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PubMed1999

Aesthetic experience, medical practice, and moral judgement. Critical remarks on possibilities to understand a complex relationship.

The aim of the paper is to examine the possible relationships between the different dimensions of aesthetics on the one hand, and medical practice and medical ethics on the other hand. Firstly, I consider whether the aesthetic perception of the human body is relevant for medical practice. Secondly, a possible analogy between the artistic process and medical action is examined. The third section concerns the comparison between medical ethical judgements and aesthetic judgement of taste. It is concluded that the mutual relevance between the aesthetic sphere, moral judgement and medical practice can be understood only if we recognize these spheres as distinct.

Esthetics↗
PubMed1998

On medicine and health enhancement--towards a conceptual framework.

This paper contains an attempt at constructing a semantic framework for the field of health enhancement. The latter is here conceived as an extremely general category covering the whole area of health care and health promotion. With this framework as a basis I attempt to define the place of medicine within the enterprise of health enhancement. I finally indicate some normative issues for the future, in particular problems and possible developments for medicine as a species of health enhancement.

Ethics, Medical↗
PubMed1999

Paradigms and personhood: a deepening of the dilemmas in ethics and medical ethics.

There are many calls for a definition of personhood, but also many logical and Wittgensteinian reasons to think fulfilling this is unimportant or impossible. I argue that we can consider many contexts as language-games and consider the person as the key player in each. We can then examine the attributes, presuppositions and implications of personhood in those contexts. I use law and therapeutic psychology as two examples of such contexts or language-games. Each correlates with one of the classic "theories" of ethics-deontology and consequentialism. But each is a large enough cluster to consider them as paradigms in a sense related to Thomas Kuhn's notion in The Structure of Scientific Revolutions. Showing the presuppositions about and "takes" on personhood together with the connections involved in the paradigms deepens the dilemmas we already know to be present.

Bioethical Issues↗
PubMed2000

A pathological view of disease.

This paper is a response to Christopher Boorse's recent defense of his Biostatistical Theory (BST) of health and disease. Boorse maintains that his concept of theoretical health and disease reflects the "considered usage of pathologists." I argue that pathologists do not use "disease" in the purely theoretical way that is required by the BST. Pathology does not draw a sharp distinction between theoretical and practical aspects of medicine. Pathology does not even need a theoretical concept of disease. Its focus is not theoretical, but practical; pathology's goal is to contribute to the healing of patients. Pathology, even experimental pathology, is not value-free. Not only "disease" but also such terms as "nerve" and "organ" are laden with conceptual values.

Biometry↗
PubMed1998

Codes and morals: is there a missing link? (The Nuremberg Code revisited).

Codes are a well known and popular but weak form of ethical regulation in medical practice. There is, however, a lack of research on the relations between moral judgments and ethical Codes, or on the possibility of morally justifying these Codes. Our analysis begins by showing, given the Nuremberg Code, how a typical reference to natural law has historically served as moral justification. We then indicate, following the analyses of H. T. Engelhardt, Jr., and A. MacIntyre, why such general moral justifications of codes must necessarily fail in a society of "moral strangers." Going beyond Engelhardt we argue, that after the genealogical suspicion in morals raised by Nietzsche, not even Engelhardt's "principle of permission" can be rationally justified in a strong sense--a problem of transcendental argumentation in morals already realized by I. Kant. Therefore, we propose to abandon the project of providing general justifications for moral judgements and to replace it with a hermeneutical analysis of ethical meanings in real-world situations, starting with the archetypal ethical situation, the encounter with the Other (E. Levinas).

Codes of Ethics↗
PubMed2001

The 'medical body' as philosophy's arena.

Medicine, as Byron Good argues, reconstitutes the human body of our daily experience as a "medical body," unfamiliar outside medicine. This reconstitution can be seen in two ways: (i) as a salutary reminder of the extent to which the reality even of the human body is constructed; and (ii) as an arena for what Stephen Toulmin distinguishes as the "intersection" of natural science and history, in which many of philosophy's traditional (and traditionally abstract) questions are given concrete and urgent form. This paper begins by examining a number of dualities between the medical body and the body familiar in daily experience. Toulmin's epistemological analysis of clinical medicine as combining both universal and existential knowledge is then considered. Their expression, in terms of attention, respectively, to natural science and to personal history, is explored through the epistemological contrasts between the medical body and the familiar body, noting the traditional philosophical questions which they in turn illustrate.

Consciousness↗
PubMed1998

The concept of health and disease.

Examining the naturalist and normativist concepts of health and disease this article starts with analysing the view of C. Boorse. It rejects Boorse's account of health as species-typical functioning, giving a critique of his view based on evolutionary theory of contemporary biology. Then it gives a short overview of the normativist theories of health, which can be objectivist and subjectivist theories. Rejecting the objectivist theories as philosophically untenable, it turns to the subjectivist theories of Gert and Culver, and to the view of Nordenfelt. These theories give quite a good subjectivist account of health and disease, but they do not pay enough attention to the notion of the environment, without which it is impossible to define health and disease. Starting with their definitions but introducing the notion of "reasonable social norms", the article arrives at the following definition of health: The healthier a physical or mental characteristic, process, reaction is, the more it makes it possible for the individual to adapt to reasonable social norms without pain and suffering, and the longer, and happier a life it will be able to ensure him in that society.

Adaptation, Physiological↗
PubMed1998

The body as object versus the body as subject: the case of disability.

This paper is prompted by the charge that the prevailing Western paradigm of medical knowledge is essentially Cartesian. Hence, illness, disease, disability, etc. are said to be conceived of in Cartesian terms. The paper attempts to make use of the critique of Cartesianism in medicine developed by certain commentators, notably Leder (1992), in order to expose Cartesian commitments in conceptions of disability. The paper also attempts to sketch an alternative conception of disability--one partly inspired by the work of Merleau-Ponty. In particular, three key Cartesian claims are identified and subjected to criticism. These are as follows: (a) The claim that the body is an object, (b) what is termed here 'the modularity thesis', and (c) the claim that the body cannot be constitutive of the self (i.e. since the soul/mind/brain is). In opposition to these claims, it is argued that the body is properly viewed as a subject; that there are neither purely mental, nor purely physical disabilities; and that selves are constituted, at least in part, by their bodies.

Persons with Disabilities↗
PubMed1999

The limits of medical practice.

Should medicine be defined as the enterprise in charge of the health problems of society? If so, then any problem (individual, public, social or political) that can be reformulated as a "health problem" could serve as a goal of medicine. If, on the other hand, medicine--or medicine proper--is defined in terms of some limited goal and limited means, then some medical professionals would find themselves working in other fields than medicine. It could be of some importance to the patient to know whether the medical professional he meets is engaged in medical practice (aiming at the patient's health), research, public health or some other project which involves medical competence. Obviously, some of these enterprises may have conflicting goals. This paper will analyse various candidates for being a model of medicine, discuss some of the consequences, and argue for a limited view of medical practice.

Humans↗
PubMed1999

The troublesome concept of the person.

In today's bioethical debates, the concept of the person plays a major role. However, it does not hold this role justly. The purpose of this paper is to argue that the concept of the person is unsuited to be a central concept in bioethical debates, because its use is connected with serious problems. First, the concept is superfluous. Secondly, it is a confusing concept and it lacks pragmatic use. Thirdly, its use leads to simplifications. Finally, the concept can easily be used as a cover-up concept. Therefore, it is argued that relinquishing the concept of the person could enhance the clarity and quality of bioethical debate. Moreover, the historic origin of much of the present confusion surrounding the concept of the person is clarified. It is demonstrated that three influences resulting from Locke's ideas on the person and personal identity can be determined as contributing factors to the confusion and controversy within the present bioethical debates centering around the person.

Beginning of Human Life↗
PubMed2000

Managing one's body using self-management techniques: practicing autonomy.

This paper discusses some of the anthropological and philosophical features of the use of self-management plans by patients with a chronic disease, focusing on patients with asthma. Characteristics of this technologically mediated form of self-care are contrasted with the work of Mauss and Foucault on body techniques and techniques of self. The similarities and differences between self-management of asthma and Foucault's technologies of self highlight some of the ways in which self-management contributes to modifications in the definitions of patients and physicians. Patients, in measuring their lung function, first come to rely on measurements more than on felt disturbances, but next, felt disturbances become modified by previous measurements. Physicians, one the other hand, see their role changed from expert to being a participant in a joint treatment. It is argued that the concept of agency is more appropriate for describing the advantage of self-management for patients than autonomy.

Anti-Asthmatic Agents↗
PubMed2001

On the goals of medicine, health enhancement and social welfare.

Bengt Brülde in his article "The Goals of Medicine. Towards a Unified Theory" has proposed a normative theory of the goals of medicine within which the concept of quality of life plays a crucial role. In Brülde's analysis, however, the very concept of medicine is deliberately left quite vague and it is therefore difficult to see how the goals of medicine are related to the goals of closely allied enterprises such as health promotion and social welfare. In this reply I therefore propose an analysis of these related conceptual areas. I do this mainly in two respects. (1) Following the nomenclature in a previously published article (Nordenfelt, 1998) I propose a systematic conceptual framework for all varieties of health enhancement and distinguish different notions of medicine within this framework. A consequence of this analysis is, for instance, that the means and also the immediate goals of medicine in its broadest sense are more diversified than the means and immediate goals of medicine in its narrowest sense. (2) From this position I expand the topic further by comparing medicine and health enhancement with social welfare and try to trace the basic features between--as well as the common properties of--these different enterprises.

Clinical Medicine↗
PubMed2001

Plato and holistic medicine.

Popular visions of holistic health and holistic medicine are not so much reactions to perceived excesses of technological medicine as they are visions of the good life itself and how to attain it. This paper attempts to clarify some of the concepts associated with holistic health and medicine. The particular vision of holistic health presented here is well exemplified in the writings of Plato. First, I examine the scientific concept of holism and argue that, while medicine is inadequately characterized by scientific reductionism, any plausible holistic medicine must make room for a limited scientific reductionism. Next, I analyze the complexity of Plato's usage of "health" and demonstrate some of the parallels between Plato's thought and popular and scientific visions of holistic health. Finally, I look at what Plato has to say about medical practice and the relation of medicine and philosophy as therapies for the whole person.

Greek World↗
PubMed2001

Historical and philosophical reflections on patient autonomy.

Contemporary American medical ethics was born during a period of social ferment, a key theme of which was the espousal of individual rights. Driven by complex cultural forces united in the effort to protect individuality and self-determined choices, an extrapolation from case law to rights of patients was accomplished under the philosophical auspices of 'autonomy.' Autonomy has a complex history; arising in the modern period as the idea of self-governance, it received its most ambitious philosophical elaboration in Kant's moral philosophy. In examining the Kantian construction, it is evident that neither his universal moral imperative nor his rigorous application of self-legislated ethical action can sustain our own notions of moral agency in a pragmatic, pluralistic society. But the Kantian position is useful in highlighting that self-governance is not equivalent to 'autonomy,' and this distinction defines the limits of autonomy in the clinical setting. A critique of Engelhardt's idea of 'principle of permission' is used to illustrate autonomy's eclipse as a governing principle for medical ethics.

Bioethical Issues↗