Philosophy, ethics, and humanities in medicine : PEHM最新文献

{"title":"Commentary: patient well-being and individual outcomes in the medical practice: impulses from philosophy.","authors":"Gernot Rüter,&nbsp;Thomas Fröhlich","doi":"10.1186/s13010-019-0071-x","DOIUrl":"https://doi.org/10.1186/s13010-019-0071-x","url":null,"abstract":"<p><p>In an everyday private practice setting, regularly also existential topics will emerge from doctor-patient encounters. These are often questions of coping with life and lifestyle. To enable a thorough discussion of such topics, an implicit, and sometimes also explicit reference to a philosophical background is needed. Philosophical concepts to be used in this realm are discussed. An individual patient-doctor interaction is used as an example to demonstrate the doctor's choice of hermeneutical and phenomenological philosophical concepts.</p>","PeriodicalId":520749,"journal":{"name":"Philosophy, ethics, and humanities in medicine : PEHM","volume":" ","pages":"2"},"PeriodicalIF":1.9,"publicationDate":"2019-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s13010-019-0071-x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36910314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dialectics of mindfulness: implications for western medicine.","authors":"Sebastian Sauer,&nbsp;Siobhan Lynch,&nbsp;Harald Walach,&nbsp;Niko Kohls","doi":"10.1186/1747-5341-6-10","DOIUrl":"https://doi.org/10.1186/1747-5341-6-10","url":null,"abstract":"<p><p>Mindfulness as a clinical and nonclinical intervention for a variety of symptoms has recently received a substantial amount of interest. Although the application of mindfulness appears straightforward and its effectiveness is well supported, the concept may easily be misunderstood. This misunderstanding may severely limit the benefit of mindfulness-based interventions. It is therefore necessary to understand that the characteristics of mindfulness are based on a set of seemingly paradoxical structures. This article discusses the underlying paradox by disentangling it into five dialectical positions - activity vs. passivity, wanting vs. non-wanting, changing vs. non-changing, non-judging vs. non-reacting, and active acceptance vs. passive acceptance, respectively. Finally, the practical implications for the medical professional as well as potential caveats are discussed.</p>","PeriodicalId":520749,"journal":{"name":"Philosophy, ethics, and humanities in medicine : PEHM","volume":" ","pages":"10"},"PeriodicalIF":1.9,"publicationDate":"2011-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1747-5341-6-10","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40087141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A funny thing happened on the way to the journal: a commentary on Foucault's ethics and Stuart Murray's \"Care of the self\".","authors":"Madeleine J Murtagh","doi":"10.1186/1747-5341-3-2","DOIUrl":"https://doi.org/10.1186/1747-5341-3-2","url":null,"abstract":"<p><p>Stuart Murray's 'Care and the self: biotechnology, reproduction, and the good life' utilizes Foucault's \"care of the self\" to examine health domains in its title. The present author discusses three important articulations of concern with the Foucauldian concepts of care of the self that are absent in the work of Murray and others: first, the voluntarism and individualism inherent in ideas about care of the self; second, the absence of the interactional and relational; and, third, the perpetuation of the interpretation of Foucault's concept of governmentality, 'the conduct of conduct', as primarily coercive.</p>","PeriodicalId":520749,"journal":{"name":"Philosophy, ethics, and humanities in medicine : PEHM","volume":" ","pages":"2"},"PeriodicalIF":1.9,"publicationDate":"2008-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1747-5341-3-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41063318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why the way we consider the body matters - reflections on four bioethical perspectives on the human body.","authors":"Silke Schicktanz","doi":"10.1186/1747-5341-2-30","DOIUrl":"https://doi.org/10.1186/1747-5341-2-30","url":null,"abstract":"<p><strong>Background: </strong>Within the context of applied bioethical reasoning, various conceptions of the human body are focused upon by the author in relation to normative notions of autonomy.</p><p><strong>Results: </strong>The author begins by descriptively exploring some main positions in bioethics from which the \"body\" is conceptualized. Such positions conflict: the body is that which is constitutive of the individual's experience and perception, or it is conceived of materially or mechanistically; or as a constructed locus, always historically and culturally transformed. The author goes on to suggest a methodological approach that dialectically considers embodiment from four different perspectives: as bodily self-determination, as respect for the bodily unavailability of the other, as care for bodily individuality; and lastly, as acknowledgement of bodily-constituted communities. These four perspectives encompass autonomy in two of its main interpretations: as the capability of a person to act independent of external forces, and as the moral ideal of pursuing individual wishes by means of role distance, self-limitation and universalization. Various bioethical cases are utilized to show how the four perspectives on the body can complement one another.</p><p><strong>Conclusion: </strong>The way we consider the body matters. The author's dialectical method allows a premise-critical identification and exploration of bioethical problems concerning the body. The method is potentially applicable to other bioethical problems.</p>","PeriodicalId":520749,"journal":{"name":"Philosophy, ethics, and humanities in medicine : PEHM","volume":" ","pages":"30"},"PeriodicalIF":1.9,"publicationDate":"2007-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1747-5341-2-30","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41049559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The ethics of donation and transplantation: are definitions of death being distorted for organ transplantation?","authors":"Ari R Joffe","doi":"10.1186/1747-5341-2-28","DOIUrl":"https://doi.org/10.1186/1747-5341-2-28","url":null,"abstract":"<p><p>A recent commentary defends 1) the concept of 'brain arrest' to explain what brain death is, and 2) the concept that death occurs at 2-5 minutes after absent circulation. I suggest that both these claims are flawed. Brain arrest is said to threaten life, and lead to death by causing a secondary respiratory then cardiac arrest. It is further claimed that ventilation only interrupts this way that brain arrest leads to death. These statements imply that brain arrest is not death itself. Brain death is a devastating state that leads to death when intensive care, which replaces some of the brain's vital functions such as breathing, is withdrawn and circulation stops resulting in irreversible loss of integration of the organism. Circulatory death is said to occur at 2-5 minutes after absent circulation because, in the context of DCD, the intent is to not attempt reversal of the absent circulation. No defense of this weak construal of irreversible loss of circulation is given. This means that patients in identical physiologic states are dead (in the DCD context) or alive (in the resuscitation context); the current state of death (at 2-5 minutes) is contingent on a future event (whether there will be resuscitation) suggesting backward causation; and the commonly used meaning of irreversible as 'not capable of being reversed' is abandoned. The literature supporting the claim that autoresuscitation does not occur in the context of no cardiopulmonary resuscitation is shown to be very limited. Several cases of autoresuscitation are summarized, suggesting that the claim that these cases are not applicable to the current debate may be premature. I suggest that brain dead and DCD donors are not dead; whether organs can be harvested before death from these patients whose prognosis is death should be debated urgently.</p>","PeriodicalId":520749,"journal":{"name":"Philosophy, ethics, and humanities in medicine : PEHM","volume":" ","pages":"28"},"PeriodicalIF":1.9,"publicationDate":"2007-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1747-5341-2-28","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41034058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The ethics of clinical innovation in psychopharmacology: Challenging traditional bioethics.","authors":"S Nassir Ghaemi,&nbsp;Frederick K Goodwin","doi":"10.1186/1747-5341-2-26","DOIUrl":"https://doi.org/10.1186/1747-5341-2-26","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To assess the scientific and ethical basis for clinical innovation in psychopharmacology.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a literature review, utilizing MEDLINE search and bibliographic cross-referencing, and historical evidence regarding the discovery and development of new medications in psychiatry. Clinical innovation was defined as use of treatments in a clinical setting which have not been well-proven in a research setting.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Empirical data regarding the impact of clinical innovation in psychopharmacology are lacking. A conceptual and historical assessment of this topic highlights the ethical and scientific importance of clinical innovation. Ethically, it touches a borderline that, in our judgment, is not adequately framed in contemporary mainstream bioethics. Currently, research is viewed as not at all benefiting the patients who participate in it, while clinical care is viewed as being solely for the benefit of patients. Clinical innovation straddles these two worlds, uncomfortably at times. While many argue that clinical innovation should either be avoided or folded into research projects, we argue that clinical innovation is necessary for progress in psychopharmacology research, and that it can prosper best when guided by the following ethical principles: 1.) The treatment should be based on a viable hypothesis. 2.) Whenever possible, one's clinical observations should be reported so they can be evaluated by the scientific community. 3.) One should be willing to report unexpected observations of drug effects. 4.) A high standard of informed consent should be maintained. Again, this proposal goes against the standard view among bioethicists that research and clinical care are categorically opposed activities, as made clear by the either-or dichotomy of the Belmont Report on bioethics. This approach has so polarized our profession into clinicians versus researchers, that many clinicians will not apply new knowledge produced by clinical research until it eventually gets incorporated into formal treatment guidelines, while researchers have little to guide them as to what kind of new knowledge it is most important to provide.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Summary: &lt;/strong&gt;Clinical innovation brings out the ambiguities in our current ethical conceptions of research versus clinical care. Yet, historically, clinical innovation has been an important contributor to progress in psychopharmacology. We argue that clinical innovation should not be discouraged, but rather it should occur under certain ethical conditions.\"Almost everyone can and should do research...because almost everyone has a unique observational opportunity at some time in his life which he has an obligation to record.... If one considers the fundamental operations or methods of research, one immediately realizes that most people do research at some time or another, except that they do not call their activity by that name. T","PeriodicalId":520749,"journal":{"name":"Philosophy, ethics, and humanities in medicine : PEHM","volume":" ","pages":"26"},"PeriodicalIF":1.9,"publicationDate":"2007-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1747-5341-2-26","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41026700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Framework for a new dialogue between psychoanalysis and neurosciences: is the combined neuro-psychoanalytic approach the missing link?","authors":"Grigoris Vaslamatzis","doi":"10.1186/1747-5341-2-25","DOIUrl":"https://doi.org/10.1186/1747-5341-2-25","url":null,"abstract":"<p><p>Freud's legacy deriving from his work The project for a scientific psychology (1895) could give a new impetus to the dialogue between psychoanalysis and neurosciences. A rapproachment phase is warrented. Based on the work of psychoanalysts who are themselves neuroscientists (such as Mauro Mancia, Martha Koukkou and Harold Shevrin) or have a long term dialogue with neuroscientists (Arnold Modell), three points of epistemological congruence are described: 1. dualism is no longer a satisfactory solution 2. cautions for the centrality of interpretation (hermeneutics) 3. the self-criticism of neuroscientists.</p>","PeriodicalId":520749,"journal":{"name":"Philosophy, ethics, and humanities in medicine : PEHM","volume":" ","pages":"25"},"PeriodicalIF":1.9,"publicationDate":"2007-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1747-5341-2-25","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41008663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The United States Revised Uniform Anatomical Gift Act (2006): new challenges to balancing patient rights and physician responsibilities.","authors":"Joseph L Verheijde,&nbsp;Mohamed Y Rady,&nbsp;Joan L McGregor","doi":"10.1186/1747-5341-2-19","DOIUrl":"https://doi.org/10.1186/1747-5341-2-19","url":null,"abstract":"<p><p>Advance health care directives and informed consent remain the cornerstones of patients' right to self-determination regarding medical care and preferences at the end-of-life. However, the effectiveness and clinical applicability of advance health care directives to decision-making on the use of life support systems at the end-of-life is questionable. The Uniform Anatomical Gift Act (UAGA) has been revised in 2006 to permit the use of life support systems at or near death for the purpose of maximizing procurement opportunities of organs medically suitable for transplantation. Some states have enacted the Revised UAGA (2006) and a few of those have included amendments while attempting to preserve the uniformity of the revised Act. Other states have introduced the Revised UAGA (2006) for legislation and remaining states are likely to follow soon. The Revised UAGA (2006) poses challenges to the Patient Self Determination Act (PSDA) embodied in advance health care directives and individual expression about the use of life support systems at the end-of-life. The challenges are predicated on the UAGA revising the default choice to presumption of donation intent and the use of life support systems to ensure medical suitability of organs for transplantation. The default choice trumps the expressed intent in an individual's advance health care directive to withhold and/or withdraw life support systems at the end-of-life. The Revised UAGA (2006) overrides advance directives on utilitarian grounds, which is a serious ethical challenge to society. The subtle progression of the Revised UAGA (2006) towards the presumption about how to dispose of one's organs at death can pave the way for an affirmative \"duty to donate\". There are at least two steps required to resolve these challenges. First, physicians and hospitals must fulfill their responsibilities to educate patients on the new legislations and document their preferences about the use of life support systems for organ donation at the end-of-life. Second, a broad based societal discussion must be initiated to decide if the Revised UAGA (2006) infringes on the PSDA and the individual's right of autonomy. The discussion should also address other ethical concerns raised by the Revised UAGA (2006), including the moral stance on 1) the interpretation of the refusal of life support systems as not applicable to organ donation and 2) the disregarding of the diversity of cultural beliefs about end-of-life in a pluralistic society.</p>","PeriodicalId":520749,"journal":{"name":"Philosophy, ethics, and humanities in medicine : PEHM","volume":" ","pages":"19"},"PeriodicalIF":1.9,"publicationDate":"2007-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1747-5341-2-19","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40958802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}