Journal of Medicine and Philosophy最新文献

The conventional admiration for supererogatory acts, where individuals sacrifice themselves to aid others, contrasts sharply with the hesitance observed when considering the living donation of vital organs. This article challenges this inconsistency, contending that no relevant moral difference exists between other celebrated supererogatory acts and the act of living vital organ donation. I go beyond the proposed concept of organ donation euthanasia, advocating for the moral permissibility of living vital organ donation, even though one is not facing imminent death from other causes.

Diagnosis, as the statement of the disease from which the patient suffers, is a central element in modern medicine. However, a diagnosis is more than just a statement about an illness aimed at guiding treatment. It is also a powerful speech act with important social and other consequences for its recipient, as several sociologists have observed. In this article, I discuss the nature of the speech act of diagnosis. I then draw on social ontology, in particular Searle's theory about how the social world is constructed, to show how a statement of diagnosis generates an institutional fact about the person diagnosed, and thus how it can have power over its recipient. Next I describe some of the consequences of this in the contexts of somatic medicine and psychiatry, noting the consequences it can have for people's lives beyond those caused by the illness itself.

It has been proposed that technical systems that estimate patient choices and preferences should guide treatment when patients are incapacitated. However, the ethical debate about such Patient Preference Predictors needs conceptual clarity. We distinguish between choices and preferences, between types of preferences, and between preferences over treatments and preferences over how treatment decisions are made. These distinctions show that respect for autonomy can take several forms: respect for a person's explicit choices, for her overall preferences, or for her most central and enduring values. We argue that while Predictors may enhance beneficence, and reduce uncertainty and conflict, they raise normative questions about which preferences should be estimated and respected. In particular, we question the moral relevance of hypothetical choices, as well as the legitimacy of idealizing preferences beyond restored competence. Preferences over decision methods can be instrumental to treatment outcomes but can also be intrinsic. The latter may sometimes conflict with preferences regarding outcomes.

Both advocates and critics of human enhancement technology today agree that it will change fundamental parameters of human existence. This paper explores the ethical dimension of human enhancement from the perspective of Daoism (Daoism is an umbrella under which we have daojia (The lineage of the Dao, or philosophical Daoism) and daojiao (the teachings on the Dao or Daoist religion). In this paper, the discussion is focused on philosophical Daoism represented by Laozi and Zhuangzi in the Pre-Han period and religious Daoism after the Han period to explicate their different views toward technology and human enhancement. English translations of the Daodejing are my own. English quotations from the Zhuangzi text are from Burton Walston's translation.). I contend that Daoist tradition is multifaceted and heterogeneous, encompassing several different outlooks and positions, and thus its views on technology in general and genetic enhancement in particular are much more complicated than a simple answer of yes or no. My discussion focuses on two kinds of Daoism in ancient China; namely, philosophical Daoism represented by Zhuangzi and religious Daoism developed in the later Han period (the firstt-second centuries CE). The paper offers two different accounts of Daoist positions on human enhancement and then discusses their ethical implications.

The ethical issue of conscience rights is a conflict of at least two values: the autonomy of the physician and the autonomy of the patient. The task of commentators is to circumscribe the right to refuse (for the clinician) and the right to request (of the patient) in a way that preserves a healthy pluralism. In arguing for circumscribing each right, one risks assuming a moral claim ab initio, thus the arguments for circumscription are circular. This article argues on non-circular grounds for a wide tolerance for conscientious objections. Argued here is that given philosophical naturalism and evolutionary theory, one should be skeptical of moral claims, especially claims of the sort that one ought to do such and such. If the argument presented here is valid and sound, bioethicists (at least secular ones) should be more skeptical of what one is obligated to do. And that includes being skeptical about what others are obligated to do.

I explore the term "medical complications" (hereafter "complications") by investigating and differentiating the numerous types of events that tend to be described as complications. I distinguish medical errors from medical malpractice by suggesting that the latter involves negligence or breach of duty. I describe both types of events as being "reasonably foreseeable" (even if they tend to only be reasonably preventable in the latter case) in that they tend to occur due to malfunctions, breakdowns of protocols, etc., that can be anticipated. By contrast, force majeure events (e.g., earthquakes, acts of war, floods) are not reasonably foreseeable and not subject to the control of relevant parties. I distinguish between foreground risks and background: the former are those risks that are probabilistically or modally dependent on the particular intervention, whereas the latter are those risks, which are not significantly affected, probabilistically or modally, by the intervention in question. I then propose that complications should be thought of as all and only actualized foreground risks, which are distinct from medical errors and malpractice. I conclude by considering how my view opens the door to consider medical mistakes (often due to overworked clinicians) in a new light.

In the realm of bioethics, discussions on conscientious objection are predominantly categorized into three frameworks: absolutism, the incompatibility thesis, and the compromise account. Advocates of the compromise account attempt to reconcile the principles of absolutism with the incompatibility thesis. Within this framework, there also exist two distinct interpretations. The first is the theory of prima facie right to conscientious objection, which suggests that such objections may leave behind moral residues, necessitating practitioners' referrals to resolve these residues. The second interpretation is the theory of all-things-considered right to conscientious objection, which posits that practitioners must satisfy specific conditions prior to exercising this right, aiming for a compromise that precedes the objection and leaves no moral residues. This article explores the differentiation between virtue-related and impermissible wrongdoings and advocates for a justified conscientious objection based on practitioners' right to commit virtue-related wrongdoings. This stance rejects both absolutism and the incompatibility thesis. It further argues that the theory of all-things-considered right to conscientious objection fares better than the theory of prima facie right. Consequently, it contends that no duty to refer should persist following a conscientious objection.

This paper presents a new view on the moral foundations of the practice of informed consent in clinical medicine. It draws on the ideal of "Hippocratic Consent" and the principle of respect for bodily integrity to develop a justification for informed consent in clinical medicine that does not appeal to the principle of patient autonomy. The paper contends that these two notions, once clarified and appropriately distinguished from autonomy, can explain much of what is valuable in the practice of informed consent in this context. After outlining the advantages of this approach over the standard autonomy-based approach to informed consent, the paper discusses a limited role for the principle of autonomy to play on the margins of clinical medicine, rather than at its core.

A novel method of organ donation after circulatory death called normothermic regional perfusion (NRP) could mitigate the organ shortage crisis and lead to superior outcomes for organ recipients. In NRP, following a pronouncement of death by circulatory criteria, arteries leading to the brain are occluded and abdominal circulation is reinitiated in situ. A prominent objection to NRP maintains that it kills the donor since the arterial occlusion prevents blood from reaching the brain after circulation is reinitiated. Proponents of this objection recommend that transplant surgeons use normothermic machine perfusion (NMP) instead of NRP. In NMP, organs are removed from the donor's body and perfused by machines using nutrient-enriched donor blood following the circulatory determination of death. Here I argue that if NRP kills the donor, then so does NMP. But I argue that features of NMP that clear the practice of the charge of impermissible homicide are also present in NRP. Like NMP, NRP at most preemptively causes the donor to die at the same time he would have died otherwise. It does not hasten death.

A shortage in deceased donor kidneys for transplantation has persisted for decades. In their report "Realizing the Promise of Equity in the Organ Transplantation System," the US National Academies urge the study of "survival benefit" as a potentially equity-promoting criterion for allocating these life-enhancing and preserving organs. But the report generates a dilemma. Its account of equity is amenable to two interpretations. On one interpretation, using survival benefit to determine priority for transplantation would frequently be inequitable. On the other interpretation, equity would fail to justify the use of survival benefit as an allocation criterion. Indeed, the latter reading would leave survival benefit's use no more justified by equity considerations than the use of "longevity matching," a practice that, the report implies, diminishes the chances of transplant for minority candidates. This article puts in doubt whether survival benefit is a tool suited to promote equity in deceased donor kidney allocation.