organ. While their efforts to reform the practice of medicine and the training of physicians were unsuccessful, recent research in the psychology of language and health and recommendations for more patient-centered communication resonate with the principles underlying Viktor von Weizsäcker’s and Thure von Uexküll’s integrated medicine. (shrink)

Health is on of those subjects that seems easy to define and then, the closer one gets, is more and more difficult to understand. Does the health of a schizophrenic really improve by being sedated and kept in an asylum? Is a course of Prozac or psychotherapy aimed to make someone happy really a medicine? These incompatible views are most visible in the NHS which has over the decades become the focus of all these projections of health. At the (...) expense of the taxpayer many are being cured while there is no money for some of those who have physical ailments in a real sense. In this book, Theodore Dalrymple sets out to tear into the myths that he believes our politicians have created, with anecdotes from his own experience as a doctor. (shrink)

Cortisone, initially known as ‘compound E’ was the medical sensation of the late 1940s and early 1950s. As early as April 1949, only a week after Philip Hench and colleagues first described the potential of ‘compound E’ at a Mayo Clinic seminar, the New York Times reported the drug’s promise as a ‘modern miracle’ in the treatment of rheumatoid arthritis. Given its high profile, it is unsurprising that historians of medicine have been attracted to study the innovation of cortisone. (...) It arrived at the end of a decade of ‘therapeutic revolutions’, kicked off by penicillin transforming the treatment of bacterial infections and ending with hopes of a revolution in the treatment of non-infectious, chronic inflammatory diseases. Despite these studies of cortisone’s introduction, few historians have taken the story forward and considered how cortisone was adopted and adapted into clinical practice. This article tells the longer of how the drug and its derivatives were taken from research laboratories and integrated into clinical practice; what has in recent decades become known as translational medicine. In exploring cortisone’s first decade in Britain, we focus specifically on its role in the treatment of RA. Our approach is always to consider cortisone’s use in the context of other treatments available to clinicians, and at local and national institutional settings. We do not discuss the many other therapeutic uses of cortisone, which ranged for topical applications for skin diseases to the management of cancers, especially childhood leukaemia, nor do we discuss its close analogue ACTH—AdenoCorticoTropic Hormone. We think there are lessons in our study for TM policies today. (shrink)

This article adopts Husserl’s transcendental phenomenology to explore the complex relationship between patients and physicians. It delves into the coexistence of two distinct voices in the realm of medicine and health: the “voice of medicine” and the “voice of life-world.” Divided into three sections, the article emphasizes the importance of shifting from a scientific-medical attitude to a more personalistic approach in physician–patient interactions. This shift aims to prevent depersonalization and desubjectification. Additionally, it highlights the equal and irreducible nature (...) of patients while acknowledging the vital role physicians hold in the realm of illness. The article stresses the need for a balanced and equitable relationship between both parties, rooted in the shared life-world. Moreover, empathy is underscored as a crucial element in fostering meaningful dialogue, wherein understanding diverse perspectives and attitudes towards illness is paramount. The article argues that differences between patients and physicians are necessary for empathy, while shared similarities form its foundation. Ultimately, a harmonious relationship facilitates empathy and enables the constitution of a new sense of life for both patients and physicians. (shrink)

This article isolates ten prepositions, which constitute the undercurrent paradigm of contemporary discourse of health disease and medicine. Discussion of the interrelationship between those prepositions leads to a systematic refutation of this paradigm. An alternative set is being forwarded. The key notions of the existing paradigm are that health is the natural condition of humankind and that disease is a deviance from that nature. Natural things are harmonious and healthy while human made artifacts are coercive interference with natural balance. (...) It is suggested that the current paradigm is influenced by the world of finances and by instrumental reason. The alternative model suggests that human nature cannot be delineated. Humans fashion their own selves and nature by artificial means, medicine among them. The article discusses the implications of the paradigm adapted in various scholarly and popular debates such as the use of sex hormones for contraception, the care of the elderly, holistic medicine and distributive justice in health care. Medicine is not an isolated or a privileged realm. There is no unique entitlement to health care. It is always part of a broader agenda of social values and institutions. A open view of human societies, values and practices as they are situated within concrete material conditions is the platform required for an integrative and creative discourse of health care. (shrink)

The liberal approach to ethics quite naturally tends toward the classic individualistic theory of society, to reductionism or psychologism so-called, that is, to a reduction of all social action to individual action. For example, liberalism allows one to experiment with new medications on one's own body. By extension, liberalism allows one to experiment, it seems, on another person's body with new medication if one acts as the other person's agent, that is, if one has the other person's proper consent. We (...) all know that new medicines are introduced into the market experimentally; indeed, government agencies, such as food and drug administrations, are supposed to supervise such experimentations and eliminate from the market as quickly as possible new (or old) medications that prove harmful. Hence, the very introduction of a new medicine into the market requires the consent of the public - in the form of proper permits to manufacture and market new (and old) drugs and other medications. Yet there is a flaw in this description. The act of permission is not made by individual citizens to doctors who act as their agents. (shrink)

In this paper, we discuss how access to health-related data by private insurers, other than affecting the interests of prospective policy-holders, can also influence their propensity to make personal data available for research purposes. We take the case of national precision medicine initiatives as an illustrative example of this possible tendency. Precision medicine pools together unprecedented amounts of genetic as well as phenotypic data. The possibility that private insurers could claim access to such rapidly accumulating biomedical Big Data (...) or to health-related information derived from it would discourage people from enrolling in precision medicine studies. Should that be the case, the economic value of personal data for the insurance industry would end up affecting the public value of data as a scientific resource. In what follows we articulate three principles – trustworthiness, openness and evidence – to address this problem and tame its potentially harmful effects on the development of precision medicine and, more generally, on the advancement of medical science. (shrink)

To inform the ongoing discussion of whether claims of conscientious objection allow medical professionals to refuse to perform tasks that would otherwise be their duty, this paper begins with a review of the philosophical literature that describes conscience as either a moral sense or the dictate of reason. Even though authors have starkly different views on what conscience is, advocates of both approaches agree that conscience should be obeyed and that keeping promises is a conscience-given moral imperative. The paper then (...) considers exemplars of conscientious objection—Henry David Thoreau, Mohandas Gandhi, and Martin Luther King Jr.—to identify the critical feature of conscientious objection as willingness to bear the burdens of one’s convictions. It concludes by showing that medical professionals who put their own interests before their patients’ welfare violate their previous commitments and misappropriate the title “conscientious objector” because they are unwilling to bear the burdens of their choices and instead impose burdens on their patients and colleagues. (shrink)

‘Individualized medicine’ is an emerging paradigm in clinical life science research. We conducted a socio-empirical interview study in a leading German clinical research group, aiming at implementing ‘individualized medicine’ of colorectal cancer. The goal was to investigate moral and social issues related to physician–patient interaction and clinical care, and to identify the points raised, supported and rejected by the physicians and researchers. Up to now there has been only limited insight into how experts dedicated to individualized medicine (...) view its problems. Interviews with researchers and clinicians (n= 19) were based on a prestructured questionnaire. The content analysis revealed a broad spectrum of opinions. Major findings were (a) disappointments with the limits of the current therapy regimen and clinical practice; (b) problematic impacts on physician–patient relationship; and (c) an informed consent procedure which is mainly based on paternalistic assumptions. According to our analysis, major problems will be uncertainties related to the biomarker's sensitivity and specificity, and the identification of ‘non-responders’. However, the findings also indicate that experts expect evidence-based medicine to replace decisions based on gut feeling or hierarchical structures. (shrink)

How should one think about innovation in medicine and surgery? Increasingly, the answer to this question has involved reference to what might be called the regulatory ethics paradigm (REP). The regulatory ethics paradigm holds that deviations from standard care involve a degree or kind of experimentation that requires the application of a set of procedures designed to assure the protection of the rights and welfare of the subjects of research. In REP, innovative treatments are regarded as questionable until they (...) are framed in a research protocol with formal mechanisms of informed consent. The protocol must be reviewed and approved by an Institutional Review Board (IRB) or equivalent. The regulatory ethics paradigm in effect imposes the condition that clinical innovations be conducted according to scientific research methodologies. It creates the presumption that without review by an IRB, innovation cannot be conducted in an ethically defensible fashion. The regulatory ethics paradigm also requires the preparation of investigational protocols according to sound evidentiary and methodological standards. In so doing, it creates a presumption that innovations that are not rigorously validated are ethically dubious. These assumptions have deep roots. The Belmont Report, for example, articulated the orienting intuition that “radically new procedures... should... be made the object of formal research at an early stage [emphasis added] in order to determine whether they are safe and effective”.1 The Belmont Report takes the view that formal research to establish safety and efficacy of new interventions is usually feasible at an early stage in the development of a novel intervention. It thus establishes a bias that innovative treatments be conducted and evaluated under a research protocol that has passed muster at an IRB review. Given the …. (shrink)

Society has historically not taken a benign view of genetic disease. The laws permitting sterilization of the mentally re tarded~ and those proscribing consanguineous marriages are but two examples. Indeed as far back as the 5th-10th centuries, B.C.E., consanguineous unions were outlawed (Leviticus XVIII, 6). Case law has traditionally tended toward the conservative. It is reactive rather than directive, exerting its influence only after an individual or group has sustained injury and brought suit. In contrast, state legislatures have not been (...) inhibited in enacting statutes. Many of their products can be characterized as hasty, unnecessary, ill-conceived, and based on the heart rather than the head. Moreover the lack of expert consultation sought has also been remarkable. One state legislature, for example, has advocated immunization for sickle cell anemia! Many others have enacted laws for the screening of inborn errors of metabolism, e.g., phenylketon uria, but have poorly defined the lines of responsibility to secure compliance. A spate of specific disease-related bills has emerged in the u.S. Congress, each seeking recognition and appropriations. Sickle cell anemia, hemophilia, Cooley's anemia and Tay-Sachs disease have been among the front-runners for support. Finally, in 1975, Congress has begun to examine an omnibus bill concerning all forms of genetic disease. The bill, termed the National Genetic Diseases Act is, however, still far from being enacted. (shrink)

Francis Collins had an impressive track record as a gene hunter (cystic fibrosis, neurofibromatosis, Huntington’s disease) when he was appointed Director of the Human Genome Project (HGP) in 1993. In June 2000, together with Craig Venter and President Bill Clinton, he presented the draft version of the human genome sequence to a worldwide audience during a famous press conference. And in 2009, President Barack Obama nominated him as director of the National Institutes of Health (NIH), the largest Tfunding agency for (...) biomedical research in the world. s The In 2006, Collins published his book The Language of God,3 an autobiographical account of the HGP and its scientific, historical, and societal significance, with special attention paid to the impact of the human sequence on the way we see our world and ourselves.4 Now, by way of a sequel, he has written The Language of Life. Wherea Language of God focused on the genome sequence of mankind in general, and on the HGP as a “revolution” in biomedicine, the new book, as indicated by its subtitle, is oriented towards “the revolution in personalized medicine”, the impact of the genomics revolution on the personal lives of individuals. Before subjecting Collins’ book to a closer reading, I first of all would like to explain how I will read it and from what perspective. Why is genomics in general, and the HGP and its aftermath in particular, a subject of interest to a philosopher like me? Why did I become interested in assessing the HGP and in studying the work and views of some of its key contributors? (shrink)

Evidence-based medicine is seen not only as an important means to improve the quality of medical care, but also as an instrument to control costs. In view of the scarcity of health care resources, decisions on the allocation of care will have to be made more explicitly and should be made more transparent.

The article’s aim is to explore human hand allograft recipients’ postoperative experience of disownership and their gradual experience of their new hand as theirs, with the aid of the work of the French phenomenologist Maurice Merleau-Ponty. Many have used a Merleau-Pontinian perspective in the analysis of embodiment. Far fewer have used it in medico-ethical analysis. Drew Leder’s phenomenologically based ethics of organ donation and organ sale is an exception to this tendency. The article’s second aim is to examine Leder’s phenomenologically (...) based ethics of organ donation and organ sale. Though I find parts of Leder’s approach promising, I also elaborate a line of reasoning that draws on Merleau-Ponty, that does allow us to argue for certain kinds of organ donation and against organ sale—and that avoids some of the problems with Leder’s approach. This alternative route builds on the concept of the integrity of the body-subject. (shrink)

Recently I reported in this journal1 how it became necessary for a judge to settle a dispute between the pharmaceutical industry and certain Dutch pharmacists. It considered the question of whether a pharmacist is permitted, without prior consultation, to give a patient a generic drug instead of the patent drug mentioned on the prescription.Another dispute has now arisen after the pharmaceutical industry discovered that healthcare insurers were paying general practitioners a bonus if they prescribed generic drugs, such as simvastatin or (...) omeprazol (which reduces the …. (shrink)

From Italian physician Hieronymus Mercurialis’s contention that the stomach was ‘the king of the belly’, to its promotion by the end of the nineteenth century to the ‘monarch of humanity’ in patent medicine, to Byron Robinson’s discovery of the enteric nervous system in 1907 (a mesh of neural connectivity that led him to dub the gut ‘the second brain’), there has historically been a longstanding awareness of the expansive reach of the gut in the functions of the body. In (...) the nineteenth century, the authority of the gut and its allyship with the brain became a focus for writers thinking about the intersections of illness and ‘modern life’. In medical texts, domestic health manuals, patent medicine, and fiction, the electric telegraph in particular became a way of envisaging what we would now call the ‘gut-brain axis’. The telegraphic metaphor enabled a view of digestion as not simply a mechanical or chemical process, but one that was understood in terms of time, space, and communication. However, such a framework also suggested problems of connection that were common to both systems, emphasising not only the healthy body’s quasi-telegraphic networks but also its vulnerability to delay, disruption, and pathological incoherence. This article will explore the use of telegraphic technologies as proxies for theorising gastric connection and more broadly the concept of ‘gastric time’ as a key conceit for understanding digestion as a process that was and is subject to the idiosyncrasies of bodily rhythms. (shrink)

This paper consists of two parts. In the first part, I will introduce a philosophical toolbox that I call ‘conceptual scaffolding,’ which helps to reflect holistically on phenomena and concepts. I situate this framework within the landscape of conceptual analysis and conceptual engineering, exemplified by the debate about the concept of disease. Within the framework of conceptual scaffolding, I develop the main idea of the paper, which is ‘the binocular model of plural medicine’, a holistic framework for analyzing medical (...) concepts and phenomena. In the second part, I demonstrate the use and value of the binocular model by analyzing, through the lenses of the model, the phenomenon of health wearable devices and their effects on the concept of diagnosis. (shrink)

Dostoevsky wrote that love in action is a harsh and terrible thing compared to love in dreams. That reality is particularly evident in medicine, where there is an almost universal, involuntary participation of physicians and other healthcare workers in the suffering of their patients. This paper explores this phenomenon through the paradigm of ‘mystery’ as explained by the French existentialist philosopher Gabriel Marcel. A mystery is different from a problem in the sense that the former requires the active immersion (...) of the person involved in order to be truly experienced. It is a ‘meta-problem’ that cannot be analyzed objectively and separately from the person that it affects, without changing the nature of the thing experienced. The authors contend that the human suffering encountered in medicine is one such phenomenon, and the paper draws on illustrations of this concept in art and literature. Awareness of the subtle but important difference between mystery and problem may help physicians better understand their personal entanglement with the suffering of patients. (shrink)

This foreword explores the history of the American Society of Law, Medicine & Ethics and its role in promoting access to care and antiracism.

The article examines the statements made by Immanuel Kant with reference to medicine as well as the impact of his philosophy on medicine. It describes the initial reaction of Kantian philosophy on medicine in the late 18th and early 19th century and its influence in the late 20th century.

Health defined as the psychophysiological capacity to act or respond appropriately in a wide variety of situations, is enhanced by many means other than preventing and treating disease and injury. Therefore no choice of a particular medical intervention is likely to maximize health for all people with (or at risk for) a given disease. As a result, if medical practitioners are to be fully competent in the sense of knowing not only how to perform procedures but when and when not (...) to do so, they must be able to support patients (and those who know and care about them) in weighing all of the many factors which bear upon the decision as to which, if any, medical interventions are likely to improve the person''s health. (shrink)

During the 19th century, missionaries profoundly impacted China’s social and scientific advancement. Their efforts faced challenges because of deeply ingrained superstitions and polytheistic traditions. Missionaries adopted diverse approaches such as spreading scientific knowledge, establishing educational institutions and conducting medical missions to further their mission. Notably, medical missions played a vital role in alleviating suffering, eradicating prejudice and fostering opportunities for the spread of Christianity in China. Through providing medical services, missionaries gained trust and goodwill within local communities, showcasing Christian compassion (...) and benevolence. Additionally, they founded medical schools, translated foreign medical works and established medical journals, contributing to the development of modern Chinese medicine to some extent. Contribution: This article delves into the medical practices of 19th-century medical missionaries. It asserts that these medical missionaries played a pivotal role in establishing the groundwork for the advancement of modern medicine in China. Furthermore, the article suggests that contemporary missionary activities in China can draw inspiration from the model set by these historical medical missionaries, emphasising the enduring relevance of their approach in conducting effective missionary work today. (shrink)

In a heart-wrenching TEDx Beacon Street talk entitled "A Journey Through Infertility: Over Terror's Edge", Camille Preston narrates her traumatic journey through infertility. Although she is now the mother of a child, Preston's characterization of infertility as "over terror's edge" and as "a journey" finds a graphic expression in Paula Knight's The Facts of Life, Emily Steinberg's Broken Eggs, and Phoebe Potts's Good Eggs. Unlike Preston, these authors do not give birth to a child; however, they authentically portray the tribulations (...) of infertility in their respective graphic memoirs. While Knight's memoir chronicles her traumatic experience of being an infertile woman in a society that... (shrink)

The philosophers of science who viewed causality as a metaphysical headache were right. Yet when they concluded that it is of no scientific import and of less practical import, they were clearly in error. I say clearly because they thereby recommended that we replace cause by mere empirical correlation, which obviously will not do. Here is an obvious example which proves them in error without even touching upon the question of what science is.