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The limitations of narrative medicine. 叙事医学的局限性。
Theoretical medicine and bioethics Pub Date : 2025-06-01 Epub Date: 2025-04-16 DOI: 10.1007/s11017-025-09713-6
Rajeev Dutta
{"title":"The limitations of narrative medicine.","authors":"Rajeev Dutta","doi":"10.1007/s11017-025-09713-6","DOIUrl":"https://doi.org/10.1007/s11017-025-09713-6","url":null,"abstract":"<p><p>Narrative medicine has emerged over the past few decades as an exciting approach to medical practice, interweaving the practice of medicine with the practices of literary analysis and reflective writing. It is often claimed that narrative medicine enables practitioners to understand and empathize with patient stories, effectively 'joining' patients in illness. However, I argue that there are reasons to be suspicious of narrative medicine's ability to promote patient-centered care. I begin by questioning the distinctiveness of narrative knowledge, suggesting that it is neither able to be propositional knowledge ('knowledge-that') nor phenomenal/experiential knowledge ('knowledge-what-it's-like'). Then, I consider an alternative reading of narrative medicine, by which narratives are simply ways to structure patient information so that a physician can more readily empathize with the patient. I dismiss this alternative as unsatisfactory given that it depends on either all patients building narratives or physicians imposing narrative structure(s) where one does not inherently exist, thus overriding patients. Finally, I provide possible supplements and alternatives to narrative medicine, proposing that active listening and the removal of systemic barriers to physicians' abilities to provide humanistic care (e.g., lower administrative, profit, and documentation burdens) may be a first step to putting empathetic patient care on the forefront. Ultimately, I think that these efforts (while their fruition may present difficulty), rather than sifting through patient information to construct and elevate narratives, present the opportunity to accurately refocus patient-centered care.</p>","PeriodicalId":94251,"journal":{"name":"Theoretical medicine and bioethics","volume":"46 3","pages":"247-264"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12037677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049187","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}
引用次数: 0
Intending to avoid the treatment burdens only: the doctrine of double effect and withholding or withdrawing life-sustaining treatment. 只打算避免治疗负担：双重效果理论以及暂停或撤消维持生命的治疗。
Theoretical medicine and bioethics Pub Date : 2025-06-01 Epub Date: 2025-03-21 DOI: 10.1007/s11017-025-09712-7
Hitoshi Arima
{"title":"Intending to avoid the treatment burdens only: the doctrine of double effect and withholding or withdrawing life-sustaining treatment.","authors":"Hitoshi Arima","doi":"10.1007/s11017-025-09712-7","DOIUrl":"10.1007/s11017-025-09712-7","url":null,"abstract":"<p><p>It is often believed that withholding or withdrawing life-sustaining treatment is justifiable only when the patient's death is not intended. Also, in accordance with this belief, many argue that the justification of withholding/withdrawing life-sustaining treatment is an application of the doctrine of double effect (hereafter DDE). This paper aims to defend these accounts from some important criticisms. Baruch Brody maintains that most people intend the patient's death when they withhold/withdraw such treatments and that therefore, there are many cases of withholding/withdrawing treatment that are clearly justifiable but rendered unjustifiable by the accounts. Daniel P. Sulmasy asserts that withholding/withdrawing treatment rarely satisfies DDE's fourth condition (that the good effect of the act is proportionately greater than its bad effect) because the goodness of avoiding treatment burden seldom compares to the badness of shortening life. I examine these claims and show that they are mistaken. Central to the discussion in this paper is the idea that those who withhold/withdraw life-sustaining treatment often only intend to avoid the burdens posed by the treatment itself and not to shorten the patient's life. It will be argued that both Brody and Sulmasy are led to an erroneous conclusion because they fail to have an accurate understanding of this idea and its implications.</p>","PeriodicalId":94251,"journal":{"name":"Theoretical medicine and bioethics","volume":" ","pages":"209-230"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12037424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143675120","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}
引用次数: 0
Take another five. A response to Adams. 再喝五杯。对亚当斯的回应。
Theoretical medicine and bioethics Pub Date : 2025-06-01 Epub Date: 2025-03-25 DOI: 10.1007/s11017-025-09711-8
Michiel De Proost, Seppe Segers
{"title":"Take another five. A response to Adams.","authors":"Michiel De Proost, Seppe Segers","doi":"10.1007/s11017-025-09711-8","DOIUrl":"10.1007/s11017-025-09711-8","url":null,"abstract":"","PeriodicalId":94251,"journal":{"name":"Theoretical medicine and bioethics","volume":" ","pages":"269-272"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The role of the enrolling clinician in emergency research conducted under an exception from informed consent. 在知情同意例外情况下进行的急诊研究中，入组临床医生的作用。
Theoretical medicine and bioethics Pub Date : 2025-06-01 Epub Date: 2025-04-01 DOI: 10.1007/s11017-025-09710-9
Katherine Sahan, Ethan Cowan, Mark Sheehan
{"title":"The role of the enrolling clinician in emergency research conducted under an exception from informed consent.","authors":"Katherine Sahan, Ethan Cowan, Mark Sheehan","doi":"10.1007/s11017-025-09710-9","DOIUrl":"10.1007/s11017-025-09710-9","url":null,"abstract":"<p><p>The Exception from Informed Consent (EFIC) permits patient enrolment into therapeutic emergency research where obtaining informed consent is challenging. Yet this fails to resolve a core ethical conflict in the research and has generated controversy. This is because existing justification and practice has relied on applying EFIC per study-a wholesale permission to enroll irrespective of circumstance-instead of per patient. Our novel justification for enrolment centers on applying EFIC per patient, which empowers the enrolling clinician to judge whether to enroll patients with an Exception. This contrasts with the idea that clinician judgment is surplus to the judgements already made by institutions in deciding the research may proceed. Instead, we show that enrolling clinician's judgment is ethically significant and should not be overlooked: attending to this strengthens the research ethically and reduces controversy. There should be a bigger role for the clinician in the research enrolment space.</p>","PeriodicalId":94251,"journal":{"name":"Theoretical medicine and bioethics","volume":" ","pages":"231-246"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12037652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143757110","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}
引用次数: 0
Can AI principlism without explicability be coherent? A response to Segers and De Proost. 没有可解释性的人工智能原则能连贯吗？这是对西格斯和德普罗斯特的回应。
Theoretical medicine and bioethics Pub Date : 2025-06-01 Epub Date: 2025-03-22 DOI: 10.1007/s11017-025-09709-2
Jonathan Adams
{"title":"Can AI principlism without explicability be coherent? A response to Segers and De Proost.","authors":"Jonathan Adams","doi":"10.1007/s11017-025-09709-2","DOIUrl":"10.1007/s11017-025-09709-2","url":null,"abstract":"","PeriodicalId":94251,"journal":{"name":"Theoretical medicine and bioethics","volume":" ","pages":"265-268"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Wellness versus flourishing in medical education: a critique toward a new synthesis. 健康与繁荣的医学教育：对新综合的批判。
Theoretical medicine and bioethics Pub Date : 2025-05-14 DOI: 10.1007/s11017-025-09714-5
Benjamin W Frush, Daniel T Kim, Jeff Fritz, Kristján Kristjánsson
{"title":"Wellness versus flourishing in medical education: a critique toward a new synthesis.","authors":"Benjamin W Frush, Daniel T Kim, Jeff Fritz, Kristján Kristjánsson","doi":"10.1007/s11017-025-09714-5","DOIUrl":"https://doi.org/10.1007/s11017-025-09714-5","url":null,"abstract":"<p><p>In response to the increasingly acknowledged physical, emotional, and psychological challenges of medical education, 'wellness' initiatives have been widely instituted. While the idea of 'wellness' represents a well-intentioned effort to mitigate these stressors, we argue that this notion lacks the moral and philosophical grounding to allow students and trainees to thrive and, on its own, cannot serve as a sufficient goal for medical education reform efforts. We propose the neo-Aristotelian concept of 'flourishing' as a better overarching goal for undergraduate and graduate medical education to pursue in their efforts to better equip their students amidst the challenges of medical school and residency training.</p>","PeriodicalId":94251,"journal":{"name":"Theoretical medicine and bioethics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
FAN, RUIPING, ed. Incentives and Disincentives in Organ Donation: A Multicultural Study Among Beijing, Chicago, Tehran, and Hong Kong. Cham: Springer Nature Switzerland, 2023. 305 pp. £66.67 (cloth); £53.39 (paper). ISBN 3031292383 (cloth); ISBN 3031292405 (paper). 范瑞平主编：《器官捐献的激励与抑制：北京、芝加哥、德黑兰和香港的多元文化研究》。Cham: b施普林格瑞士自然，2023。305页，66.67英镑（布）；£53.39(纸)。ISBN 3031292383（布）；ISBN 3031292405（论文）。
Theoretical medicine and bioethics Pub Date : 2025-05-13 DOI: 10.1007/s11017-025-09715-4
Luis Cordeiro-Rodrigues
{"title":"FAN, RUIPING, ed. Incentives and Disincentives in Organ Donation: A Multicultural Study Among Beijing, Chicago, Tehran, and Hong Kong. Cham: Springer Nature Switzerland, 2023. 305 pp. £66.67 (cloth); £53.39 (paper). ISBN 3031292383 (cloth); ISBN 3031292405 (paper).","authors":"Luis Cordeiro-Rodrigues","doi":"10.1007/s11017-025-09715-4","DOIUrl":"https://doi.org/10.1007/s11017-025-09715-4","url":null,"abstract":"","PeriodicalId":94251,"journal":{"name":"Theoretical medicine and bioethics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Defending a choice-based system for the determination of death. 为基于选择的死亡判定系统辩护。
Theoretical medicine and bioethics Pub Date : 2025-04-01 Epub Date: 2024-10-07 DOI: 10.1007/s11017-024-09689-9
William Choi
{"title":"Defending a choice-based system for the determination of death.","authors":"William Choi","doi":"10.1007/s11017-024-09689-9","DOIUrl":"10.1007/s11017-024-09689-9","url":null,"abstract":"","PeriodicalId":94251,"journal":{"name":"Theoretical medicine and bioethics","volume":" ","pages":"201-204"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142383138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Response to "The conceptual Injustice of the brain death standard". 回应 "脑死亡标准在概念上的不公正"。
Theoretical medicine and bioethics Pub Date : 2025-04-01 Epub Date: 2024-09-28 DOI: 10.1007/s11017-024-09686-y
Grigory Ostrovskiy
{"title":"Response to \"The conceptual Injustice of the brain death standard\".","authors":"Grigory Ostrovskiy","doi":"10.1007/s11017-024-09686-y","DOIUrl":"10.1007/s11017-024-09686-y","url":null,"abstract":"","PeriodicalId":94251,"journal":{"name":"Theoretical medicine and bioethics","volume":" ","pages":"197-199"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142335626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Benjamin's translation as dialectical abduction: a novel epistemic framework for diagnostic hypothesizing. 本雅明的翻译作为辩证溯因：诊断假设的新认知框架。
Theoretical medicine and bioethics Pub Date : 2025-04-01 Epub Date: 2025-02-14 DOI: 10.1007/s11017-025-09698-2
Shalom Schlagman
{"title":"Benjamin's translation as dialectical abduction: a novel epistemic framework for diagnostic hypothesizing.","authors":"Shalom Schlagman","doi":"10.1007/s11017-025-09698-2","DOIUrl":"10.1007/s11017-025-09698-2","url":null,"abstract":"<p><p>In this paper I present a novel understanding of diagnostic hypothesis that draws ideas from Walter Benjamin's work on translation. My framework originates from previous literature that aligns diagnostic hypothesis with Peircean 'abduction.' I argue that the abductive step, rather than being an inference to the best explanation, is a strategic conjecture that is simultaneously interrogative and interpretive. While Peirce places the burden of interpretation solely on semiotic analysis, I develop a form of dialectical abduction that draws on Benjamin's distinction between semiotic and mimetic faculties of language. I further argue that while all abduction functions through language interpretation, diagnostic abduction works not simply as interpretation but is more accurately described as the translation of patient narrative and clinician investigation into the language of clinical medicine. I then analyze diagnostic translation within the dialectical framework for translation described by Benjamin, and use this model to develop suggestions for a methodology of clinical abduction.</p>","PeriodicalId":94251,"journal":{"name":"Theoretical medicine and bioethics","volume":" ","pages":"177-195"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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