Medicine Health Care and Philosophy最新文献_第9页

Towards a concept of embodied autonomy: In what ways can a patient's body contribute to the autonomy of medical decisions? 实现自主的概念:病人的身体在哪些方面有助于医疗决策的自主?

IF 2.1 2区哲学

Medicine Health Care and Philosophy Pub Date : 2023-09-01 DOI: 10.1007/s11019-023-10159-7

Jonathan Lewis, Søren Holm

{"title":"Towards a concept of embodied autonomy: In what ways can a patient's body contribute to the autonomy of medical decisions?","authors":"Jonathan Lewis, Søren Holm","doi":"10.1007/s11019-023-10159-7","DOIUrl":"https://doi.org/10.1007/s11019-023-10159-7","url":null,"abstract":"\"Bodily autonomy\" has received significant attention in bioethics, medical ethics, and medical law in terms of the general inviolability of a patient's bodily sovereignty and the rights of patients to make choices (e.g., reproductive choices) that concern their own body. However, the role of the body in terms of how it can or does contribute to a patient's capacity for, or exercises of their autonomy in clinical decision-making situations has not been explicitly addressed. The approach to autonomy in this paper is aligned with traditional theories that conceive autonomy in terms of an individual's capacities for, and exercises of rational reflection. However, at the same time, this paper extends these accounts by arguing that autonomy is, in part, embodied. Specifically, by drawing on phenomenological conceptions of the experience of autonomy, we argue that, in principle, the body is a necessary component of the capacity for autonomy. Secondly, through the presentation of two different cases, we highlight ways in which a patient's body can contribute to the autonomy of treatment choices. Ultimately, we hope to encourage others to explore additional conditions under which a concept of embodied autonomy should be employed in medical decision making, how its underlying principles might be operationalised in clinical situations, and its consequences for approaches to patient autonomy in healthcare practice, policy, and law.","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":"26 3","pages":"451-463"},"PeriodicalIF":2.1,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10425513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10078324","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: 1

The fertility of moral ambiguity in precision medicine. 精准医疗中道德歧义的泛滥。

IF 2.1 2区哲学

Medicine Health Care and Philosophy Pub Date : 2023-09-01 DOI: 10.1007/s11019-023-10160-0

Jeanette Bresson Ladegaard Knox, Mette Nordahl Svendsen

{"title":"The fertility of moral ambiguity in precision medicine.","authors":"Jeanette Bresson Ladegaard Knox, Mette Nordahl Svendsen","doi":"10.1007/s11019-023-10160-0","DOIUrl":"https://doi.org/10.1007/s11019-023-10160-0","url":null,"abstract":"Although precision medicine cuts across a large spectrum of professions, interdisciplinary and cross-sectorial moral deliberation has yet to be widely enacted, let alone formalized in this field. In a recent research project on precision medicine, we designed a dialogical forum (i.e. 'the Ethics Laboratory') giving interdisciplinary and cross-sectorial stakeholders an opportunity to discuss their moral conundrums in concert. We organized and carried out four Ethics Laboratories. In this article, we use Simone de Beauvoir's concept of moral ambiguity as a lens to frame the participants' experience with fluid moral boundaries. By framing our approach through this concept we are able to elucidate irremediable moral issues that are collectively underexplored in the practice of precision medicine. Moral ambiguity accentuates an open and free space where different types of perspectives converge and can inform each other. Based on our study, we identified two dilemmas, or thematic interfaces, in the interdisciplinary moral deliberations which unfolded in the Ethics Laboratories: (1) the dilemma between the individual and the collective good; and (2) the dilemma between care and choice. Through our investigation of these dilemmas, we show how Beauvoir's concept of moral ambiquity not only serves as a fertile catalyst for greater moral awareness but, furthermore, how the concept can become an indispensable part of the practices of and the discourse about precision medicine.","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":"26 3","pages":"465-476"},"PeriodicalIF":2.1,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10243698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10100481","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

'You have to put a lot of trust in me': autonomy, trust, and trustworthiness in the context of mobile apps for mental health. “你必须非常信任我”:在心理健康移动应用程序的背景下，自主、信任和可信赖。

IF 2.1 2区哲学

Medicine Health Care and Philosophy Pub Date : 2023-09-01 DOI: 10.1007/s11019-023-10146-y

Regina Müller, Nadia Primc, Eva Kuhn

{"title":"'You have to put a lot of trust in me': autonomy, trust, and trustworthiness in the context of mobile apps for mental health.","authors":"Regina Müller, Nadia Primc, Eva Kuhn","doi":"10.1007/s11019-023-10146-y","DOIUrl":"https://doi.org/10.1007/s11019-023-10146-y","url":null,"abstract":"Trust and trustworthiness are essential for good healthcare, especially in mental healthcare. New technologies, such as mobile health apps, can affect trust relationships. In mental health, some apps need the trust of their users for therapeutic efficacy and explicitly ask for it, for example, through an avatar. Suppose an artificial character in an app delivers healthcare. In that case, the following questions arise: Whom does the user direct their trust to? Whether and when can an avatar be considered trustworthy? Our study aims to analyze different dimensions of trustworthiness in the context of mobile health app use. We integrate O'Neill's account of autonomy, trust, and trustworthiness into a model of trustworthiness as a relational concept with four relata: B is trustworthy with respect to A regarding the performance of Z because of C. Together with O'Neill's criteria of trustworthiness (honesty, competence, and reliability), this four-sided model is used to analyze different dimensions of trustworthiness in an exemplary case of mobile health app use. Our example focuses on an app that uses an avatar and is intended to treat sleep difficulties. The conceptual analysis shows that interpreting trust and trustworthiness in health app use is multi-layered and involves a net of interwoven universal obligations. At the same time, O'Neill's approach to autonomy, trust, and trustworthiness offers a normative account to structure and analyze these complex relations of trust and trustworthiness using mobile health apps.","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":"26 3","pages":"313-324"},"PeriodicalIF":2.1,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10425297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10132713","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: 2

What makes a health system good? From cost-effectiveness analysis to ethical improvement in health systems. 是什么造就了一个好的卫生系统?从成本效益分析到卫生系统的道德改进。

IF 2.1 2区哲学

Medicine Health Care and Philosophy Pub Date : 2023-09-01 DOI: 10.1007/s11019-023-10149-9

James Wilson

{"title":"What makes a health system good? From cost-effectiveness analysis to ethical improvement in health systems.","authors":"James Wilson","doi":"10.1007/s11019-023-10149-9","DOIUrl":"https://doi.org/10.1007/s11019-023-10149-9","url":null,"abstract":"Fair allocation of scarce healthcare resources has been much studied within philosophy and bioethics, but analysis has focused on a narrow range of cases. The Covid-19 pandemic provided significant new challenges, making powerfully visible the extent to which health systems can be fragile, and how scarcities within crucial elements of interlinked care pathways can lead to cascading failures. Health system resilience, while previously a key topic in global health, can now be seen to be a vital concern in high-income countries too. Unfortunately, mainstream philosophical approaches to the ethics of rationing and prioritisation provide little guidance for these new problems of scarcity. Indeed, the cascading failures were arguably exacerbated by earlier attempts to make health systems leaner and more efficient. This paper argues that health systems should move from simple and atomistic approaches to measuring effectiveness to approaches that are holistic both in focusing on performance at the level of the health system as a whole, and also in incorporating a wider range of ethical concerns in thinking about what makes a health system good.","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":"26 3","pages":"351-365"},"PeriodicalIF":2.1,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10175915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10432252","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

Intentional presence and the accompaniment of dying patients. 有意陪伴濒死病人。

IF 2.1 2区哲学

Medicine Health Care and Philosophy Pub Date : 2023-09-01 DOI: 10.1007/s11019-023-10161-z

Alexandra Guité-Verret, Mélanie Vachon, Dominique Girard

引用次数: 0

What's wrong with medical black box AI? 医疗黑匣子AI出了什么问题？

IF 2.1 2区哲学

Medicine Health Care and Philosophy Pub Date : 2023-09-01 DOI: 10.1007/s11019-023-10168-6

Bert Gordijn, Henk Ten Have

引用次数: 0

Temporal uncertainty in disease diagnosis. 疾病诊断的时间不确定性。

IF 2.1 2区哲学

Medicine Health Care and Philosophy Pub Date : 2023-09-01 DOI: 10.1007/s11019-023-10154-y

Bjørn Hofmann

{"title":"Temporal uncertainty in disease diagnosis.","authors":"Bjørn Hofmann","doi":"10.1007/s11019-023-10154-y","DOIUrl":"https://doi.org/10.1007/s11019-023-10154-y","url":null,"abstract":"There is a profound paradox in modern medical knowledge production: The more we know, the more we know that we (still) do not know. Nowhere is this more visible than in diagnostics and early detection of disease. As we identify ever more markers, predictors, precursors, and risk factors of disease ever earlier, we realize that we need knowledge about whether they develop into something experienced by the person and threatening to the person's health. This study investigates how advancements in science and technology alter one type of uncertainty, i.e., temporal uncertainty of disease diagnosis. As diagnosis is related to anamnesis and prognosis it identifies how uncertainties in all these fields are interconnected. In particular, the study finds that uncertainty in disease diagnosis has become more subject to prognostic uncertainty because diagnosis is more connected to technologically detected indicators and less closely connected to manifest and experienced disease. These temporal uncertainties pose basic epistemological and ethical challenges as they can result in overdiagnosis, overtreatment, unnecessary anxiety and fear, useless and even harmful diagnostic odysseys, as well as vast opportunity costs. The point is not to stop our quest for knowledge about disease but to encourage real diagnostic improvements that help more people in ever better manner as early as possible. To do so, we need to pay careful attention to specific types of temporal uncertainty in modern diagnostics.","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":"26 3","pages":"401-411"},"PeriodicalIF":2.1,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10425509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10432763","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

From biocolonialism to emancipation: considerations on ethical and culturally respectful omics research with indigenous Australians. 从生物殖民主义到解放:对土著澳大利亚人伦理和文化尊重组学研究的思考。

IF 2.1 2区哲学

Medicine Health Care and Philosophy Pub Date : 2023-09-01 DOI: 10.1007/s11019-023-10151-1

Gustavo H Soares, Joanne Hedges, Sneha Sethi, Brianna Poirier, Lisa Jamieson

{"title":"From biocolonialism to emancipation: considerations on ethical and culturally respectful omics research with indigenous Australians.","authors":"Gustavo H Soares, Joanne Hedges, Sneha Sethi, Brianna Poirier, Lisa Jamieson","doi":"10.1007/s11019-023-10151-1","DOIUrl":"https://doi.org/10.1007/s11019-023-10151-1","url":null,"abstract":"As part of a (bio)colonial project, the biological information of Indigenous Peoples has historically been under scientific scrutiny, with very limited benefits for communities and donors. Negative past experiences have contributed to further exclude Indigenous communities from novel developments in the field of omics research. Over the past decade, new guidelines, reflections, and projects of genetic research with Indigenous Peoples have flourished in Australia, providing opportunities to move the field into a place of respect and ethical relationships. This review explores the ethical and cultural implications of the use of biological samples from Indigenous communities in biomedical research. A structured framework outlining emerging topics of interest for the development of respectful omics research partnerships with Indigenous Australians is presented. This paper highlights aspects related to Indigenous governance, community and individual consent, respectful handling of biological samples, data management, and communication in order to protect Indigenous interests and rights and to promote communities' autonomy.","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":"26 3","pages":"487-496"},"PeriodicalIF":2.1,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10425494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10151005","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

Towards trust-based governance of health data research. 健康数据研究的基于信任的治理。

IF 2.1 2区哲学

Medicine Health Care and Philosophy Pub Date : 2023-06-01 Epub Date: 2023-01-12 DOI: 10.1007/s11019-022-10134-8

Marieke A R Bak, M Corrette Ploem, Hanno L Tan, M T Blom, Dick L Willems

{"title":"Towards trust-based governance of health data research.","authors":"Marieke A R Bak, M Corrette Ploem, Hanno L Tan, M T Blom, Dick L Willems","doi":"10.1007/s11019-022-10134-8","DOIUrl":"10.1007/s11019-022-10134-8","url":null,"abstract":"Developments in medical big data analytics may bring societal benefits but are also challenging privacy and other ethical values. At the same time, an overly restrictive data protection regime can form a serious threat to valuable observational studies. Discussions about whether data privacy or data solidarity should be the foundational value of research policies, have remained unresolved. We add to this debate with an empirically informed ethical analysis. First, experiences with the implementation of the General Data Protection Regulation (GDPR) within a European research consortium demonstrate a gap between the aims of the regulation and its effects in practice. Namely, strictly formalised data protection requirements may cause routinisation among researchers instead of substantive ethical reflection, and may crowd out trust between actors in the health data research ecosystem; while harmonisation across Europe and data sharing between countries is hampered by different interpretations of the law, which partly stem from different views about ethical values. Then, building on these observations, we use theory to argue that the concept of trust provides an escape from the privacy-solidarity debate. Lastly, the paper details three aspects of trust that can help to create a responsible research environment and to mitigate the encountered challenges: trust as multi-agent concept; trust as a rational and democratic value; and trust as method for priority setting. Mutual cooperation in research-among researchers and with data subjects-is grounded in trust, which should be more explicitly recognised in the governance of health data research.","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":"26 2","pages":"185-200"},"PeriodicalIF":2.1,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9835739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9464042","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: 3

"Overestimated technology - underestimated consequences" - reflections on risks, ethical conflicts, and social disparities in the handling of non-invasive prenatal tests (NIPTs). “高估技术——低估后果”——对处理非侵入性产前检查(nipt)的风险、伦理冲突和社会差异的反思。

IF 2.1 2区哲学

Medicine Health Care and Philosophy Pub Date : 2023-06-01 DOI: 10.1007/s11019-023-10143-1

Marion Baldus

{"title":"\"Overestimated technology - underestimated consequences\" - reflections on risks, ethical conflicts, and social disparities in the handling of non-invasive prenatal tests (NIPTs).","authors":"Marion Baldus","doi":"10.1007/s11019-023-10143-1","DOIUrl":"https://doi.org/10.1007/s11019-023-10143-1","url":null,"abstract":"New technologies create new complexities. Since non-invasive prenatal tests (NIPTs) were first introduced, keeping pace with complexity constitutes an ongoing task for medical societies, politics, and practice. NIPTs analyse the chromosomes of the fetus from a small blood sample. Initially, NIPTs were targeted at detecting trisomy 21 (Down syndrome): meanwhile there are sequencing techniques capable of analysing the entire genome of the unborn child. These yield findings of unclear relevance for the child's future life, resulting in new responsibility structures and dilemmas for the parents-to-be.The industry's marketing strategies overemphasize the benefits of the tests while disregarding their consequences. This paper chooses the opposite path: starting with the underestimated consequences, it focuses on adverse developments and downsides. Disparities, paradoxes, and risks associated with NIPTs are illustrated, ethical conflicts described. Indications that new technologies developed to solve problems create new ones are examined. In the sense of critical thinking, seemingly robust knowledge is scrutinized for uncertainties and ambiguities. It analyses how the interplay between genetic knowledge and social discourse results in new dimensions of responsibility not only for parents-to-be, but also for decision-makers, authorities, and professional societies, illustrated by a review of different national policies and implementation programmes. As shown by the new NIPT policy in Norway, the consequences can be startling. Finally, a lawsuit in the United States illustrates how an agency can risk forfeiting its legitimation in connection with the inaccuracy of NIPTs.","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":"26 2","pages":"271-282"},"PeriodicalIF":2.1,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10023216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9456458","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