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Pellegrino and Thomasma's Anatomy of Clinical Judgments Revisited. 重新审视Pellegrino和Thomasma的临床判断解剖。
IF 1.9 3区 哲学
Journal of Medicine and Philosophy Pub Date : 2025-09-29 DOI: 10.1093/jmp/jhaf029
Michael Trimble, Pat Croskerry
{"title":"Pellegrino and Thomasma's Anatomy of Clinical Judgments Revisited.","authors":"Michael Trimble, Pat Croskerry","doi":"10.1093/jmp/jhaf029","DOIUrl":"https://doi.org/10.1093/jmp/jhaf029","url":null,"abstract":"<p><p>In 1981, Edmund Pellegrino and David Thomasma published A Philosophical Basis of Medical Practice. In this work, they situated the process of clinical judgment in the clinical encounter between an individual doctor and their patient. The encounter revolves around three questions: What can be wrong? What can be done? And what should be done for this patient? They analyzed the complete process of clinical reasoning involving both technical and ethical aspects. Pellegrino and Thomasma's subsequent work focused more on professionalism and ethics, while more recent analysis of clinical decision-making has been in the realm of psychology rather than along philosophical lines, particularly in the use of dual-process theory. Here we seek to review Pellegrino and Thomasma's analysis and to reintegrate the technical and ethical aspects of clinical reasoning.</p>","PeriodicalId":47377,"journal":{"name":"Journal of Medicine and Philosophy","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Artificial Intelligence for Serious Illness Communication: Proactive Approaches to Mitigating Harm. 重大疾病沟通中的人工智能：减轻伤害的主动方法。
IF 1.9 3区 哲学
Journal of Medicine and Philosophy Pub Date : 2025-09-29 DOI: 10.1093/jmp/jhaf024
Elise C Tarbi, Brigitte N Durieux, Anne Kwok, Donna M Rizzo, Charlotta Lindvall
{"title":"Artificial Intelligence for Serious Illness Communication: Proactive Approaches to Mitigating Harm.","authors":"Elise C Tarbi, Brigitte N Durieux, Anne Kwok, Donna M Rizzo, Charlotta Lindvall","doi":"10.1093/jmp/jhaf024","DOIUrl":"https://doi.org/10.1093/jmp/jhaf024","url":null,"abstract":"<p><p>Serious illness communication is at the core of palliative care, aligning care with patient preferences and improving patient and family experience. Artificial Intelligence (AI) methods have increasingly been applied to palliative care and provide promising opportunities for measuring and enhancing communication (e.g., capturing speech patterns and delivering feedback). Yet, given known disparities in palliative care and the limitations afforded by our natural communication datasets, this task must be approached with caution. Focusing on the study of communication, we consider assumptions that may be baked into our models (e.g., in data, definitions, measurements, and outcomes) and ways to mitigate potential harm across stages of model development-from setting priorities for AI research and applications in our field, to conducting new data collection efforts which are inclusive and more representative, to incorporating patient-family feedback. Transparency and thoughtfulness in this line of innovation may help us leverage AI to provide more equitable, higher-quality serious illness care (see Figure 1). Fig. 1. Visual abstract.</p>","PeriodicalId":47377,"journal":{"name":"Journal of Medicine and Philosophy","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A Matter of Judgment? Second-Hand Medical Knowledge and Professional Responsibility. 判断问题？二手医学知识与职业责任。
IF 1.9 3区 哲学
Journal of Medicine and Philosophy Pub Date : 2025-09-29 DOI: 10.1093/jmp/jhaf026
Andreas Eriksen
{"title":"A Matter of Judgment? Second-Hand Medical Knowledge and Professional Responsibility.","authors":"Andreas Eriksen","doi":"10.1093/jmp/jhaf026","DOIUrl":"https://doi.org/10.1093/jmp/jhaf026","url":null,"abstract":"<p><p>Professional judgment is of contested value today. Some argue that the current availability of tools for aligning decisions with evidence-based standards implies that individual judgment should be limited as much as possible. This article argues to the contrary: professional judgment remains a precondition for responsible practice. Nevertheless, increased epistemic dependence-the turn to second-hand medical knowledge-alters the domains of judgment. As first-order evidence has become overwhelming and opaque to practitioners, they need intelligent ways of placing their trust, of integrating different kinds of epistemic tools, and taking responsibility for consequences. The article suggests how these tasks can be seen as a complement to the original ambition of the evidence movement of promoting research literacy.</p>","PeriodicalId":47377,"journal":{"name":"Journal of Medicine and Philosophy","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Role of Empathy in Critical Reasoning and the Limitations of Medical AI Systems. 同理心在批判性推理中的作用以及医疗人工智能系统的局限性。
IF 1.9 3区 哲学
Journal of Medicine and Philosophy Pub Date : 2025-09-28 DOI: 10.1093/jmp/jhaf022
Martina Favaretto, Kyle Stroh
{"title":"The Role of Empathy in Critical Reasoning and the Limitations of Medical AI Systems.","authors":"Martina Favaretto, Kyle Stroh","doi":"10.1093/jmp/jhaf022","DOIUrl":"https://doi.org/10.1093/jmp/jhaf022","url":null,"abstract":"<p><p>The recent developments of medical AI systems (MAIS) open up questions as to whether and to what extent MAIS can be modeled to include empathetic understanding, as well as what impact MAIS' lack of empathetic understanding would have on its ability to perform the necessary critical analyses for reaching a diagnosis and recommending medical treatment. In this article, we argue that current medical AI systems' ability to empathize with patients is severely limited due to its lack of first-person experiences with human interests and that efforts to correct for this deficit-by having MAIS interpret patients' medical and non-medical interests-will encounter significant obstacles. Finally, we demonstrate how MAIS' lack of empathy is likely to hinder its performance in crucial aspects of the processes through which useful medical diagnoses are reached and through which appropriate treatment recommendations for patients are determined.</p>","PeriodicalId":47377,"journal":{"name":"Journal of Medicine and Philosophy","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Epistemically Transformative Medical Procedures and Informed Consent. 认知变革的医疗程序和知情同意。
IF 1.9 3区 哲学
Journal of Medicine and Philosophy Pub Date : 2025-09-24 DOI: 10.1093/jmp/jhaf025
Rajeev R Dutta
{"title":"Epistemically Transformative Medical Procedures and Informed Consent.","authors":"Rajeev R Dutta","doi":"10.1093/jmp/jhaf025","DOIUrl":"https://doi.org/10.1093/jmp/jhaf025","url":null,"abstract":"<p><p>I argue that true informed consent is impossible to obtain for certain medical procedures in which epistemic transformation occurs. Cases in which undergoing a procedure itself provides new experiential information, that is, phenomenal knowledge (what I call \"knowledge-what-it's-like\"), true informed consent for that procedure cannot be attained from knowing facts about the procedure (\"knowledge-that\") alone. If epistemically transformative medical procedures indeed undermine informed consent as I argue they do, I suggest that there are important implications for the decision-making of patients considering these procedures (e.g., chemotherapy, invasive surgeries, cochlear implants, gender-affirming procedures). Rather than solely communicating biological, clinical, and epidemiological facts about procedures, clinicians should supplement pre-procedure counseling with previous patient testimonials or even virtual/augmented reality to compensate (albeit partially) for the \"knowledge-what-it's-like\" that is absent prior to undergoing epistemically transformative medical procedures. Although these interventions may not (accurately) convey what it is like to undergo the procedure, they address the traditionally under-explored experiential aspect of medical treatments in medical decision-making from the patient's perspective.</p>","PeriodicalId":47377,"journal":{"name":"Journal of Medicine and Philosophy","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
AI and Healthcare Disparities: Lessons from a Cautionary Tale in Knee Radiology. 人工智能与医疗保健差距：膝关节放射学警示故事的教训。
IF 1.9 3区 哲学
Journal of Medicine and Philosophy Pub Date : 2025-09-14 DOI: 10.1093/jmp/jhaf020
Gordon Hull
{"title":"AI and Healthcare Disparities: Lessons from a Cautionary Tale in Knee Radiology.","authors":"Gordon Hull","doi":"10.1093/jmp/jhaf020","DOIUrl":"https://doi.org/10.1093/jmp/jhaf020","url":null,"abstract":"<p><p>Enthusiasm about the use of artificial intelligence (AI) in medicine has been tempered by concern that algorithmic systems can be unfairly biased against racially minoritized populations. This article uses work on racial disparities in knee osteoarthritis diagnoses to underline that achieving justice in the use of AI in medical imaging requires attention to the entire sociotechnical system within which it operates, rather than isolated properties of algorithms. Using AI to make current diagnostic procedures more efficient risks entrenching existing disparities; a recent algorithm points to some of the problems in current procedures while highlighting systemic normative issues that need to be addressed while designing further AI systems. The article thus contributes to a literature arguing that bias and fairness issues in AI be considered as aspects of structural inequality and injustice and to highlighting ways that AI can be helpful in making progress on these.</p>","PeriodicalId":47377,"journal":{"name":"Journal of Medicine and Philosophy","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A Matter of Trust: Principles to Ethically Assess AI in Health Care. 信任问题：对医疗保健中的人工智能进行道德评估的原则。
IF 1.9 3区 哲学
Journal of Medicine and Philosophy Pub Date : 2025-09-14 DOI: 10.1093/jmp/jhaf023
Bryan C Pilkington, Brian P A T R I C K Green, Charles E Binkley
{"title":"A Matter of Trust: Principles to Ethically Assess AI in Health Care.","authors":"Bryan C Pilkington, Brian P A T R I C K Green, Charles E Binkley","doi":"10.1093/jmp/jhaf023","DOIUrl":"https://doi.org/10.1093/jmp/jhaf023","url":null,"abstract":"<p><p>In this article, we focus on questions of agency in emerging technologies related to decision-making in medicine. We discuss three principles that were subsumed when bioethics embraced principlism: consent, confidentiality, and veracity. We argue that the advent of artificial intelligence and its employment within health care, impacts the physician-patient relationship in a way that its inclusion in other areas does not. In particular, we take up ethical dilemmas caused by AI related to trust, and illustrate how reflection on these subsumed principles helps to critique accurately policies related to the use of AI in health care and to navigate dilemmas associated with a loss of trust. We conclude by contrasting these principles with the proposed \"five principles\" system for AI, highlighting some areas of agreement, but also showing where consent, confidentiality, and veracity are necessary additions for ethically employing AI.</p>","PeriodicalId":47377,"journal":{"name":"Journal of Medicine and Philosophy","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Towards Excellence: Virtue and the Principle of Autonomy in Informed Consent for Clinical Trials. 走向卓越：美德与临床试验知情同意的自主原则。
IF 1.3 3区 哲学
Journal of Medicine and Philosophy Pub Date : 2025-07-21 DOI: 10.1093/jmp/jhaf002
Alexander Montes
{"title":"Towards Excellence: Virtue and the Principle of Autonomy in Informed Consent for Clinical Trials.","authors":"Alexander Montes","doi":"10.1093/jmp/jhaf002","DOIUrl":"10.1093/jmp/jhaf002","url":null,"abstract":"<p><p>In this article, I argue that approximating virtues such as care and respectfulness are necessary to conduct an informed consent discussion for clinical trials adequately. I argue against Beauchamp and Childress' principlism insofar as it claims that virtues do not have \"advantages\" over the principle of respecting autonomy. When we elaborate what it means to facilitate autonomy in a consent discussion adequately, we find we are describing the virtues. This is because virtues do have an advantage over principles insofar as virtues provide us with rich descriptions of not only what we should do (respect autonomy), but how to do so (with the virtues of respectfulness, care, etc.). Thus, the principle of respecting autonomy points back to the virtues. I conclude by showing how cultivation of these virtues can help rectify well-known shortcomings in the informed consent process.</p>","PeriodicalId":47377,"journal":{"name":"Journal of Medicine and Philosophy","volume":" ","pages":"295-307"},"PeriodicalIF":1.3,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Boundaries of Disease: Vagueness and Overdiagnosis. 疾病的界限：模糊和过度诊断。
IF 1.3 3区 哲学
Journal of Medicine and Philosophy Pub Date : 2025-07-21 DOI: 10.1093/jmp/jhaf001
Christopher Boorse
{"title":"Boundaries of Disease: Vagueness and Overdiagnosis.","authors":"Christopher Boorse","doi":"10.1093/jmp/jhaf001","DOIUrl":"10.1093/jmp/jhaf001","url":null,"abstract":"<p><p>In five related essays, Mary Jean Walker and Wendy Rogers, joined in one essay by Jenny Doust, defend various theses about the concept of disease. First, they argue \"disease\" is a cluster concept, not a \"classically structured\" one definable by necessary and sufficient conditions. Second, \"disease\" is vague, in the standard philosophical sense of having borderline cases. In fascinating detail, they argue that this vagueness shows up almost everywhere one looks among ordinary diseases, even if disease is taken to require dysfunction. Still, they conclude, vagueness per se need not be a problem because logicians and philosophers know several ways to handle it. Third, Rogers and Walker believe that the vagueness of \"disease\" is a clue to how to reduce the much-discussed medical problem of \"overdiagnosis\": the diagnosis of permanently harmless disease. Finally, they find my analysis of disease-the \"biostatistical theory\" (BST)-defective and dangerous in four different ways: it offers insufficient guidance on how to draw disease boundaries; it does not fit actual medical practice in doing so; it is ambiguous as to reference class; and it facilitates overdiagnosis. In this article, I freely concede the vagueness of disease, but argue that it is considerably less than Rogers and Walker suppose, and no threat to the BST in any case. I also rebut all their other charges of deficiency in my analysis.</p>","PeriodicalId":47377,"journal":{"name":"Journal of Medicine and Philosophy","volume":" ","pages":"231-247"},"PeriodicalIF":1.3,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Depression and Autonomy in Physician-Assisted Suicide. 医生协助自杀中的抑郁和自主。
IF 1.3 3区 哲学
Journal of Medicine and Philosophy Pub Date : 2025-07-21 DOI: 10.1093/jmp/jhaf005
Rina Tzinman
{"title":"Depression and Autonomy in Physician-Assisted Suicide.","authors":"Rina Tzinman","doi":"10.1093/jmp/jhaf005","DOIUrl":"10.1093/jmp/jhaf005","url":null,"abstract":"<p><p>The standard view in medical practice is that patients have to be in an appropriate state of mind to count as autonomous. For example, according to the Macarthur Competency Assessment Tool for Treatment patients need to be able to: (1) communicate a choice; (2) factually understand the issues; (3) appreciate their situation; and (4) rationally manipulate information. These capacities are normally taken to be compromised by factors that may diminish one's capacity to properly assess one's situation. One of these diminishing factors is depression, which is especially relevant to decisions about assisted suicide or termination of treatment, since depression might contribute to the patient's leaning towards an action resulting in her death. I argue, however, that in certain circumstances, depression and the accompanying desires can be appropriate. Specifically, I demonstrate that even when depression is a factor in the patient's decision, it does not automatically undermine autonomy.</p>","PeriodicalId":47377,"journal":{"name":"Journal of Medicine and Philosophy","volume":" ","pages":"285-294"},"PeriodicalIF":1.3,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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