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Hypochondriacal Doubt: How It Devours Itself Despite Its Seeming Consistence. 疑病症：它如何吞噬自己，尽管它看似一致。
IF 1.3 3区 哲学
Journal of Medicine and Philosophy Pub Date : 2025-04-16 DOI: 10.1093/jmp/jhaf009
José María Ariso
{"title":"Hypochondriacal Doubt: How It Devours Itself Despite Its Seeming Consistence.","authors":"José María Ariso","doi":"10.1093/jmp/jhaf009","DOIUrl":"https://doi.org/10.1093/jmp/jhaf009","url":null,"abstract":"<p><p>Hypochondriasis-currently split into the \"somatic symptom disorder\" and the \"illness anxiety disorder\" diagnoses-is characterized by the patient's conviction that minor symptoms are signs of a severe illness, even after undertaking medical exams that could not detect any disorder. In this paper, I analyze the basic hypochondriacal doubt, that is, calling into question the practitioners' reassurance that no evidence of serious disease has been found to account for his symptom. Specifically, I take as reference Ludwig Wittgenstein's posthumous work, On Certainty, to explain how a genuine doubt differs from a behavior that merely seems to be a doubt. On this basis, I clarify in which respects hypochondriacal doubt turns out to be a consistent doubt. But then, I reveal why such doubt makes no sense. Lastly, I show how medical and nurse staff as well as the hypochondriac's family can progressively help him overcome the aforementioned doubt.</p>","PeriodicalId":47377,"journal":{"name":"Journal of Medicine and Philosophy","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987634","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 Contradictions in the Criteria for Diagnosing Hypermobile Ehlers-Danlos Syndrome as Reflecting Some of the Philosophical Debates about the Threshold between the Normal and the Pathological. 超动性埃勒-丹洛斯综合征诊断标准的矛盾反映了一些关于正常与病理界限的哲学争论。
IF 1.3 3区 哲学
Journal of Medicine and Philosophy Pub Date : 2025-04-16 DOI: 10.1093/jmp/jhaf004
Mar Rosàs Tosas
{"title":"The Contradictions in the Criteria for Diagnosing Hypermobile Ehlers-Danlos Syndrome as Reflecting Some of the Philosophical Debates about the Threshold between the Normal and the Pathological.","authors":"Mar Rosàs Tosas","doi":"10.1093/jmp/jhaf004","DOIUrl":"https://doi.org/10.1093/jmp/jhaf004","url":null,"abstract":"<p><p>The arrival of some diagnoses tends to bring about relief because it validates suffering and grants access to social legitimization, medical resources, and economic aid. This is the case of the Ehlers-Danlos Syndrome (EDS), a pathology with multisystemic involvement characterized by general laxity. Patients find it difficult to secure a diagnosis of one of its types-hypermobile EDS-due to a lack of awareness among physicians, the multiple changes that the diagnostic criteria undergo, and their increasing restrictivity. Consequently, several patients are intermittently let in and out of the diagnostic label, which leads some members of family, friends, administration, working environment, and healthcare professionals to view these patients with a skeptical gaze. This article argues that the ambiguity and contradictions surrounding the diagnosis of hEDS partially result from and reflect two philosophical controversies on the nature of disease. First, the debate between naturalists and normativists. Second, the discussion on the line-drawing problem. It concludes by urging healthcare practitioners to tell patients the implications of these contradictions-mainly, that medicine can work, and does work, without definitive diagnostic criteria.</p>","PeriodicalId":47377,"journal":{"name":"Journal of Medicine and Philosophy","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991435","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 : 2025-04-07 DOI: 10.1093/jmp/jhaf005
Rina Tzinman
{"title":"Depression and Autonomy in Physician-Assisted Suicide.","authors":"Rina Tzinman","doi":"10.1093/jmp/jhaf005","DOIUrl":"https://doi.org/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":""},"PeriodicalIF":1.3,"publicationDate":"2025-04-07","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
The Morality of Assisted Dying. 协助死亡的道德。
IF 1.3 3区 哲学
Journal of Medicine and Philosophy Pub Date : 2025-04-07 DOI: 10.1093/jmp/jhaf003
Stephen Richards
{"title":"The Morality of Assisted Dying.","authors":"Stephen Richards","doi":"10.1093/jmp/jhaf003","DOIUrl":"https://doi.org/10.1093/jmp/jhaf003","url":null,"abstract":"<p><p>This essay analyzes the morality of assisted dying. To do this, it is necessary to recognize that assisted dying is the outworking of a larger process. This process unavoidably begins with the key moral conception of human dignity. Emphasis upon individualism in society has caused a restructuring of the dignity concept, changing what is most highly valued. This altered concept of dignity gives rise to assisted dying, yet is morally flawed. This is because it is an understanding of dignity that minimizes people's vulnerability, dismisses coercive forces that are brought into effect, encourages undue confidence in safeguards, and removes any sustained basis for respect of the individual. Autonomy, as the primary justification for assisted dying in contemporary society, is an abbreviated understanding of the restructured concept of dignity and therefore subject to the same criticisms. Assisted dying arises from a deficient and self-defeating foundation that mark it as immoral.</p>","PeriodicalId":47377,"journal":{"name":"Journal of Medicine and Philosophy","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796835","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 : 2025-04-01 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":"https://doi.org/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":""},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","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
A Critical Interpretive Literature Review of Phronesis in Medicine. 医学Phronesis的批判性解释性文献综述。
IF 1.3 3区 哲学
Journal of Medicine and Philosophy Pub Date : 2025-03-20 DOI: 10.1093/jmp/jhae045
Sabena Yasmin Jameel
{"title":"A Critical Interpretive Literature Review of Phronesis in Medicine.","authors":"Sabena Yasmin Jameel","doi":"10.1093/jmp/jhae045","DOIUrl":"10.1093/jmp/jhae045","url":null,"abstract":"<p><p>This article presents the results of a rigorous critical interpretive review that maps the current literature on phronesis in medicine. The literature in this area involves varied disciplines, centuries, and conceptions and is extensive, but through a focused review, this study seeks to clarify definitions and key distinctions. It thereby aims to elucidate a depth of meaning and understanding regarding phronesis in medicine to inform future work on the topic. Specifically, 12 themes are inductively identified and analyzed from the literature, and organized into three chronological categories of past, present, and future. A narrative summation of the literature to date is then offered, assessing the varied conceptual applications of phronesis to medical practice, the emerging literature on its applicability to organizations, prospects for empirical work on the concept, and its application in medical education.</p>","PeriodicalId":47377,"journal":{"name":"Journal of Medicine and Philosophy","volume":" ","pages":"117-132"},"PeriodicalIF":1.3,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11925555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Understanding the Psychology of Practical Wisdom. 理解实践智慧的心理学。
IF 1.3 3区 哲学
Journal of Medicine and Philosophy Pub Date : 2025-03-20 DOI: 10.1093/jmp/jhae050
Howard Nusbaum
{"title":"Understanding the Psychology of Practical Wisdom.","authors":"Howard Nusbaum","doi":"10.1093/jmp/jhae050","DOIUrl":"10.1093/jmp/jhae050","url":null,"abstract":"<p><p>The longstanding view of doctors as scientists has been an emphasis in the MCAT and medical school training. However, the AAMC recommended recognizing the importance of social and behavioral science for medicine. There is also a growing realization that being a smart problem solver and the physician as scientist model emphasizes a cold cognitive problem-solving paradigm that overlooks other human capacities that may be critical to medical reasoning and decision-making. Considering a smart physician versus a wise physician, intelligence and problem-solving are important, but a wise physician can use other important capacities beyond intelligence and rationality. This could benefit patients by introducing patient and family perspective taking, as well as compassion in doctor-patient interaction. By reconceptualizing professions from the perspective of practical wisdom, this may increase resilience to problems such as burnout. I outline some psychological capacities viewed as important in wise reasoning that are not about traditional views of intelligence. I argue that wise reasoning is not a native talent but a skill that can be developed. I argue that different kinds of experiences can increase aspects of empathy, epistemic humility, perspective taking, and wise reasoning and I examine evidence that wise reasoning may increase resilience.</p>","PeriodicalId":47377,"journal":{"name":"Journal of Medicine and Philosophy","volume":" ","pages":"104-116"},"PeriodicalIF":1.3,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025026","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
Virtue Monism and Medical Practice: Practical Wisdom as Cross-Situational Ethical Expertise. 德性一元论与医疗实践：作为跨情境伦理专家的实践智慧。
IF 1.3 3区 哲学
Journal of Medicine and Philosophy Pub Date : 2025-03-20 DOI: 10.1093/jmp/jhae051
Mario De Caro, Federico Bina, Sofia Bonicalzi, Riccardo Brunetti, Michel Croce, Skaistė Kerusauskaite, Claudia Navarini, Elena Ricci, Maria Silvia Vaccarezza
{"title":"Virtue Monism and Medical Practice: Practical Wisdom as Cross-Situational Ethical Expertise.","authors":"Mario De Caro, Federico Bina, Sofia Bonicalzi, Riccardo Brunetti, Michel Croce, Skaistė Kerusauskaite, Claudia Navarini, Elena Ricci, Maria Silvia Vaccarezza","doi":"10.1093/jmp/jhae051","DOIUrl":"10.1093/jmp/jhae051","url":null,"abstract":"<p><p>This article defends the centrality of practical wisdom in medical practice by building on a monistic view of moral virtue, termed the \"Aretai model,\" according to which possession of practical wisdom is necessary and sufficient for virtuousness, grounding both moral growth and effective moral behavior. From this perspective, we argue that practical wisdom should be conceived as a cross-situational ethical expertise consisting of four skills:moral perception, moral deliberation, emotion regulation, and moral motivation. Conceiving of practical wisdom as both overall virtuousness and ethical expertise makes it possible to deal adequately with the uniqueness of concrete ethically relevant situations. We contend that this becomes particularly evident in the context of medical practice, both in terms of decision-making and action-taking, especially in the most challenging or contentious clinical cases. We conclude the article by suggesting the potential implications of the Aretai model for continuing education in medical and healthcare professions.</p>","PeriodicalId":47377,"journal":{"name":"Journal of Medicine and Philosophy","volume":" ","pages":"80-92"},"PeriodicalIF":1.3,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075887","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
Challenges Facing the Appeal to Practical Wisdom in Medicine and Beyond. 医学及其他领域对实践智慧诉求面临的挑战。
IF 1.3 3区 哲学
Journal of Medicine and Philosophy Pub Date : 2025-03-20 DOI: 10.1093/jmp/jhae047
Christian B Miller
{"title":"Challenges Facing the Appeal to Practical Wisdom in Medicine and Beyond.","authors":"Christian B Miller","doi":"10.1093/jmp/jhae047","DOIUrl":"10.1093/jmp/jhae047","url":null,"abstract":"<p><p>As work on practical wisdom and medicine accelerates, now is a good time to outline some important challenges that any approach to developing an account of this virtue faces. More specifically, I develop five challenges having to do with the existence and nature of practical wisdom, and whether it connects with objective and general normative truths. The main goal is to provide a guide to the challenges themselves and some of the options available for tackling them, rather than trying to resolve them here.</p>","PeriodicalId":47377,"journal":{"name":"Journal of Medicine and Philosophy","volume":" ","pages":"93-103"},"PeriodicalIF":1.3,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11925554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Changing the Paradigm: Practical Wisdom as True North in Medical Education. 改变范式：实践智慧是医学教育的真北。
IF 1.3 3区 哲学
Journal of Medicine and Philosophy Pub Date : 2025-03-20 DOI: 10.1093/jmp/jhae048
Margaret L Plews-Ogan
{"title":"Changing the Paradigm: Practical Wisdom as True North in Medical Education.","authors":"Margaret L Plews-Ogan","doi":"10.1093/jmp/jhae048","DOIUrl":"10.1093/jmp/jhae048","url":null,"abstract":"<p><p>The practice of medicine is a complex endeavor requiring high levels of knowledge and technical capability, and the capacity to apply the skills and knowledge to do the right thing in the right way, for the right reason, in a particular context. The orchestration of the virtues, managing uncertainty, applying knowledge and technical skills to a particular individual in a particular circumstance, and exercising the virtues in challenging circumstances, are the tasks of practical wisdom. Centuries ago, Aristotle suggested that capacities for wise action are developed through practice, experience, and reflection. Neuroscience and cognitive psychology are now beginning to contribute to our understanding of the complex interplay between emotion, cognition, and behavior that is necessary for wise action, and how this capacity for wise action can be developed. In this paper, I propose that wisdom offers an appropriate true north for medical education. Wisdom shifts the focus beyond the simple acquisition of knowledge and technical skills and integrates essential virtues like compassion, trustworthiness, humility, and the balancing of the virtues, into the professional formation for medical students. Informed by the humanities, the neurosciences, and the social sciences, we must now integrate the skills and practices necessary to the development of practical wisdom into medical education at all levels.</p>","PeriodicalId":47377,"journal":{"name":"Journal of Medicine and Philosophy","volume":" ","pages":"133-146"},"PeriodicalIF":1.3,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075880","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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