Digital medicine is a medical treatment that combines technology with drug delivery. The promises of this combination are continuous and remote monitoring, better disease management, self-tracking, self-management of diseases, and improved treatment adherence. These devices pose ethical challenges for patients, providers, and the social practice of medicine. For patients, having both informed consent and a user agreement raises questions of understanding for autonomy and informed consent, therapeutic misconception, external influences on decision making, confidentiality and privacy, and device dependability. For providers, (...) digital medicine changes the relationship where trust can be verified, clinicians can be monitored, expectations must be managed, and new liability risks may be assumed. Other ethical questions include direct third-party monitoring of health treatment, affordability, and planning for adverse events in the case of device malfunction. This article seeks to lay out the ethical landscape for the implementation of such devices in patient care. (shrink)

In “Artificial Intelligence, Social Media and Depression: A New Concept of Health-Related Digital Autonomy,” Laacke and colleagues posit a revised model of autonomy when using digital algori...

Despite the promise of international collaboration and sharing by bringing together bioethicists from throughout the world at the 2024 IAB conference in Qatar, I will not be attending. The authors...

In October 2021, the Allen Institute for Artificial Intelligence publicly released Delphi, an artificial intelligence system trained to make general moral decisions (Allen Institute for Artifi...

Volume 20, Issue 10, October 2020, Page 29-31.

Although the AAMC requires annual reporting of medical humanities teaching, most literature is based on single-school case reports and studies using information reported on schools’ websites. This study sought to discover what medical humanities is offered in North American allopathic and osteopathic undergraduate medical schools. An 18-question, semi-structured survey was distributed to all 146 member schools of the American Association of Medical Colleges and the American Association of Colleges of Osteopathic Medicine. The survey sought information on required and elective humanities (...) content, hours of humanities instruction, types of disciplines, participation rates, and humanities administrative structure. The survey was completed by 134 schools. 70.8% of schools offered required and 80.6% offered electives in humanities. Global health and writing were the most common disciplines. Schools required 43.9 mean and 30 median hours in humanities. In the first two years, most humanities are integrated into other course work; most electives are offered as stand-alone classes. 50.0% of schools report only 0-25% of students participating in humanities electives. Presence of a certificate, concentration or arts journal increased likelihood of humanities content but decreased mean hours. Schools with a medical humanities MA had a higher number of required humanities hours. Medical humanities content in undergraduate curriculum is lower than is indicated in the AAMC annual report. Schools with a formal structure have a greater humanities presence in the curriculum and are taken by more students. (shrink)

In the last decade, the humanities have been shrinking in number of students, percent of faculty, and in number of degrees awarded. Humanities students also earn lower salaries than their STEM-prepared peers. At the same time, the health humanities have been in ascendance over the last fifteen years. The number of majors, minors and certificates has increased 266% in that time frame, attracting large numbers of students and preparing future patients, lay caregivers, and health care providers to interact with a (...) complicated and dehumanized medical system. In 1982, British philosopher and educator Stephen Toulmin declared that medicine saved philosophy from irrelevance and possibly extinction. I propose that the health humanities can serve a similar function to stave off the decline of the broader humanities. The health humanities can model an applied approach for the broader humanities to attract student interest; develop students’ capacity for critical reading, writing and reflection about health and medicine in society, practice, and their own lives and inoculate all students against the influence of medicine, whether through preparing pre-health students to navigate the hidden medical curriculum or preparing future patients to navigate the health care system. (shrink)

Academic programs in the medical/health humanities have proliferated widely in recent years, and the professional, academic, and cultural drivers of this growth promise sustained new program development. In this article, we present the results of a survey sent to representatives of one hundred twenty-four baccalaureate and ten graduate programs in the medical/health humanities to assess the experiences and needs of existing programs. Survey results confirm the interest in and need for a descriptive toolkit as opposed to a prescriptive manual; indicate (...) what data and materials are most needed to support the successful development of new academic programs in the field; and identify areas for future research. Recognizing a need for program development resources, the Health Humanities Consortium has initiated the creation of a comprehensive online toolkit. We discuss survey results and the toolkit in relation to the drivers of new program growth. Finally, we describe resources now available through the HHC’s new online program toolkit, including existing programs; sample syllabi; sample curricula templates; program rationale; proposal templates; and graduation data. (shrink)

The Health Humanities Consortium was established in 2015 to “promote health humanities scholarship, education, and practice through transdisciplinary methods and theories that focus on the intersection of the arts and humanities, health, illness, and healthcare.” As the founding co-chairs of the HHC, we provide a history of the founding of this organization in this article, describing the journey of its creation, the choices and challenges it faced as a new organization, and our hopes for a rich future.

In 2005, President George Bush read John Barry’s The Great Influenza: The Story of the Deadliest Pandemic in History. After his experiences of 9/11 and Hurricane Katrina, Bush began the first White...

Rurality in the modern United States (US) is characterized as a small population spread over a wide area of land. Only approximately 21% of the population lives in rural areas, which is defined as...

In their target article, Nelson, Lushkov, Pomerantz, and Weeks demonstrate that there has been a lack of discussion on rural bioethics issues in published, or at least indexed, literature. They con...

Much of the recent AI-LLM literature has been apocalyptic in pointing out the risks of AI technology, “mitigating the risk of extinction from AI should be a global priority alongside other societal...

Over the last decade, public health and bioethics have been courting each other, trying to figure out a way to inform and assist one another. Ethics in public health began in epidemiology and public health in ethics began in health law. Attempts have been made to create both an ethics of and in public health. Although many edited volumes and even model curriculums have been created for the teaching of public health ethics, most efforts are mired in medical ethics and (...) do not take the unique population perspective of public health. Several challenges to the development and teaching of public health ethics remain, including the issue of ethics being a required public health competency and the questions: what should be in a public health ethics curriculum, where will instructors be trained and how wi;l such faculty be paid? A true public health ethics will help professionals address issues of values, critical thinking and decision making. (shrink)

In the fall of 2021 a news story reported of a successful experimental xenotransplant of a genetically engineered pig kidney in to the circulatory system of a research subject who was dead by neurological criteria. Although not a first of its kind, this case raises the issue of the ethics of research on those declared brain dead. Such possibilities have been discussed in the published literature since 1974, when Willard Gaylin expressed concern over human dignity when he imagined hospital wards (...) filled with “neomorts” used for education, teaching, research, and manufacturing. In this essay, the author explores the nuances of whether such subjects are considered alive, dead, or something in between. Notions of consent/ permission and risk/benefit are determined by this categorization. After discussing the 2005 Consensus Panel Guidelines on Research with the Recently Dead, the essay concludes with the need for a liminal state between living and dead that respects human dignity but also recognizes the utilitarian value of such experiments to protect fully alive humans. Having not just guidelines but oversight structures such as the University of Pittsburgh’s Committee for Oversight of Research Involving the Dead (CORID) and regulations are necessary if such work is to become more common. (shrink)

Miguel is an eighteen‐year‐old male transferred to Alamo Hospital for antivenom treatment after a rattlesnake bite while sleeping on railroad tracks. His “coyote,” an individual who guides undocumented people across the U.S. border from Mexico, dropped him off at a clinic. By the time Miguel was transferred from the clinic to Alamo, he was in complete paralysis and at risk for heart failure, requiring ventilator support to breathe. A person who receives treatment for a snake bite within one to two (...) hours has a 99 percent chance of recovery, but for Miguel, at least fifteen hours had already passed. A hospital ethicist at Alamo contacted the Mexican consulate, and together they arranged for Miguel's father to come to Alamo and make decisions for him. His physicians have determined that he is in a persistent vegetative state and can no longer benefit from hospital treatment. However, no long‐term care facility will accept him. Miguel is undocumented and unfunded. Miguel's father wishes to take his son home, but the cost of transporting him is high,and their home state in Mexico has no ventilator available for him and no consistent supply of electricity to run it. What should the hospital do? (shrink)

The Macmillan Interdisciplinary Handbooks: Philosophy series serves undergraduate college students who have had little or no exposure to philosophy, as well as the curious lay reader. Following this first primer volume, which introduces both the discipline and the topics of the remaining nine volumes, each handbook will usher the reader into a subfield of philosophy (see list of titles below), and explore fifteen to thirty topics in that subfield. Every chapter in each volume will use vehicles such as film to (...) facilitate understanding of philosophical issues; for example, the film Dead Man Walking may be used as an introduction to issues related to the death penalty. (shrink)

The authors conducted a baseline survey of baccalaureate and graduate degree health humanities programs in the United States and Canada. The object of the survey was to formally assess the current state of the field, to gauge what kind of resources individual programs are receiving, and to assess their self-identified needs to become or remain programmatically sustainable, including their views on the potential benefits of program accreditation. A 56-question baseline survey was sent to 111 institutions with baccalaureate programs and 20 (...) institutions with graduate programs. Respondents were asked about three areas: (1) program administration (managing unit, paid director, faculty lines, paid staff, funding sources); (2) educational program (curricular structure, CIP code usage, completion rates); and (3) views on accreditation for the field. A clear majority of respondents agreed that some form of accreditation or consultation service could address resource and sustainability issues. Overall, the survey responses to staffing, curricular structure, and support suggest the need for developing a sustainable infrastructure for health humanities. (shrink)

In the rapidly evolving healthcare environment, perhaps no role is in greater flux and redefinition than that of the clinical bioethicist. The discussion of ethics consultation in the bioethics literature has moved from an ambiguous concern regarding its proper place in the clinical milieu to the more provocative question of which methods and theories should best characterize the intellectual and practical work it claims to do. The American Society for Bioethics and Humanities addressed these concerns in its 1998 report, CoreCompetenciesforHealthCareEthicsConsultation. (...) The report tries to answer the question as to what disciplinary training, background experience, and levels of knowledge in ethics the clinical ethics consultant should have, and what specific skills and character traits the clinical ethics consultant should cultivate. In addition to acquiring knowledge of common bioethical issues, theoretical concepts in ethical theory and moral reasoning, and health-related law and policy, the report also recommends that ethics consultants demonstrate knowledge of the health beliefs and perspectives of patients and healthcare providers. In our opinion, this recommendation underscores a crucial aspect of the practice of ethics consultation in the increasingly multicultural settings of healthcare institutions. Clearly, the dynamic of American life and culture is permeated with diversity and variety as new groups suffuse their own beliefs and faith perspectives into the health sector. New immigrant groups force society to question traditional healthcare practices and to accommodate changing medical needs. (shrink)

Volume 19, Issue 10, October 2019, Page W1-W2.

We examined the management of completed advance directives including why participants completed a document, what procedures and values they chose, with whom they held end-of-life conversations, and where they stored their document. Participants elected to complete a SurveyMonkey survey that was made available to individuals who wrote an advance directive through Texas-LivingWill.org; 491 individuals elected to fill out the survey, aged 19 to 94 years. The survey asked multiple questions about why participants completed an advance directive, where they would store (...) it, and with whom they had conversations about their end-oflife wishes. A list of procedures and values allowed participants to indicate what they refused or requested in their advance directive. Advance directives are most often completed to allow patients to prepare and control the healthcare they wish to receive when dying. One-half to two-thirds of individuals refuse common end-of-life medical procedures, and the rest request the procedures. We found a correlation between the choice to refuse or request a procedure and the age of the participant. Participants reported that their end-of-life conversations most often occurred with their spouse. Respondents often reported that their advance directive was stored with their physician and power of attorney for healthcare, conversations with those individuals rarely happened. Advance directives document patients’ requests for and refusals of end-of-life care. Physicians and surrogates need to be better educated so that the documents are part of a meaningful conversation with the patient. Because patients’ choices change over their lifespan, these documents need to be revisited regularly and not completed as a onetime event. (shrink)

Talk of 'spirituality' and 'individual religion' is proliferating both in popular discourse and scholarly works. Increasingly people claim to be 'spiritual but not religious,' or to prefer 'individual religion' to 'organized religion.' Scholars have for decades noted the phenomenon - primarily within the middle class - of individuals picking and choosing elements from among various religious traditions, forming their own religion or spirituality for themselves. While the topics of 'spirituality' and 'individual religion' are regularly treated as self-evident by the media (...) and even some scholars of religion, Capitalizing Religion provides one of the first critical analyses of the phenomenon, arguing that these recent forms of spirituality are in many cases linked to capitalist ideology and consumer practices. Examining cases such as Eckhart Tolle's The Power of Now, and Karen Berg's God Wears Lipstick, Craig Martin ultimately argues that so-called 'individual religion' is a religion of the status quo or, more critically, 'an opiate of the bourgeoisie.' Capitalizing Religion: Ideology and Opiate of the Bourgeoisie is a landmark publication in critical religious studies. (shrink)

Scholasticism, appropriation, and censure -- Humanists' invectives and Aristotle's impiety -- Renaissance Aristotle, Renaissance Averroes -- Italian Aristotelianism after Pomponazzi -- Religious reform and the reassessment of Aristotelianism -- Learned anti-Aristoteliansim -- History, erudition, and Aristotle's past -- Pious novelty.

What causes winds was regarded as one of the most difficult questions of early modern natural philosophy. Vitruvius, the ancient Roman architectural author, put forth an alternative to Aristotle’s theory by likening the generation of wind to the actions of the aeolipile, which he believed made artificial winds. As Vitruvius’s work proliferated during the sixteenth and seventeenth centuries, numerous natural philosophers, including Descartes, used the aeolipile as a model for nature. Yet, interpretations of Vitruvius’s text and of the relation of (...) the aeolipile to natural winds varied according to definitions and conceptions of air, wind, rarefaction, condensation, and vapor. (shrink)

The well-established finding that siblings growing up in the same family turn out to be very different from one another has puzzled psychologists and behavior geneticists alike. In this theoretical note we describe the possible ontogeny and phylogeny of a sibling differentiation mechanism. We suggest that sibling competition for parental investment results in sibling differentiation on a number of characteristics, producing different developmental trajectories within families. Variations in developmental trajectories within families may have had fitness advantages in ancestral environments because(a) (...) sibling competition for extrafamilial resources would be reduced and(b) these variations would be suited to environments containing a variety of niches or to changing environments. Predictions derived from this model and an example of an application to attachment theory are presented. (shrink)

In this paper I describe the context and goals of Francisco Vallés' In IV librum Meteorologicorum commentaria. Vallés' work stands as a landmark because it interprets a work of Aristotle's natural philosophy specifically for medical doctors and medical theory. Vallés' commentary is representative of new understandings of Galenic-Hippocratic medi-cine that emerged as a result of expanding textual knowledge. These approaches are evident in a number of sixteenth-century commentaries on Meteorologica IV; in particular the works of Pietro Pomponazzi, Lodovico Boccadiferro, Jacob (...) Schegk, and Francesco Vimercati. Vallés' conviction that Meteorologica IV is relevant to medical knowledge depends on his understanding of Aristotle's theory of homeomerous substances and their relation to composite substances. The application of Meteorologica IV to medical topics became commonplace in the following years, and this Aristotelian book became widely known as a bridge between natural philosophy and medicine. (shrink)

There is still very little constitutional control over the decision to use armed force, and very limited domestic implementation of the international principles of jus ad bellum, notwithstanding the increasing overlap between international and domestic legal systems and the spread of constitutional democracy. The relationship between constitutional and international law constraints on the use of armed force has a long history. Aspects of constitutional theory, liberal theories of international law, and transnational process theory of international law compliance, suggest that constitutional (...) design could legitimately be used as a pre-commitment device to lock-in jus ad bellum principles, and thereby enhance compliance with that regime of international law. This paper examines the case of Japan's Constitution to determine the extent to which its war-renouncing provisions incorporated, and are consistent with, international law principles on the use of armed force, and whether the provisions operated to effectively constrain government policy. It concludes that the drafters of the Constitution did incorporate international law principles from jus ad bellum in Art. 9(1), though they also grafted on sui generis prohibitions and rules from jus in bello in Art. 9(2) as well, which complicates the story. The provision was embraced in the ratification process, and became the source of powerful constitutive norms that have helped shape Japan's sense of identity. The paper examines the interpretation of Art. 9, as informed by international law, and concludes that despite deep conflicts over competing narratives and understandings of the provision, the long-standing government interpretation of the provision is consistent with Japan's obligations under the jus ad bellum regime. In looking at the operation of Art. 9, the paper finds that despite the early use of Art. 9 by governments as a pretext behind which it could pursue desired policy objectives, the provision did operate to effectively constrain government policy in times of apparent crisis. During the Gulf War in particular, Art. 9 effectively bound a straining government to the mast, preventing Japan's participation in the war. It did so not only in its operation as a legal norm, effectively enforced by the Cabinet Legislation Bureau, but also as a powerful constitutive and social norm. As such, the experience of Japan with Art. 9 provides support for the argument that it is feasible to incorporate principles of jus ad bellum into national constitutions, so as to effectively constrain government policy with respect to engaging in armed conflict. Broader arguments as to why that might be desirable, or whether it has served Japan well or ill, are left for another day. (shrink)

ABSTRACT It is well attested that Francis Bacon considered his History of Winds to be an exemplar, but what lessons should be taken from its example have been subject to debate. Instead of looking at this work as a mere model for the fusion of natural history and natural philosophy, it is also possible to see Bacon as trying to provide tentative solutions to outstanding questions regarding the wind, a topic that was deeply scrutinized during the early modern period. An (...) examination of Bacon’s provisional concluding rules reveals deep correspondences with earlier works, such as José de Acosta’s Natural and Moral History of the Indies, that revised classical understandings of the wind based on experience, experiments, and accounts of travels beyond Europe. Understanding the History of Winds as a genuine attempt to solve outstanding questions about the wind uncovers its debt to earlier traditions, including those related to Renaissance natural history, and shows it’s influence in relation to specific theories of the wind beyond its call for methodological reform. (shrink)

The subject of meteorology was central to Girolamo Cardano’s thought. It held together his encyclopedism by tying the celestial realm to the sublunary world and human action. Meteorology, for Cardano, links abstract knowledge to the practical and operative. While many of his Aristotelian predecessors understood weather prediction as distinct from meteorology as a natural philosophical field, Cardano’s profound interest in conjectural arts and probabilistic reasoning led him to tie causal explanations to methods of forecasting future conditions of the air and (...) their effects on humans, especially regarding health and disease. While it might be expected that Cardano would have emphasized astrological tools for weather forecasting, instead he went in a different direction, namely, embracing the ancient tradition of weather signs and revising Aristotelian theories of winds. At the end of his career, which he mostly spent writing commentaries on Hippocratic writings, he integrated his understanding of weather signs with Hippocratic rules of prognosis, revising traditional understandings of the causes of winds. (shrink)

In the faculty of arts at the University of Padua in the years around 1600 professors debated the reliability of astrology, the existence of occult celestial influences, and the idea that celestial heat is present in living bodies. From the 1570s to the 1620s many professors in the faculty of arts pushed back against astrology and Jean Fernel's theories surrounding astral body. Girolamo Mercuriale, Alessandro Massaria and Eustachio Rudio thought that some forms of astral causation and Fernel's ideas were incompatible (...) with their observations of disease, Aristotle's philosophy and Hippocratic theories. Later, Santorio Santorio and Cesare Cremonini, who were allied to the political circle of Paolo Sarpi, polemicized against astrology. Their writings show that at Padua medical theory was linked to Aristotelian cosmology, which emphasized the incommensurability between celestial and terrestrial elements. Their rejection of astrology, however, did not lead to the complete marginalization of astrology at Padua. By the middle of the 1620s, as the political climate changed in Venice, the University of Padua hired professors who promoted astrology and Fernel's theories about the celestial nature of innate heat. The diversity of opinions about astrology reflected Venice's divided politics and multiple approaches to interpreting Aristotle and other authorities. (shrink)