Rationale: In this article, I argue that we need a new perspective in the debate on autonomy in medicine, to understand many of the problems we face today – dilemmas that are situated at the intersection of autonomy and heteronomy, such as why well informed and autonomous people make unhealthy lifestyle choices. If people do not choose what they want, this is not simply caused by their lack of character or capability, but also by the fact that absolute autonomy (...) is impossible; autonomous individuals are ‘contaminated’ by heteronymous aspects, by influences from ‘outside’. Consequently, there are many good reasons to question the widely accepted hierarchical opposition of autonomy (progress) versus heteronomy (paternalism) in medicine. In an earlier article an analysis is made of the neologism ‘oughtonomy’ to support the thesis that when it comes down to human existence, autonomy and heteronomy are intertwined, rather than being merely opposites. Methods: In this article, I reflect upon how social conditions might improve our ‘choice architecture’, what Thaler & Sunstein have called ‘nudging’: how to change individual health choices without being paternalistic? I explore the extent to which both oughtonomy and nudging are able to challenge the question of autonomy in today’s medicine. Results and Conclusions: Autonomy may and should be a shared target in today’s medicine, but we should never forget that it is always intertwined with heteronomy. Starting from this perspective, progress in medicine demands far more than the increase of autonomy. (shrink)

This paper adapts Kuhn’s conceptual framework to developmental episodes in the theory and practice of medicine. Previous attempts to understand the reception of Ignaz Semmelweis’s work on puerperal fever in Kuhnian terms are used as a starting point. The author identifies some limitations of these attempts and proposes a new way of understanding the core Kuhnian notions of “paradigm,” “progress,” and “revolution” in the context of a socially embedded technoscience such as medicine.

Rationale One's understanding of medical progress – what it is, how it is pursued and how it is assessed – may be deeply dependent on one's understanding of the metaphysics of medicine, and of diseases in particular. -/- Aims and Objectives In this paper I present a new account of the nature of diseases, neither realist nor constructivist, and describe what progress in medicine looks like if we understand diseases in this way. -/- Conclusions This new (...) account, Constructive Realism, may provide a better account of medicine than either realism or constructivism. (shrink)

One of the central goals of precision medicine is to dissolve the long-standing tension between the population-level data provided by traditional randomized controlled trials and the physician’s need to prescribe therapies for their individual patient. The RCT can tell the physician that therapy A is, on average, more effective than therapy B for a population of patients, P, but this does not tell her whether A is more effective for the particular patient, p1, in front of her. However, by (...) leveraging the tools and insights of molecular biology, precision medicine hopes to prospectively determine which therapies will work for which patients and overcome this problem. Fundamental to the... (shrink)

The question what scientific progress means for a particular domain such as medicine seems importantly different from the question what scientific progress is in general. While the latter question received ample treatment in the philosophical literature, the former question is hardly discussed. I argue that it is nonetheless important to think about this question in view of the methodological choices we make. I raise specific questions that should be tackled regarding scientific progress in the medical sciences (...) and demonstrate their importance by means of an analysis of what evidence-based medicine (EBM) has, and has not, to offer in terms of progress. I show how critically thinking about EBM from the point of view of progress can help us in putting EBM and its favoured methodologies in the right perspective. My conclusion will be that blindly favouring certain methods because of their immediately tangible short-term benefits implies that we parry the important question of how best to advance progress in the long run. This leads us to losing sight of our general goals in doing research in the medical sciences. (shrink)

The Term 'Practical Progress' in Biomedical Sciences. A Structuralistic Approach to the Reconstruction of Epistemological Terms in Medicine. An attempt is made to elucidate the structure of the term 'practical progress' and to reconstruct it logically. The importance of discovery and confirmation of new regularities as well as of practical rules arising from them depends on their contribution to the solution of practical problems. The application of this structuralistic definition of 'practical progress' is demonstrated with an (...) example from cardiac surgery concerning the solution of the practical medical problem of myocardial protection during open heart surgery. (shrink)

David Bohm, in his "causal theory", made the correct Hegelian synthesis of Einstein's thesis that there is a "there" there, and Bohr's antithesis of "thinglessness" (Nick Herbert’s term). Einstein was a materialist and Bohr was an idealist. Bohm showed that quantum reality has both. This is “physical dualism” (my term). Physical dualism may be a low energy approximation to a deeper monism of cosmic consciousness called "the super-implicate order" (Bohm and Hiley’s term), “pregeometry” (Wheeler’s term), “substratum” (Dirac’s term), “funda-MENTAL space” (...) (Hameroff’s term), “Chi” (Chinese medicine & Falun Gong) etc., but for our immediate pragmatic purpose of constructing naturally conscious nano-computers and of virtually reverse engineering alleged reports of propellantless UFO propulsion (French Intelligence Report, 1999 [email protected] Vol. 5, No. 11, Part 1 -- August 1, 1999 & NIDS report "Best UFO Cases - Europe", I. Von Ludwiger) to the stars and beyond, physical dualism will work. (shrink)

In a series of recent papers, I have made three arguments about how to define “disease” and evaluate and apply possible definitions. First, I have argued that definitions should not be seen as traditional conceptual analyses, but instead as proposals about how to define and use the term “disease” in the future. Second, I have pointed out and attempted to address a challenge for dysfunction-requiring accounts of disease that I call the “line-drawing” problem: distinguishing between low-normal functioning and dysfunctioning. Finally, (...) I have used a dysfunction-requiring approach to argue that some extremely prevalent conditions, such as high blood pressure, high cholesterol, and ductal carcinoma in situ, are not diseases, but instead are risk factors. Four of the papers in this issue directly engage my previous work. In this commentary, I applaud the advances these authors make, address points of disagreement, and make suggestions about where the discussion should go next. (shrink)

The article provides an overview of important topics in contemporary medical ethics. Methodologically, it is a literature review. The article addresses only a limited selection of the problematic areas, which are, however, related to each other: digitisation of medicine, genome editing, personalised medicine as well as ethical problems and dilemmas of allocation in healthcare. The global COVID-19 pandemic has emerged as a focus and trigger. Reflections on human rights and justice in medicine are fundamental not only on (...) the individual and social level but also on a global scale. The fundamental question is how society as a whole can be involved in the complex biopolitical and bioethical debate. The social and cultural consequences of life increasingly being understood as a technical product rather than a gift are serious.Contribution: The article also reflects on the specific contribution that Christian theology, and in particular the reformed heritage, can make to bioethical debates in modern society. The distinction between instrumental knowledge [Verfügungswissen] and orientational knowledge [Orientierungswissen] is helpful for its better understanding. A crucial result of this article is that medical treatment is repeatedly faced with ethical dilemmas. Moreover, medical progress not only creates new and better solutions to medical problems, it also raises new ethical questions that did not exist before. The purpose of medical ethics lies in identifying such dilemmas and developing ethical decision-making processes that help us to deal with such dilemmas to some extent. (shrink)

Interest in the ethics of research on human subjects, stimulated by atrocious human experimentation during WWII and the resultant Nuremberg Code, has been sustained by examples of unethical research in many countries and by proliferation of codes and guidelines. Such interest has intensified in recent years in association with expanding international collaborative research endeavors. The ongoing controversy in international research ethics takes place at two levels. At the practical level it is about the competing concerns of those predominantly interested in (...) doing research to advance knowledge and those who, while supporting the need for research, are more acutely aware of the potential to exploit vulnerable participants, especially in developing countries. At the level of theory the controversy pits ethical universalism against moral relativism.In her recent review of agreements and controversies in international research ethics, Ruth Macklin has concluded that, despite seeming agreement on several issues, many different viewpoints persist. In her view it is unlikely that these will be resolved easily. (shrink)

Interest in the ethics of research on human subjects, stimulated by atrocious human experimentation during WWII and the resultant Nuremberg Code, has been sustained by examples of unethical research in many countries and by proliferation of codes and guidelines. Such interest has intensified in recent years in association with expanding international collaborative research endeavors. The ongoing controversy in international research ethics takes place at two levels. At the practical level it is about the competing concerns of those predominantly interested in (...) doing research to advance knowledge and those who, while supporting the need for research, are more acutely aware of the potential to exploit vulnerable participants, especially in developing countries. At the level of theory the controversy pits ethical universalism against moral relativism.In her recent review of agreements and controversies in international research ethics, Ruth Macklin has concluded that, despite seeming agreement on several issues, many different viewpoints persist. In her view it is unlikely that these will be resolved easily. (shrink)

Medical explanations have often been thought on the model of biological ones and are frequently defined as mechanistic explanations of a biological dysfunction. In this paper, I argue that topological explanations, which have been described in ecology or in cognitive sciences, can also be found in medicine and I discuss the relationships between mechanistic and topological explanations in medicine, through the example of network medicine and medical genetics. Network medicine is a recent discipline that relies on (...) the analysis of various disease networks in order to find organizing principles in disease explanation. My aim is to show how topological explanations in network medicine can help solving the conceptual issues that pure mechanistic explanations of the genetics of disease are currently facing, namely the crisis of the concept of genetic disease, the progressive geneticization of diseases and the dissolution of the distinction between monogenic and polygenic diseases. However, I will also argue that topological explanations should not be considered as independent and radically different from mechanistic explanations for at least two reasons. First, in network medicine, topological explanations depend on and use mechanistic information. Second, they leave out some missing gaps in disease explanation that require, in turn, the development of new mechanistic explanations. Finally, I will insist on the specific contribution of topological explanations in medicine: they push us to develop an explanation of disease in general, instead of focusing on single explanations of individual diseases. This last point may have major consequences for biomedical research. (shrink)

In our current climate of rapid technological progress, it seems counterintuitive to think that modern science can learn anything of ethical value from the dark recesses of the nineteenth century or earlier. However, this happens to be quite true, with plenty of knowledge and wisdom to be gleaned by studying our scientific predecessors. Presently, our journals are flooded with original concepts and potential breakthroughs, a continuous stream of ideas pushing the frontiers of knowledge ever forward. Some ideas flourish while (...) others flounder; but what sets the two apart? The distinguishing feature between success and failure within this context is the ability to discern the appropriate time to accept an innovation with open arms, versus when to take a more cautious approach. And the primary arbiters for whether an idea will catch on or not are the professional audience. I illustrate this concept by comparing the initial reception of two innovative ideas from Medicine’s past: sterile technique, and prefrontal lobotomy. Sterile technique was first introduced by Dr. Ignaz Semmelweis and was initially ridiculed and rejected, with Semmelweis eventually dying in exile. Conversely, lobotomy was accepted and lauded and its inventor, Dr. Egas Moniz, won the Nobel Prize for his “discovery”. This begs the question: why was a technique with the potential to save millions of lives initially rejected, whereas paradoxically, one that compromised and sometimes destroyed lives, accepted? Here I explore and analyze the potential reasons why, suggest how we can learn from these mistakes of the past and apply new insight to some current ethical dilemmas. (shrink)

The rapid adoption and implementation of artificial intelligence in medicine creates an ontologically distinct situation from prior care models. There are both potential advantages and disadvantages with such technology in advancing the interests of patients, with resultant ontological and epistemic concerns for physicians and patients relating to the instatiation of AI as a dependent, semi- or fully-autonomous agent in the encounter. The concept of libertarian paternalism potentially exercised by AI (and those who control it) has created challenges to conventional (...) assessments of patient and physician autonomy. The unclear legal relationship between AI and its users cannot be settled presently, an progress in AI and its implementation in patient care will necessitate an iterative discourse to preserve humanitarian concerns in future models of care. This paper proposes that physicians should neither uncritically accept nor unreasonably resist developments in AI but must actively engage and contribute to the discourse, since AI will affect their roles and the nature of their work. One’s moral imaginative capacity must be engaged in the questions of beneficence, autonomy, and justice of AI and whether its integration in healthcare has the potential to augment or interfere with the ends of medical practice. (shrink)

After having received little attention over the past decades, one of the least known human rights—the right to enjoy the benefits of scientific progress and its applications—has had its dust blown off. Although included in the Universal Declaration of Human Rights (UDHR) and in the International Covenant on Economic, Social and Cultural Rights (ICESCR)—be it at the very end of both instruments -this right hardly received any attention from States, UN bodies and programmes and academics. The role of science (...) in societies and its benefits and potential danger were discussed in various international fora, but hardly ever in a human rights context. Nowadays, within a world that is increasingly turning to science and technology for solutions to persistent socio-economic and development problems, the human dimension of science also receives increased attention, including the human right to enjoy the benefits of scientific progress and its applications. This contribution analyses the possible legal obligations of States in relation to the right to enjoy the benefits of scientific progress and its applications, in particular as regards health. (shrink)

In a randomized clinical trial (RCT), a group of patients, initially assembled through a mixture of deliberation (involving explicit inclusion and exclusion criteria) and serendipity (which patients happen to walk into which doctor’s clinic while the trial is in progress), are divided by some random process into an experimental group (members of which will receive the therapy under test) and a control group (members of which will receive some other treatment – perhaps placebo, perhaps the currently standard treatment for (...) the condition at issue). In a ‘double blind’ trial neither the patient nor the clinician knows to which of the groups a particular patient belongs. The results of double blind randomized controlled trials are almost universally regarded as providing the ‘gold standard’ for evidence in medicine. Fairly extreme claims to this effect can be found in the literature. For example the statistician Tukey wrote (1977, p. 679) “almost the only source of reliable evidence [in medicine] … is that obtained from … carefully conducted randomised trials”. And the clinician Victor Herbert claimed (1977, p. 690) “..the only source of reliable evidence rising to the level of proof about the usefulness of any new therapy is that obtained from wellplanned and carefully conducted randomized, and, where possible, coded (double blind) clinical trials. [Other] studies may point in a direction, but cannot be evidence as lawyers use the term evidence to mean something probative … [that is] tending to prove or actually proving”. Finally, the still very influential movement in favour of ‘Evidence Based Medicine’ (EBM) that began at McMaster University in the 1980s was initially often regarded as endorsing the claim that only RCTs provide real scientifically telling evidence. (shrink)

This article critically evaluates the central claims of the various feminist responses to new reproductive arrangements and technologies. Proponents of a “progressivism” object to naive technological optimism and raise questions about the control of such technology. Others, such as the FINRRAGE group, raise concerns about the potentially damaging consequences of the new technologies for women. While a central concern is whether these technologies reinforce harmful biologically determinist stereotypes of women, it may be that these critiques function with a devastating gender (...) blindness that puts women at risk in other, heretofore unnoticed, ways. (shrink)

The aim of this paper is to discuss a key question in the history and philosophy of medicine, namely how scholars should treat the practices and experimental hypotheses of modern life science laboratories. The paper seeks to introduce some prominent historiographical methods and theoretical approaches associated with biomedical research. Although medical scientists need no convincing that experimentation has a significant function in their laboratory work, historians, philosophers, and sociologists long neglected its importance when examining changes in medical theories or (...) progress in scientific knowledge. The reason appears to have been the academic influence of the then dominant tradition in the history of ideas, but was also due to a misconception of what could usefully be termed the view on “historical ontology.” During the last two decades, there have been many books and research articles that have turned towards the subject, so that the study of experimental practice has become a major trend in the contemporary history and philosophy of medicine. A closer look at the issue of laboratory research shows that concepts in medicine and the life sciences cannot be understood as historically constant, free-standing ideas, but have to be regarded as dependent on local research settings. They often carry particular “social memories” with them and thus acquire important ethical implications. (shrink)

Conscience-based refusals by health care professionals to provide care to eligible patients are problematic, given the monopoly such professionals hold on the provision of such services. This article reviews standard ethical arguments in support of conscientious refuser accommodation and finds them wanting. It discusses proposed compromise solutions involving efforts aimed at testing the genuineness and reasonability of refusals and rejects those solutions too. A number of jurisdictions have introduced policies requiring conscientious refusers to provide effective referrals. These policies have turned (...) out to be unworkable. They subject patients to a health care delivery lottery, which is incompatible with the fundamental values of medical professionalism. This paper sheds light on transnational efforts aimed at undermining progress made in reproductive health by means of conscientious refusal accommodation claims. The view that the accommodation of conscientious refusers is indefensible on consequentialist ethical grounds, as well as on grounds related to medical professionalism itself, is defended. (shrink)

Taking people’s longevity as a measure of good life, humankind can proudly say that the average person is living a much longer life than ever before. The AIDS epidemic has however for the first time in decades stalled and in some cases even reverted this trend in a number of countries. Climate change is increasingly becoming a major challenge for food security and we can anticipate that hunger caused by crop damages will become much more common. -/- Since many of (...) the challenges humanity faced in the past were overcome by inventive solutions coming from the life sciences, we are compelled to reconsider how we incentivize science and technology development so that those in need can benefit more broadly from scientific research. There is a huge portion of the world population that is in urgent need for medicines to combat diseases that are currently neglected by the scientific community and could immensely benefit from agricultural research that specifically targets their environmental conditions. At the same time efforts have to be made to make the fruits of current and future research more widely accessible. These changes would have to be backed by a range of moral arguments to attract people with diverging notions of global justice. This article explores the main ethical theories used to demand a greater share in the benefits from scientific progress for the poor. Since life sciences bring about a number of special concerns, a short list of conflictive issues is also offered. (shrink)

The aim of this paper is to discuss a key question in the history and philosophy of medicine, namely how scholars should treat the practices and experimental hypotheses of modern life science laboratories. The paper seeks to introduce some prominent historiographical methods and theoretical approaches associated with biomedical research. Although medical scientists need no convincing that experimentation has a significant function in their laboratory work, historians, philosophers, and sociologists long neglected its importance when examining changes in medical theories or (...) progress in scientific knowledge. The reason appears to have been the academic influence of the then dominant tradition in the history of ideas, but was also due to a misconception of what could usefully be termed the view on “historical ontology.” During the last two decades, there have been many books and research articles that have turned towards the subject, so that the study of experimental practice has become a major trend in the contemporary history and philosophy of medicine. A closer look at the issue of laboratory research shows that concepts in medicine and the life sciences cannot be understood as historically constant, free-standing ideas, but have to be regarded as dependent on local research settings. They often carry particular “social memories” with them and thus acquire important ethical implications. (shrink)

In this article, I will argue in favor of both the ethical and epistemological utility of explanations in artificial intelligence -based medical technology. I will build on the notion of “explicability” due to Floridi, which considers both the intelligibility and accountability of AI systems to be important for truly delivering AI-powered services that strengthen autonomy, beneficence, and fairness. I maintain that explicable algorithms do, in fact, strengthen these ethical principles in medicine, e.g., in terms of direct patient–physician contact, as (...) well as on a longer-term epistemological level by facilitating scientific progress that is informed through practice. With this article, I will therefore attempt to counter arguments against demands for explicable AI in medicine that are based on a notion of “whatever heals is right.” I will elucidate my elaboration on the positive aspects of explicable AI in medicine as well as by pointing out risks of non-explicable AI. (shrink)

This study forms part of a larger research project examining the election process for the Nobel prizes for Physiology or Medicine at the Karolinska Institute in Stockholm, and the role and function of the prizes in early 20th century Swedish and international medicine. The purpose of the study is to clarify the decision-making process which led to the Nobel prize for Paul Ehrlich in 1908, for work on immunity. His award was preceded by the most dramatic conflict within (...) the prize authority concerning any prizewinner prior to World War I, and thus is apt to illuminate both the implicit and explicit criteria and the strategies used in the prize deliberations.Ehrlich's chemical ideas on the immune response were criticized by the physical chemist Svante Arrhenius who recommended the application of his disciplines's methods and principles on immunological problems. This criticisms were brought into the Nobel prize debate by J.E. Johansson, a physiologist who asserted that Ehrlich's research was of little scientific value and therefore not worthy of a prize. Yet the majority of the Institute, led by its chairmam, the chemist K.A.H. Mörner, succeeded in awarding Ehrlich. (shrink)

AbstractDespite the fact that people usually believe that individual health rights have an intrinsic value, they have, in fact, only extrinsic value. They are context dependent. While in normal conditions the current societies try to guarantee individual health rights, the challenge arises in emergency situations. Ones of them are pandemics including current covid-19 pandemic. Emergency situations challenge individual health rights due to insufficient medical resources and non-random criteria of selection of patients. However, there are some reasons to assume that societal (...) and technological processes in the near future will threaten permanently individual health rights in normal conditions. Such processes include progress in commonly available human enhancement technologies, and progress in robotics and automation. In this paper I show how individual health rights will be challenged in both scenarios including catastrophic events and future technological progress. In both cases, the idea of assisted dying is discussed as possibly the unique healthcare principle available for people whose individual health rights will be limited or canceled due to catastrophes or technological and financial exclusion. The special case of future space missions is also discussed as an example of an extreme environment affecting the way moral norms are viewed in health care ethics. (shrink)

The International Panel on Social Progress is an independent association of top research scholars with the goal of assessing methods for improving the main institutions of modern societies. The IPSP has produced a report consisting of twenty-two chapters in three volumes that distills the research of these scholars and outlines what the best social science has to say about positive social change. Written in accessible language by scholars across the social sciences and humanities, these volumes assess the achievements of (...) world societies in past centuries, the current trends, the dangers that we are now facing, and the possible futures in the twenty-first century. It covers the main socio-economic, political, and cultural dimensions of social progress, global as well as regional issues, and the diversity of challenges and their interplay around the world. The authors offer a cautious optimistic conclusion: multiple ideas for social progress and better policies are already available and deserve to be tested and implemented. (shrink)

International cooperation is an integral part of furthering medical and scientific progress. Many specilist societies exist for that purpose and have written into their constitutions that such cooperation and coordination is their aim. They hope to achieve their aims by exchange, in all languages, of information and by so doing strengthen the relations between individual physicians and scentists as well as between corporate professional bodies from different countries. However, at the same time emphasis is laid on the political neutrality (...) of such organsations. Increasingly, this 'neutrality' is being questioned as doctors and scientists become aware of abuse and distortion of their profession taking place in other countries. H Merskey highlights the problems and offers his opinion on the ethics of maintaining these professional relationships with colleagues abroad who are involved in such abuse and distortion. (shrink)

The practice of medicine involves obtaining, evaluating and analyzing information drawn from a variety of sources; thus physicians assess and act upon information that varies in terms of both reliability and the extent to which it may be directly perceived. In the hospital setting, physicians’ progress notes provide a record of this process that serves as a primary means of communication between treaters who are not co-present with one another; accordingly, in order to permit independent evaluation of the (...) information they contain, physicians have developed a repertoire of linguistic devices to express differing attitudes towards the information that their notes convey. In this article, through the microanalysis of a pediatric resident’s note, I demonstrate how physicians use evidential markers, including the passive voice and agentless constructions, to construct frameworks of credibility and responsibility that both underlie and enable medical work. These grammatical devices permit the physician-reader to weigh for himself or herself the evidence which supports the conclusions reached. (shrink)

This is the first of three volumes containing a report from the International Panel on Social Progress. The IPSP is an independent association of top research scholars with the goal of assessing methods for improving the main institutions of modern societies. Written in accessible language by scholars across the social sciences and humanities, these volumes assess the achievements of world societies in past centuries, the current trends, the dangers that we are now facing, and the possible futures in the (...) twenty-first century. It covers the main socio-economic, political, and cultural dimensions of social progress, global as well as regional issues, and the diversity of challenges and their interplay around the world. This particular volume covers topics such as economic inequality and growth, finance and corporations, labor, capitalism, and social justice. (shrink)

This is the third of three volumes containing a report from the International Panel on Social Progress. The IPSP is an independent association of top research scholars with the goal of assessing methods for improving the main institutions of modern societies. Written in accessible language by scholars across the social sciences and humanities, these volumes assess the achievements of world societies in past centuries, the current trends, the dangers that we are now facing, and the possible futures in the (...) twenty-first century. It covers the main socio-economic, political, and cultural dimensions of social progress, global as well as regional issues, and the diversity of challenges and their interplay around the world. This particular volume covers topics such as world cultures and religions, families, global health, education, and the contributions of social sciences to institutional change. (shrink)

This open access collection brings together a team of leading scholars and rising stars to consider what experimental philosophy of medicine is and can be. While experimental philosophy of science is an established field, attempts to tackle issues in philosophy of medicine from an experimental angle are still surprisingly scarce. A team of interdisciplinary scholars demonstrate how we can make progress by integrating a variety of methods from experimental philosophy, including experiments, sociological surveys, simulations, as well as (...) history and philosophy of science, in order to yield meaningful results about the core questions in medicine. They focus on concepts central to philosophy of medicine and medical practice, such as death, pain, disease and disorder, advance directives, medical explanation, disability and informed consent. Presenting empirical findings and providing a crucial foundation for future work in this dynamic field, this collection explores new ways for philosophers to cooperate with scientists and reveals the value of these collaborations for both philosophy and medicine. The eBook editions of this book are available open access under a CC BY-NC-ND 4.0 licence on bloomsburycollections[dot]com. Open access was funded by the European Research Council Starting Grant. (shrink)

The singular expertise of family physicians is the ability to manage complexity with pragmatism, both clinically and ethically. Telemedicine raises multiple questions about the nature of the patient‐physician relationship as manifested in clinical encounters. Some of these questions are concerning, underscoring the need to assess whether medical care is better with this new technology—or if it is just different or maybe even worse. It seems clear, however, that, regardless of its limitations, telemedicine is here to stay. The pragmatic complex ethical (...) question, then, is how all of us together—both medical professionals and society at large—will manage it. (shrink)

The promotion of conservation agriculture for smallholders in sub-Saharan Africa is subject to ongoing scholarly and public debate regarding the evidence-base and the agenda-setting power of involved stakeholders. We undertake a political analysis of CA in Zambia that combines a qualitative case study of a flagship CA initiative with a quantitative analysis of a nationally representative dataset on agricultural practices. This analysis moves from an investigation of the knowledge politics to a study of how the political agendas of the actors (...) involved are shaping agrarian practices. From its initial focus on CA as soil conservation and sustainable agriculture, the framing of the initiative has evolved to accommodate shifting trends in the policy arena. In tandem with the increased focus on climate adaptation, we see an increased emphasis on private sector-led modernisation. The initiative has shifted its target group from the poorest smallholders to prospective commercial farmers, and has forged connections between its farmer-to-farmer extension network and private input suppliers and service providers. The link between CA and input intensification is reflected in national statistics as a significantly higher usage of herbicides, pesticides and mineral fertilizer on fields under CA tillage compared to other fields. We argue that the environmental and participation agendas are used to buttress CA as an environmentally and socially sustainable agricultural development strategy, while the prevailing practice is the result of a common vision for a private sector-led agricultural development shared between the implementing organisation, the donor and international organisations promoting a new green revolution in Africa. (shrink)

This paper highlights methods — other than legislative and regulatory directives — through which decision-makers may use law and the legal system to facilitate the systems-wide change that the IOM calls for.

In silico medicine is still forging a road for itself in the current biomedical landscape. Discursively and rhetorically, it is using a three-way positioning, first, deploying discourses of personalised medicine, second, extending the 3Rs from animal to clinical research, and third, aligning its methods with experimental methods. The discursive and rhetorical positioning in promotions and statements of the programme gives us insight into the sociability of the scientific labour of advancing the programme. Its progress depends on complex (...) social, institutional and technological conditions which are not external to its epistemology, but intricately interwoven with it. This article sets out to show that this is the case through an analysis of the process of computational modelling that is at the core of its epistemology. In this paper I show that the very notion of ‘model’ needs to be re-thought for in silico medicine, and propose a replacement, in the form of the ‘Model-Simulation-Experiment-System’ or MSE-system, which is simultaneously an epistemological, social and technological system. I argue that the MSE-system is radically mediated by social relations, technologies and symbolic systems. We need now to understand how such mediations operate effectively in the construction of robust MSE-systems. (shrink)

Throughout history, the world has been concerned with progress in different areas, and Medicine has not been the exception. Nevertheless, has this progress been positive in the sense of entailing benefits? The question emerges considering that through this progress, human beings have been able to modify natural processes. Considering this, the research question is: What is the role that medicine—a human and scientific discipline—must play, and which is the concept of what a human being must (...) have in a world where utilitarianism prevails over non-material benefits? Also, what are the implications of that role and concept on the decision-making about health, notions about humanity and, areas which require responsibility? The rise of artificial procedures which generate life, simultaneously defying time leads to the main objective of this paper: To present ideas on the current perception about the medical practice; in terms of responsibility about the human side of the patient, related to artificial practices. A second objective is to approach a social topic that motivates to reflect on new and recurring practices in the medical field. This topic will be studied from a hermeneutical perspective to establish relations and an interpretative approach between them, through Thiebaut’s work and Tría’s Philosophy of the Limit, considering the concept of human being and considering that there are limits which should be respected. Afterwards, the focus will be on the medical praxis and its sense of responsibility regarding human beings. (shrink)

The development of animal ethics has been characterized by both progress and absurdity. More activity in animal welfare has occurred in the past 50 years than in the previous 500, with large numbers of legislative actions supplanting the lone anti-cruelty laws. Nonetheless, there remains a tendency to confuse animal ethics with human ethics. I found this to be the case when my colleagues and I were drafting federal law requiring control of pain in invasive research. The history of animal (...) ethics vacillates between Descartes’ denial of thought and feeling in animals and British empiricism, including the great skeptic David Hume, who affirmed in no uncertain terms the existence of animal mind. This approach was continued in British empiricism, culminating in the work of Charles Darwin. But despite Darwinian domination of biology and psychology, psychology was captured by denial of mind and consciousness by JB Watson, father of behaviorism. Denial of thought and feeling in animals continued in 20th century science and medicine while society in general became ever more firm in asserting their existence. (shrink)

This paper provides both an overview of and a personal perspective on the field of ‘anti-ageing’. In the late 20th century, progress in the science of ageing re-invigorated activity designed to avoid biological ageing. For some the objective was to abolish the need to die of old age. This anti-ageing movement includes a diverse range of people: hard scientists working in well-funded and established university laboratories, slick corporate-marketing executives and new-age entrepreneurs selling herbal elixirs. The movement has attracted anti-anti-ageing (...) critical comment from three sources: moral critique located in philosophy and religion, scepticism from established scientists in the field of biology and gerontology, and challenge from critical social gerontology. Anti-ageing activists have labelled their critics as ‘conservative’ for opposing the inevitable progress of science. The paper argues that the alternative perspective, which sees the anti-ageing movement as a route by which a biologisation of old age inhibits people from achieving a culturally valued final part to life, is the progressive one. (shrink)