In the United Kingdom (UK), ethical guidance for doctors assumes a therapeutic setting and a normal doctor–patient relationship. However, doctors with dual obligations may not always operate on the basis of these assumptions in all aspects of their role. In this paper, the situation of UK occupational physicians is described, and a set of models to characterise their different practices is proposed. The interaction between doctor and worker in each of these models is compared with the normal (...) doctor–patient relationship, focusing on the different levels of trust required, the possible power imbalance and the fiduciary obligations that apply. This approach highlights discrepancies between what the UK General Medical Council guidance requires and what is required of a doctor in certain roles or functions. It is suggested that using this modelling approach could also help in clarifying the sources of moral conflict for other doctors with “dual obligations” in their various roles. (shrink)

Reagon, Bellin and Boniface argue that traditional models of evidence-based practice focus too much on randomised controlled trials and neglect 'the multiple truths of occupational therapy'. This opinion piece points out several flaws in their argument, and suggests that it is unethical to rely on weaker evidence sources when higher quality evidence exists. Ironically, the evidence that they provide to support their argument regarding different types of evidence is itself very weak.

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Ideas 65.2 (2004) 191-211 [Access article in PDF] Oratory and Rhetoric in Renaissance Medicine Nancy G. Siraisi Hunter College In Renaissance medical practice rhetoric had an ambiguous reputation. Many authors warned physicians against use of persuasion or repeated some version of the truism that patients are cured not by eloquence but by medicines. On the other hand, physicians were also reminded that by (...) speaking well they helped patients to have confidence in their advice and to understand directions, which in turn facilitated cure.1 Yet some aspects of medical culture of the period between 1450 and 1600 seem profoundly attentive to rhetoric, at least as regards the use of language, performative elements, and the influence of these features in ancient models (most notably Galen himself).2 One area in which rhetoric had an unambiguous, acknowledged, and essential place was in the medical orations pronounced at university ceremonies. A sample follows: Pursuit of all these different things by study, investigation of obscurities with ingenuity, conquest of difficulties with industry, and—after penetrating into the very fibers of the earth and searching everywhere into the arcana of the whole of nature and from all herbs, fruits, trees, animals, gems, and even poisons—inquiry after remedies and the proper way to use them for all the ills of human life from so many authors, so many disciplines, and even from the very stars: these things, I say, [End Page 191] have uncovered so many hidden cures, been attained with such arduous powers of the mind, completed with so much effort of memory, offer so many things necessary for the health of the entire human race in common, that does not indeed [the entire enterprise of medicine] seem to have been superhuman and really in a certain way divine?3This nicely exuberant example of Renaissance medical rhetoric exemplifies the genre in several respects. The oration to which it belongs was originally delivered to an academic faculty of medicine by a physician; it shows the impact in medical settings of the revival of epideictic rhetoric, and its author drew on learned sources and commonplaces about medicine that belonged to a store of broadly humanistic erudition, shared both in and outside the medical profession. In fact the only truly distinctive feature of this passage is its author. It comes from Erasmus's Encomium medicinae, which he wrote in 1499 for a friend—a physician named Gysbertus—to deliver to the medical faculty of the University of Paris.4If Gysbertus was exceptionally fortunate in his ghost, many other surviving medical orations are internal products of medical faculties, the work of university masters or students of medicine. But whoever their authors, orations delivered in or written for an academic medical setting offer some telling illustrations both of the way in which certain kinds of humanistic interests and requirements came to penetrate medical learning and of the reaction of humanistic rhetoric to medicine. "Medical humanism" is usually understood to encompass both the core enterprise of intensive philological study, editing, and translation of Greek medical texts—never the occupation of more than a handful of hellenist scholars—and also the reception and scientific influence of the fruits of their labors among a wider medical audience. But Renaissance medicine was also a humanistic discipline in a much broader and more inclusive sense; that is, it both fostered and provided ample scope for the development among learned physicians of interests characteristic of humanistic culture in general: rhetoric, history, biography, fascination with remote peoples and places, and antiquarianism. At the same time, as the passage from Erasmus quoted [End Page 192] above demonstrates, humanists outside the medical profession interested themselves in medicine and controlled a stock of rhetorical commonplaces on the subject. To be sure, the penetration of terminology and concepts from medicine into the general culture long antedated the Renaissance.5 But the revival of rhetoric together with attention to ancient sources and commonplaces provided humanist observers with new tools for commenting, sometimes in quite specific and detailed terms, on the contemporary medical scene, a phenomenon... (shrink)

Next SectionEvidence based medicine is rightly at the core of current medicine. If patients and society put trust in medical professional competency, and on the basis of that competency delegate all kinds of responsibilities to the medical profession, medical professionals had better make sure their competency is state of the art medical science. What goes for the ethics of clinical trials goes for the ethics of medicine as a whole: anything that is scientifically doubtful is, other things (...) being equal, ethically unacceptable. This particularly applies to so called orphaned fields of medicine, those areas where medical research is weak and diverse, where financial incentives are lacking, and where the evidence regarding the aetiology and treatment of disease is much less clear than in laboratory and hospital based medicine. Examples of such orphaned fields are physiotherapy, psychotherapy, medical psychology, and occupational health, which investigate complex syndromes such as RSI, whiplash, chronic low back pain, and chronic fatigue syndrome. It appears that the primary ethical problem in this context is the lack of attention to the orphaned fields. Although we agree that this issue deserves more attention as a matter of potential injustice, we want to argue that, in order to do justice to the interplay of heterogeneous factors that is so typical of the orphaned fields, other ethical models than justice are required. We propose the coordination model as a window through which to view the important ethical issues which relate to the communication and interaction of scientists, health care workers, and patients. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Adolph Meyer’s Psychobiology in Historical Context, and Its Relationship to George Engel’s Biopsychosocial ModelEdwin R. Wallace IV (bio)Keywordspsychobiology, integrative models of psychiatry, biopsychosocial modelBefore addressing the importance of Adolf Meyer and the question of his impact on the biopsychosocial model of the psychoanalytical internist George Engel, let us tersely sketch the history of functionalism in medicine/psychiatry, and of the nineteenth/early twentieth century’s progressive abandonment of it in (...) favor of basic science reductive models of “disease,” not illness.FunctionalismWhereas Hippocratic physicians diagnosed diatheses in terms of humoral excesses or deficiencies, their primary emphasis was on the ill person. They began with careful histories of the patient’s complaints and his or her daily life course, customary activities, typical foods and beverages imbibed, and the exacerbation or relief of symptoms associated with any or all of these. They also asked questions about his physical and social environment. They carefully looked for any clinically pertinent signs, and might physically examine the patient or his excretions. When they arrived at a diagnosis (say, an excess of yellow or black bile, or of blood or phlegm), they would educate the patient about it and discuss possible approaches. Although leeching, emetics, or purgatives might be prescribed, “dietetics” was the core of the treatment. Much more than recommendations about dietary intake, this involved conversations about “lifestyle” management in general: exercise, fresh air, habit changes, and perhaps bathing in mineral waters or spas. If the patient were “melancholic” (which then included what we would now consider a variety of psychiatric disorders), he or she might be prescribed daily swimming and other forms of vigorous exercise, conversations with a philosopher, [End Page 347] attendance at theatrical comedies, or even referral to an Asklepian temple for “incubation sleep” and priestly dream interpretation. Often doctors worked closely with physical trainers, to whom they sent their patients. In short, their orientation was holistic (“mind”/”body” integration), directed first and foremost toward an individual ill person.In the second century, C.E. Galen, despite his humoral and anatomical pathologies, was similarly holistic or functionalist. He resorted to a variety of physical examinational methods while also attending to the patient’s mental/emotional status. He described one case where he was attending a woman for syncopal episodes. His examinations of her included his customary attention to the pulse. During one evening session, a servant entered and happened to mention that he had just seen the handsome Pylades dancing. Suddenly her pulse became irregular and she fainted straight away. This led Galen to consider love sickness, and perhaps not humoral or organ pathology. He tested his hypothesis during subsequent visits. Whenever another dancer or actor was mentioned, her pulse remained regular and her sensorium alert, but when Pylades was mentioned the irregular pulse and fainting recurred. Because she was married, Galen realized her insoluble conflict, and treated her accordingly.From the fall of Rome until the rise of University Medicine in the later Middle Ages, medical lore and doctoring was in monastic hands—each monastery had its clerical medic, who might also attend outsiders. They were attuned to the traditional triad of major mental disorders—mania, melancholia, and phrenitis—which they explained somatically. However, they also encountered lesser mental/emotional disorders for which they developed their own nosology. “Scrupulosity,” for example, characterized a committed monk with an unrealistic sense of sinfulness and guilt—which often drove him to self-mortification such as flagellation, hair shirts with chains underneath, and so forth, for which the remedy was kindly pastoral counseling. “Accedia” was akin to our “dysthymia,” whose sufferer was affected by sadness, lassitude, and impaired capacity to carry out the monastic routine. This was viewed as straddling the boundary between sickness and sin. Routine physical labor (“occupational therapy”) and prayers, confession, penance, and “pep talks” were prescribed.When universities with medical schools arose in the latter Middle Ages, students’ educations were mostly bookish and theoretical. Hippocratic and Galenic somatic orientations were still preeminent. (Vesalius would not publish his illustrated anatomical text until 1543.) Dietetics and purgatives, bloodletting, and so on were still favored treatments. Nevertheless, doctors gave considerable time and attention to their patients as ill... (shrink)

The main aims of this article are to demonstrate the presence of two physiological conceptions of pleasure in the Hippocratic Corpus, pointing out the differences between them and conjecturing about the reverberation of one of them in Plato’s dialogue Gorgias. We can find in texts of Greek medicine a description of pleasure produced during sexual intercourse and another related to the occurrence of pleasure during nourishment. However, the second account, unlike the first one, is strongly marked by the notion (...) of pleasure as replenishment. Identifying a physiological conception of pleasure featured by a process of filling in the Hippocratic Corpus is relevant because a very similar conception seems to be taken as starting point by Plato in his reflections on pleasure. (shrink)

Aristotle is oftentimes viewed through a strictly philosophical lens as heir to Plato and has having introduced logical rigor where an emphasis on the theory of Forms formerly prevailed. It must be appreciated that Aristotle was the son of a physician, and that his inculcation of the thought of other Greek philosophers addressing health and the natural elements led to an extremely broad set of biologically- and medically-related writings. As this article proposes, Aristotle deepened the fourfold theory of the elements (...) with anatomic and physiologic observations. In books like History of Animals, Parts of Animals, and the lost Anatomai, he actively dissected organisms and recorded his findings. The corpus of medically-related literature Aristotle developed had a direct influence on subsequent Greek thinkers, including Galen, and on Medieval Islamic and modern Western practitioners such as William Harvey. Aristotle's ideas continue to influence modern medical thinkers in Europe and America through both his interpretation by European philosophers gaining the attention of medical humanists, and his writings' enduring impact on medical researchers balancing scientific with more personalistic approaches to medicine. (shrink)

Occupational Health Nursing (OHN) has followed a complex path to build and strengthen its theoretical basis. Starting with Public Health core principles, theories were shaped by the dualism of person worker and working environment, where sometimes the centre of the thought was given to the latter and other times to the former. The problem was not much on such conflict but on the definition of the correct OHN focus and whether genuine nursing knowledge was being applied. We are worried (...) that other disciplines radically influenced the theoretical path taken by OHN theorists. To approach this problem, a unitary‐transformative perspective can help us describe and analyse this phenomenon and engage scholars to reflect upon the accurate epistemological focus of OHN. We aimed to deepen this reflection and uncover a new OHN theoretical focus. (shrink)

This paper explores the epistemology of extrapolation from model organisms to humans in molecular medicine. We take into account two common views on the issue, the homology view and the disanalogy view. In response to both interpretations, we argue that the foundational basis of extrapolations cannot simply be provided by homology and that relevant disanalogies can, thanks to the techniques of molecular biology, be experimentally controlled and exploited to allow useful and reliable extrapolations. The case of "humanised mice" in (...) the context of cancer stem cell research provides evidence of how animal models can be construed to approximate bona fide causal analogue models of human diseases. To supplement this view we show how the epistemology of model organisms needs to take into account the engineering side of molecular medicine. Model organisms are often manipulated to create analogies or remove disanalogies with the target system. We maintain that highlighting this feature is fundamental to explain what warrants extrapolation in the search for the molecular causes of disease. (shrink)

Abstract.Since the gene splicing debates of the 1980s, the public has been exposed to an ongoing sequence of genetic and reproductive technologies. Many issue areas have outcomes that lose track of people's inner values or engender opposing religious viewpoints defying final resolution. This essay relocates the discussion of what is an acceptable application from the individual to the societal level, examining technologies that stand to address large numbers of people and thus call for policy resolution, rather than individual fiat, in (...) their application. A major source of guidance is the “Genetic Frontiers” series of professional dialogues and conferences held by the National Conference for Community and Justice from 2002 to 2004. Genetic testing, human gene therapy, genetic engineering of plants and animals, and stem cell technology are examined. While differences in perspective on the beginning of life persist, a stepwise approach to the examination of genetic testing reveals areas of general agreement. Stewardship of life, human co‐creativity with the divine, and social justice help define the bounds of application of genetic engineering and therapy; compassionate care plays a major role in establishing stem cell policy. Active, sustained dialogue is a useful resource for enabling sharing of religious values and crystallization of policies. (shrink)

Systems medicine is a promising new paradigm for discovering associations, causal relationships and mechanisms in medicine. But it faces some tough challenges that arise from the use of big data: in particular, the problem of how to integrate evidence and the problem of how to structure the development of models. I argue that objective Bayesian models offer one way of tackling the evidence integration problem. I also offer a general methodology for structuring the development of (...) class='Hi'>models, within which the objective Bayesian approach fits rather naturally. (shrink)

Medicine in a Neurocentric World: About the Explanatory Power of Neuroscientific Models in Medical Research and Practice Content Type Journal Article Category Editorial Notes Pages 307-313 DOI 10.1007/s12376-009-0036-2 Authors Lara Huber, University Medical Center of the Johannes Gutenberg University Mainz Institute for History, Philosophy and Ethics of Medicine Am Pulverturm 13 55131 Mainz Germany Lara K. Kutschenko, University Medical Center of the Johannes Gutenberg University Mainz Institute for History, Philosophy and Ethics of Medicine Am Pulverturm 13 (...) 55131 Mainz Germany Journal Medicine Studies Online ISSN 1876-4541 Print ISSN 1876-4533 Journal Volume Volume 1 Journal Issue Volume 1, Number 4. (shrink)

The intent of this research article is to argue with the line of reasoning of arguments from Paul Hager and other educational theorists against the front-end model of education. The model is rejected because it cannot be achieved in occupational preparation, and, moreover, those critics said that it is based on a wrong idea of conceptual interpretation of learning that makes it less conducive to lifelong learning in the long run. The framework which is rejected is a sharp distinction (...) of two concepts; process and product. The reason of rejection is that the sharp distinction does not exist. However, from the research, many analyses show that the front-end model is one of the most important aspects of employment and vocational education, which is the belief that actual practice at work will guarantee the skills of learners before they enter the actual operation. Based on a method of postmodern philosophical analysis, I found that the relationship between education and work is a highly complex relationship. The result of this complexity makes it impossible to have a perfect reason for Hager and his colleagues to reject the significance of the front-end model as concluded by their previous research. On the other hand, I argue that we would have more weight in reasoning if we are to point out that the new policy of lifelong learning still requires a new interpretation on integrity of front-end model of career preparation. This is because the more plausible definition of human being from Hannah Arendt is related to work and working. From what is conceptualized here as an argument of imperfect employability, I pointed out that the rejection of front-end model itself has an important base of conceptualization that does not match the definition of such conditions of being human. Therefore, the rejection of front-end model should be considered as an argument that does not yet have enough weight in reasoning. (shrink)

This article presents an archaeological inquiry into the early histories of Quality of Life (QoL) measures, and takes this as an occasion to rethink the concept of the ‘medical model of disability’. Focusing on three instruments that set the ground for the emergence of QoL measures, namely, the Karnofsky Performance Scale (KPS, 1948), and the classification of functional capacity as a diagnostic criterion for heart diseases (Bainton, 1928) and as a supplementary aid to therapeutic criteria in rheumatoid arthritis ( Steinbrocker, (...) Traeger, and Batterman, 1949 ) – I discuss how medicine, throughout the emergence of QoL, began to expand its gaze beyond the confines of the body to what that body does in daily life. Building upon Armstrong et al.’s notion of ‘distal symptoms’ (2007) and Wahlberg’s idea of ‘knowledge of living’ (2018), I propose the notion of disabilitization to encapsulate this expansion of the clinical gaze, through which medicine has come to articulate diseases and their treatments in new ways, and in so doing, has inadvertently created disability as a new kind of knowledge category in itself – a category that is defined not through its reduction to mere pathology, but through its dispersal into everyday life. I present this concept not as a periodization, but as a provocative discontinuity with the totalizing history assumed within the medical model of disability, and in so doing, ask what, in fact, holds ‘the medical model’ together, and whether there might be other ways of understanding medicine’s complex relationship to disability than what the concept of the medical model allows us to envisage. (shrink)

This study investigated the possible mediation of career distress in the relationship between major incongruence and occupational engagement and whether this mediation depends on the degree of outcome expectation. Moderated mediation analysis was tested on a sample of 346 Korean undergraduate students. The results indicated that career distress mediated the relationship between major incongruence and occupational engagement. Moreover, the negative indirect effect of major incongruence on occupational engagement through career distress weakened as the level of outcome expectation (...) increased. The significant mediation effect of career distress is meaningful given the evidence on the role of emotion in career adaptation. In addition, the significant moderation effect of cognitive evaluation and belief in the mediating relationship on career problem, career emotion, and career behavior is meaningful in that it provides insights in cognitive intervention that could be effective in career counseling. (shrink)

the structure of medical science with a special focus on the role of generalizations and universals in medicine, and (2) philosophy of medicine's relation with the philosophy of science. I argue that a usually overlooked aspect of Kuhnian paradigms, namely, their characteristic of being "exemplars", is of considerable significance in the biomedical sciences. This significance rests on certain important differences from the physical sciences in the nature of theories in the basic and the clinical medical sciences. I describe (...) those differences and maintain that they are these differentiating features that require the use of more comparative and analogical reasoning in medicine. I suggest that Kitcher's recent introduction of the notion of a ‘practice’ may have similar implications if it is construed to contain more analogical elements than he appears to recognize in his initial formulation. Finally I argue that though Gorovitz and MacIntyre's characterization of medicine as a "science of particulars" bears some similarities with my thesis, I maintain that such a position without careful qualification can lead to ignoring both the nature of generalizations in these sciences and their role as positive analogies tying together a family of overlapping models. Keywords: medical reasoning, biomedical theories/paradigms, science of particulars, philosophy of medicine CiteULike Connotea Del.icio.us What's this? (shrink)

Previous research has shown that female leaders lead slightly more effective than male leaders. However, women are still underrepresented in higher management. In this study, we seek to contribute to a deeper understanding of this paradox by proposing and testing an innovative model that integrates different research streams on gender and leadership. Specifically, we propose power motivation and transformational leadership as two central yet opposing dynamics that underlie the relation between gender and leadership role occupancy. We tested this model in (...) a sample of 256 employees. Results provided support for the proposed relations. These findings contribute to a more detailed and comprehensive understanding for central dynamics that link gender and leadership role occupancy. Moreover, they provide important insights for interventions that are targeted at reducing the gender gap in leadership. We discuss the theoretical and practical implications of these findings. (shrink)

In this paper, we explore the desires that play a role at the palliative stage and relate them to various approaches to patient autonomy. What attitude can physicians and other caregivers take to the desires of patients at the palliative stage? We examine this question by introducing five physicians who are consulted by Jackie, an imaginary patient with metastatic lung carcinoma. By combining the models of the physician-patient relationship developed by Emanuel and Emanuel (1992) and the Hellenistic approaches to (...) desires analyzed by Nussbaum (1994), five different ways of dealing with desires in the context of palliative care are sketched. The story of Jackie shows that desires are to a certain extent responsive to reasoning. In the palliative process, that can be a reason to devote attention to the desires of patients and caregivers and to determine which desires need to be fulfilled, which are less important, and how they are linked to emotions the patient has. (shrink)

This paper examines the way in which causal relations are understood in the dominant model in contemporary medicine. It argues that the causal relation is not definable in terms of the condition relation, but that in general for conditions of an occurrence to be among its causes they must answer instrumental interests in a certain way, and there are further criteria for distinguishing 'the' cause of a disease (i.e., its etiological agent) from other causal factors, which are based upon (...) instrumental interests peculiar to medicine. It also argues that diseases are complex processes of which both clinical and underlying patho-physiological manifestations are proper parts (as contrasted with effects). (shrink)

This paper aims to show how medical scientists may use metaphor in ways closely parallel to poets. Those who believe metaphor has any role at all in science may describe its use in various ways. Associationists think metaphors are based upon likenesses, and collapse the notions of model and metaphor together. But, as an example from the work of Louis Pasteur suggests, metaphor need not be based upon likenesses. Rather it may play a role in making possible a model'sexplanatory significance. (...) Models may presuppose metaphors. The Pasteur example also suggests metaphor may play a part in creating likenesses through its role in classification and reclassification. It is in these ways that the use of metaphor in medical science most closely parallels that in poetry. (shrink)

With the ascent of modern epidemiology in the Twentieth Century came a new standard model of prediction in public health and clinical medicine. In this article, we describe the structure of the model. The standard model uses epidemiological measures-most commonly, risk measures-to predict outcomes (prognosis) and effect sizes (treatment) in a patient population that can then be transformed into probabilities for individual patients. In the first step, a risk measure in a study population is generalized or extrapolated to a (...) target population. In the second step, the risk measure is particularized or transformed to yield probabilistic information relevant to a patient from the target population. Hence, we call the approach the Risk Generalization-Particularization (Risk GP) Model. There are serious problems at both stages, especially with the extent to which the required assumptions will hold and the extent to which we have evidence for the assumptions. Given that there are other models of prediction that use different assumptions, we should not inflexibly commit ourselves to one standard model. Instead, model pluralism should be standard in medical prediction. (shrink)

The increasing availability of large‐scale, complex data has made research into how human genomes determine physiology in health and disease, as well as its application to drug development and medicine, an attractive field for artificial intelligence (AI) approaches. Looking at recent developments, we explore how such approaches interconnect and may conflict with needs for and notions of causal knowledge in molecular genetics and genomic medicine. We provide reasons to suggest that—while capable of generating predictive knowledge at unprecedented pace (...) and scale—if and how these approaches will be integrated with prevailing causal concepts will not only determine the future of scientific understanding and self‐conceptions in these fields. But these questions will also be key to develop differentiated policies, such as for education and regulation, in order to harness societal benefits of AI for genomic research and medicine. (shrink)

Previous research has shown that female leaders lead slightly more effective than male leaders. However, women are still underrepresented in higher management. In this study, we seek to contribute to a deeper understanding of this paradox by proposing and testing an innovative model that integrates different research streams on gender and leadership. Specifically, we propose power motivation and transformational leadership as two central yet opposing dynamics that underlie the relation between gender and leadership role occupancy. We tested this model in (...) a sample of 256 employees. Results provided support for the proposed relations. These findings contribute to a more detailed and comprehensive understanding for central dynamics that link gender and leadership role occupancy. Moreover, they provide important insights for interventions that are targeted at reducing the gender gap in leadership. We discuss the theoretical and practical implications of these findings. (shrink)

BackgroundExpertise has been a contentious concept in Evidence-Based Medicine. Especially in the early days of the movement, expertise was taken to be exactly what EBM was rebelling against—the authoritarian pronouncements about “best” interventions dutifully learned in medical schools, sometimes with dire consequences. Since then, some proponents of EBM have tried various ways of reincorporating the idea of expertise into EBM, with mixed results. However, questions remain. Is expertise evidence? If not, what is it good for, if anything?MethodsIn this article, (...) I describe and analyze the three historical models of expertise integration in EBM and discuss the difficulties in putting each into practice. I also examine accounts of expertise from disciplines outside of medicine, including philosophy, sociology, psychology, and science and technology studies to see if these accounts can strengthen and clarify what EBM has to say about expertise.ResultsOf the accounts of expertise discussed here, the Collins and Evans account can do most to clarify the concept of expertise in EBM.ConclusionsWith some additional clarification from EBM proper, theoretical resources from other disciplines might augment the current EBM account of expertise. (shrink)

Health care is not merely a matter of individual encounters between patients and physicians or other health care personnel. For patients and those who provide health care come to these encounters already possessed of learned habits of perception and judgment, valuation and action, which define their roles in relation to one another and affect every aspect of their encounter. So the presuppositions of these encounters must be examined if our understanding of patients' autonomy is to be complete. In this paper (...) I sketch three models of what is presupposed in the relationship between the health care professional and the lay patient; and I discuss the ways in which patients' autonomy is preserved and/or compromised under each of the three models. The models discussed are the Guild Model, the Commercial Model, and the Interactive Model. (shrink)

Today’s medical ethics involve two different viewpoints based on how we understand the role of conscience in medicine and the purpose of healthcare. The first view, called the health-directed model, sees medicine as a way to improve health and promote healing, while also respecting the values of both patients and doctors. In this model, doctors need some discretionary space to decide how to achieve the best health outcomes in their practice. On the other hand, the service-provider model sees (...) the main goal of medicine as providing a service, especially healthcare, with a strong focus on protecting patient autonomy. In this view, doctors are required to provide care even when it goes against their personal beliefs. The goal of this article is to explore the foundations and arguments of these two medical models. Understanding the key ideas behind these models is important for deciding whether to support or oppose conscientious objection in medical ethics. Additionally, the article aims to figure out which model makes a stronger case and to offer advice on how to engage with the opposing view from a virtue ethics perspective. (shrink)

This article examines the role of medical doctors, AI designers, and other stakeholders in making applied AI and machine learning ethically acceptable on the general premises of shared decision-making in medicine. Recent policy documents such as the EU strategy on trustworthy AI and the research literature have often suggested that AI could be made ethically acceptable by increased collaboration between developers and other stakeholders. The article articulates and examines four central alternative models of how AI can be designed (...) and applied in patient care, which we call the ordinary evidence model, the ethical design model, the collaborative model, and the public deliberation model. We argue that the collaborative model is the most promising for covering most AI technology, while the public deliberation model is called for when the technology is recognized as fundamentally transforming the conditions for ethical shared decision-making. (shrink)

Psychosomatic medicine, with its prevailing biopsychosocial model, aims to integrate human and exact sciences with their divergent conceptual models. Therefore, its own conceptual foundations, which often remain implicit and unknown, may be critically relevant. We defend the thesis that choosing between different metaphysical views on the ‘mind–body problem’ may have important implications for the conceptual foundations of psychosomatic medicine, and therefore potentially also for its methods, scientific status and relationship with the scientific disciplines it aims to integrate: (...) biomedical sciences, psychology and social sciences. To make this point, we introduce three key positions in the philosophical ‘mind–body’ debate and investigate their consequences for the conceptual basis of the biopsychosocial model in general and its ‘psycho-biological’ part in particular. Despite the clinical merits of the biopsychosocial model, we submit that it is conceptually underdeveloped or even flawed, which may hamper its use as a proper scientific model. (shrink)

Many countries currently invest in technologies and data infrastructures to foster precision medicine (PM), which is hoped to better tailor disease treatment and prevention to individual patients. But who can expect to benefit from PM? The answer depends not only on scientific developments but also on the willingness to address the problem of structural injustice. One important step is to confront the problem of underrepresentation of certain populations in PM cohorts via improved research inclusivity. Yet, we argue that the (...) perspective needs to be broadened because the (in)equitable effects of PM are also strongly contingent on wider structural factors and prioritization of healthcare strategies and resources. When (and before) implementing PM, it is crucial to attend to how the organisation of healthcare systems influences who will benefit, as well as whether PM may present challenges for a solidaristic sharing of costs and risks. We discuss these issues through a comparative lens of healthcare models and PM-initiatives in the United States, Austria, and Denmark. The analysis draws attention to how PM hinges on—and simultaneously affects—access to healthcare services, public trust in data handling, and prioritization of healthcare resources. Finally, we provide suggestions for how to mitigate foreseeable negative effects. (shrink)

The development of causal modelling since the 1950s has been accompanied by a number of controversies, the most striking of which concerns the Markov condition. Reichenbach's conjunctive forks did satisfy the Markov condition, while Salmon's interactive forks did not. Subsequently some experts in the field have argued that adequate causal models should always satisfy the Markov condition, while others have claimed that non-Markovian causal models are needed in some cases. This paper argues for the second position by considering (...) the multi-causal forks, which are widespread in contemporary medicine (Section 2). A non-Markovian causal model for such forks is introduced and shown to be mathematically tractable (Sections 6, 7, and 8). The paper also gives a general discussion of the controversy about the Markov condition (Section 1), and of the related controversy about probabilistic causality (Sections 3, 4, and 5). (shrink)