Medicine Health Care and Philosophy最新文献_第3页

Formative embodiment and early life: a comparative health humanities reading of development, meaning, and mental life. 形成的体现和早期生活：发展、意义和精神生活的比较健康人文阅读。

IF 3.6 2区哲学

Medicine Health Care and Philosophy Pub Date : 2026-12-01 Epub Date: 2026-07-31 DOI: 10.1007/s11019-026-10383-x

Christopher Fernandes

{"title":"Formative embodiment and early life: a comparative health humanities reading of development, meaning, and mental life.","authors":"Christopher Fernandes","doi":"10.1007/s11019-026-10383-x","DOIUrl":"10.1007/s11019-026-10383-x","url":null,"abstract":"This paper brings insights from classical Indic, Tantric, Daoist, and Hellenistic medical traditions into dialogue with contemporary developmental science to examine the metaphysical, relational, and moral status of the embryo during its formation. Modern embryology provides detailed scientific explanations of genetic, epigenetic, and physiological development. However, it pays comparatively less attention to how embodied life emerges and to the philosophical significance of early embryonic development. The study adopts a comparative health humanities approach to examine how concepts such as garbha, prāṇa, qì, pneuma, developmental plasticity, and maternal-fetal relationality reflects different cultural and philosophical understandings of embryological formation. Rather than treating classical traditions as precursors of modern biology, the analysis identifies both convergences and divergences in how these traditions conceptualize vitality, embodiment, temporality, and developmental continuity. Across these traditions, embryological development is understood not as the unfolding of a pre-existing essence but as the progressive organization of embodied life through interacting physiological, environmental, temporal, and relational conditions. The comparison reveals both shared insights and important differences among these traditions. Although concepts such as prāṇa, qì, and pneuma describe aspects of formative life, they should not be reduced to modern biological categories. By bringing these perspectives into dialogue, the paper shows how comparative health humanities can broaden contemporary understandings of development, embodiment, vulnerability, and care while respecting the historical context of each tradition.","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":"1005-1023"},"PeriodicalIF":3.6,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632189","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

Inaudible and invisible: epistemic injustice and the failure of recognition as a single intersubjective relation. Pain as particularly illuminating case. 听不清和看不见：认识上的不公正和作为单一主体间关系的认识的失败。疼痛是一个特别有启发性的例子。

IF 3.6 2区哲学

Medicine Health Care and Philosophy Pub Date : 2026-12-01 Epub Date: 2026-07-14 DOI: 10.1007/s11019-026-10371-1

Helmar Bornemann-Cimenti

{"title":"Inaudible and invisible: epistemic injustice and the failure of recognition as a single intersubjective relation. Pain as particularly illuminating case.","authors":"Helmar Bornemann-Cimenti","doi":"10.1007/s11019-026-10371-1","DOIUrl":"10.1007/s11019-026-10371-1","url":null,"abstract":"Miranda Fricker's concept of epistemic injustice and Axel Honneth's theory of recognition have each been applied, separately, to chronic pain. The relationship between them is usually construed as sequential: epistemic injustice is thought to produce failures of recognition, or prior misrecognition to ground later epistemic marginalisation. This article rejects that reading. It argues that, in the clinical encounter with a person in pain, the relation between the two is not exhausted by causal succession. They are analytically separable dimensions of a single intersubjective relation, dimensions that cannot, in that encounter, be treated apart without descriptive and practical loss. The act by which a clinician withholds credibility from a patient's testimony is the same act by which recognition is refused to that patient as a suffering subject. The claim is offered as a heuristic rather than an ontological thesis. Pain is presented not as uniquely paradigmatic but as a particularly illuminating case within a broader class of testimonially dependent suffering, since its privacy, its dependence on testimony, and the mediating role of diagnostic language converge in it with unusual clarity. The argument bears on recognition theory; on medical ethics, where remedies addressed to one dimension alone prove insufficient; and on clinical practice, where diagnostic classification operates as a technology of recognition.","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":"955-965"},"PeriodicalIF":3.6,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148438417","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

Choosing how to decide: empowering patients for shared decision-making in end-of-life care. 选择如何决定：在临终关怀中赋予患者共同决策的权力。

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/s11019-026-10389-5

Nicholas Abernethy

{"title":"Choosing how to decide: empowering patients for shared decision-making in end-of-life care.","authors":"Nicholas Abernethy","doi":"10.1007/s11019-026-10389-5","DOIUrl":"10.1007/s11019-026-10389-5","url":null,"abstract":"Shared Decision-Making (SDM) is a process wherein patients and clinicians make healthcare decisions collaboratively. There are two main versions of SDM. The first is narrow SDM, wherein the clinician's role is limited to things like providing information and eliciting (without challenging) the patient's preferences. The second is broad SDM, wherein the clinician participates in the decision-making in various additional ways (e.g., by providing recommendations). In this paper, I argue that there are cases where a patient would not be wronged by a clinician letting them choose from a range of versions of SDM - including narrow SDM and types of broad SDM - for an end-of-life treatment decision. This paper's structure is as follows. First, I explain my proposal. Second, I provide a brief rationale for it. Third, I thoroughly defend it from the likeliest objection, which holds that clinicians in the relevant cases should offer only narrow SDM because broad SDM would unduly influence patients. This paper's originality comes from (i) presenting a new and uniquely detailed proposal for when and how to offer versions of SDM and (ii) exploring the ethical implications of a patient's choice of a version, understood as an act of consent. The main purpose of my proposal's many details is to maximize how much the SDM would advance patient autonomy (and, secondarily, patient wellbeing).","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":"931-945"},"PeriodicalIF":3.6,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799567","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

Ontological deskilling: clinical expertise and the changing disease object in precision medicine. 本体论去技能化：精准医学中临床专业知识与疾病对象的变化。

IF 3.6 2区哲学

Medicine Health Care and Philosophy Pub Date : 2026-12-01 Epub Date: 2026-07-08 DOI: 10.1007/s11019-026-10377-9

Anastasios E Germenis

{"title":"Ontological deskilling: clinical expertise and the changing disease object in precision medicine.","authors":"Anastasios E Germenis","doi":"10.1007/s11019-026-10377-9","DOIUrl":"10.1007/s11019-026-10377-9","url":null,"abstract":"Concerns about physician deskilling in AI-enabled medicine usually ask how automated systems substitute for, attenuate, or distort clinical capacities. This article argues that precision medicine introduces a distinct object-side problem. Its dominant classificatory operation is not simply finer nosological classification but stratification for action: patients are grouped and regrouped for treatment selection, risk allocation, surveillance, trial eligibility, and prediction. In doing so, precision medicine fragments established disease categories, connects conditions across former boundaries, temporalizes disease into trajectories and thresholds, and produces actionable risk states and algorithmic subgroups. If clinical expertise is acquired through relatively stable nosological categories, then preserved skills may become insufficient when those categories no longer organize the clinical object in the same way. I call this failure of fit ontological deskilling. The article distinguishes it from technological deskilling, diagnostic uncertainty, overdiagnosis, medicalization, plastic diagnostics, and ordinary adaptive-learning demands. Drawing on Canguilhem, Mol, phenomenological intentionality, and accounts of expertise, it argues that ontological deskilling changes the conditions of clinical judgment, uncertainty, and responsibility. The appropriate response is critical nosological awareness: the ability to use disease categories competently while recognizing their contingency, plurality of functions, and susceptibility to transformation.","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":"903-921"},"PeriodicalIF":3.6,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406353","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

The dis-economy of precision medicine: how stratification multiplies social tension in healthcare systems. 精准医疗的不经济：分层如何加剧医疗系统中的社会紧张。

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/s11019-026-10381-z

Raef Kozman, Fabrice Jotterand

{"title":"The dis-economy of precision medicine: how stratification multiplies social tension in healthcare systems.","authors":"Raef Kozman, Fabrice Jotterand","doi":"10.1007/s11019-026-10381-z","DOIUrl":"10.1007/s11019-026-10381-z","url":null,"abstract":"Precision medicine (PM) promises better outcomes by aligning prevention and treatment with molecular and phenotypic profiles. But precision is not merely a clinical refinement; it is an epistemic shift in how health systems classify risk, allocate eligibility and define value. In this study, we argue that broad adoption of PM creates structural tension within solidarity-based health systems and exposes limits in conventional cost-effectiveness evaluation. Ethically, PM converts pooled probabilistic uncertainty into individualized biological prediction, making access increasingly conditional on measurement, interpretation and pathway completion. Economically, PM fragments evaluable populations, destabilizes counterfactual comparison and shifts value from discrete products to information-dependent care pathways. As a result, standard metrics such as the incremental cost-effectiveness ratio (ICER) often become sensitive not only to biological effect, but also to governance: who is tested, how results are interpreted, which downstream services are funded and who can complete the pathway. We suggest that the instability observed in PM appraisal is not simply a technical problem of modeling, but a sign that the object of evaluation has changed. Recognizing this structural shift is essential if PM is to be integrated into health systems committed to both equity and evaluability.","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":"923-930"},"PeriodicalIF":3.6,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148424984","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

Caring for the lonely: an ethical case for social prescribing against loneliness. 照顾孤独者：社会处方对抗孤独的伦理案例。

IF 3.6 2区哲学

Medicine Health Care and Philosophy Pub Date : 2026-12-01 Epub Date: 2026-08-21 DOI: 10.1007/s11019-026-10386-8

Zohar Lederman

引用次数: 0

From illness to stillness: on becoming (a) patient. 从疾病到静止：成为病人。

IF 3.6 2区哲学

Medicine Health Care and Philosophy Pub Date : 2026-10-16 DOI: 10.1007/s11019-026-10411-w

Drew Leder, Kevin Aho

{"title":"From illness to stillness: on becoming (a) patient.","authors":"Drew Leder, Kevin Aho","doi":"10.1007/s11019-026-10411-w","DOIUrl":"https://doi.org/10.1007/s11019-026-10411-w","url":null,"abstract":"Illness is often understood as a disruption of ordinary temporality, fracturing narrative continuity, constricting horizons of possibility, and immersing sufferers in the slow, uncertain rhythms of waiting. Drawing on phenomenology, existential philosophy, pathography, and East Asian wisdom traditions, this article examines the relationship between growing ill and growing still, being a patient and developing patience. While contemporary accounts of illness have richly described experiences of temporal distortion, boredom, loss, and desynchronization, less attention has been given to the possibility that illness may also cultivate forms of composure, attentiveness, and moral endurance. We argue that the temporal disruptions associated with illness, disability, and aging, by interrupting the accelerated rhythms of late modern life, can create opportunities for stillness, presence, and renewed responsiveness. For this we coin the term st/illness. We also distinguish between being a patient, insofar as it connotes passivity and dependence, and being patient, an active virtue that allows one to meet the temporal demands imposed by bodily limitation and breakdown. While not minimizing or romanticizing the physical and emotional suffering often associated with illness, the article explores how illness can also function as a pharmakon in the Greek sense-both poison and remedy-revealing possibilities for resonance, contemplative presence, and existential transformation. This offers a framework for understanding how patients may sometimes flourish within, rather than despite the altered temporalities of illness.","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208031","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

The clicking doctors: how the mouse restructures clinical attention. 点击医生：鼠标如何重组临床注意力。

IF 3.6 2区哲学

Medicine Health Care and Philosophy Pub Date : 2026-10-14 DOI: 10.1007/s11019-026-10407-6

Wilhelm Haverkamp

{"title":"The clicking doctors: how the mouse restructures clinical attention.","authors":"Wilhelm Haverkamp","doi":"10.1007/s11019-026-10407-6","DOIUrl":"https://doi.org/10.1007/s11019-026-10407-6","url":null,"abstract":"The attention of office-based physicians is increasingly structured less by the patients in front of them than by the screen beside them - by the clicks, notifications, system lags, and task-switching that the practice information system demands. Research on cognitive load and burnout documents the demands of screen work, but commonly used outcome measures do not directly assess whether repeated fragmentation changes habitual patterns of clinical attention. This article pursues exactly that question: what screen work may change is less the amount of attention than its disposition. Drawing on research into attention residue, system response times, and time-and-motion evidence from ambulatory care, it identifies three mechanisms through which screen work restructures clinical attention: attention residue, response-time fragmentation, and interface-induced switching. Unlike cognitive load, these mechanisms may reshape the disposition of clinical attention itself - the way a physician attends to the patient, which may become shallower, more reactive, and more externally driven. The claim is marked throughout as a research-guiding hypothesis: the three mechanisms are measurable, their cumulative dispositional effect is not yet. It then shows why automation does not dissolve the problem, and why the growing evidence on ambient-AI documentation neither confirms nor refutes it. Because every finding cited remains compatible with simple time scarcity, the article specifies the design that would begin to discriminate between the two: a carry-over design presenting the same unhurried clinical task to the same physicians at the end of a high-switch and a low-switch day, scaled to a cohort with repeated measurement. It closes with three design requirements: switch ceilings, context preservation after interruptions, and protected attentional time.","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185074","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

How do we understand the pain of the other? The role of imagination in the verbal communication of physical pain. 我们如何理解他人的痛苦？想象在身体疼痛的语言交流中的作用。

IF 3.6 2区哲学

Medicine Health Care and Philosophy Pub Date : 2026-10-14 DOI: 10.1007/s11019-026-10410-x

Adriana Joanna Mickiewicz

引用次数: 0

The anatomy of the intolerable: atrophy of moral astonishment in medicine. 无法忍受的解剖：医学中道德惊讶的萎缩。

IF 3.6 2区哲学

Medicine Health Care and Philosophy Pub Date : 2026-10-10 DOI: 10.1007/s11019-026-10409-4

Alexis Alejandro Garcia-Rivero

{"title":"The anatomy of the intolerable: atrophy of moral astonishment in medicine.","authors":"Alexis Alejandro Garcia-Rivero","doi":"10.1007/s11019-026-10409-4","DOIUrl":"https://doi.org/10.1007/s11019-026-10409-4","url":null,"abstract":"Medicine is devoted to care, yet its history includes circumstances in which physicians and medical institutions participated in exclusion, coercion, and organized harm. That contradiction raises a difficult question: how can something initially experienced as unacceptable become familiar enough to cease provoking the same moral response? I introduce atrophy of moral astonishment as a historical-philosophical concept for examining this change. It refers to a gradual, context-dependent, and potentially reversible weakening of the capacity to experience harm, exclusion, or indignity as something that interrupts ordinary practice and calls for moral judgment. The argument draws on medicine under National Socialism, the Nazi patient-killing program Aktion T4, the genocide against the Tutsi in Rwanda, and examples of professional resistance. These contexts are not treated as historically or morally equivalent. They are used to examine how categorization, legitimation, repetition, socialization, and routine can alter what remains morally salient. The proposal is distinguished from adjacent accounts of moral disengagement, ethical fading, ethical blindness, moral sensitivity, moral distress, and normalization of deviance. Resistance shows that accommodation is never inevitable, while historical memory may restore some of the critical distance that routine erodes. For medicine, the central implication is that professional formation should preserve the capacity to question what familiarity has made ordinary.","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171124","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