Medicine Health Care and Philosophy最新文献

{"title":"Proxy consent to clinical research participation: how should it be justified?","authors":"Julius Sim, Anthony Wrigley","doi":"10.1007/s11019-026-10326-6","DOIUrl":"10.1007/s11019-026-10326-6","url":null,"abstract":"<p><p>In situations where first-hand, contemporaneous consent cannot be obtained from potential research participants-such as from those who lack competence-consent may be sought from a proxy, such as a family member. Such proxy consent must be shown to have a sound moral justification if it is to be an acceptable alternative to first-hand consent. Two standards traditionally proposed for this purpose are those of substituted judgment and best interests. We describe and discuss the limitations of these two approaches, with particular reference to ways in which the context of research differs from that of clinical practice, where proxy consent has been more widely utilized. Other approaches that expand upon or depart from these traditional justifications are then discussed, namely the authentic life, endorsed life, and substituted interests models, as well as one that grounds proxy consent in a putative obligation to participate in research. Whilst these models obviate some of the limitations of the substituted judgment and best interests approaches, they have shortcomings of their own, and do not take full account of all of the relevant values and motivations that obtain in the context of clinical research. We propose an alternative and, in our view, more fruitful approach to justifying proxy consent to research participation-based on W D Ross's moral intuitionism-that does not rest upon a single moral principle but can accommodate a range of both deontological and consequentialist prima facie values.</p>","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":"465-481"},"PeriodicalIF":3.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13086740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146195896","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":"Can health technologies be \"care optimizers\"? A normative evaluation of digital health technologies in light of postphenomenological reflections.","authors":"Orhan Onder, Ilhan Ilkilic","doi":"10.1007/s11019-026-10337-3","DOIUrl":"10.1007/s11019-026-10337-3","url":null,"abstract":"<p><p>The integration of new technologies such as artificial intelligence (AI) into healthcare has initiated profound changes in clinical practice, reshaping not only clinical workflows but the relational structure of care itself. Among the most significant developments is the transformation of the traditional doctor–patient dyad into a doctor–patient–technology triad. Philosophical studies of technology, especially postphenomenological research, argue that technologies should not be understood as neutral tools but as mediators of perception and action. Building on this perspective, we argue that ethical evaluation must move beyond description toward a normative orientation for understanding how such mediation reshapes care relations. To this end, we draw on postphenomenological theory of technological mediation in relation to contemporary clinical practices and develop a normative evaluative framework grounded in patient wellbeing, understood as an emergent, relational quality of care. Rather than deriving evaluative categories from a single tradition, the framework integrates insights from quality-of-care scholarship and care-ethical perspectives, informed by relational accounts of clinical practice. It operationalizes this orientation across five domains (care quality, patient-centeredness, decision-making, access and communication, and care practices) understood as relational sites where technological mediation can enhance or compromise care. Using clinical decision support systems (CDSS) as an analytically demanding test case, we introduce the concept of the care optimizer as a descriptive-normative category identifying technologies that structure the conditions under which care unfolds. By anchoring evaluation in patient wellbeing and situating technological mediation within a normative horizon, the framework translates postphenomenological insights into ethically actionable guidance and aims to ensure that digital health innovations reinforce, rather than undermine, the moral commitments of medicine.</p>","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":"505-521"},"PeriodicalIF":3.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13086759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147357107","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":"Are Health Nudges (Dis)Empowering?","authors":"Per-Anders Tengland","doi":"10.1007/s11019-025-10322-2","DOIUrl":"10.1007/s11019-025-10322-2","url":null,"abstract":"<p><p>Health nudges have become popular in public health and health promotion, not least in countries that have liberal or libertarian policies. One reason is that nudges aim to change people's health-related behavior in a positive direction without infringing upon their freedom. There are other strategies to try to achieve health. Comparing behavior change and empowerment models, previous research found that empowerment is morally recommendable, both as a strategy and as a goal. Empowered people are good at taking care of their health. Using empowerment as an evaluative model, this paper investigates to what extent nudging as a health-promotion strategy leads to empowerment. Nudging can be empowering insofar as it leads to better health, although its effects on people's empowerment might be rather small, depending on whether the nudge creates a healthy habit or not. However, nudges do not, in general, have positive effects on other empowering factors, such as a person's knowledge, skills, self-confidence, self-esteem, or autonomy, since nudges typically bypass deliberate reflection. Moreover, nudging belongs to a group of manipulative strategies that appear to be detrimental to people's ability for autonomy. Thus, nudges risk being disempowering.</p>","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":"451-463"},"PeriodicalIF":3.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13086823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145960567","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":"Cure as medicine's constitutive aim: a defence of the refined curative thesis.","authors":"Likhwa Ncube","doi":"10.1007/s11019-026-10336-4","DOIUrl":"10.1007/s11019-026-10336-4","url":null,"abstract":"<p><p>Medicine has persisted for thousands of years despite frequent therapeutic failures. What explains its persistence despite its failure to cure? I contend that the Inquiry thesis's view - seeing medicine's \"core business\" as prediction and understanding - rests on an unhelpful conceptual distinction between main goal and core business, along with an implausible \"No Bullshit\" premise. Instead, I support the refined Curative Thesis (RCT): medicine is united by a teleological (constitutive) aim to help the sick through socially organised and accountable interventions, even when cures are uncertain. Using conceptual analysis and analogies from comedy, mining, and policing, I demonstrate that professions can survive repeated failures in their main goals, revealing a symmetry: prediction and explanation often fail as well. This work is innovative in three ways: it discards \"core business\" as a defining tool, introduces a teleological boundary that accommodates epistemic diversity, and redefines prediction and understanding as instrumental goods intrinsic to medicine. It also relates RCT to other recent curative-focused and related accounts, such as Smart (Synthese 201(6):194, 2023); Varga (Science, medicine, and the aims of inquiry, Cambridge University Press, Cambridge, 2024); Stegenga (Care and cure, University of Chicago Press, Chicago, 2018), clarifying their significance.</p>","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":"411-421"},"PeriodicalIF":3.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13086788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147436645","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":"Are you weary of illness? Coping and existential positioning in life with myasthenia gravis.","authors":"Malene Missel, Nanna Witting, Malene Beck","doi":"10.1007/s11019-026-10332-8","DOIUrl":"10.1007/s11019-026-10332-8","url":null,"abstract":"<p><p>This article explores what it means to position oneself existentially in relation to illness weariness in myasthenia gravis. Grounded in phenomenology and informed by autoethnographic principles, the study examines how the body's changing disposition shapes lived meaning and coping in chronic illness. Phenomenological vignettes serve as experiential entry points, followed by reflective interpretation inspired by Havi Carel, Maurice Merleau-Ponty, Drew Leder, and Kay Toombs. Two experiential themes emerge. First, When the body doesn't always follow one's lead anymore shows how myasthenia gravis disrupts habitual rhythm and bodily trust. Bodily hesitation and the oscillation between resistance and responsiveness give rise to illness weariness-an existential modality distinct from physical fatigue or mood. Within this terrain, uncompromisingness appears as a quiet, existential stance; a refusal to let illness fully determine the direction of one's life, expressed through a persistent insistence on participation and dignity. Second, Physical activity and relational support as existential coping practices demonstrates how movement and relationship sustain existential positioning. Physical activity becomes an existential practice through which hope, orientation, and embodied rhythm are maintained, not by erasing illness weariness but by placing it alongside an uncompromising insistence on participation. At the same time, relational support, here exemplified by an attuned neurologist, serves as a subtle relational nudge that grounds and strengthens the will to continue. The study conceptualizes illness weariness and uncompromisingness as a continuum of existential responses shaped by bodily fluctuation and relational context. These insights extend beyond myasthenia gravis and point to the importance of existential attentiveness and relational continuity in clinical care.</p>","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":"323-335"},"PeriodicalIF":3.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13086731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147272487","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":"Chronic pain and unrecognized grief: epistemic barriers to personal and social recognition.","authors":"Christopher Jude McCarroll, Ying-Tung Lin, Dominik Koesling, Claudia Bozzaro","doi":"10.1007/s11019-026-10333-7","DOIUrl":"10.1007/s11019-026-10333-7","url":null,"abstract":"<p><p>What is it to grieve? What is the nature of grief? An intuitive and straightforward answer to these questions, one that will be familiar to all of us, is that grief is an emotional reaction to the death of a close loved one. Grief is intimately connected to bereavement. However, grief can arise in situations beyond the death of a significant other and is revealed to be a much more complex and heterogeneous experience. People can grieve over all sorts of losses. What makes our response to these losses one of grief? We can understand all these losses as involving a loss of life possibilities, which impacts one's practical identity and who one takes oneself to be. Importantly, a close examination of the phenomenology of chronic pain helps illuminate the ways in which it also involves the kind of losses that we can grieve over. The losses involved in experiences of chronic pain impact one's practical identity in ways that can lead to grief. This chronic pain grief remains largely unrecognized, however. We outline four epistemic barriers to recognizing the grief involved in experiences of chronic pain.</p>","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":"371-382"},"PeriodicalIF":3.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13086747/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147379026","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":"Women's pain and psychogenic diagnoses.","authors":"Tiina Carita Rosenqvist, Sara Purinton","doi":"10.1007/s11019-026-10327-5","DOIUrl":"10.1007/s11019-026-10327-5","url":null,"abstract":"<p><p>Healthcare providers often rely on the following sort of concerning reasoning when encountering patients with difficult-to-explain symptoms: in the absence of evidence for a physical cause, the symptoms are presumed to be psychological in origin. In this paper, we take up this concern in the context of chronic pain, with particular attention to how such reasoning disproportionately affects women and how it interacts with the many levels of gender bias in medicine. We first examine the unwarranted inference from diagnostic uncertainty to psychogenic diagnosis and explore how identity prejudice and diagnostic uncertainty interact in clinical practice. We then consider additional contributors to diagnostic uncertainty concerning women's pain: gendered research gaps and male-centered diagnostic paradigms. After outlining the harms associated with psychogenic diagnoses, we consider the objection that such diagnoses might be pragmatically justified. We end by calling for a more nuanced approach to diagnosing and treating chronic pain.​​.</p>","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":"353-369"},"PeriodicalIF":3.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146144082","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":"Humanization by depersonalization: historical contexts of the detainees' hospital during the war in Gaza.","authors":"Y M Barilan","doi":"10.1007/s11019-026-10340-8","DOIUrl":"10.1007/s11019-026-10340-8","url":null,"abstract":"<p><p>Following the massacre on October 7th, 2023, Israel built a field hospital to care for wounded prisoners who were among the perpetrators of that massacre. Since Israel's ground invasion of Gaza, the facility has been caring for captured \"unlawful combatants\". The hospital, which operated for nearly a year is made historically unique by its civilian, voluntary and makeshift structure of care on the medical side, along with the severe security measures imposed upon the patients-detainees. Based on extensive interviews with team members and related documents, this paper narrates the creation of this field hospital in its first five months of operation, its routines of care and key ethical challenges, from the perspective of its healthcare professionals, the hospital's ethics committee and the Israel Ministry of Health. Caregivers are constantly torn between their professional standards and natural empathy, on the one hand, and, on the other, a strong need to distinguish their Hamas patients from all others, including heinous criminals and other Palestinian detainees captured outside the context of the war in Gaza. The hospital team members try to restrain their empathy, usually seeking professional limits between compassion and inhumanity. The second part of the article offers reflections on the peculiarities of the field hospital and the special care ethics developed there, from the perspectives of the biopsychosocial model and the sociological distinction between \"bare life\" and \"political life\". Prison medicine, unlawful combatants, Geneva Convention, biopsychosocial model.</p>","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":"423-438"},"PeriodicalIF":3.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147366855","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":"Building science and subjectivity from flesh. Towards a reconceptualization of neurophenomenology as a contribution to interdisciplinary health research.","authors":"Harald A Wiltsche, Kristin Zeiler","doi":"10.1007/s11019-025-10319-x","DOIUrl":"10.1007/s11019-025-10319-x","url":null,"abstract":"<p><p>Radical neurophenomenology offers new ways to re-thinking subjectivity and objectivity, and the relation between them. More specifically, radical neurophenomenology crucially relies on the notion of constitution to circumvent the pitfalls that were associated with older, dualistic frameworks. Building on existing work, our paper has two primary goals. First, we will argue that Merleau-Ponty's later work provides a suitable framework for elaborating a viable concept of (co-)constitution. As we will discuss, it is especially Merleau-Ponty's notion of the flesh which allows for a better way to understand the concept of constitution. However, our paper extends beyond purely theoretical analysis and interpretation. Our second goal is to illustrate the pragmatic gain of our clarificatory efforts by discussing how a viable concept of constitution should affect and inform the understanding of modern neuroimaging techniques and a qualitative phenomenological philosophy analysis of subjectivity and lived experience, and how this contributes to neurophenomenological inquiries.</p>","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":"293-307"},"PeriodicalIF":3.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13086734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145913434","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":"An overview of African philosophy and implications for nursing and midwifery practice: an African hermeneutic analysis.","authors":"Jonathan Bayuo","doi":"10.1007/s11019-025-10298-z","DOIUrl":"10.1007/s11019-025-10298-z","url":null,"abstract":"<p><p>While nursing and midwifery have long drawn from Western and Eastern philosophies, the transformative potential of African philosophy remains only a recent phenomenon, perpetuating a gap in culturally grounded care paradigms. This scholarship addresses this lacuna by interrogating the nature of African philosophy and its implications for nursing and midwifery practice using an African hermeneutic approach. Six distinct approaches to defining African philosophy emerged. Across these schools, two unifying themes redefine core disciplinary concepts: communitarian personhood, which positions identity as a relational, moral achievement rather than an individual birthright; and holism, which interweaves physical, spiritual, social, and environmental well-being into an indivisible whole.</p>","PeriodicalId":47449,"journal":{"name":"Medicine Health Care and Philosophy","volume":" ","pages":"25-37"},"PeriodicalIF":3.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139009","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}