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PubMed2005

Limits to doubt.

Supported by Ian Hacking's concept of "intervention," and Charles Taylor's concept of "intentionality," this article argues that doubting is acting, and that doubting is therefore subject to the same demands of responsibility as any other action. The argument is developed by using medical practice as a test-case. The central suggestion is that the demand of acting responsibly limits doubt in medicine. The article focuses on two such limitations to doubt. Firstly, the article argues that it is irresponsible to doubt that our actions can harm other people. Secondly, the article argues that it is irresponsible not to strive for coherence between our utterances of doubt and our other actions. Incoherence here can cause "cultural impoverishment." In a larger context this article also argues that medicine can enrich our epistemology, because medical knowledge displays important traits of knowledge that are downplayed in traditional epistemology derived from mathematics and physics. In particular, medicine makes it possible to get the relation between ethics and epistemology into sharper focus. The endpoint in medical epistemology is "responsible action," and not certainty in and of itself.

Ethics↗
PubMed2005

Aristotle and headless clones.

Cloned organisms can be genetically altered so that they do not exhibit higher brain functioning. This form of therapeutic cloning allows for genetically identical organs and tissues to be harvested from the clone for the use of the organism that is cloned. "Spare parts" cloning promises many opportunities for future medical advances. What is the ontological and ethical status of spare parts, headless clones? This paper attempts to answer this question from the perspective of Aristotle's view of the soul. Aristotle's metaphysics as applied to his view of biological essences generates an ethic that can contribute to moral reasoning regarding the use of headless spare parts clones. The task of this paper is to show the implications that Aristotle's view of the soul, if it is true, would have on the ethics of headless, spare parts cloning.

Cloning, Organism↗
PubMed2005

Simplified models of the relationship between health and disease.

The concepts of health and disease are crucial in defining the aim and the limits of modern medicine. Accordingly it is important to understand them and their relationship. However, there appears to be a discrepancy between scholars in philosophy of medicine and health care professionals with regard to these concepts. This article investigates health care professionals' concepts of health and disease and the relationship between them. In order to do so, four different models are described and analyzed: the ideal model, the holistic model, the medical model and the disjunctive model. The analysis reveals that each model has its pros and cons, and that health care professionals appear to apply more than one models. Furthermore, the models and the way health care professionals' use them may be helpful for scholars in philosophy of medicine with regard to developing theories and communicating them to health care professionals.

Attitude of Health Personnel↗
PubMed2005

Sorting out the concept 'disorder'.

Current debates concerning the concept of mental disorder involve many different philosophical issues. However, it is not always clear from these discussions how, or whether, these issues relate to one another, or in exactly what way they are important for the definition of disorder. This article aims to sort through some of the philosophical issues that arise in the current literature and provide a clarification of how these issues are related to one another and whether they are necessary for defining disorder. I argue that the main concern in defining disorder, namely demarcation, is obscured by a number of these other philosophical issues and that a focus on demarcation gives us a means of placing these other issues in a clarifying context.

Cognition↗
PubMed2005

Foundations of interdisciplinarity: a Lonergan perspective.

The postmodern enterprise, with its foundationlessness, fragmentariness, constructivism, and neopragmatism challenges interdisciplinarity. This paper discusses functional specialization and interdisciplinary method which provides a basis for interdisciplinary collaboration. In functional specialization, successive stages in the process of coming to know are distinguished. These stages correspond to Lonergan's four levels of consciousness, namely experiencing the data, coming to understanding through addressing questions which arise from the data, and judgment about which hypothesis best fits the data. Authenticity, which involves genuine attentiveness, intelligence, reasonableness, and responsibility, guides the appropriate attitude in interdisciplinary work.

Awareness↗
PubMed2004

'Prosthetic fit': on personal identity and the value of bodily difference.

It is within the context of a person's life story, we argue, that the idea of wearing a prosthesis assumes place and meaning. To develop this argument, a brightly colored hook prosthesis for children is taken as a starting point for reflection. The prosthesis can be seen as fitting this person perfectly, when the bodily difference is understood as positively adding to this person's identity. The choice for the prosthesis is normative in a moral sense, in that it is grounded in a person's fundamental convictions with respect to his being and living. This understanding of 'how to live' can best be grasped--as is suggested--in contrastive terms of 'sameness' and 'otherness'. Striving for conformity and similarity would do no justice to the experiences and ideals of unique persons, and would come at great cost. Moreover, society is not benefited by persons who merely conform, who copy and imitate others, but by those who willfully live up to their own unique standards.

Adaptation, Psychological↗
PubMed2004

The philosophy of medicine: development of a discipline.

This paper is a critical examination of the development of the philosophy of medicine as a discipline. It highlights two major themes in the contemporary debate about the philosophy of medicine: the scope of the discipline and the relation of the discipline to its cognate disciplines. A broad view of the philosophy of medicine is defended and the philosophy of medicine is seen as a philosophical sub-discipline. These views depend in important ways on three factors: a general metaphysical world view, particular understandings of the cognate disciplines, and the perspective from which one asks the questions about the nature of the discipline. It is proposed that the future of the philosophy of medicine may follow the philosophy of science in that philosophical, sociological and historical studies may combine in a mutually enriching way to form "medicine studies."

History, 18th Century↗
PubMed2004

Vulnerability: what kind of principle is it?

The so-called European principles of bioethics are a welcome enrichment of principlist bioethics. Nevertheless, vulnerability, dignity and integrity can perhaps be more accurately understood as anthropological descriptions of the human condition. They may inspire a normative language, but they do not contain it primarily lest a naturalistic fallacy be committed. These anthropological features strongly suggest the need to develop deontic arguments in support of the protection such essential attributes of humanity require. Protection is to be universalized, since all human beings share vulnerability, integrity and dignity, thus fundamenting a mandate requiring justice and respect for fundamental human rights. Being a feature of all humanity, vulnerability is improperly extended to designate destitute individuals and populations. Rather, they are in a state of fallen vulnerability, for they already are harmed in some way, and have become deprived of their range of capabilities. These individuals are destitute and are no longer in command of their fundamental human rights. They have lost the status of unharmed vulnerability; identifying them as susceptible--vulnerated and no longer only vulnerable--stresses the point that bioethics demands specific social action to palliate or remove their distress. When harm does occur--in the form of disease, for example-, individuals are no longer vulnerable--for they have ceased to be intact -, they become susceptible to additional deprivations and sickness; integrity is demeaned and dignity is offended, leading to states of dysfunction that require specific remedial social practices, aimed at treating and removing injuries. The main point this paper addresses is that vulnerability--as well as dignity and integrity--are descriptive characteristics of human beings qua humans, which are not normative in themselves, but fundamental enough to inspire bioethical requirements of protection and respect for human rights in the wake of social justice. A clear distinction must be made in regard to human beings who are injured by poverty, sickness, discriminating deprivations or suffer other destitutions, having ceased to be only vulnerable for they are no longer intact. These individuals and populations require more than protection, their needs must be met by specific care and remedial measures to be identified and instigated by bioethics qua applied ethics.

Anthropology, Cultural↗
PubMed2005

The medical theory of Richard Koch I: theory of science and ethics.

Richard Koch first made his appearance in the 1920s with works published on the foundations of medicine. These publications describe the character of medicine as an action and the status of medicine within the theory of science. One of his conclusions is that medicine is not a science in the original sense of the word, but a practical discipline. It serves a practical purpose: to heal the sick. All medical knowledge is oriented towards this purpose, which also defines the physician's role. One kind of knowledge is diagnosis, which is strictly understood in relation to therapy, and is at the core of medical thinking. Diagnosis is not the assignment of a term of a species to a patient's disease: this would not do justice to the individuality of a clinical manifestation and would fail to provide a reason for individual therapy. Nevertheless, the terms assigned to diseases, although fictitious, are not useless, but assist in differentiating various phenomena. These conclusions carry ethical consequences. Because the task of helping the sick constitutes medicine, morals not only set ethical limits: medicine originates in a moral decision. If there are no diseases but only individual sick people, disease can not be defined as an abnormality. The individual benefit to the patient must not necessarily be the complete restoration of health. With its object being incalculable, medicine cannot guarantee its own success. Here the physician has to develop principles that allow for the best possible response to the challenges faced in varying situations of conduct.

Ethics, Medical↗
PubMed2005

Respect for persons, respect for integrity: remarks for the conceptualization of integrity in social ethics.

Even though respect for integrity is hailed in several authoritative legal and ethical documents, and is typically presented as a complement to respect for autonomy, it is largely neglected in many leading works in ethics. Is such neglect warranted, or does it express a prejudice? This article argues that the latter is the case, and that this is due to misplaced conceptual concerns. It offers some proposals as regards the conceptualization of integrity in social ethics in general and in biomedical ethics in particular. Five main directions of interpretation of "integrity" are discerned and shown to be relevant for different areas of biomedical ethics. The defense of respect for integrity is served by a softening of principlism and by greater attention to context among the initial critics of this principle.

Ethics, Medical↗
PubMed2004

Biomechanical and phenomenological models of the body, the meaning of illness and quality of care.

The predominant model of the body in modern western medicine is the machine. Practitioners of the biomechanical model reduce the patient to separate, individual body parts in order to diagnose and treat disease. Utilization of this model has led, in part, to a quality of care crisis in medicine, in which patients perceive physicians as not sufficiently compassionate or empathic towards their suffering. Alternative models of the body, such as the phenomenological model, have been proposed to address this crisis. According to the phenomenological model, the patient is viewed as an embodied person within a lived context and through this view the physician comes to understand the disruption illness causes in the patient's everyday world of meaning. In this paper, I explore the impact these two models of the patient's body have had on modern medical practice. To that end I first examine briefly the historical origins of the biomechanical and phenomenological models, providing a historical context for the discussion of each model's main features in terms of machine-world and life-world. Next, I discuss the impact each model has had on the patient-physician relationship, and then I examine briefly the future development of each model. The meaning of illness vis-à-vis each model of the patient's body is finally examined, especially in terms of how these two models affect the patient's interpretation of illness. The paper concludes with a discussion of the biomechanical and phenomenological models, in terms of the quality of care crisis in modern western medicine.

Biomechanical Phenomena↗
PubMed2004

On the autonomy turf. Assessing the value of autonomy to patients.

Within the western health-care context autonomy is a central value. Still, as it is used within this context it is far from clear what we are actually talking about. In this article the author outlines four different uses or aspects of autonomy: self-determination, freedom, desire-fulfilment and independence. One important conclusion will be that in order to be able to respect autonomy in a way that actually brings value to the patient's life we need to clearly assess what aspect of autonomy the patient values and for what reason it is valued by the patient.

Choice Behavior↗
PubMed2005

Could the ethics of institutionalized health care be anything but Kantian? Collecting building blocks for a unifying metaethics.

Is a Health Care Ethics possible? Against sceptical and relativist doubts Kantian deontology may advance a challenging alternative affirming the possibility of such an ethics on the condition that deontology be adopted as a total programme or complete vision. Kantian deontology is enlisted to move us from an ethics of two-person informal care to one of institutions. It justifies this affirmative answer by occupying a commanding meta-ethical stand. Such a total programme comprises, on the one hand, a dual-aspect strategy incorporating the macro- (institutional) and micro- (person-to-person) levels while, on the other, it integrates consistently within moral epistemology a meta-ethics with lower-ground moral theories. The article describes the issues to be dealt with and the problems which have to be solved on the way to a unifying theory of that kind (Sections I-III) and indicates elements of Kantian moral philosophy which may serve as building blocks (Section IV). Among these are not only Kant's ideas concerning the moral acting of persons and his ideas concerning civil society and state but also his ideas concerning morality, schematism and religion.

Delivery of Health Care↗
PubMed2005

Resourcifying human bodies--Kant and bioethics.

This essay roughly sketches two major conceptions of autonomy in contemporary bioethics that promote the resourcification of human body parts: (1) a narrow conception of autonomy as self-determination; and (2) the conception of autonomy as dissociated from human dignity. In this paper I will argue that, on the one hand, these two conceptions are very different from that found in the modern European tradition of philosophical inquiry, because bioethics has concentrated on an external account of patient's self-determination and on dissociating dignity from internal human nature. However, on the other hand, they are consistent with more recent European philosophy. In this more recent tradition, human dignity has gradually been dissociated from contextual values, and human subjectivity has been dissociated from objectivity and absolutized as never to be objectified. In the concluding part, I will give a speculative sketch in which Kant's internal inquiry of maxim of ends, causality and end, and dignity as iirreplaceability is recombined with bioethics' externalized one and used to support an extended human resourcification.

Bioethics↗
PubMed2005

Towards a dynamic definition of health and disease.

A multifactorial and growing crisis of health care systems in the developed world has affected medicine. In order to provide rational responses, some central concepts of the past, such as the definitions of health and disease, need to be updated. For this purpose physicians should initiate a new debate. As a point of departure the following definitions are proposed: Health is a dynamic state of wellbeing characterized by a physical, mental and social potential, which satisfies the demands of a life commensurate with age, culture, and personal responsibility. If the potential is insufficient to satisfy these demands the state is disease. This term includes sickness, illness, ill health, and malady. The described potential is divided into a biologically given and a personally acquired partial potential. Their proportions vary throughout the life cycle. The proposed definitions render it empirically possible to diagnose persons as healthy or diseased and to apportion some of the responsibility for their state of health to individuals themselves. Treatment strategies should always consider three therapeutic routes: improvements of the biologically given and of the personally acquired partial potentials and adaptations of the demands of life. These consequences favourably contrast with those resulting from the WHO-definition of health.

Disease↗