Medical practice is practiced morality, and clinical research belongs to normative ethics. The present book elucidates and advances this thesis by: 1. analyzing the structure of medical language, knowledge, and theories; 2. inquiring into the foundations of the clinical encounter; 3. introducing the logic and methodology of clinical decision-making, including artificial intelligence in medicine; 4. suggesting comprehensive theories of organism, life, and psyche; of health, illness, and disease; of etiology, diagnosis, prognosis, prevention, and therapy; and 5. investigating the moral and (...) metaphysical issues central to medical practice and research. Many systems of (classical, modal, non-classical, probability, and fuzzy) logic are introduced and applied. Fuzzy medical deontics, fuzzy medical ontology, fuzzy medical concept formation, fuzzy medical decision-making and biomedicine and many other techniques of fuzzification in medicine are introduced for the first time. -/- . (shrink)

The notions of health, illness, and disease are fuzzy-theoretically analyzed. They present themselves as non-Aristotelian concepts violating basic principles of classical logic. A recursive scheme for defining the controversial notion of disease is proposed that also supports a concept of fuzzy disease. A sketch is given of the prototype resemblance theory of disease.

In a previous paper the concept of disease was fuzzy-logically analyzed and a sketch was given of a prototype resemblance theory of disease (Sadegh-Zadeh (2000). J. Med. Philos., 25:605–38). This theory is outlined in the present paper. It demonstrates what it means to say that the concept of disease is a nonclassical one and, therefore, not amenable to traditional methods of inquiry. The theory undertakes a reconstruction of disease as a category that in contradistinction to traditional views is not (...) based on a set of common features of its members, that is individual diseases, but on a few best examples of the category, called its prototypes, and a similarity relationship such that a human condition is considered a disease if it resembles a prototype. It enables new approaches to resolving many of the stubborn problems associated with the concept of disease. (shrink)

What follows is a brief comment on Ludwik Fleck's paper on the foundations of medical knowledge translated by Thaddeus J. Trenn in this issue. Since the original is much older than I am, I have some scruples in presenting the critical thoughts which occurred to me when I read it a few years ago. Despite the criticism, I am very sympathetic to most of what Fleck has told us in his tragically neglected work. Two facts make Fleck's tragedy even more (...) disturbing: (i) others have given rise to post-Fleck revolutions in epistemology by exploiting his ideas while omitting proper references to him, and (ii) sociology of science, precisely what Fleck wanted to promote, has emerged without his work being operative in any sense. In my commentary, I shall examine his concept of social conditioning of knowledge. CiteULike Connotea Del.icio.us What's this? (shrink)

This paper argues that the key distinguishing feature between simulation and mere resemblance lies in its representational function. Defining this function requires addressing two critical conditions: how neural resemblance denotes its object and how specific content is grounded in such resemblance when it functions as representation. To begin with, the paper posits that the object of simulation is determined by its cognitive role within a broader cognitive system. Second, it examines three potential frameworks for grounding the content of simulation: the (...) Neural Correspondence Thesis (NCT), the Functional Correspondence Thesis (FCT), and the Context-Dependent Correspondence Thesis (CDCT). Both NCT and FCT, the paper shows, encounter problems of content indeterminacy because of their oversimplified assumptions about the relationship between neural activations and mental states. FCT, in particular, faces the issue of over-permissiveness, wherein multiple neural activation patterns correspond to the same mental state, undermining the connection between functional roles and specific content. In response, the paper introduces CDCT as a more robust replacement, addressing both content indeterminacy and over-permissiveness by incorporating context-sensitive mappings between neural states and mental content. Drawing an analogy from the idea of cognitive maps in rats, the paper demonstrates how CDCT clarifies the role of context in shaping the mapping between neural activations and mental content, thereby offering a more precise framework for tackling the complexities of content determination in mental simulations. (shrink)

ZusammenfassungWas ist praktisches Wissen?Die Diskussion über diese Frage hat sich in den letzten Jahrzehnten darauf konzentriert, das praktische Wissen als ein Wissen- wie aufzufassen. Im Folgenden wird eine weitere Differenzierung dieser Ansicht vorgenommen, indem durch eine Analyse der Syntax des klinischpraktischen Wissens dafür geworben wird, dieses Wissen als eine Kategorie von bedingten Geboten für das ärztliche Handeln in der klinischen Entscheidungsfindung zu betrachten. Syntaktisch gesehen, sind diese Gebote deontische Normen („conditional obligations“). Da sie durch die diagnostisch-therapeutische Forschung (= klinische Forschung) (...) aufgestellt und erforscht werden, muss die klinische Forschung als eine deontische Disziplin angesehen werden. Sie ist deshalb dem Bereich der normativen Ethik zuzuordnen. Im direkten Zusammenhang damit ist die klinische Praxis – als eine überzeitliche Institution, nicht als das Handeln von Einzelpersonen – als praktizierte Moral im Dienste der Menschen („Karitas“) einzustufen, weil sie aus dem Versuch besteht, jene Gebote umzusetzen. (shrink)

According to a dominant interpretation of the simulation hypothesis, in recognizing an emotion we use the same neural processes used in experiencing that emotion. This paper argues that the view is fundamentally misguided. I will examine the simulational arguments for the three basic emotions of fear, disgust, and anger and argue that the simulational account relies strongly on a narrow sense of emotion processing which hardly squares with evidence on how, in fact, emotion recognition is processed. I contend that the (...) current body of empirical evidence suggests that emotion recognition is processed in an integrative system involving multiple cross-regional interactions in the brain, a view which squares with understanding emotion recognition as an information-rich, rather than simulational, process. In the final section, I discuss possible objections. (shrink)

At least as important as a particular item of medical knowledge itself is to know something about the relationships of that knowledge to the experiential world it is talking about. The reason is that the patients the physician is concerned with are parts of that experiential world. So, when using any knowledge in her practice, e.g., some knowledge on infectious diseases, a morally conscientious doctor will be interested in whether, and in what way, this knowledge relates to the ‘world out (...) there’. Does the medical knowledge she employs bear any relevance to the bodies and souls of her patients? Does it enable her to understand the patient’s suffering, illness experience, and illness narrative? Will it help her find useful diagnoses and treatments? Are there in fact any indicators of such qualities of medical knowledge? Why not use astrology, Ayurveda, or exorcism instead of the theory of infectious diseases? A prerequisite for dealing with such questions is the awareness of the relationships between medical knowledge and its referent, i.e., of the semantics of medical knowledge, on the one hand; and of the pragmatic factors beyond this semantics, which influence the role medical knowledge plays in health care, on the other, e.g., social and economic processes. In the present chapter, we shall look at these issues with an eye toward understanding why some particular information is allowed to enter the medical world as knowledge, whereas other information is considered unacceptable or quackery. Is there a clear line of demarcation between medical knowledge and self-deception? To begin with, we will discuss the issues of truth and justification because, as pointed out in Section 10.1 on page 402, knowledge is traditionally defined as justified true belief . These two defining features of knowledge, truth and justifiedness, are due to the classical conception of knowledge as the representation of some ‘reality’. This ancient, representational postulate brings with it that the predominant view on the semantics of medical knowledge is realism, i.e., the view that medical knowledge is concerned with and represents ‘the real world out there’. We shall therefore need to inquire into the philosophy and medical relevance of this doctrine before we proceed to alternative views. Our discussion thus divides into the following five parts: 12.1 Justified True Belief; 12.2 Realism; 12.3 Anti-Realism; 12.4 Beyond Realism and Anti-Realism in Medicine; 12.5 Social Epistemology. (shrink)

This article aims at highlighting the specificities of Gaston Bachelard’s «La poétique de la rêverie», seen as the pivot of Motesquieu’s imaginary creation in Persian Letters. The Same and the Other are two essential terms when trying to find the place imagology plays in an intercultural approach where France and Persia are associated with an enchanted exoticism. Criteria such as space, taste, the marvellous and verisimilitude will be examined in order to analyse the images vehiculated by the perceived society and (...) by the perceiving one and to evaluate Montesquieu’s genius for social irony. (shrink)

Due to the intricate nature of its subject matter, medicine is always threatened by speculations and disagreements about which among its entities exist, e.g., any specific biological structures, substructures or substances, pathogenic agents, pathophysiological processes, diseases, psychosomatic relationships, therapeutic effects, and other possible and impossible things. To avoid confusion, and to determine what entities an item of medical knowledge presupposes to exist if it is to be true, we need medical ontology. The term “medical ontology” we understand to mean the (...) study that seeks to ascertain what entities exist in the world of medicine, which formal relations hold between them, and whether there are any relatioships between types of medical research and practice, on the one hand; and the new worlds they create, on the other. (shrink)

Some simulationists have argued that the information obtained during the perceptual process of facial expression (the geometric features) is sufficient for recognition of the emotion intended by that expression. Drawing on evidence from cross-cultural studies, with particular attention to conceptual act theories, I show that both emotion expression and recognition are top-down modulated by expressivity norms, observer-specific internal representations, and expectations. I thus conclude that direct simulation, or a purely bottom-up approach, is not sufficient for emotion recognition. Next, I will (...) consider the generate and test strategy as an alternative to direct simulation. This is a highly promising approach in that top-down and bottom-up processes work in parallel, according to the presence, or not, of additional information. For this reason, it avoids the difficulties of direct simulation. I will argue, however, that it is based on a misconception of emotions, specifically on how emotions are represented in the brain. To improve the model, I distinguish between two different categorical approaches to emotions, then argue that only one of which is viable in a simulational account of emotion recognition. (shrink)

On the basis of a ten-place comparative value relation, artificially reduced to a binary relation, some human value structures are studied and a concept of value kinematics is proposed. A miniature value logic is outlined, making it possible with precision to handle several explicated value notions and to analyze interrelations between them. Finally, the question is discussed whether health can be said to be an absolute and an intrinsic value.

Western (deductive) logic originated in Greek antiquity. It found its first expression in those works of the great philosopher Aristotle (384–322 BC) which have come to be known as the Organon, i.e., ‘instrument’. Aristotle’s logic, also known as syllogistics, was unsystematically concerned with patterns of reasoning and argumentation. It remained in this rudimentary state relatively unchanged and unchallenged until the second half of the nineteenth century. At that time, logic underwent a period of unprecedented reform and modernization, due in large (...) part to the German mathematician Gottlob Frege (1848– 1925) It thus became more and more a mathematical endeavor of studying the structure and peculiarities of artificial, formal languages. In this new form, logic gave rise in the twentieth century to disciplines such as theoretical informatics and programming languages, and transformed our lives through computation, information processing, and the Internet. A formal language consists, in effect, of a particular alphabet and some precise rules of forming, and transforming, strings over this alphabet. There exist several types of formal languages analyzed in logic. Depending on their structure, they are called first-order languages, second-order languages, and so on. Today a logic is considered a theory of such a language and is, correspondingly, referred to as a first-order logic, a second-order logic, and so on. In this chapter, we shall outline a first-order logic as a paragon of deductive logic. Its full name is: “Classical, first-order predicate logic with identity”. What all these expressions mean exactly, will become clear below. The logic we shall study first is termed classical logic because the idea to create such an instrument, or ‘organon’, is rooted in Greek antiquity. Owing to its origin, it is based on three time-honored Aristotelian doctrines. For these and several other reasons that we shall discuss later in this chapter, it is also called a logic of the Aristotelian style, or an Aristotelian logic for short. (shrink)

Clinical practice is where the clinical encounter and decision-making occur. Thus, it constitutes the focus of medicine. Since the time of Hippocrates, it has been composed of five activities that have come to be known as anamnesis, i.e., history taking or clinical interview, diagnosis, prognosis, therapy, and prevention. These five activities are fundamental features of the healing relationship. The present chapter is devoted to the analysis and discussion of their logical, methodological, and philosophical problems. Usually, the patient expects the physician (...) to be an expert of her specialty devoid of a bad reputation. This constitutes what may be called a good doctor, i.e., one whose clinical decisions are right and good in most cases, at least in as many cases as another expert in the same area also achieves. In what follows, we shall analyze the characteristics and presuppositions of such right and good clinical decisions. To this end, we shall undertake a conceptual analysis of the clinical encounter and its outcomes, in order to develop a theory of clinical practice. Our analysis consists of the following five parts: 9.1 The Clinical Encounter; 9.2 Anamnesis and Diagnosis; 9.3 Prognosis; 9.4 Therapy; 9.5 Prevention. (shrink)

The language of medicine is an extension of everyday language by adding technical terms such as "appendicitis", "angina pectoris", "blood pressure" and the like. It is therefore characterized by semantic chaos. Most of its terms are either not defined or ill-defined. The chaos would not deserve any attention, however, if it were not practically detrimental in research and practice. The best way to prevent the damage it causes is to learn in medicine something about methods of scientific concept formation. The (...) present chapter provides a concise and unrivalled introduction to such a methodology. We shall discuss the main methods of scientific concept formation known today, that is, all methods of definition and explication. Our discussion divides into the following four sections and is based on, and extends, the most valuable pioneering studies by Carl Gustav Hempel and, especially, Patrick Suppes (Hempel, 1952; Suppes, 1957, 151–173, 246–260): 6.1 What a Definition is; 6.2 What Role a Definition Plays; 6.3 Methods of Definition; 6.4 What an Explication is. (shrink)

As a science and practice of intervention and control, medicine is concerned with cure and care, the promotion and protection of health, and the prevention of maladies and human suffering. This wide-ranging task is accomplished through medical practice and medical research, though no sharp boundary between them can be drawn. A widespread misconception about medicine has it that medicine is concerned with illness and disease. However, the subject of medicine is the patient, i.e., Homo patiens, but not illness or disease, (...) with the ends being directed toward the relief, prevention of human suffering, and saving human life. Accordingly, medicine needs a theory of the patient first of all. Nosology and pathology as studies of illness and disease may be viewed as elements of such a theory of the Homo patiens. Seen from this perspective, clinical research and practice are to be based on the question: What is a patient? That is, what characteristics distinguish a patient from a non-patient? The present chapter is concerned with this question. The inquiry into what a patient, i.e., Homo patiens, is, intersects with anthropology that is concerned with the question of what is a human being? This is the fundamental philosophical question of medicine because, as an experimental and diagnostic-therapeutic discipline, it undertakes momentous interventions in human life. It therefore needs an image of the human being so as to ascertain whether medical interventions are in accord with, or contravene, that image. For example, it is a legitimate question to ask whether the transplantation of animal cells, tissues, and organs into humans, i.e., xenotransplantation, or whether the designing of offspring by genetic engineering, is morally permissible. Since anthropology is basically a philosophical endeavor, medicine at its foundations turns out to intersect with philosophy. We shall consider the patient as a bio-psycho-social agent who is suffering or whose life is threatened by some occurrences inside or outside of her body, usually called diseases, pathogenic environments, etc. Our aim is to understand what these occurrences may look like and how they may be conceptualized, systematized, recognized, causally analyzed, and controlled. Thus, our discussion consists of the following five sections: 7.1 The Suffering Individual; 7.2 The Bio-Psycho-Social Agent; 7.3 Health, Illness, and Disease; 7.4 Systems of Disease; 7.5 Etiology (= Science of Clinical Causation). (shrink)

The brief sketch of the problematic character of the traditional semantic conception of meaning demonstrated that meaning cannot be separated from the role the users of a language play in their communication with one another. One of the features of this role is the control of the language use and verbal behavior of individuals by the community. It is thus the community that determines and judges what words and sentences ‘mean’. This is just indicative of the pragmatic dimension of language. (...) Consequently, what medical terms and sentences ‘mean’, and what someone ‘means’ by using a particular medical term or sentence, also depends on pragmatic contexts and circumstances. To understand the importance and practical consequences of this pragmatic perspective, we will now consider the following three central aspects: 3.1 The So-Called Language Games, 3.2 Assertion, Acceptance, and Rejection, 3.3 Speech Acts in Medicine, 3.4 The Pragmatic Impact of Medical Language, 3.5 The Communal Origin of Medical Language. (shrink)

Karl Jaspers zählt zu den bedeutendsten Philosophen des 20. Jahrhunderts. Obwohl es bereits eine international etablierte Jaspersforschung gibt, haben die meisten seiner Werke jedoch noch keinen angemessenen Eingang in die historische und systematische Lehre der Philosophie gefunden. Diese Aufsatzsammlung gibt erstmals einen Einblick in die wichtigsten Begriffe seines philosophischen Denkens. Zu diesen Begriffen gehören Begriffe wie Grenzsituation, Freiheit, Menschenbild, Kommunikation, Philosophischer Glaube, Chiffre, Böses, Wahrheit, Vernunft, Gehäuse, Wissenschaft, Logik, Sprachphilosophie, Psychopathologie, Psychologie der Weltanschauung, Ethik, Einsamkeit, Erziehung, Politik, Universität, Achsenzeit, Philosophia (...) perennis und interkulturelle Philosophie. Einige dieser Begriffe wurden von Jaspers geprägt und gingen dauerhaft als neue Begriffe in die Philosophie, die Psychologie und die Psychopathologie ein. Die anderen Begriffe knüpfen zwar dem Wortlaut nach an die klassische Tradition der europäischen Philosophie an, wurden von Jaspers jedoch im Sinne einer Weltphilosophie umgestaltet und erweitert. Dieser Sammelband ist nicht nur ein einführendes Kompendium für Studierende der Philosophie, der verschiedenen Theologien der Weltreligionen sowie der Sozial- und Kulturwissenschaften. Er kann auch philosophisch Interessierten den Zugang zur Philosophie von Jaspers erleichtern. (shrink)

The purpose of this study was to investigate the relationship between authentic leadership and the three dimensions of employee well-being. Furthermore, attachment insecurity was considered as a mediating factor between authentic leadership and the three dimensions of employee well-being. Data were obtained from a field sample of 212 health care providers with patient contact at five hospitals in the North East of Iran. Initially, collected data were analyzed with multiple confirmatory factor analyses. Then, structural equation modeling was applied to test (...) proposed hypotheses. First, it was shown that authentic leadership negatively impacted attachment insecurity. Second, attachment insecurity proved to be a factor impinging upon job satisfaction. On the contrary, higher levels of attachment insecurity was associated with higher levels of perceived stress and stress symptoms. Third, it was revealed that attachment insecurity partially mediated the relationship between authentic leadership and job satisfaction and fully mediated the relationship between authentic leadership, perceived stress, and stress symptoms. According to the literature of authentic leadership, this is one of the first research studies, and literally the first in the East exploring the effects of authentic leadership on the exclusive combination of dimensions offered in this paper. Moreover, researchers in the field of management have not delved enough into attachment and its antecedents and consequences in leader–follower relationship. This is one of the first studies to provide evidence of the relationship between authentic leadership, attachment security and employee well-being. As a further analysis, the final model was separately put under the two different lens of gender and some interesting findings were discussed in the discussion. (shrink)