Medicine Health Care and Philosophy最新文献

{"title":"Phenomenology and ethics of terminal pain. Cicely Saunders' proposal.","authors":"Ilaria Malagrinò","doi":"10.1007/s11019-025-10273-8","DOIUrl":"10.1007/s11019-025-10273-8","url":null,"abstract":"<p><p>Differently from pre-technological societies, the contemporary one, when faced with pain, always thinks it can prepare a therapeutic response using the technique as the most valid form to dominate it. However, medicalization and pharmacology of pain prevent it from becoming language. Thus, medical progress makes men much more vulnerable to pain. If, on the one hand, the benefits of anesthesia constitute an unparalleled achievement, on the other, they generate a sense of indifference to life. This is precisely why it is important and urgent to return to listening to the cry of pain. In this sense, particularly commendable were the efforts of Cicely Saunders, who dedicated her entire life to listening to pain and made listening to pain the cornerstone of the philosophy of the Hospice Movement. Therefore, this paper aims to propose a reconstruction of the phenomenology of terminal pain that emerges in Cicely's writings, highlighting its particularity and usefulness in designing a better approach to pain management. Terminal pain has a strong ethical dimension that requires not only a therapeutic but, above all, an ethical response. The proposal of care that derives from Saunders' reflections focuses on the direct encounter with the other caught in its aspect of contact and restores importance to the medical art imagined as \"pathic,\" which, based on a complete or comprehensive wisdom, surpasses the classical humanistic vision and dichotomy which separates it from the purely biomedical one.</p>","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":"487-499"},"PeriodicalIF":3.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051104","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}

{"title":"The role of clinicians in the looping effect: epistemic injustices and looping breaks.","authors":"Christophe Gauld, Boris Nicolle, Axel Constant, Anne-Marie Gagné-Julien","doi":"10.1007/s11019-025-10279-2","DOIUrl":"10.1007/s11019-025-10279-2","url":null,"abstract":"<p><p>The debate on whether psychiatric disorders can be studied as natural kinds has raised controversy, reviving socio-constructionist arguments about the influence of social factors on psychiatric categories. A key concept in this discussion is the \"looping effect\", which describes how individuals change in response to their classifications, necessitating revisions to those classifications. We argue that, until now, the broad discussions around the looping effect have greatly failed to integrate the perspectives surrounding clinicians and patients. We examine more closely the dynamic and unstable nature of psychiatric diagnoses by proposing two key hypotheses: first, that understanding the looping effect requires incorporating both clinician and patient viewpoints, and that when done adequately, such an incorporation can facilitate the work of the clinician by creating feedback loops (i.e., the iterative adjustment of clinical interpretations based on patient responses); and second, that epistemic injustices between clinicians and patients can create disruptions in these feedback loops, which we call \"looping breaks\", rendering them ineffective. Looping breaks can happen at the clinical level of the relationship between the patient and the clinician or at the nosological level (during the process of revising a classification). We suggest that looping breaks can be caused by a denial or minimization of credibility based on identity prejudice, or due to an epistemic disadvantage, affecting the experiential feedback of patients following the announcement of a diagnosis. To substantiate our claims, we first examine the impact of looping effects in the interaction between patients and clinicians. Second, we investigate the impact of these interactions at the nosological level, on the broader diagnostic framework. We identify epistemic injustices as critical factors that can lead to looping breaks at both levels, thus affecting the stability and validity of psychiatric diagnoses. Our findings underscore the importance of an epistemic approach to the looping effect, emphasizing both knowledge validity and justice in clinician-patient relationships and among clinicians themselves.</p>","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":"561-576"},"PeriodicalIF":3.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12380643/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250286","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}

{"title":"A normativity mapping review on end-of-life care in long-term care institutions by authors from Germany, Austria, and Switzerland.","authors":"Ingrid Metzler, Hanna Mayer, Giovanni Rubeis, Jasmin Eppel-Meichlinger","doi":"10.1007/s11019-025-10278-3","DOIUrl":"10.1007/s11019-025-10278-3","url":null,"abstract":"<p><p>This article presents the findings of a \"normativity mapping review\" designed to make visible the breadth of normative understandings at work within interdisciplinary scholarship on end-of-life care in long-term care institutions. The scope of the literature was limited to peer-reviewed articles authored by scholars affiliated with institutions in Austria, Germany, and Switzerland. Terms and slogans associated with the hospice movement were used as keywords to search for literature in both German and English. During data analysis, values, frameworks, and actions were systematically extracted from the articles. Actions were then clustered into four groups: one involving actions aimed at planning future end-of-life decision-making; another focused on transforming cultures of care; a third encompassing end-of-life practices; and a fourth consisting of residual actions. A comparison of two of these groups shows that normative understandings of end-of-life care in long-term care institutions take shape around two poles-a procedural pole, involving standardised tools that can be used in specific practices to address challenges and improve care, and a substantive pole, centred on the embodied competencies and moral sensibilities of caregivers in realising visions of good end-of-life care.</p>","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":"607-621"},"PeriodicalIF":3.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12380933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235563","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}

{"title":"Moral reasoning skills: what they are and how they can be furthered in health professions education.","authors":"Annett Wienmeister","doi":"10.1007/s11019-025-10289-0","DOIUrl":"https://doi.org/10.1007/s11019-025-10289-0","url":null,"abstract":"<p><p>It is widely agreed that moral reasoning skills are an important aspect of ethical competency in the health professions and that students should acquire those skills. Nevertheless, ethics instructors might find it difficult to choose specific exercises and methods to further those skills because there is no shared understanding of what the term \"moral reasoning skills\" implies. As a result, there is a didactical gap between learning objective and methodology. In this paper, I demonstrate that and why the term \"moral reasoning\" is an underdetermined concept in the didactics literature of the health professions. With reference to the discipline of informal logic I will introduce a definition of the term and quality criteria for good moral reasoning that facilitate didactical interventions. I introduce three basic suggestions that instructors can follow if they want to further moral reasoning skills in students. I show how the three suggestions translate into specific learning objectives, which help instructors design exercises and choose appropriate methods for teaching and learning. Towards the end, I will discuss the critical factor of time in educational settings.</p>","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144974130","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}

{"title":"Doing philosophy and the future of the 'good doctor' paradigm.","authors":"Faye Tucker","doi":"10.1007/s11019-025-10294-3","DOIUrl":"10.1007/s11019-025-10294-3","url":null,"abstract":"<p><p>The author argues for the substantive doing of philosophy (as opposed to learning about it) as part of medical training. The paper presents a view of medical education as diminishing the critical thinking skills and humanistic values of future clinicians in favour of fact-recall and pattern recognition. This is due to increasingly assessment-driven curriculums and the need to meet extremely high, and rigorous, institutional and industry/sector standards. The author argues that current medical training favours a particular kind of learning, and therefore produces a particular kind of clinician, that may meet these standards and thrive in competitive and high-pressure practice but may not be best for patients. Furthermore, as artificial intelligence (AI) and emerging technologies rapidly change the landscape of medicine, current medical training may also not be best for these clinicians. The 'good doctors' that we are currently training, face a 'survival of the fittest situation' whereby they are no longer able to survive in a changing landscape, and therefore medical education is failing our future 'good doctors'. Changes to the content and delivery of medical education need to happen now to mitigate this failing and give doctors: first, what they need to survive; and second, what they need to properly care for patients in a changing industry, increasingly served by AI. Doing philosophy has the potential to cultivate the thinking skills, inter-personal skills, personal attributes, and humanistic values needed by the 'good doctor' of the future.</p>","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875978","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}

{"title":"The pitfalls of \"toughing it out\": mapping stoic attitudes in cancer patients. A scoping review.","authors":"Alexis Harerimana, Julian David Pillay, Gugu Mchunu","doi":"10.1007/s11019-025-10293-4","DOIUrl":"10.1007/s11019-025-10293-4","url":null,"abstract":"<p><strong>Background: </strong>Stoicism (with an upper-case 'S') as a life philosophy promotes resilience, self-control and rational acceptance of adversity. In contrast, lower-case stoicism, including pseudo-stoicism or stoic attitudes-characterised by emotional suppression and the silent endurance of pain or hardship-has been linked to adverse health outcomes among cancer patients. Thus, further research is needed to understand the drawbacks of stoic attitudes in cancer patients. This scoping review aims to map stoic attitudes in cancer patients, particularly in relation to potential health consequences. The review adhered to Levac et al.'s framework for scoping reviews. A systematic search was conducted from five electronic databases: CINAHL, Emcare, Medline Ovid, Scopus, and Web of Science. Manual searches were conducted using Google and Google Scholar. A total of 955 records were identified, 526 were screened (title and abstracts), and 450 were excluded. After reviewing 76 full-text articles, 12 studies satisfied the inclusion criteria for data extraction and thematic analysis, consisting of five qualitative and seven quantitative studies. A time frame of 10 years was considered, ranging from 2014 to 2024. This scoping review revealed that pseudo-stoic attitudes in cancer patients often lead to emotional suppression, reduced social support, delayed help-seeking and poor management of symptoms such as pain. These attitudes were linked to poorer psychological outcomes and underreporting of symptoms, especially among older males and rural cancer patients. Studies found that stoic traits were sometimes associated with persistence and treatment adherence among cancer patients. Pseudo-stoicism hinders emotional expression and delays help-seeking, leading to adverse health outcomes; however, stoic attitudes are also associated with adaptive qualities, such as psychological endurance and a commitment to care. Therefore, it is vital to promote balanced coping strategies that honour resilience while encouraging open emotional engagement among cancer patients.</p>","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875980","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}

{"title":"Exhaustion disorder: the genesis of a diagnosis that exists only in Sweden.","authors":"Fredrik Svenaeus","doi":"10.1007/s11019-025-10292-5","DOIUrl":"10.1007/s11019-025-10292-5","url":null,"abstract":"<p><p>In a scientific report published 2003 a psychiatric research group in Sweden proposed to the National Board of Health and Welfare that a new diagnosis with the name \"exhaustion disorder\" (\"utmattningssyndrom\") (ED) should be created in the Swedish diagnostic system. Two years later the board approved the proposal and the diagnosis was registred in the Swedish version of ICD-10. Since 2005 the prevalence of ED in Sweden has gradually increased and at the current date more than 40 000 people are on long-term sick leave as a result of the diagnosis. Interestingly, there is no corresponding medical diagnosis outside of Sweden, although patients in other countries are declared ill with similar symptoms, receiving other diagnoses, such as burnout, depression, acute stress or adjustment disorder. In this paper, the history of ED is told and an attempt is made to answer the question why it has come to exist and prevail in Sweden despite no evidence of validity. The analysis is performed by scrutinizing the criteria for the diagnosis and how it has been connected to the granting of sick leave in the Swedish social insurance system. In conjunction with this, a phenomenological analysis is provided of how ED has been named and interpreted in the Swedish society as a particular form of life-narrative pattern. This pattern of break-down and rebuild of a more in-tune-with-nature version of oneself in recovering from ED is found in Swedish popular culture, and it is supported by academic studies, self-help books and the strategies of rehabcenters.</p>","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875979","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}

{"title":"Defining complementary and alternative medicine : Revisiting the Debate and Plea for a Strategy Based on Plausible Effectiveness.","authors":"Alexander Kremling, Jan Schildmann","doi":"10.1007/s11019-025-10291-6","DOIUrl":"https://doi.org/10.1007/s11019-025-10291-6","url":null,"abstract":"<p><p>Discourse about Complementary and alternative medicine (CAM) is also controversial in several respects, including terminology. Understanding and using the term 'CAM' precisely remains necessary in some discussions. This article provides a contribution to a terminologically more reflected debate about CAM. Analytical methods are applied to analyse 'CAM' conceptually: reasons to define CAM are discussed, common definitions are critically analysed in light of argumentative plausibility, and typical conceptual needs in the debate about CAM are described. Based on this, an evidence definition of CAM is sketched. Complementary and alternative medicine is typically defined by positive attributes or (more usefully) by unconventionality. While the latter provides a viable definitional strategy, several questions remain regarding the logic and applicability. Attempts to improve CAM definitions should consider (a) presenting necessary and sufficient conditions, (b) separating 'complementary', 'alternative' and 'integrative', (c) understanding 'CAM' relative to specific diseases and (d) being explicit about possible changes of the CAM status. These requirements are used to develop a definition of CAM centring around the notion of probable specific effectiveness-a definitional strategy that might solve flaws in the current CAM discourse by spelling out some of the reasons why certain practices are not part of conventional treatment. The example of the cancer drug Imatinib serves to demonstrate the usefulness of focusing on plausibility of effectiveness instead of conventionality. Defining CAM in light of evidence properties might improve the debate. Independent of the terminological strategy pursued, articles and guidelines on CAM should at least reflect the implications and pros and cons of their own terminological decision. An evidence definition should be developed in detail.</p>","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838221","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}

{"title":"Developing more inclusive approaches to animal research and patient involvement.","authors":"David Mawufemor Azilagbetor, Gail Davies, Lester Darryl Geneviève, David Martin Shaw, Bernice Simone Elger","doi":"10.1007/s11019-025-10288-1","DOIUrl":"https://doi.org/10.1007/s11019-025-10288-1","url":null,"abstract":"<p><p>Doing scientific research with animals is a subject of intense societal debate, often involving polarized and public discussions with stakeholders and groups interested in animal research. Patients, given their medical conditions, have a high stake in biomedical research, including research involving animals. However, their perspectives are rarely heard in policy-related discussions on animal experiments. This essay discusses the positions and stakes of groups involved in public discourse and policy-relevant engagements. It further explores the legitimate interest of patients and the need for an all-inclusive approach to animal research policy. This subject is complex and democratic societies must address societal issues with an all-inclusive approach to reach policy decisions reflecting the interests of all stakeholders. The positions of groups-pro-animal research stakeholders and anti-animal-research advocates-with vested interests involved in animal research discourse considerably shape research policies. Animal research policies arguably affect patients. Through democratic ideals, inclusive approaches that are suitable for resolving science-driven societal issues, and initiatives currently guiding animal research policies, patients need to actively be involved in public discourses and policy-relevant decision-making processes in deciding the place of animal research in biomedical advancement as a society.</p>","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838222","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}

{"title":"Reclaiming human dignity: a critical review of contemporary theories in light of ontological foundations.","authors":"Patrícia Frantz, Francisca Rego, Stela Barbas","doi":"10.1007/s11019-025-10290-7","DOIUrl":"10.1007/s11019-025-10290-7","url":null,"abstract":"<p><p>Contemporary healthcare ethics often invokes the concept of human dignity as a normative cornerstone. Yet beneath this apparent consensus lies a fragmentation of meaning: dignity is variably interpreted as autonomy, capacity, recognition, or social construction-with little agreement on its essential content or justification. This conceptual disarray weakens the ethical coherence of bioethical decision-making and obscures the true nature of the human person. This article offers a critical review of the predominant contemporary theories of human dignity, including recognition-based approaches, capabilities theory, procedural pragmatism, and postmodern critiques. We expose the internal tensions and philosophical fragilities of each, especially when applied to medical practice. In contrast, we defend an ontologically grounded understanding of dignity-one that recognizes the human being as a unified, rational, embodied substance possessing intrinsic worth by virtue of being. By recovering this ontological foundation, we argue for a more coherent, universal, and morally resilient framework for healthcare ethics-one capable of upholding the inviolability of the person beyond shifting cultural, legal, or utilitarian paradigms.</p>","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769187","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}