Medicine Health Care and Philosophy最新文献

A reply to "Fundamental issues in epistemic injustice in healthcare" by Nielsen, Nordgaard & Henriksen (2025) : Corresponding author. 对Nielsen， Nordgaard & Henriksen（2025）的“医疗保健中认知不公正的基本问题”的回复：通讯作者。

IF 3.6 2区哲学

Medicine Health Care and Philosophy Pub Date : 2026-12-01 Epub Date: 2026-08-18 DOI: 10.1007/s11019-026-10392-w

Eleanor A Byrne, Havi Carel, Fred Cooper, Dan Degerman, Alice Monypenny, Matthew Broome

引用次数: 0

The algorithmic covenant: why AI-driven consent must not replace clinician responsibility. 算法契约：为什么人工智能驱动的同意不能取代临床医生的责任。

IF 3.6 2区哲学

Medicine Health Care and Philosophy Pub Date : 2026-12-01 Epub Date: 2026-07-06 DOI: 10.1007/s11019-026-10376-w

Kiran S Joshi

{"title":"The algorithmic covenant: why AI-driven consent must not replace clinician responsibility.","authors":"Kiran S Joshi","doi":"10.1007/s11019-026-10376-w","DOIUrl":"10.1007/s11019-026-10376-w","url":null,"abstract":"Health systems are increasingly deploying artificial intelligence (AI) tools to deliver procedural information, generate documentation, and support patient-facing \"consent\" workflows. Although such tools may improve aspects of an already deficient consent process, they create a risk of substitution: treating algorithm-mediated disclosure as ethically equivalent to clinician-led dialogue. This paper performs a conceptual analysis of the \"algorithmic covenant\" - the implicit expectation that automation will preserve the moral commitments of care. It draws on legal standards of material risk, sociotechnical scholarship on \"moral crumple zones\", and the tension between managerial and professional ethics. Current AI deployments risk facilitating \"responsibility laundering.\" By prioritising system-level efficiency, institutions may use AI to standardise disclosure while leaving individual clinicians to absorb blame and legal risk for the resulting compliance artefact. This creates a misaligned responsibility structure where the institution controls the content, but the clinician bears the risk, potentially degrading consent into a digitised tick-box exercise. To preserve the ethical integrity of informed consent, AI must be governed strictly as an assistive technology. Policy and workflow design must explicitly assign responsibility for verifying patient understanding to named clinicians, ensuring that automation supports - rather than displaces - the clinician's non-delegable ethical responsibility for informed consent.","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":"887-894"},"PeriodicalIF":3.6,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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

Diagnostic reification and the conservativity test: a pragmatic criterion for ontological commitments in medicine. 诊断具体化与保守性检验：医学本体论承诺的语用标准。

IF 3.6 2区哲学

Medicine Health Care and Philosophy Pub Date : 2026-12-01 Epub Date: 2026-08-14 DOI: 10.1007/s11019-026-10390-y

Justus Maria Prinz, Christian Prinz

{"title":"Diagnostic reification and the conservativity test: a pragmatic criterion for ontological commitments in medicine.","authors":"Justus Maria Prinz, Christian Prinz","doi":"10.1007/s11019-026-10390-y","DOIUrl":"10.1007/s11019-026-10390-y","url":null,"abstract":"Diagnosis is indispensable to medicine, yet diagnostic labels often acquire more authority than their evidence can bear. They come to function as if they named natural entities that explain, authorize, and stabilize clinical action. This article proposes a pragmatic criterion for evaluating that ontological surplus: the Conservativity Test. The test asks which clinical, institutional, explanatory, and self-interpretive consequences follow from treating a diagnostic label as a disease entity, but would not already follow from a label-free base description of symptoms, signs, impairments, risks, mechanisms, values, and lived experience. It does not presuppose that diagnoses are either natural kinds or mere social constructions. Rather, it distinguishes conservative shorthand, justified non-conservativity, and reifying non-conservativity. To avoid circularity, the article develops a minimal-ontological account of base description and connects it with pluralist realism and causal-cluster accounts of kinds. Situating the test within the epistemology of diagnosis, it treats diagnostic labels as revisable causal-explanatory hypotheses and spells out why unjustified ontological surplus carries epistemic, clinical, ethical, and institutional costs. It then identifies four modes of diagnostic reification: explanatory, threshold, nominal-institutional, and looping. Prediabetes, ADHD, and long COVID serve as stress tests for the framework. Phenomenologically, the test protects the lived complexity of illness against both objectifying reduction and epistemic dismissal. Ethically, it offers a participatory audit for clinicians, guideline panels, researchers, and patient communities deciding when diagnostic names should coordinate care, justify intervention, or carry stronger ontological commitments.","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":"1067-1079"},"PeriodicalIF":3.6,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148766443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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

Hope, fertility, and the ethics of clinical discernment: a personalist supplement to ethical decision-making in gynecological practice. 希望、生育和临床辨别力的伦理：妇科实践中伦理决策的个人主义补充。

IF 3.6 2区哲学

Medicine Health Care and Philosophy Pub Date : 2026-12-01 Epub Date: 2026-07-10 DOI: 10.1007/s11019-026-10379-7

John Mary Francis M Nuqui, Keycee L Duarte

{"title":"Hope, fertility, and the ethics of clinical discernment: a personalist supplement to ethical decision-making in gynecological practice.","authors":"John Mary Francis M Nuqui, Keycee L Duarte","doi":"10.1007/s11019-026-10379-7","DOIUrl":"10.1007/s11019-026-10379-7","url":null,"abstract":"This article examines gynecological decision-making in clinical contexts where interventions carry significant implications for fertility and future reproductive possibilities. Conditions such as uterine fibroids, endometriosis, and ovarian cysts are commonly managed through treatments that differ in their potential impact on reproductive capacity, introducing an ethical dimension beyond immediate symptom management. This proposes a theological-bioethical framework of clinical discernment as a conceptual supplement to shared decision-making in reproductive healthcare. Drawing primarily on Karol Wojtyla's personalist philosophy, it advances an account of the human person as an irreducible moral subject whose embodied life carries existential and relational significance. Clinical discernment is understood as a structured ethical orientation that enhances standard biomedical reasoning by integrating attention to value-laden dimensions of fertility-related care. The framework articulates hope as an ethically relevant category referring to the openness of the patient's future possibilities, and fertility as a dimension of embodied personhood with relational meaning beyond biological function. On this basis, the article outlines a fertility-sensitive approach to gynecological care emphasizing proportionality in intervention, clarity and responsibility in risk communication, and holistic patient accompaniment. The paper concludes that integrating clinical discernment into gynecological decision-making offers a philosophically and theologically grounded enrichment of contemporary reproductive healthcare by aligning biomedical practice with a personalist account of moral agency, embodied dignity, and future-oriented care.","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":"1111-1124"},"PeriodicalIF":3.6,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148424686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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 symbolic reading of therapeutic transition: a theoretical reflection on embodiment, meaning, and change. 对治疗过渡的象征性解读：对体现、意义和变化的理论反思。

IF 3.6 2区哲学

Medicine Health Care and Philosophy Pub Date : 2026-12-01 Epub Date: 2026-09-09 DOI: 10.1007/s11019-026-10394-8

Federica Marino

{"title":"A symbolic reading of therapeutic transition: a theoretical reflection on embodiment, meaning, and change.","authors":"Federica Marino","doi":"10.1007/s11019-026-10394-8","DOIUrl":"10.1007/s11019-026-10394-8","url":null,"abstract":"Therapeutic transition is commonly framed within biomedical discourse as an instrumental modification aimed at optimizing clinical outcomes. While this perspective is indispensable for clinical decision-making, it captures only a limited dimension of what therapeutic change entails. This article proposes a symbolic-theoretical framework for understanding therapeutic transition as a meaningful reconfiguration of embodied experience rather than as a purely technical adjustment. Drawing on phenomenology, medical anthropology, narrative theory, and medical humanities, the paper reconceptualizes the body as an interpretative field through which therapeutic change is lived, negotiated, and integrated into personal identity. It argues that symbolic interpretation is not an optional supplement to biomedical explanation, but a structural necessity for articulating dimensions of therapeutic experience that resist outcome-based evaluation. On this basis, the article identifies a symbolic architecture of therapeutic transition composed of modulation, regulation, suspension, and persistence. These dimensions do not describe stages or trajectories, but recurring structural patterns through which change is experienced. Their configuration reveals the inherently asymmetrical and partial nature of therapeutic transformation, challenging totalizing models of healing. By foregrounding asymmetry, limits, and finitude, the paper reframes therapeutic transition as a process of meaningful adjustment rather than comprehensive resolution. It argues that attention to symbolic frameworks enriches medical understanding by clarifying the human limits within which therapeutic intervention operates, without opposing empirical medicine or undermining its epistemic authority.","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":"1139-1147"},"PeriodicalIF":3.6,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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

Indigenous medical knowledge and its encounter with Western medicine in colonial India. 印度殖民地的本土医学知识及其与西方医学的相遇。

IF 3.6 2区哲学

Medicine Health Care and Philosophy Pub Date : 2026-12-01 Epub Date: 2026-08-18 DOI: 10.1007/s11019-026-10391-x

Lakshmi Kanta Das

引用次数: 0

Post-trial obligations and participant enrollment in brain pioneering research: should we expand inclusion criteria? 脑先驱研究的试验后义务和参与者登记：我们应该扩大纳入标准吗？

IF 3.6 2区哲学

Medicine Health Care and Philosophy Pub Date : 2026-12-01 Epub Date: 2026-07-11 DOI: 10.1007/s11019-026-10380-0

Christopher Bobier, Daniel J Hurst

引用次数: 0

Epistemic disadvantage and therapeutic asymmetry in psychiatric care. 精神科护理中的认知劣势与治疗不对称。

IF 3.6 2区哲学

Medicine Health Care and Philosophy Pub Date : 2026-12-01 Epub Date: 2026-07-07 DOI: 10.1007/s11019-026-10378-8

Christophe Gauld, Pauline Espi

{"title":"Epistemic disadvantage and therapeutic asymmetry in psychiatric care.","authors":"Christophe Gauld, Pauline Espi","doi":"10.1007/s11019-026-10378-8","DOIUrl":"10.1007/s11019-026-10378-8","url":null,"abstract":"In a recent commentary, Alcalay argues that the concept of epistemic disadvantage provides a useful framework for understanding forms of epistemic harm that may arise even in the absence of epistemic injustice. We agree that this concept identifies an important category of harms associated with warranted asymmetries of expertise and offers valuable insights into both clinical and nosological practices. However, we suggest that, in some clinical situations, clinicians may intentionally maintain interpretative distance from a patient's explicit narrative while fully recognizing its sincerity, meaning, and experiential value. We argue that psychiatric care frequently involves what we call therapeutic asymmetry, i.e., situations in which interpretative distance forms part of the therapeutic process itself. Using examples based on suicidality, loyalty conflicts, mania and AI sycophancy, we aim to show that clinicians may sometimes refrain from accepting patient narratives at face value because suffering can affect capacities for self-understanding, self-deliberation and decision-making. Therapeutic asymmetry highlights the role of alterity, interpretation, and clinical judgment in situations where patients seek assistance precisely because they struggle to understand, interpret, or transform aspects of their own experience.","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":"1193-1196"},"PeriodicalIF":3.6,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148399589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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

Cost-effectiveness, pharmaceutical pricing and the value flower - doing some gardening. 成本效益，药品定价和价值花-做一些园艺。

IF 3.6 2区哲学

Medicine Health Care and Philosophy Pub Date : 2026-12-01 Epub Date: 2026-07-07 DOI: 10.1007/s11019-026-10373-z

Lars Sandman, Martin Henriksson, Erik Gustavsson, David Lindqvist, Niklas Juth

{"title":"Cost-effectiveness, pharmaceutical pricing and the value flower - doing some gardening.","authors":"Lars Sandman, Martin Henriksson, Erik Gustavsson, David Lindqvist, Niklas Juth","doi":"10.1007/s11019-026-10373-z","DOIUrl":"10.1007/s11019-026-10373-z","url":null,"abstract":"During the recent years, ISPOR has proposed a number of values that could be taken into account in health technology assessments, for instance when doing an evaluation of what determines society's price for pharmaceutical treatments. These includes values that are not usually considered in health economic evaluation of pharmaceutical pricing, for instance option value, the value of hope and knowing, insurance value, the value of avoiding contagion, and scientific spillover. If these values were included in assessments of pricing of pharmaceutical, it would lead to broadening the cost-effectiveness analysis. We scrutinize the these suggested new value petals of the so-called value flower from two points of views: ethical value theory and the practical implications for a public healthcare system of a European kind, which factors in considerations of traditional cost-effectiveness (primarily in terms of net cost and quality-adjusted life years) and justice (primarily in terms of severity) from the outset. We argue that some of the suggested value petals should not be included in the health economic assessment for several reasons related to value theory or practical considerations in the welfare state: some are mutually conflicting, some do not point out unequivocally positive values, some entails double counting, some are already included in healthcare systems with universal coverage, or can be better handled by other means than by affecting pharmaceutical pricing. A few new petals have potential merit, for instance equity, but much work, both normative and empirical, is required if they should be included in the assessment of pharmaceuticals.","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":"979-994"},"PeriodicalIF":3.6,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148399548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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

A defense of empathy: Edith Stein, nursing, and prisoner/patients. 为同理心辩护：伊迪丝·斯坦，护理，囚犯/病人。

IF 3.6 2区哲学

Medicine Health Care and Philosophy Pub Date : 2026-12-01 Epub Date: 2026-06-17 DOI: 10.1007/s11019-026-10369-9

Micah Rojo, Farr Curlin

{"title":"A defense of empathy: Edith Stein, nursing, and prisoner/patients.","authors":"Micah Rojo, Farr Curlin","doi":"10.1007/s11019-026-10369-9","DOIUrl":"10.1007/s11019-026-10369-9","url":null,"abstract":"Many nurses fear empathizing too much with patients. They worry that empathy requires letting their guard down, which, when caring for a potentially violent patient, will make them vulnerable to the risk of assault. They worry that as empathy leads the nurse to reckon with who the other is, it will draw out prejudices the nurse might have toward some categories of persons. And nurses worry that empathy will cause them to experience and be burdened too much by the patient's suffering. These fears are perhaps most distilled in nurses' relationships with prisoner/patients, and situating our analysis within such relationships, this paper asks how philosopher Edith Stein's accounts of empathy and community address nurses' fears when caring for patients who may pose danger to them. We argue first that empathy for the prisoner/patient permits nurses to anticipate the patient's future actions, including violent ones. Second, what Stein calls reiterated empathy allows nurses to discern prisoner/patients' appraisal of the nurse's care and to self-correct, as needed, any stigmatizing care. Finally, though the suffering of patients is indeed too much for the nurse to bear alone, following Stein we suggest that through relationships of solidarity the nurse may meaningfully bear that suffering in community, and the community may meaningfully bear that suffering in the nurse. In Edith Stein, who, in addition to studying philosophy, had worked briefly as a nurse, we find resources to address nurses' misconceptions and fears of empathy and to enliven nurses' care.","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":"947-954"},"PeriodicalIF":3.6,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148266548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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