Medicine Health Care and Philosophy最新文献

{"title":"From application to reciprocity: Merleau-Ponty and what it means for physicians to philosophize.","authors":"Daisuke Son","doi":"10.1007/s11019-026-10406-7","DOIUrl":"https://doi.org/10.1007/s11019-026-10406-7","url":null,"abstract":"<p><p>Philosophy in medicine is often described through application: philosophical concepts are brought to bear on illness, clinical relationships, ethics, or education. Yet this language can obscure forms of inquiry in which clinical experience also reshapes philosophical questions. This paper develops a conceptual account of reciprocal clinical philosophizing: a bidirectional, open-ended, and dialogical practice in which philosophical inquiry and clinical experience can each generate, constrain, and revise questions posed by the other. The argument does not claim that philosophy of medicine has generally been one-way; Canguilhem, phenomenological psychopathology, and contemporary phenomenology of illness already exemplify reciprocal inquiry. Rather, the \"application model\" is used as an ideal-typical contrast that names a recurrent pressure to make philosophy clinically legible through portable concepts, tools, or measurable outcomes. Three worked examples from Merleau-Ponty-language and expression, medical objectification, and intersubjectivity-show how reciprocity can operate. In each, philosophy unsettles a clinical category while clinical realities, including institutional asymmetry and the necessity of objectification, place pressure back on philosophical interpretation. I argue that the novelty of reciprocal clinical philosophizing lies not in discovering reciprocity, but in clarifying its structure and its implications for how physicians can participate in philosophical inquiry.</p>","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138837","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":"Flourishing under constraint: character education and virtue ethics as the foundation of professionalism in medical education and clinical practice.","authors":"Svanur Sigurbjörnsson, Vilhjálmur Árnason","doi":"10.1007/s11019-026-10403-w","DOIUrl":"https://doi.org/10.1007/s11019-026-10403-w","url":null,"abstract":"<p><p>Contemporary biomedical ethics has been shaped largely by principle-based and outcome-oriented frameworks, yet these approaches insufficiently account for the role of character in clinical judgement and professional formation on which their fruitful use depends. This paper develops a systems-aware virtue-ethical framework for medical education in which professionalism is understood as a sustained mode of professional agency arising from the coordinated exercise of cultivated moral and epistemic character, clinical competence, and practical wisdom within institutional conditions. Drawing on neo-Aristotelian virtue ethics and interdisciplinary research in philosophy, psychology, and medical education, the framework integrates virtue ethics, professional identity formation, flourishing, role modelling, and institutional analysis. It explains how professional character and competence are cultivated longitudinally, integrated through practical wisdom, and either enabled or constrained by educational and healthcare environments. Role modelling is repositioned as one mechanism within a broader pedagogy of character formation rather than as a pedagogical identity to be formally adopted. The paper concludes that medical education should attend simultaneously to the formation of practitioners and to the institutional conditions under which professional agency can be exercised and sustained. Character education should be understood as a central ethical and formative dimension of medical training, providing a more adequate foundation for professionalism than approaches focused primarily on rules, outcomes, or wellness.</p>","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116682","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 harm that wasn't: moral residue, near-miss events, and the ethics of harmless error in procedural medicine.","authors":"Boris Nikolic","doi":"10.1007/s11019-026-10405-8","DOIUrl":"https://doi.org/10.1007/s11019-026-10405-8","url":null,"abstract":"<p><p>A surgeon performing a retroperitoneal procedure inadvertently begins dissecting the wrong kidney. The error is recognized intraoperatively, the correct structure is identified, and the procedure is completed successfully. The patient suffers no measurable clinical harm. The institution classifies the event as a near-miss, and no disclosure is initiated. This paper argues that the classification, while legally defensible, is morally inadequate. The absence of measurable clinical harm does not eliminate the ethical obligations a serious procedural error generates; it displaces them onto forms of harm-relational, professional, and institutional-that the standard harm-based framework cannot capture. Drawing on Bernard Williams's concept of moral residue and Nussbaum's account of shame and concealment, the paper argues that patients have a right to know that a serious error occurred in their care even when it produced no measurable injury, and that the near-miss framework, while valuable as a learning instrument, mischaracterizes the ethical obligations such errors generate. A central section examines the etiology of the error-institutional failure, diagnostic insufficiency, and individual inattention-and defends an invariance thesis: what varies with etiology is the remediation owed and the party who owes it, not the patient's claim to an honest account of what occurred in her own body. The invariance follows from the framework: an obligation fluctuating with the cause of an error would track culpability rather than the relational structure of the encounter. A framework of relational disclosure is proposed as an alternative grounded in the ethics of trust, recognition, and institutional integrity.</p>","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116645","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":"No appeal to moral status required: rethinking the argument for the moral advantage of stem cell-based embryo models in research.","authors":"Davide Battisti","doi":"10.1007/s11019-026-10401-y","DOIUrl":"https://doi.org/10.1007/s11019-026-10401-y","url":null,"abstract":"<p><p>Stem Cell-Based Embryo Models (SCBEMs) have been welcomed enthusiastically because they would allow the study of specific phases of human embryonic development without resorting to embryos produced in vitro. This enthusiasm is based on the idea that research on such models is morally less problematic than research on human embryos. However, this position has recently been challenged, as some authors argue that there are no good reasons to attribute a different moral status to SCBEMs compared to embryos, and the focus on such models risks obscuring an appropriate evaluation of embryonic experimentation rather than representing a genuine moral advancement. In light of this disagreement, I discuss what I call the Argument for the Moral Advantage of SCBEMs and aim to defend it against recent criticisms. I first present the standard version of the argument and argue that it assumes embryos possess direct moral status based on their potential to become persons. Then, after discussing criticisms of the standard version, I explore revising the argument. I first consider relying on the embryos' symbolic moral value; after dismissing this move, I introduce a revised version of the argument based on the pro tanto minimization of moral conflicts, rather than on embryos' moral status or value. After defending the revised argument against several objections, I finally discuss regulatory issues concerning SCBEMs research.</p>","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116685","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":"Beyond Cure: Care as Medicine's Constitutive End and the Limits of a Cure-Centered Account.","authors":"Jay J Oh","doi":"10.1007/s11019-026-10402-x","DOIUrl":"https://doi.org/10.1007/s11019-026-10402-x","url":null,"abstract":"<p><p>Cure occupies a prominent place among the goods of medicine, yet its limits raise a fundamental question about medicine's constitutive end. Chronic illness, disability, dementia, frailty, and dying reveal circumstances in which medicine retains substantial obligations despite the absence of cure. These cases invite renewed reflection on what medicine is fundamentally for. This article argues that care constitutes medicine's moral foundation and the broader framework within which cure derives its meaning and purpose. Drawing primarily on Edmund Pellegrino's philosophy of medicine, together with contemporary debates concerning medicine's constitutive aims and scholarship on suffering, vulnerability, and human dignity, the argument proceeds in five stages. First, it examines the relationship between care, cure, and the ends of medicine, situating the argument within competing accounts of medicine's defining aims. Second, it examines the influence of the curative ideal on modern conceptions of medical success. Third, it considers how chronic illness, disability, dementia, aging, and dying expose the limits of cure as an account of medicine's enduring obligations. Fourth, it argues that medical care constitutes a distinct moral practice arising from the fiduciary structure of the clinical encounter, in which professional knowledge and competence respond to patient vulnerability. Fifth, it considers the implications of this account for medicine increasingly shaped by artificial intelligence and digital technologies. The central claim is that medicine exists not because diseases require treatment but because persons seek help in matters concerning health, illness, suffering, and bodily vulnerability. Cure remains one of medicine's greatest goods, but it does not constitute medicine's ultimate end. Cure serves the good of the patient; care names medicine's enduring commitment to that good across changing clinical circumstances. This account preserves the importance of therapeutic intervention while explaining why medicine's obligations persist when cure is unavailable.</p>","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070320","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":"Eudynamic bioethics.","authors":"Luis de Miranda","doi":"10.1007/s11019-026-10404-9","DOIUrl":"https://doi.org/10.1007/s11019-026-10404-9","url":null,"abstract":"<p><p>A woman's chronic pain is controlled to a stable score, yet her sleep, her work, her singing, and her partnership have narrowed around her condition. Each clinical decision was defensible; what failed is the existential composition around them. This article proposes eudynamia as the concept bioethics lacks: the distributed activity through which possibilities are composed across the conditions of a life so that securing one does not foreclose the others. Ernst Daniel August Bartels coined Eudynamie in § 55 of his Lehrbuch der allgemeinen Pathologie (1819) for a physiological capacity working as it should, then observed that its value changes with the capacities beside it. His relational biology identified the configurational problem but lacked an account of what a life-capacity is a capacity for. Phenomenology and 4E cognition supply the missing content, understanding life and cognition as distributed: embodied, extended, enactive, and embedded. Eudynamia is accordingly reconstructed as the work of keeping possibilities compossible across Person, Earth, Work, and Society, while dysdynamia names configurations in which local effectivity forecloses the wider life. Canguilhem's biological normativity then distinguishes compossibility from coercive coherence, since eudynamic integration preserves the creative capacity to institute new norms. The framework is illustrated in integrative care, antimicrobial stewardship, and artificial intelligence. Bioethics has learned to ask whether each decision is right. It must also learn to ask what forms of life its right decisions, taken together, are making possible.</p>","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070385","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":"Biobanks, the 'diagnostic misconception' and the distinction between altruism and reciprocity.","authors":"Kirsten Bell, Sophie Day, Helen Ward","doi":"10.1007/s11019-026-10398-4","DOIUrl":"https://doi.org/10.1007/s11019-026-10398-4","url":null,"abstract":"<p><p>In this paper, we revisit the topic of genetic biobanks and the ethical issues surrounding them. Focusing on the centrality of altruism to their conception, design and governance, we explore the ways in which the idea of participation as a \"free gift\" has served to define and constrain the terms of discussion around the ethics of biobanks. Discussing empirical evidence of widespread expectations for personal health information, often framed as a \"diagnostic misconception\", we highlight the ways in which the concept is frequently employed to protect a particular moral economy of research in which participants' expectations around the return of personal health information are reduced to a lack of informed consent. Conversely, we suggest that reciprocity provides a more accurate empirical account of participation in biobanks, although this is not merely a form of transactional exchange that flips the script of biobank participation from altruism to self-interest. We conclude that without a reconsideration of the entire conceptual edifice of biobanking, calls to create more reciprocal and solidarity-based models are likely to do little to change the status quo, and that a deeper and more anthropologically informed consideration of reciprocity would serve to improve frameworks for addressing the ethical issues that biobanks entail.</p>","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149065155","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":"When prediction becomes prescription : AI, risk, and the humanistic right to moral deliberation.","authors":"Rotem Waitzman","doi":"10.1007/s11019-026-10399-3","DOIUrl":"https://doi.org/10.1007/s11019-026-10399-3","url":null,"abstract":"<p><p>Artificial intelligence is increasingly used to estimate diagnosis, prognosis, treatment response, deterioration, mortality, and other clinically relevant risks. These predictions may improve care, but they can also acquire prescriptive force: an estimate of what is likely to occur becomes a recommendation about what ought to be done. Existing ethical discussions describe opacity, bias, automation bias, responsibility gaps, threats to autonomy, and the need for meaningful human control. These concerns are important, but they do not fully explain how an accurate, transparent, and statistically fair prediction can still narrow moral judgment. This article introduces normative compression, the process by which heterogeneous clinical evidence, uncertain probabilities, institutional priorities, and patient values are condensed into an apparently self-justifying course of action. Normative compression can occur through outcome selection, uncertainty suppression, value substitution, interface design, and institutional embedding. It is ethically significant because medical risk is never only a probability. Its acceptability depends on what outcomes mean for a particular patient, which burdens are bearable, which relationships and commitments matter, and who may legitimately decide. Drawing on relational and structural accounts of medical humanism, shared decision-making, relational autonomy, and recent work on medical AI, the article defends a humanistic right to moral deliberation. This is a moral, not necessarily legal, right to a clinical process in which prediction remains distinguishable from prescription and in which patients can participate meaningfully in interpreting, contesting, and revising the reasons for action. A seven-part PREDICT framework is proposed to operationalize this right. The article concludes that human oversight is insufficient when humans merely ratify an algorithmic recommendation. Humanistic medicine requires preserving a space in which evidence informs judgment without pre-empting it.</p>","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041390","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":"Patient autonomy despite false beliefs? On the epistemic prerequisites for autonomous treatment decisions.","authors":"Christiane Burmeister, Nikolai Münch","doi":"10.1007/s11019-026-10396-6","DOIUrl":"https://doi.org/10.1007/s11019-026-10396-6","url":null,"abstract":"<p><p>Within debates on the epistemic preconditions of patient autonomy, scholarly attention has focused predominantly on the scope and weight of cognitive competencies, while the role of doxastic attitudes towards medical information have remained comparatively underexplored. Clarifying this issue is, however, of considerable importance when dealing with patients who, though competent and properly informed by the healthcare professionals, withhold belief in the medical facts presented to them. Are such self-imposed false believes compatible with autonomous decision-making and therefore demand respect, or do they undermine its epistemic foundation? Discussing two basic concepts of \"understanding\" as well as the resulting moral impasse between paternalism and arbitrariness, we propose a new direction of inquiry along two lines: First we interrogate a tacit assumption underlying the very notion of \"self-imposed false beliefs\" by discussing the question \"Can we believe at will?\". This discussion yields a promising account that emphasizes the importance of reasons-responsiveness, shifting the focus from the belief itself to the process of belief formation. We conclude that not the truthfulness or falsity of patients' beliefs is key but by the procedural quality of their development. By drawing on the Elaboration Likelihood Model, we are invoking psychological research that supports this claim. Secondly, in order to transfer these insights to the theory and practice of medical ethics, we distinguish two notions of autonomy based on their functions as (1) ideal philosophical concept and (2) basic status designation in real life. The paper argues that in the first realm the notion of reasons-responsiveness informs our assessment of false beliefs and strategies to enhance the \"understanding\" part of autonomy, entailing limited positive duties for healthcare professionals. At the same time, appealing to the relevance of a basic concept of autonomy in the realm of legally binding decisions we argue that the strong duty of non-interference with competent patient's decisions must prevail.</p>","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026461","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":"On the tetrad of human malady: disease, illness, sickness, and existential suffering.","authors":"Bjørn Hofmann","doi":"10.1007/s11019-026-10397-5","DOIUrl":"https://doi.org/10.1007/s11019-026-10397-5","url":null,"abstract":"<p><p>The triad of disease, illness, and sickness is well established in the philosophy, sociology, and anthropology of medicine as well as in clinical practice. Nonetheless, the triad is criticized for being too simplistic and for excluding important aspects of human suffering. One such critique is that it does not account for existential suffering, which is especially relevant in severe and life-threatening diseases. Accordingly, this study investigates whether existential suffering adds to the concepts of disease, illness, and sickness making up a tetrad of human malady. To do so, I investigate the concept of existential suffering, which is frequently described in medical terms, is diagnosed, acknowledged by health professionals, managed in treatments and care, and recognized in disease classification systems. Then I present ontological, epistemological, conceptual, normative, and pragmatic justifications for extending the triad of disease, illness, and sickness with existential suffering. Lastly, I will discuss counterarguments and objections to the various justifications. I conclude that on specific premises existential suffering can be a relevant extension of the triad to a tetrad of human malady, especially in cases of severe and life-threatening disease, but that we need to avoid medicalizing existential suffering and making health professionals masters over human meaning-making.</p>","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149018275","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}