Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Philosophical Approach”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,117 records · Page 62Linked to original sources
PubMed2001

The goals of medicine. Towards a unified theory.

The purpose of this article is to present a normative theory of the goals of medicine (a theory that tells us in what respects medicine should benefit the patient) that is both comprehensive and unified. A review of the relevant literature suggests that there are at least seven plausible goals that are irreducible to each other, namely to promote functioning, to maintain or restore normal structure and function, to promote quality of life, to save and prolong life, to help the patient to cope well with her condition, to improve the external conditions under which people live, and to promote the growth and development of children. However, it seems that all these goals need to be qualified in different ways, e.g. it does not seem reasonable to improve physiological function or functional ability unless this is expected to have positive effects on quality of life and/or length of life, or to improve the quality of life in any respect, or by any means. These qualifications all suggest that the proposed goals are, as goals, conceptually, and not just causally, related to one another, and that they should therefore not be regarded in isolation. Instead, we should think of the medical enterprise as having a multidimensional goal structure rather than a single goal. In order to depict clearly how the different goals are related to one another, a multidimensional model is constructed.

Activities of Daily Living↗
PubMed2001

Utilitarianism and the measurement and aggregation of quality--adjusted life years.

It is widely accepted that one of the main objectives of government expenditure on health care is to generate health. Since health is a function of both length of life and quality of life, the quality-adjusted life-year (QALY) has been developed in an attempt to combine the value of these attributes into a single index number. The QALY approach--and particularly the decision rule that health care resources should be allocated so as to maximise the number of QALYs generated--has often been equated with the utilitarian philosophy of maximising 'the greatest happiness of the greatest number'. This paper considers the extent to which the measurement and aggregation of QALYs really is utilitarian by developing a new taxonomy in order to classify utilitarianism and the different aspects of the QALY approach. It is shown that the measurement of QALYs is consistent with a number of different moral positions and that QALYs do not have to be aggregated according to the maximisation rule. Therefore it is inappropriate to necessarily equate QALYs with utilitarianism. It is shown that much turns on what in principle the QALY represents and how in practice it can be operationalised. The paper highlights the category confusion that is often present here and suggests possible avenues for future theoretical and empirical research.

Classification↗
PubMed2001

The naturalness of the artificial and our concepts of health, disease and medicine.

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 healthcare. 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.

Disease↗
PubMed2001

On the value-ladenness of technology in medicine.

The objective of this article is to analyse the value-ladenness of technology in the context of medicine. To address this issue several characteristics of technology are investigated: i). its interventive capacity, ii). its expansiveness and iii). its influence on the concept of disease, iv). its generalising character, v). its independence of the subjective experience of the patient. By this analysis I hope to unveil the double face of technology: Technology has a Janus-face in modern medicine, and the opposite of its factual face is evaluative.

Ethics↗
PubMed2001

The finitude of nature: rethinking the ethics of biotechnology.

In order to open new possibilities for bioethics, I argue that we need to rethink our concept of nature. The established cognitive framework determines in advance how new technologies will become visible. Indeed, in this dualistic approach of metaphysics, nature is posited as limitless, as material endowed with force which causes us to lose the sense of nature as arising out of itself, of having limits, an end. In contrast, drawing upon the example of the gender assignment and construction of intersexed infants, I want to suggest for bioethics an understanding of nature that arises not from our scientific explorations, but rather from attending to our situated perceptual encounters with the world which underlie such experimentation; these encounters are too easily overlooked, and yet they are crucial for opening up new ways of thinking.

Bioethics↗
PubMed1999

Quality of life--evaluation or description?

'Quality of life' is part of many different discourses and has been used in a variety of meanings ranging from purely descriptive (as in some medical contexts) to distinctly evaluative meanings (as in some social science and political contexts). The paper argues that there are good normative reasons to make the concept of descriptive as possible at least in its medical applications and, furthermore, to reconstruct it in a thoroughgoing subjectivist way, making the reflexive self-evaluation of the subject himself or herself the ultimate standard. Attention is drawn to the fact that only few of the measures of quality of life applied in present-day medicine correspond to these requirements.

Attitude to Health↗
PubMed2000

The ends of medical intervention and the demarcation of the normal from the pathological.

This study examines the ends of medical intervention and argues that mainstream contemporary medicine assumes that appropriate ends may be discovered (i.e., naturalism), rather than created or decided upon (i.e., conventionalism). The essay then applies these considerations to the problem of the demarcation of the normal from the pathological. I argue that the common formulations of this dispute commit a fallacy, as they characterize the "normal" as a state of the organism and not as an ongoing process within it. Such a process may be characterized as self-creation and self-repair. Such considerations support the conclusion that normality may be regarded as a regulative idea, rather than as an end-state, and as part of the ends of medical intervention, depending upon choice and context.

Disease↗
PubMed2000

On values, professionalism and nosology: an essay with late commentary on essays by DeVito and Rudnick.

The essays by Scott DeVito and Abraham Rudnick are on largely the same topics--the meanings of healthy(y), normal, disease, pathological, diagnosis, etc., and they contain compatible conclusions--that medical precepts are value-laden and less objective than some naive model of scientific objectivity would suggest. This commentary opens with a brief critique of each and ends with a more in-depth account, one complaint being how lacking in weight the analyses are. In the middle portion of this commentary, I consider the sorts of values that are present in some case studies--values that give the project much more weight. These include the values, scientific and self-serving, that professionalism provides. I show how medicine and its disease-related concepts can be thought to evolve in many ways.

Clinical Medicine↗
PubMed1998

Egalitarian and maximin theories of justice: directed donation of organs for transplant.

It is common to interpret Rawls's maximin theory of justice as egalitarian. Compared to utilitarian theories, this may be true. However, in special cases practices that distribute resources so as to benefit the worst off actually increase the inequality between the worst off and some who are better off. In these cases the Rawlsian maximin parts company with what is here called true egalitarianism. A policy question requiring a distinction between maximin and "true egalitarian" allocations has arisen in the arena of organ transplantation. This case is examined here as a venue for differentiating maximin and true egalitarian theories. Directed donation is the name given to donations of organs restricted to a particular social group. For example, the family of a member of the Ku Klux Klan donated his organs on the provision that they go only to members of the Caucasian race. While such donations appear to be discriminatory, if certain plausible assumptions are made, they satisfy the maximin criterion. They selectively advantage the recipient of the organs without harming anyone (assuming the organs would otherwise go unused). Moreover, everyone who is lower on the waiting list (who, thereby, could be considered worse off) is advantaged by moving up on the waiting list. This paper examines how maximin and more truly egalitarian theories handle this case arguing that, to the extent that directed donation is unethical, the best account of that conclusion is that an egalitarian principle of justice is to be preferred to the maximin.

Beneficence↗
PubMed2004

Toward understanding aspects of the precautionary principle.

The idea of a precautionary principle (or precautionary principles) is beginning to come to the wider attention of the environmental community, governmental agencies, regulatory agencies, and the regulated community. Different precautionary principles have not been specified in detail, and, of course, this is difficult to do. Yet some specification must be done in order to understand it better and, if it is to be used for specific action-guidance, to implement it. Moreover, it is important to understand more about the principle, its background assumptions and its comparison with other principles to which we might subscribe. This paper explores aspects of the PP and its background assumptions and presuppositions, comparing them with those for risk assessment and other statements of the PP. It also briefly indicates how it resembles legal principles in addressing problems of uncertainty. Finally, it recapitulates two possible versions of the PP and suggests an application of it for an emerging threat to the environment and public health. This review suggests the PP has plausible applications and is not the radical principle some have suggested.

Bioethical Issues↗
PubMed2004

The precautionary principle and medical decision making.

The precautionary principle is a useful strategy for decision-making when physicians and patients lack evidence relating to the potential outcomes associated with various choices. According to a version of the principle defended here, one should take reasonable measures to avoid threats that are serious and plausible. The reasonableness of a response to a threat depends on several factors, including benefit vs. harm, realism, proportionality, and consistency. Since a concept of reasonableness plays an essential role in applying the precautionary principle, this principle gives physicians and patients a decision-making strategy that encourages the careful weighing and balancing of different values that one finds in humanistic approaches to clinical reasoning. Properly understood, the principle presents a worthwhile alternative to approaches to clinical reasoning that apply expected utility theory to decision problems.

Decision Making↗
PubMed2005

Well-being and fairness in the distribution of scarce health resources.

Based on a general thesis regarding the proper resolution of interpersonal conflicts, this paper suggests a normative framework for the distribution of scarce health resources. The proposed thesis includes two basic ideas. First, individual well-being is the fundamental value. Second, interpersonal conflicts affecting well-being should be resolved in light of several conceptions of fairness, reflecting the independent value of persons and the moral significance of responsibility of individuals for the existence of interpersonal conflicts. These ideas are elaborated in several principles that are applied with respect to the distribution of scarce health resources.

Dissent and Disputes↗
PubMed1985

Responsibility for personal health: a historical perspective.

Reflections about the role of human choice in determining personal health occur in the writings of practitioners and laymen throughout history. THe Greek and Roman writers emphasized the effect of life's activities. During the Middle Ages and Renaissance, disease continued to be seen as a consequence of disorder of the bodily humors, which were under the individual's control. THe rise of the paternalistic national regimes in Europe produced the view that society had the responsibility to maintain health. Jacksonian egalitarianism led to a reaction against the aggressive therapies of established professional experts, a view furthered by the Thomsonian belief that people should wrist control of their health away from orthodox physicians. Among the twentieth century reactions was the movement to urge people to have doctors evaluate laypersons' health. By the 1970s a movement emerged emphasizing again personal responsibility, which, in turn, produced a concern that this was merely "victim-blaming". Views on the role of lay people in determining personal health are heavily influenced by prevailing social, political, and moral climates.

Attitude to Health↗