From governments to the general public, one may ask about the possible contributions of historians, if any, to the understanding and management of global disasters, as e.g. the ongoing coronavirus disease 2019. Given the confuse situation at the onset of the pandemic in terms of diagnosis, treatment, and prevention, a look into past experience with nonconventional medicine seemed relevant. In the present study I surveyed secondary literature on the role of Chinese medicine, Āyurveda, and homeopathy over time. (...) The quantitative results were disappointing: nothing on Āyurveda, and one single study each on Chinese medicine and homeopathy. The quality of the former compensates for the numerical short age. The case of homeopathy is rather sui generis, since this medical system was born and blossomed during epidemics and pandemics. I conclude with a short comment on reference sources, which might serve as point of departure for future studies of Āyurveda in epidemics. (shrink)

Volume 24, Issue 9, September 2024, Page 48-50.

Volume 24, Issue 11, November 2024, Page 1-3.

Volume 24, Issue 12, December 2024, Page 6-7.

The past 10 years have seen considerable developments in the use of narrative in medicine, primarily through the emergence of the so-called narrative medicine. In this article, I question narrative medicine’s self-understanding and contend that one of the most prominent issues is its lack of a clear epistemological framework. Drawing from Gadamer’s work on hermeneutics, I first show that narrative medicine is deeply linked with the hermeneutical field of knowledge. Then I try to identify which claims (...) can be legitimately expected from narrative medicine, and which ones cannot be. I scrutinize in particular whether narrative medicine can legitimately grasp the patient’s lived experience of his or her illness. In the last section of this article, I begin to explore the potential usefulness of this epistemological clarification. This analysis allows for a further understanding of what is really at stake with narrative medicine, and thus to identify when it may be convenient, and when it may not. Furthermore, this clarification opens up promising new possibilities of dialogue with critics of the field. I conclude that narrative medicine finds its proper place as a possible tool available to mediate dialogue, which is at the heart of the clinical encounter in medical practice. (shrink)

Society has historically not taken a benign view of genetic disease. The laws permitting sterilization of the mentally re tarded~ and those proscribing consanguineous marriages are but two examples. Indeed as far back as the 5th-10th centuries, B.C.E., consanguineous unions were outlawed (Leviticus XVIII, 6). Case law has traditionally tended toward the conservative. It is reactive rather than directive, exerting its influence only after an individual or group has sustained injury and brought suit. In contrast, state legislatures have not been (...) inhibited in enacting statutes. Many of their products can be characterized as hasty, unnecessary, ill-conceived, and based on the heart rather than the head. Moreover the lack of expert consultation sought has also been remarkable. One state legislature, for example, has advocated immunization for sickle cell anemia! Many others have enacted laws for the screening of inborn errors of metabolism, e.g., phenylketon uria, but have poorly defined the lines of responsibility to secure compliance. A spate of specific disease-related bills has emerged in the u.S. Congress, each seeking recognition and appropriations. Sickle cell anemia, hemophilia, Cooley's anemia and Tay-Sachs disease have been among the front-runners for support. Finally, in 1975, Congress has begun to examine an omnibus bill concerning all forms of genetic disease. The bill, termed the National Genetic Diseases Act is, however, still far from being enacted. (shrink)

Experience and science, being the two sources of technology, have different focuses. In experiential technology, techniques and skills are emphasized while in scientific technology tool or equipment. Experiential technology is generally regarded as local knowledge, and scientific technology universal. Traditional Chinese medicine is an experiential technology. In contrast, Western medicine is set up as a scientific technology with great efforts. Through the comparison of these two medicines, this paper attempts to illustrate the difference between the two technologies and (...) in turn, the difference between these two medicines by defining these two technologies. Finally, this paper further investigates the special values of Chinese medicine. Making use of the SSK theory, this paper deconstructs the idea of universality of science, and argues that, the universality is the feature that science pursues, but not what it already has. With more historical evidence, experiential technology is more stable, while scientific technology is less stable because it updates quickly, and often changes reversely. (shrink)

The historical emphasis of medical ethics, based on substantive frameworks and principles derived from them, is no longer seen as sufficiently sensitive to the moral pluralism characteristic of our current era. We argue that moral decision-making in clinical situations is more properly derived from a process of dialogic consensus. This process entails an inclusive, noncoercive, and self-reflective dialogue within the community affected. In order to justify this approach, we make two claims—the first epistemic, and the second normative. The epistemic claim (...) follows from Habermas’ “ways” of knowing. We argue that the dialogue emanating from this episteme focuses on the relevant facts about the patient, as well as on the values attached to these facts, thus allowing facts and their meanings to serve as the basis for reflective action appropriate to the circumstances. The normative claim follows from Habermas’ discourse theory of morality and communicative action. It determines that clinical decision-making should be approached from the perspective of the actual reality of people in their situation of illness, set in their socio-cultural background, and hence be grounded in the second-person perspective. Relocating ethical decision-making from a monological space into one characterized by dialogue is especially appropriate to the clinical encounter. (shrink)

Background: Cardio-pulmonary resuscitation is the default procedure during cardio-pulmonary arrest. If a patient does not want cardio-pulmonary resuscitation, then a do not attempt resuscitation order must be documented. Often, this order is not given; even if thought to be appropriate. This situation can lead to a slow code, defined as an ineffective resuscitation, where all resuscitation procedures are not performed or done slowly. Research objectives: To describe the perceptions of nurses working on internal medicine wards of slow codes, including (...) the factors associated with its implementation. Research design: This was a cross-sectional, descriptive study. Participants completed a personal characteristics questionnaire and the Perceptions and Factors of Slow Codes questionnaire designed for this study. Participants and research context: The sample was a convenience sample of nurses working on internal medicine wards in two Israeli hospitals. Ethical considerations: The study received ethical approval from both institutions, where data were collected and stored according to institutional policy. Findings: Most reported that resuscitations were conducted according to protocol (n = 90, 76.2%). Some took their time calling the code (n = 22, 18.3%), or waited by the bedside and did not perform cardio-pulmonary resuscitation (n = 45, 37.5%). Factors most associated with slow codes were poor patient prognosis (mean = 3.52/5, standard deviation = 1.27) and a low chance of patient survival (mean = 3.37/5, standard deviation = 1.21). Two-thirds (n = 76, 66.8%) reported that slow codes were done on their unit and the majority (n = 80, 69%) perceived slow codes as ethical. Discussion: This study confirms that slow codes are part of medical care on internal medicine wards, where most nurses perceive them as an ethical alternative. These perceptions are in contrast to most legal and ethical opinions expressed in the literature. Conclusion: Nurses should be educated about the legal and ethical implications of slow codes, and qualitative and quantitative studies should be conducted that further investigate its implementation. (shrink)

This paper explains Viktor von Weizsäcker’s Gestaltkreis model as a reinterpretation of Jakob von Uexküll’s Funktionskreis. Also derived from the Funktionskreis is Thure von Uexküll’s Situationskreis model. Both Weizsäcker’s Gestaltkreis and Thure von Uexküll’s Situationskreis have evolved in the context of integrated medicine in Germany throughout the twentieth century. Focusing on the role of language in health and medicine, this paper addresses important concepts associated with the project of integrated medicine in Germany, especially the biographical approach practiced (...) by Viktor von Weizsäcker and developed by Thure von Uexküll through the concept of the biographical organ. While their efforts to reform the practice of medicine and the training of physicians were unsuccessful, recent research in the psychology of language and health and recommendations for more patient-centered communication resonate with the principles underlying Viktor von Weizsäcker’s and Thure von Uexküll’s integrated medicine. (shrink)

The Covid‐19 pandemic has altered the shape of medicine, making in‐person interactions risky for both patients and health care workers. Now, before scheduling in‐person appointments or procedures, physicians are forced to reconsider if they are truly necessary. The pandemic has thus thrown into relief the difference between evidence‐based medical care and traditional aspects of care that lack a strong evidentiary component. In this essay, we demonstrate how this has played out in prenatal care, as well as in other aspects (...) of medical care, during the pandemic. The extent to which these changes will persist beyond the most emergent phases of the pandemic is not clear, though insurance reimbursement practices and patient expectations will be determining factors. One thing, however, is certain: the longer the pandemic continues, the more difficult it will be for providers and patients to return to pre‐Covid norms. (shrink)

Defensive medicine has become pervasive. Defensive medicine is often thought of as a systems issue, the inevitable result of an adversarial malpractice environment, with consequent focus on system-responses and tort reform. But defensive medicine also has ethical and professionalism implications that should be considered beyond the need for tort reform. This article examines defensive medicine from an ethics and professionalism perspective, showing how defensive medicine is deeply problematic. First, a definition of defensive medicine is (...) offered that describes the essence of defensive practice: clinical actions with the goal of protecting the clinician against litigation or some adverse outcome. Ethical arguments against defensive medicine are considered: defensive medicine is deceptive and undermines patient autonomy; defensive medicine subjugates patient interests to physician interests and violate fiduciary obligations; defensive medicine exposes patients to harm without benefit; defensive medicine undermines trust in the profession; and defensive medicine violates obligations of justice. Possible arguments in favor of defensive medicine are considered and refuted. Defensive practice is therefore unethical and unprofessional, and should be viewed as a challenge for medical ethics and professionalism. (shrink)

The thirteen titles in this mini-set include works by some of the most well-known scientists and medical professionals of the twentieth century: Daedalus by J B S Haldane, Eos, or the Wider Aspects of Cosmogony by J H Jeans, Archimedes, or the Future of Physics by L L Whyte and the The Conquest of Cancer by H W S Wright to name but a few. Ground breaking in their day, some of the works remain controversial nearly 100 years after their (...) original publication. (shrink)

Medicine and the humanities have been exploring new ways to improve the quality of healthcare. One such collaboration is the practice of narrative medicine which uses literature to teach physicians to better meet their patients’ needs. Narrative medicine, however, draws primarily from Anglophone literature, yet post-war French literature, philosophy and criticism have much to add to the theoretical and practical underpinnings of narrative medicine. As well, such scholarship provokes a number of questions that expose certain weaknesses (...) in narrative medicine as it is practiced currently. As this paper demonstrates, drawing post-war French literature into narrative medicine opens new ways to think about life, narrative and the place of the patient in the modern healthcare system. (shrink)

There has been a move in medicine towards patient-centred care, leading to more demands from patients for particular therapies and treatments, and for wish-fulfilling medicine: the use of medical services according to the patient's wishes to enhance their subjective functioning, appearance or health. In contrast to conventional medicine, this use of medical services is not needed from a medical point of view. Boundaries in wish-fulfilling medicine are partly set by a physician's decision to fulfil or decline (...) a patient's wish in practice. In order to develop a better understanding of how wish-fulfilling medicine occurs in practice in The Netherlands, a qualitative study (15 semistructured interviews and 1 focus group) was undertaken. The aim was to investigate the range and kind of arguments used by general practitioners and plastic surgeons in wish-fulfilling medicine. These groups represent the public funded realm of medicine as well as privately paid for services. Moreover, GPs and plastic surgeons can both be approached directly by patients in The Netherlands. The physicians studied raised many arguments that were expected: they used patient autonomy, risks and benefits, normality and justice to limit wish-fulfilling medicine. In addition, arguments new to this debate were uncovered, which were frequently used to justify compliance with a patient's request. Such arguments seem familiar from conventional medicine, including empathy, the patient–doctor relationship and reassurance. Moreover, certain arguments that play a significant role in the literature on wish-fulfilling medicine and enhancement were not mentioned, such as concepts of disease and the enhancement–treatment dichotomy and ‘suspect norms’. (shrink)

Artificial neural networks (ANNs) are new mathematical techniques which can be used for modelling real neural networks, but also for data categorisation and inference tasks in any empirical science. This means that they have a twofold interest for the philosopher. First, ANN theory could help us to understand the nature of mental phenomena such as perceiving, thinking, remembering, inferring, knowing, wanting and acting. Second, because ANNs are such powerful instruments for data classification and inference, their use also leads us into (...) the problems of induction and probability. Ever since David Hume expressed his famous doubts about induction, the principles of scientific inference have been a central concern for philosophers. (shrink)

In order to explore the ways knowledge travels across spatial and cultural boundaries, this article focuses on the intriguing case of the Edinburgh-trained Scottish surgeon James Esdaile (1808–59), who, after practising conventional surgery for almost fifteen years in British colonial India, quite unexpectedly turned to mesmeric anaesthesia in the last five years of his service. By following his career and his mesmeric turn, the article describes Esdaile's subsequent public experiments in mesmeric anaesthesia in collaboration with indigenous practices and practitioners of (...) trance induction in the 1840s which led to the creation of a special mesmeric hospital in Calcutta. Although very successful, it eventually ceased to function, apparently victim to new and cheaper chemical anaesthetics. Mobilizing the insights of science studies scholarship into the processes of scientific experimentation, this article seeks to shed new light on the necessary professional, social and political investments for the making and mobility of scientific knowledge across social and cultural boundaries in a colonial setting. (shrink)

Evidence-Based Medicine (EBM) is defined as the conscious, and judicious use of current best evidence in making decisions about the care of individual patients. The greater the level of evidence the greater the grade of recommendation. This pioneering explicit concept of EBM is embedded in a particular view of medical practice namely the singular nature of the patient-physician relation and the commitment of the latter towards a specific goal: the treatment and the well being of his or her client. (...) Nevertheless, in many European countries as well as the United States, this integration of the best evidence from systematic research with clinical expertise and patient values appears to be re-interpreted in light of the scarcity of healthcare resources. The purpose of this paper is double. First, to claim that from an ethical perspective EBM should be a guideline to clinical practice; and second, that in specific circumstances EBM might be a useful tool in macro-allocation of healthcare resources. Methodologically the author follows Norman Daniels' theory of democratic accountability to justify this assumption. That is, choices in healthcare must be accountable by democratic procedures. This perspective of distributive justice is responsible for the scope and limits of healthcare services. It follows that particular entitlements to healthcare — namely expensive innovative treatments and medicines —may be fairly restricted as long as this decision is socially and democratically accountable and imposed by financial restrictions of the system. In conclusion, the implementation of EBM, as long as it limits the access to drugs and treatments of unproven scientific results is in accordance with this perspective. The use of EBM is regarded as an instrument to facilitate the access of all citizens to a reasonable level of healthcare and to promote the efficiency of the system. (shrink)

Few topics in medical ethics stimulate as much heated debate as the question of the proper place of religious beliefs in medical practice. Typically, this debate is orientated towards questions about the religious beliefs held by medical practitioners, and in particular the appropriate limits that ought to be placed on these beliefs shaping care in ways that might impact negatively on patients’ interests. In this issue, however, it is the religious beliefs of patients themselves, and how these beliefs ought to (...) be responded to by clinicians, that is the focus of analysis. In their Feature Article, Greenblum and Hubbard (pages 705–10) articulate a strong position in response to this issue. Their fundamental claim is that clinicians should not deliberate about religious commitments with religious patients when these patients are drawing on these commitments in the medical decision-making process. They present two main arguments in support of this claim: the public reason argument and the fiduciary argument, and they contend that the discussion of religious considerations should be compartmentalised and farmed out to another appropriately placed person, such as a member of the clergy. Stimulating six commentaries that interrogate aspects of both arguments and the authors’ practical proposal, Greenblum and Hubbard’s paper gets to the heart of the challenge of reconciling the public role of medical practitioners with the private encounters that substantiate the performance of this role. Greenblum and Hubbard’s first argument is that clinicians ought to limit their deliberations in decisions made with patients to presenting ‘considerations that any reasonable person could recognise as counting in favour of something’ (page 707). Drawing on the work of John Rawls and Robert Audi, the authors discount the place of religious reasons in …. (shrink)

There is a need to bring ethics and medical practice closer together, despite the risk and problems this may involve. Deontological ethics may promote sanctity of life considerations against the quality of life considerations favoured by consequentialists or utilitarians; while talk of respect for life and the value of life may point to more qualified ethical positions. This paper argues for a respect-for-life position, dismissing a utilitarian cost-benefit outlook as too simplistic; but an unqualified fixed principles approach is also ruled (...) out, both because of its unacceptable consequences in individual cases and also because of its reliance on the slippery slope argument which, it is argued, is logically and psychologically deficient. The case of genetic engineering provides an example in which the notion of respect may operate, but in which broad general principles also apply. A cautious conservatism towards accepted principles is recommended in the development of medical technologies. (shrink)

Bioethics has developed approaches to address ethical issues in health care, similar to how technology ethics provides guidelines for ethical research on artificial intelligence, big data, and robotic applications. As these digital technologies are increasingly used in medicine, health care and public health, thus, it is plausible that the approaches of technology ethics have influenced bioethical research. Similar to the “empirical turn” in bioethics, which led to intense debates about appropriate moral theories, ethical frameworks and meta-ethics due to the (...) increased use of empirical methodologies from social sciences, the proliferation of health-related subtypes of technology ethics might have a comparable impact on current bioethical research. This systematic journal review analyses the reporting of ethical frameworks and non-empirical methods in argument-based research articles on digital technologies in medicine, health care and public health that have been published in high-impact bioethics journals. We focus on articles reporting non-empirical research in original contributions. Our aim is to describe currently used methods for the ethical analysis of ethical issues regarding the application of digital technologies in medicine, health care and public health. We confine our analysis to non-empirical methods because empirical methods have been well-researched elsewhere. Finally, we discuss our findings against the background of established methods for health technology assessment, the lack of a typology for non-empirical methods as well as conceptual and methodical change in bioethics. Our descriptive results may serve as a starting point for reflecting on whether current ethical frameworks and non-empirical methods are appropriate to research ethical issues deriving from the application of digital technologies in medicine, health care and public health. (shrink)