Blaine J Fowers, Lukas F Novak, Marah Selim, Latha Chandran, Kristján Kristjánsson
{"title":"Contributions of neo-Aristotelian phronesis to ethical medical practice.","authors":"Blaine J Fowers, Lukas F Novak, Marah Selim, Latha Chandran, Kristján Kristjánsson","doi":"10.1007/s11017-024-09695-x","DOIUrl":"10.1007/s11017-024-09695-x","url":null,"abstract":"<p><p>Virtue-based ethics prioritizes phronesis (practical wisdom) because, as rules have become less action-guiding, good judgment (phronesis) becomes more necessary as a guiding meta-virtue. The view of phronesis that MacIntyre proposed in After Virtue (hereafter, AV phronesis) has been applied in medical ethics despite his substantial deviations from his source (Aristotle) in After Virtue. In this paper, we clarify the differences between the neo-Aristotelian and AV phronesis views and argue for a neo-Aristotelian phronesis with four functions (constitutive, adjudicative, emotion regulative, and blueprint). In referring to neo-Aristotelians, we refer to the recent scholars that who hark back strongly to Aristotle and have amended some of Aristotle's less palatable views by adding insights from current empirical science to the domains that he left vague. Then we discuss how AV phronesis and neo-Aristotelian phronesis differ, focusing on the distinction between technical (i.e., alterable means toward patient health such as medication choices) and phronetic (i.e., actions that are inseparable from patient health) actions in medicine. This distinction is understated in AV phronesis, but central to neo-Aristotelian phronesis. Accordingly, the neo-Aristotelian approach makes an important and unique contribution to physician ethical development.</p>","PeriodicalId":94251,"journal":{"name":"Theoretical medicine and bioethics","volume":" ","pages":"121-136"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776159","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}
{"title":"Defining 'Abortion': a call for clarity.","authors":"Nicholas Colgrove","doi":"10.1007/s11017-025-09706-5","DOIUrl":"10.1007/s11017-025-09706-5","url":null,"abstract":"<p><p>In Dobbs v. Jackson, the Supreme Court found that 'the Constitution does not confer a right to abortion.' Rather, individual states must determine whether a right to abortion exists. Following Dobbs, state abortion laws have diverged significantly. This has generated confusion over what the law permits. Consequently, some pregnant women reportedly have not received timely treatment for life-threatening conditions. Clear guidance on abortion policy is essential, therefore, since continued confusion risks lives. Sweeping calls to improve patient access to abortion will not provide clear guidance, however, since 'abortion' is defined differently across jurisdictions. In fact, there are six variables to consider when defining 'abortion': (1) the definition of 'pregnancy,' (2) whether prescribing abortifacients counts as an abortion, (3) whether abortion successfully terminates pregnancy, (4) whether abortion has some characteristic intention, (5) whether providers must know that they likely will harm fetuses, and (6) whether providers must know that their patients are pregnant. States address each variable differently, so 'abortion' means different things across jurisdictions. One may respond that legislators are solely to blame for confusion here, since medical experts, by contrast, possesses a clear definition of 'abortion.' Not so. 'Abortion' is defined inconsistently throughout the medical literature too. As such, both legal and medical domains would benefit from careful discussions of 'abortion.' Attending to the six variables identified here is a good starting place. In this essay, I suggest how best to think about each and propose a definition of 'abortion' well-suited for developing clear abortion policy in a polarized society.</p>","PeriodicalId":94251,"journal":{"name":"Theoretical medicine and bioethics","volume":" ","pages":"137-175"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11953220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694974","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":"Paul Scherz: The Ethics of Precision Medicine: The Problems of Prevention in Healthcare. University of Notre Dame Press: Notre Dame, 2024, 194 pp., $40.00 (hardcover), ISBN: 978-02682-0905-6.","authors":"Benjamin Frush","doi":"10.1007/s11017-025-09708-3","DOIUrl":"https://doi.org/10.1007/s11017-025-09708-3","url":null,"abstract":"","PeriodicalId":94251,"journal":{"name":"Theoretical medicine and bioethics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694975","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}
{"title":"Reviewers, 2024.","authors":"","doi":"10.1007/s11017-025-09697-3","DOIUrl":"https://doi.org/10.1007/s11017-025-09697-3","url":null,"abstract":"","PeriodicalId":94251,"journal":{"name":"Theoretical medicine and bioethics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143485228","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}
{"title":"The limits and possibilities of language: attending to our 'ways with words' in medicine and bioethics.","authors":"Matthew Vest","doi":"10.1007/s11017-025-09699-1","DOIUrl":"10.1007/s11017-025-09699-1","url":null,"abstract":"","PeriodicalId":94251,"journal":{"name":"Theoretical medicine and bioethics","volume":" ","pages":"5-11"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506736","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}
{"title":"Hermeneutics as impediment to AI in medicine.","authors":"Kyle Karches","doi":"10.1007/s11017-025-09701-w","DOIUrl":"10.1007/s11017-025-09701-w","url":null,"abstract":"<p><p>Predictions that artificial intelligence (AI) will become capable of replacing human beings in domains such as medicine rest implicitly on a theory of mind according to which knowledge can be captured propositionally without loss of meaning. Generative AIs, for example, draw upon billions of written sources to produce text that most likely responds to a user's query, according to its probability heuristic. Such programs can only replace human beings in practices such as medicine if human language functions similarly and, like AI, does not rely on meta-textual resources to convey meaning. In this essay, I draw on the hermeneutic philosophy of Hans-Georg Gadamer to challenge this conception of human knowledge. I follow Gadamer in arguing that human understanding of texts is an interpretive process relying on previously received judgments that derive from the human person's situatedness in history, and these judgments differ from the rules guiding generative AI. Human understanding is also dialogical, as it depends on the 'fusion of horizons' with another person to the extent that one's own prejudices may come under question, something AI cannot achieve. Furthermore, artificial intelligence lacks a human body, which conditions human perception and understanding. I contend that these non-textual sources of meaning, which must remain obscure to AI, are important in moral practices such as medicine, particularly in history-taking, physical examination, diagnostic reasoning, and negotiating a treatment plan. Although AI can undoubtedly aid physicians in certain ways, it faces inherent limitations in replicating these core tasks of the physician-patient relationship.</p>","PeriodicalId":94251,"journal":{"name":"Theoretical medicine and bioethics","volume":" ","pages":"31-49"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506732","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}
{"title":"'I am in pain': neuroethics, philosophy of language, and the representation of pain.","authors":"Peter Katz","doi":"10.1007/s11017-025-09700-x","DOIUrl":"10.1007/s11017-025-09700-x","url":null,"abstract":"<p><p>This essay considers the idea of 'representation' and pain in neuroscience, continental philosophy, and analytic philosophy. To do so, it considers two forms of representation: linguistic representation refers to how words stand in for experiences or things, while mental representation involves the mind's internal depiction of external reality. First, I consider how the question of pain may be conveyed as a question of representation through the McGill Pain Quotient. I then turn to phenomenology to consider how pain cuts straight through representation. Pain is simultaneously an extra-mental experience and an introspective phenomenal experience involving the affect of pain and the social expression of that affect. But to illustrate how pain lacks intention, I consider how the term 'representation' in the neuroscience on cognitive empathy for pain obfuscates the affective ontology of pain experiences. Linguistic expression of pain may suggest belief and representational data, while the phenomenological experience centers around the affective and embodied. Ultimately, the response to pain plays out in social acknowledgement, and both linguistic and mental representation offer necessary but insufficient understandings of ethical acknowledgement. To that end, neuroethics can offer naturalist, physicalist grounds to affirm both the analytic and continental theses about pain and language.</p>","PeriodicalId":94251,"journal":{"name":"Theoretical medicine and bioethics","volume":" ","pages":"13-30"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506733","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}
{"title":"Moral bricolage and the emerging tradition of secular bioethics.","authors":"Abram Brummett, Jason T Eberl","doi":"10.1007/s11017-025-09703-8","DOIUrl":"10.1007/s11017-025-09703-8","url":null,"abstract":"<p><p>Public bioethics aims to provide moral guidance on questions of public policy, research, and clinical ethics. However, Alasdair MacIntyre famously opened his seminal work, After Virtue, with a 'disquieting suggestion' that contemporary moral language is in such a state of disorder that securing authoritative moral guidance will not be possible. In Ethics After Babel, Jeffrey Stout responds to MacIntyre's pessimistic description of contemporary moral discourse by developing the idea of moral bricolage, which involves taking stock of the ethical questions that need answering, the available conceptual resources at hand from a variety of traditions (e.g., philosophies, theologies, law), and then reworking them to create a solution. In this essay, we draw upon MacIntyre's insight about tradition and Stout's metaphor of moral bricolage to argue that some works of bioethical consensus are appropriately described as works of moral bricolage that, when analyzed, reveal theoretical insights about an emerging tradition of secular bioethics.</p>","PeriodicalId":94251,"journal":{"name":"Theoretical medicine and bioethics","volume":" ","pages":"67-87"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506734","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}
{"title":"Can bioethics bray? Non-human animals, biosemiotics, and a road to shared decision-making.","authors":"Martin J Fitzgerald","doi":"10.1007/s11017-025-09705-6","DOIUrl":"10.1007/s11017-025-09705-6","url":null,"abstract":"<p><p>The prospect of shared decision-making with animals is an elusive one. Its elusiveness comes largely from how difficult it is to assess the linguistic abilities of animals, whether that be their ability to 'speak' or their ability to maintain propositional values. In this paper, I suggest a path to shared decision-making with animals that attempts to avoid these deadlocks by using resources from biosemiotics and Umwelt theory. I begin with an examination of the general structure of decision-making, demonstrating its future-orientation, comparison of imagined futures, and assessment of what things matter to participants in decision-making. Animals' capability of having things matter to them, due to their residence in Umwelten, offers a means to shared decision-making with animals via a process I call 'imaginative adjuncting.'</p>","PeriodicalId":94251,"journal":{"name":"Theoretical medicine and bioethics","volume":" ","pages":"103-120"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11876207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506731","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":"Bioethics as a language game: probing the quality of moral guidance in principlism.","authors":"Matthew Vest","doi":"10.1007/s11017-025-09702-9","DOIUrl":"10.1007/s11017-025-09702-9","url":null,"abstract":"<p><p>This essay asks what quality of moral guidance is offered via the language of principlism, the lingua franca of bioethics. In particular, I suggest three approaches to principlist language via Kant, Rawls, and Wittgenstein. A 'top down' Kantian view of language would seem to offer 'pure' or 'crystalline' moral guidance as autonomy, beneficence, non-maleficence, and justice function as linguistic links to draw us towards universal values up or out there to engage. While drawing upon Rawls, Beauchamp and Childress differ importantly by citing a universal morality grounded in reflective equilibrium amongst citizens. Principlism, hence, possesses a democratic form where the common morality depends upon a historically consistent majority position; what is 'universal' arises from political 'bottom up' discourses and processes. Wittgenstein, however, offers a notably different view of language that embraces the mystical and aesthetic realities of 'the ethical' while also affirming the grounding of language in everyday contexts. Not unlike the Stoics, language for Wittgenstein is ascetic in that it is a practice, a formative exercise that reveals the humility of language as an immanent 'game' that should nevertheless inspire one towards 'the ethical.'</p>","PeriodicalId":94251,"journal":{"name":"Theoretical medicine and bioethics","volume":" ","pages":"51-65"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11876201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506730","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}