Theoretical medicine and bioethics最新文献_第2页

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 : 2026-10-01 Epub 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 ethical nature of total care: a hermeneutic reconstruction of Cicely Saunders' perspective. 全面关怀的伦理本质：西塞莉·桑德斯视角的解释学重建。

Theoretical medicine and bioethics Pub Date : 2026-10-01 Epub Date: 2026-05-20 DOI: 10.1007/s11017-026-09761-6

Ilaria Malagrinò

{"title":"The ethical nature of total care: a hermeneutic reconstruction of Cicely Saunders' perspective.","authors":"Ilaria Malagrinò","doi":"10.1007/s11017-026-09761-6","DOIUrl":"10.1007/s11017-026-09761-6","url":null,"abstract":"Care has become a key concept in the theoretical literature in nursing and various health professions. However, while there is generally an agreement on the purposes of care, the same cannot be said about the nature of care. Clarifying this point is fundamental to analyzing and understanding the conceptual and ethical presuppositions of medical science and healthcare professions and to determining what to focus on to improve the quality of care. In this sense, important help comes from the discipline of palliative care. For the first time in the debate about caring, Cicely Saunders introduced the concept of 'total care.' The perspective of the Hospice Movement's founder is stimulating, even if methodologically complex, precisely because Sauders' thought does not have an exclusively speculative character. However, her writings are deeply imbued, even if not explicitly thematized, with philosophical elements, particularly a practical philosophy that arises from experience and is fascinating precisely because it challenges the traditional thought to imagine new hermeneutic horizons. Thus, the first aim of this paper is to connect these philosophical elements and to propose a critical reconstruction, analysis, commentary, and interpretation of the concept of total care in Saunders' writings. The second objective will be to propose a reflection on the meaning of care, clarifying its profound ethical nature as an act that discerns the best and most appropriate way of being and acting for both the patient and the doctor.","PeriodicalId":94251,"journal":{"name":"Theoretical medicine and bioethics","volume":" ","pages":"405-431"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147978368","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

Likelihood ratios and the dependence of clinical evidence: should individual LRs be taken at face value? 似然比和临床证据的依赖性：是否应该只看表面价值？

Theoretical medicine and bioethics Pub Date : 2026-09-30 DOI: 10.1007/s11017-026-09770-5

Matheus Bento de Souza, José Nunes de Alencar

{"title":"Likelihood ratios and the dependence of clinical evidence: should individual LRs be taken at face value?","authors":"Matheus Bento de Souza, José Nunes de Alencar","doi":"10.1007/s11017-026-09770-5","DOIUrl":"https://doi.org/10.1007/s11017-026-09770-5","url":null,"abstract":"Likelihood ratios (LRs) are often used to quantify the evidential weight of clinical findings. In diagnostic accuracy studies, however, LRs are typically reported for individual findings, not for conjunctions of findings. Since LRs for conjunctions of findings are often unavailable, influential Evidence-Based Diagnosis texts suggest that individual LRs may be multiplied to obtain joint LRs, but only under the assumption of approximate conditional independence. This assumption can be analytically convenient, but often implausible in clinical practice, where findings arise from shared pathophysiological mechanisms. This article examines the plausibility of this assumption and how a hidden dependence structure among clinical findings can affect the LR of their conjunction. To make this possible, we define the Coherence Factor ( <math><mi>Γ</mi></math> ) as the ratio between the association among findings under <math><mi>D</mi></math> and the corresponding association under <math><mrow><mo>¬</mo> <mi>D</mi></mrow> </math> . It makes explicit the hidden dependence structure in the evaluation of joint LRs: it allows one to examine, in a formal way, the plausibility of the independence assumption, without replacing statistical approaches designed to account for it. In particular, this framework supports a more cautious interpretation of individual LRs by showing how using them at face value, whether individually or multiplicatively, presupposes a specific dependence structure, one rarely instantiated in clinical practice. The consequences of this analysis do not depend on whether physicians make calculations at the bedside, since it concerns how individual LRs should be interpreted in a Bayesian framework.","PeriodicalId":94251,"journal":{"name":"Theoretical medicine and bioethics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083521","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 last low whispers revisited: a reply to Sulmasy on palliative sedation. 最后的低声耳语再次响起：对苏玛西关于姑息性镇静的回答。

Theoretical medicine and bioethics Pub Date : 2026-08-01 Epub Date: 2026-06-03 DOI: 10.1007/s11017-026-09762-5

Harrison Lee

{"title":"The last low whispers revisited: a reply to Sulmasy on palliative sedation.","authors":"Harrison Lee","doi":"10.1007/s11017-026-09762-5","DOIUrl":"10.1007/s11017-026-09762-5","url":null,"abstract":"Many ethicists who have opposed euthanasia have nonetheless approved of various practices which have been believed to hasten, or risk hastening, the death of terminally ill and suffering patients. For instance, they have approved of a practice which I shall call 'end-of-life sedation,' or 'EOL sedation.' This practice involves administering drugs with sedating effects to relieve suffering at the end of life. Some have believed that EOL sedation risks hastening death by suppressing respiration in certain cases. The main difference, according to these opponents of euthanasia, is that whereas euthanasia by definition involves an intention to kill, EOL sedation does not. At most, it is argued, EOL sedation foreseeably but unintentionally hastens, or risks hastening death as a byproduct of relieving the patient's suffering while they are still alive. As such, it has been argued that EOL sedation is supported by the rule of double effect (RDE). In his paper, \"The last low whispers of our dead,\" Daniel P. Sulmasy raises objections to a specific form of EOL sedation called 'palliative sedation,' focusing especially on two variants of that practice which have been defended by Timothy Quill and colleagues. Palliative sedation involves intentionally sedating a patient as a means of relieving their suffering rather than foreseeably sedating them as a byproduct of targeting specific symptoms. Sulmasy argues that palliative sedation, so defined, is neither supported by RDE nor permissible. Here it is argued that Sulmasy's criticisms of this practice, and of the specific variants of it which he singles out for special criticism, are unsuccessful.","PeriodicalId":94251,"journal":{"name":"Theoretical medicine and bioethics","volume":" ","pages":"281-298"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13263288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148152866","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

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 : 2026-08-01 Epub 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":"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":"299-322"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","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

Epistemic pluralism and justice at the end of life. 认识多元化与生命终结的正义。

Theoretical medicine and bioethics Pub Date : 2026-08-01 Epub Date: 2026-04-07 DOI: 10.1007/s11017-026-09751-8

Hana Abbasian, Perisa Ashar, Imeth Illamperuma, Tomisin Adebari

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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 : 2026-08-01 Epub Date: 2026-05-07 DOI: 10.1007/s11017-026-09756-3

Nicholas Colgrove

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Clarifying the definition of 'abortion' in law and clinical practice. 明确“堕胎”在法律和临床实践中的定义。

Theoretical medicine and bioethics Pub Date : 2026-08-01 Epub Date: 2026-04-07 DOI: 10.1007/s11017-026-09750-9

Johnny Sakr

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Epistemic justice and the moral status of the dead. 认识正义与死者的道德地位。

Theoretical medicine and bioethics Pub Date : 2026-08-01 Epub Date: 2026-06-01 DOI: 10.1007/s11017-026-09757-2

Piotr Grzegorz Nowak

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

Theoretical medicine and bioethics Pub Date : 2026-08-01 Epub Date: 2026-04-22 DOI: 10.1007/s11017-026-09753-6

Max F Kramer

引用次数: 0