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The self-fulfilling prophecy in medicine. 医学中的自我实现预言。
Theoretical medicine and bioethics Pub Date : 2024-10-01 Epub Date: 2024-08-09 DOI: 10.1007/s11017-024-09677-z
Mayli Mertens
{"title":"The self-fulfilling prophecy in medicine.","authors":"Mayli Mertens","doi":"10.1007/s11017-024-09677-z","DOIUrl":"10.1007/s11017-024-09677-z","url":null,"abstract":"<p><p>This article first describes the mechanism of any self-fulfilling prophecy through discussion of its four conditions: credibility, employment, employment sensitivity, and realization. Each condition is illustrated with examples specific to the medical context. The descriptive account ends with the definition of self-fulfilling prophecy and an expansion on collective self-fulfilling prophecies. Second, the normative account then discusses the moral relevance of self-fulfilling prophecies in medicine. A self-fulfilling prophecy is typically considered problematic when the prediction itself changes the predicted outcome to match the prediction (transformative self-fulfillment). I argue that also self-fulfilling prophecies that do not change the outcome but change the ways in which the outcome was realized (operative self-fulfillment), have significant ethical and epistemic ramifications. Because it is difficult to distinguish, retrospectively, between a transformative and an operative self-fulfilling prophecy, and thus between a false or true positive, it becomes equally difficult to catch mistakes. Moreover, since the prediction necessarily turns out true, there is never an error signal warning that a mistake might have been made. On the contrary, accuracy is seen as the standard for quality assurance. As such, self-fulfilling prophecies inhibit our ability to learn, inviting repetition and exacerbation of mistakes. With the rise of automated diagnostic and prognostic procedures and the increased use of machine learning and artificial intelligence for the development of predictive algorithms, attention to self-fulfilling feedback loops is especially warranted. This account of self-fulfilling prophecies is practically relevant for medical research and clinical practice. With it, researchers and practitioners can detect and analyze potential self-fulfilling mechanisms in any medical case and take responsibility for their ethical and epistemic implications.</p>","PeriodicalId":94251,"journal":{"name":"Theoretical medicine and bioethics","volume":" ","pages":"363-385"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11358258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908764","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 five? A coherentist argument why medical AI does not require a new ethical principle. 五选一？连贯主义论证为什么医学人工智能不需要新的伦理原则。
Theoretical medicine and bioethics Pub Date : 2024-10-01 Epub Date: 2024-06-08 DOI: 10.1007/s11017-024-09676-0
Seppe Segers, Michiel De Proost
{"title":"Take five? A coherentist argument why medical AI does not require a new ethical principle.","authors":"Seppe Segers, Michiel De Proost","doi":"10.1007/s11017-024-09676-0","DOIUrl":"10.1007/s11017-024-09676-0","url":null,"abstract":"<p><p>With the growing application of machine learning models in medicine, principlist bioethics has been put forward as needing revision. This paper reflects on the dominant trope in AI ethics to include a new 'principle of explicability' alongside the traditional four principles of bioethics that make up the theory of principlism. It specifically suggests that these four principles are sufficient and challenges the relevance of explicability as a separate ethical principle by emphasizing the coherentist affinity of principlism. We argue that, through specification, the properties of explicability are already covered by the four bioethical principles. The paper finishes by anticipating an objection that coherent principles could not facilitate technology induced change and are not well-suited to tackle moral differences.</p>","PeriodicalId":94251,"journal":{"name":"Theoretical medicine and bioethics","volume":" ","pages":"387-400"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141294061","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
Flourishing at the end of life. 在生命的尽头绽放光彩
Theoretical medicine and bioethics Pub Date : 2024-10-01 Epub Date: 2024-08-20 DOI: 10.1007/s11017-024-09679-x
Xavier Symons, John Rhee, Anthony Tanous, Tracy Balboni, Tyler J VanderWeele
{"title":"Flourishing at the end of life.","authors":"Xavier Symons, John Rhee, Anthony Tanous, Tracy Balboni, Tyler J VanderWeele","doi":"10.1007/s11017-024-09679-x","DOIUrl":"10.1007/s11017-024-09679-x","url":null,"abstract":"<p><p>Flourishing is an increasingly common construct employed in the study of human wellbeing. But its appropriateness as a framework of wellbeing at certain stages of life is contested. In this paper, we consider to what extent it is possible for someone to flourish at the end of life. People with terminal illness often experience significant and protracted pain and suffering especially when they opt for treatments that prolong life. Certain aspects of human goods, however, that are plausibly constitutive of flourishing-such as meaning and purpose, deep personal relationships, and character and virtue-can be uniquely realised when life is ending. We argue that there is a qualified sense in which one can flourish at the end of life but that one must make important modifications to the criteria implicit in conventional conceptions of flourishing. We close with a discussion of the empirical assessment of wellbeing at the end of life and explore the possibility of introducing a flourishing measure in palliative care practice.</p>","PeriodicalId":94251,"journal":{"name":"Theoretical medicine and bioethics","volume":" ","pages":"401-425"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11358345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142006255","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
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 : 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":"https://doi.org/10.1007/s11017-024-09686-y","url":null,"abstract":"","PeriodicalId":94251,"journal":{"name":"Theoretical medicine and bioethics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-28","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
Should vegans have children? A response to Räsänen. 素食主义者应该生孩子吗？对莱萨宁的回应。
Theoretical medicine and bioethics Pub Date : 2024-08-01 Epub Date: 2024-05-14 DOI: 10.1007/s11017-024-09664-4
Louis Austin-Eames
{"title":"Should vegans have children? A response to Räsänen.","authors":"Louis Austin-Eames","doi":"10.1007/s11017-024-09664-4","DOIUrl":"10.1007/s11017-024-09664-4","url":null,"abstract":"<p><p>Joona Räsänen argues that vegans ought to be anti-natalists and therefore abstain from having children. More precisely, Räsänen claims that vegans who accept a utilitarian or rights-based argument for veganism, ought to, by parity of reasoning, accept an analogous argument for anti-natalism. In this paper, I argue that the reasons vegans have for refraining from purchasing animal products do not commit them to abstaining from having children. I provide novel arguments to the following conclusion: while there is good reason to believe that factory farming results in a net disutility and involves treating non-human animals as mere means, there is not good reason to believe that having children results in a net disutility or involves treating the children as mere means. Subsequently, I respond to what I take to be Räsänen's underlying reasoning-that vegans are committed to abstaining from other practices which cause unnecessary suffering. I respond by arguing that this is plausibly false as various practices which cause unnecessary suffering are likely permissible, whereas factory farming is not.</p>","PeriodicalId":94251,"journal":{"name":"Theoretical medicine and bioethics","volume":" ","pages":"303-319"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11255060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140917522","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
The conceptual injustice of the brain death standard. 脑死亡标准在概念上的不公正。
Theoretical medicine and bioethics Pub Date : 2024-08-01 Epub Date: 2024-05-07 DOI: 10.1007/s11017-024-09663-5
William Choi
{"title":"The conceptual injustice of the brain death standard.","authors":"William Choi","doi":"10.1007/s11017-024-09663-5","DOIUrl":"10.1007/s11017-024-09663-5","url":null,"abstract":"<p><p>Family disputes over the diagnosis of brain death have caused much controversy in the bioethics literature over the conceptual validity of the brain death standard. Given the tenuous status of brain death as death, it is pragmatically fruitful to reframe intractable debates about the metaphysical nature of brain death as metalinguistic disputes about its conceptual deployment. This new framework leaves the metaphysical debate open and brings into focus the social functions that are served by deploying the concept of brain death. In doing so, it highlights the epistemic injustice of medicolegal authorities that force people to uniformly accept brain death as a diagnosis of death based on normative considerations of institutional interests, such as saving hospital resources and organ supplies, rather than empirical evidence of brain death as death, which is insufficient at best and nonexistent at worst. In light of this injustice, I propose the rejection of the uniform standard of brain death in favor of a choice-based system that respects families' individualized views of death.</p>","PeriodicalId":94251,"journal":{"name":"Theoretical medicine and bioethics","volume":" ","pages":"261-276"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140878283","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
Reconsidering the utilitarian link between veganism and antinatalism. 重新考虑素食主义与反生育主义之间的功利联系。
Theoretical medicine and bioethics Pub Date : 2024-08-01 Epub Date: 2024-05-29 DOI: 10.1007/s11017-024-09675-1
Joona Räsänen
{"title":"Reconsidering the utilitarian link between veganism and antinatalism.","authors":"Joona Räsänen","doi":"10.1007/s11017-024-09675-1","DOIUrl":"10.1007/s11017-024-09675-1","url":null,"abstract":"","PeriodicalId":94251,"journal":{"name":"Theoretical medicine and bioethics","volume":" ","pages":"321-323"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162789","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
Using curiosity to render the invisible, visible. 用好奇心让无形变得有形。
Theoretical medicine and bioethics Pub Date : 2024-08-01 Epub Date: 2024-05-20 DOI: 10.1007/s11017-024-09665-3
Katherine Cheung
{"title":"Using curiosity to render the invisible, visible.","authors":"Katherine Cheung","doi":"10.1007/s11017-024-09665-3","DOIUrl":"10.1007/s11017-024-09665-3","url":null,"abstract":"<p><p>Virtues commonly associated with physicians and other healthcare professionals include empathy, respect, kindness, compassion, trustworthiness, and many more. Building upon the work of Bortolloti, Murphy-Hollies, and others, I suggest that curiosity as a virtue has an integral role to play in healthcare, namely, in helping to make those who are invisible, visible. Practicing the virtue of curiosity enables one to engage with and explore the experiences of patients and contributes toward building a physician-patient relationship of trust. As the perspectives and experiences of patients can be too often dismissed or lost within medical settings, curiosity can allow physicians to deeply know their patients, and thus provide better care. However, caution must be exercised so as to not to venture into inappropriate curiosity, where questions are asked for improper reasons or to help satisfy the personal interest of physicians. Finally, I sketch out two cases-on chronic pain and on vaccine hesitancy-to illustrate where curiosity can play a valuable role.</p>","PeriodicalId":94251,"journal":{"name":"Theoretical medicine and bioethics","volume":" ","pages":"251-259"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141066349","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 irrationality of human confidence that an ageless existence would be better. 人类认为不老的生活会更好的非理性自信。
Theoretical medicine and bioethics Pub Date : 2024-08-01 Epub Date: 2024-06-18 DOI: 10.1007/s11017-024-09674-2
Susan B Levin
{"title":"The irrationality of human confidence that an ageless existence would be better.","authors":"Susan B Levin","doi":"10.1007/s11017-024-09674-2","DOIUrl":"10.1007/s11017-024-09674-2","url":null,"abstract":"<p><p>Transhumanists and their fellow travelers urge humanity to prioritize the development of biotechnologies that would eliminate aging, delivering 'an endless summer of literally perpetual youth.' Aspiring not to age instantiates what philosopher Martha Nussbaum calls the yearning for 'external transcendence,' or the fundamental surpassing of human bounds due to confidence that life without them would be better. Based on Immanuel Kant's account of the parameters of human understanding, I argue that engineering agelessness could not be a rational priority for humanity on the level of public policy. This stance is complemented by an argument focused on individual decision-making in liberal-democratic milieus, where no governing conception of the good is presumed and the first-personal level matters greatly. Here, drawing on philosopher and cognitive scientist Laurie Ann Paul's concept of 'transformative experience,' I maintain that individuals could not 'rationally,' meaning, here, 'prudentially,' say 'yes' to agelessness. Absorbing the irrationality of human zeal to eliminate aging, based on assurance that an ageless existence would be better, should spur a redoubled dedication to human flourishing.</p>","PeriodicalId":94251,"journal":{"name":"Theoretical medicine and bioethics","volume":" ","pages":"277-301"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11255003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141422374","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
Autonomy-based bioethics and vulnerability during the COVID-19 pandemic: towards an African relational approach. 在 COVID-19 大流行期间，基于自主权的生命伦理学与脆弱性：走向非洲关系方法。
Theoretical medicine and bioethics Pub Date : 2024-06-01 Epub Date: 2024-05-25 DOI: 10.1007/s11017-024-09671-5
Mbih Jerome Tosam
{"title":"Autonomy-based bioethics and vulnerability during the COVID-19 pandemic: towards an African relational approach.","authors":"Mbih Jerome Tosam","doi":"10.1007/s11017-024-09671-5","DOIUrl":"10.1007/s11017-024-09671-5","url":null,"abstract":"<p><p>The COVID-19 pandemic has provoked new interest in the notion of vulnerability and in identifying alternative approaches for responding to vulnerable patients and populations during health emergencies. In this paper, I argue that the autonomy-based approach (the most dominant approach in bioethics) to responding to vulnerability during health emergencies is deficient because it focuses only on the interests, values, and decisions of the individual patient. It overly emphasizes respect for autonomy and not respect for the patient as it does not consider the patient as a social and relational agent. Indeed, relational approaches to autonomy like the feminist and indigenous sub-Saharan African ethical approaches are promising alternatives. In this essay, I use the indigenous African relational approach to autonomy as an example of an alternative method which can be used to respond to vulnerability during a global health emergency like COVID-19.</p>","PeriodicalId":94251,"journal":{"name":"Theoretical medicine and bioethics","volume":" ","pages":"183-197"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141094833","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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