Theoretical medicine and bioethics最新文献

Promoting deceased organ donation: should familist incentives be adopted in Islamic regions? 促进死者器官捐献：伊斯兰地区应采取家庭主义激励措施吗？

Theoretical medicine and bioethics Pub Date : 2026-06-01 Epub Date: 2026-03-03 DOI: 10.1007/s11017-026-09746-5

Sanwar Siraj, Ruiping Fan

引用次数: 0

The importance of enworlded selfhood for understanding chronic pain-related suffering. 赋予自我对于理解慢性疼痛相关痛苦的重要性。

Theoretical medicine and bioethics Pub Date : 2026-06-01 Epub Date: 2026-03-03 DOI: 10.1007/s11017-026-09747-4

Fredrik Svenaeus

{"title":"The importance of enworlded selfhood for understanding chronic pain-related suffering.","authors":"Fredrik Svenaeus","doi":"10.1007/s11017-026-09747-4","DOIUrl":"10.1007/s11017-026-09747-4","url":null,"abstract":"In the research and literature on pain-related suffering, a difference has recently been made between suffering processes of the minimal self in contrast to the hardships of the narrative self. This article proposes that an in-between layer of selfhood needs to be distinguished and studied to understand pain-related suffering in a more thorough manner: the enworlded self. Pain-related suffering is a complex phenomenon involving mood-related processes and everyday challenges on at least three different levels: lived bodily experiences, lifeworld matters, and questions about personal identity. These three different levels correspond to three connected aspects of layered selfhood: the minimal self, the enworlded self, and the narrative self. By using a published memoire focusing on chronic pain experiences, this article attempts to enlighten the middle ground of enworlded selfhood and also identifies two different regions of the lifeworld in which the damaging and alienating experiences take their toll: the work-world and the family-world. In addition, a third region of the lifeworld is identified: the patient-world, a region which is formed and expands as the chronic-pain sufferer searches for medical-professional advice and assistance. By addressing the three different layers of selfhood and how they interact in the everyday life of the patient, chronic-pain suffering can be better understood and, also, possibly alleviated by taking appropriate measures that fit the attuned pattern of the pain experiences of each individual.","PeriodicalId":94251,"journal":{"name":"Theoretical medicine and bioethics","volume":" ","pages":"213-230"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13102727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147350224","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

An inability-based account of psychiatric harm. 一种基于残疾的精神伤害的描述。

Theoretical medicine and bioethics Pub Date : 2026-06-01 Epub Date: 2026-03-23 DOI: 10.1007/s11017-026-09749-2

Luca Malatesti

引用次数: 0

A structured analysis of the concept of brain death. 对脑死亡概念的结构化分析。

Theoretical medicine and bioethics Pub Date : 2026-06-01 Epub Date: 2026-03-21 DOI: 10.1007/s11017-026-09748-3

Rainer J Beckmann

引用次数: 0

On the method of diagnosis. 论诊断方法。

Theoretical medicine and bioethics Pub Date : 2026-06-01 Epub Date: 2026-03-12 DOI: 10.1007/s11017-026-09741-w

Ammar Naqvi

{"title":"On the method of diagnosis.","authors":"Ammar Naqvi","doi":"10.1007/s11017-026-09741-w","DOIUrl":"10.1007/s11017-026-09741-w","url":null,"abstract":"Diagnosis is a foundational task in clinical medicine, yet its reasoning structure remains under-explained in medical education. This paper presents a five-step model of diagnostic reasoning that analyses the epistemic foundation of diagnosis: namely, the structured process by which clinicians construct coherence under constraint. The model describes diagnosis as a disciplined convergence from presenting data toward an explanatory frame that is internally consistent, pathophysiologically plausible, and resistant to contradiction. Grounded in coherence-based epistemology and abductive inference, the framework clarifies how clinicians move from presentation to working diagnosis through five recursive phases: problem framing, perspective construction, constraint application, stabilisation, and clarification. It integrates, rather than replaces, existing approaches-such as dual-process theory, illness script development, and Bayesian updating-by making their underlying reasoning structure explicit and teachable. The model serves as a scaffold for reasoning transparency, structured feedback, and reflective practice. It provides coherence criteria for assessing diagnostic thought and supports formative instruction across simulation, objective structured clinical examination (OSCE), and bedside contexts. While awaiting empirical validation, the present framework offers a theoretical foundation for studying how diagnostic coherence develops and can be taught. In this account, diagnosis is not defined by classification or probability alone, but by the clinician's capacity to construct and sustain an explanatory model that coheres with evidence and contextual constraints.","PeriodicalId":94251,"journal":{"name":"Theoretical medicine and bioethics","volume":" ","pages":"149-194"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147446579","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

Correspondence on "defining 'abortion'": response to Sakr. 关于“定义‘堕胎’”的通信：对萨克尔的答复。

Theoretical medicine and bioethics Pub Date : 2026-05-07 DOI: 10.1007/s11017-026-09756-3

Nicholas Colgrove

引用次数: 0

A shared grammar: a counterfactual dialogue between disease and illness. 共享的语法：疾病与疾病之间的反事实对话。

Theoretical medicine and bioethics Pub Date : 2026-04-28 DOI: 10.1007/s11017-026-09755-4

Roland Rosmond

{"title":"A shared grammar: a counterfactual dialogue between disease and illness.","authors":"Roland Rosmond","doi":"10.1007/s11017-026-09755-4","DOIUrl":"https://doi.org/10.1007/s11017-026-09755-4","url":null,"abstract":"An enduring divide separates the biomedical account of disease from the phenomenological understanding of illness. In this article, I develop a two-level counterfactual model that treats these domains as parallel and formally comparable modes of reasoning: the Clinical Counterfactual (CC) for causal hypotheses and the Experiential Counterfactual (EC) for goal-directed patient claims. Grounded in Biostatistical Theory and operationalized through Homeostatic Property Cluster theory, the framework fixes background conditions for counterfactual assessment and anchors diagnosis in causal-mechanistic disruption rather than population averages alone. An Integration Condition evaluates coherence between levels, and an intervention is favored only if at least one admissible scenario exists in which removing the dysfunction resolves the symptom and enables the realization of the patient's valued activity. Practically, I outline a structured documentation workflow in which CCs and ECs are articulated in parallel and linked by a deviation-analysis protocol that is activated when the two levels diverge. The protocol treats disagreement as diagnostically informative, prompting focused re-examination of causal assumptions, value priorities, and evidential gaps. Conceptually, the framework avoids reducing reasons to causes. It employs counterfactual difference-making as a shared analytical language while preserving distinct explanatory roles at each level. Unlike patient-centered outcome approaches that assess values mainly post hoc, this model integrates patient goals ex ante into causal reasoning itself, with patient-reported outcomes serving as downstream validation rather than as the integrative glue. The result is a disciplined and transparent heuristic for clinical reasoning, particularly under conditions of uncertainty, contestation, and incomplete knowledge, that renders causal inferences, patient goals, and normative assumptions explicit and mutually testable.","PeriodicalId":94251,"journal":{"name":"Theoretical medicine and bioethics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793720","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

Dignity as a social-psychological signal: operationalizing "people like us" in clinical institutions. 尊严作为一种社会心理信号：在临床机构中实现“像我们这样的人”。

Theoretical medicine and bioethics Pub Date : 2026-04-26 DOI: 10.1007/s11017-026-09754-5

Novita Toding, Feriyanto, Elia Firda Mufidah, Agus Setiawan

引用次数: 0

The bioethicist as advisor. 由生物伦理学家担任顾问。

Theoretical medicine and bioethics Pub Date : 2026-04-22 DOI: 10.1007/s11017-026-09753-6

Max F Kramer

引用次数: 0

Safeguarding the dead donor rule in the age of normothermic regional perfusion: organismic unity, irreversibility, and epistemic responsibility. 正常区域灌注时代对死亡供体规则的维护：机体统一性、不可逆性与认知责任。

Theoretical medicine and bioethics Pub Date : 2026-04-16 DOI: 10.1007/s11017-026-09752-7

Ersun Augustinus Kayra

{"title":"Safeguarding the dead donor rule in the age of normothermic regional perfusion: organismic unity, irreversibility, and epistemic responsibility.","authors":"Ersun Augustinus Kayra","doi":"10.1007/s11017-026-09752-7","DOIUrl":"https://doi.org/10.1007/s11017-026-09752-7","url":null,"abstract":"Contemporary controlled donation after circulatory determination of death (cDCD) faces a widening epistemic gap: as resuscitative and perfusion technologies expand the ability to restore regional circulation, the inferential distance between the concept of death and bedside determinations becomes more salient. I defend organismic unity-the permanent loss of the organism's capacity for integrated self-maintenance-as the most defensible biological criterion of death. Yet this criterion is underdeterminate at the bedside: it must be tracked by fallible proxies operating under time pressure and uncertainty. The central claim is modal: if irreversibility is constitutive of death, then protocols must distinguish biological impossibility from practical or policy-based non-intervention. In cDCD contexts, what is often operationally established is not biological irreversibility in the strongest sense but a form of prudential warrant under a normative frame of non-intervention (i.e., permanence). I develop (1) a taxonomy and protocol-facing hierarchy of irreversibility senses, (2) an analysis of what 5-min no-touch intervals can and cannot establish, and (3) a conceptual geography of normothermic regional perfusion (NRP) variants, including the thoracoabdominal hard case. From these epistemic limits I derive second-order safeguards-conservatism, transparency, independence, corrigibility, and public accountability-grounded both in deontic respect for the patient and in the dead donor rule (DDR)'s role as a trust-sustaining commitment device. I conclude that safeguarding the dead donor rule in the age of NRP requires neither metaphysical pretense nor DDR abandonment, but institutional integrity: taxonomic clarity about irreversibility, verifiable cerebral exclusion, and second-order safeguards that make uncertainty governable.","PeriodicalId":94251,"journal":{"name":"Theoretical medicine and bioethics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147701389","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