Medicine Health Care and Philosophy最新文献

Nielsen et al. (2025) have recently argued that the study of epistemic injustice in healthcare is subject to issues that, left unaddressed, threaten the ongoing research programme. One of their central worries is a lack of appropriate empirical evidence to support claims about the ubiquity and seriousness of these epistemic injustices which are commonly endorsed and rehearsed in publications on the topic. As researchers on the project Epistemic Injustice in Healthcare (EPIC), we offer responses to their concerns. While we sympathise with and develop some of their concerns, we express caution regarding others. We argue for an ongoing research agenda which is empirically-informed but maintains a pluralistic approach to research methods and approaches. This, we argue, is necessary in order to accommodate the complex social phenomenon of epistemic injustice in healthcare contexts.

Health systems are increasingly deploying artificial intelligence (AI) tools to deliver procedural information, generate documentation, and support patient-facing "consent" workflows. Although such tools may improve aspects of an already deficient consent process, they create a risk of substitution: treating algorithm-mediated disclosure as ethically equivalent to clinician-led dialogue. This paper performs a conceptual analysis of the "algorithmic covenant" - the implicit expectation that automation will preserve the moral commitments of care. It draws on legal standards of material risk, sociotechnical scholarship on "moral crumple zones", and the tension between managerial and professional ethics. Current AI deployments risk facilitating "responsibility laundering." By prioritising system-level efficiency, institutions may use AI to standardise disclosure while leaving individual clinicians to absorb blame and legal risk for the resulting compliance artefact. This creates a misaligned responsibility structure where the institution controls the content, but the clinician bears the risk, potentially degrading consent into a digitised tick-box exercise. To preserve the ethical integrity of informed consent, AI must be governed strictly as an assistive technology. Policy and workflow design must explicitly assign responsibility for verifying patient understanding to named clinicians, ensuring that automation supports - rather than displaces - the clinician's non-delegable ethical responsibility for informed consent.

Diagnosis is indispensable to medicine, yet diagnostic labels often acquire more authority than their evidence can bear. They come to function as if they named natural entities that explain, authorize, and stabilize clinical action. This article proposes a pragmatic criterion for evaluating that ontological surplus: the Conservativity Test. The test asks which clinical, institutional, explanatory, and self-interpretive consequences follow from treating a diagnostic label as a disease entity, but would not already follow from a label-free base description of symptoms, signs, impairments, risks, mechanisms, values, and lived experience. It does not presuppose that diagnoses are either natural kinds or mere social constructions. Rather, it distinguishes conservative shorthand, justified non-conservativity, and reifying non-conservativity. To avoid circularity, the article develops a minimal-ontological account of base description and connects it with pluralist realism and causal-cluster accounts of kinds. Situating the test within the epistemology of diagnosis, it treats diagnostic labels as revisable causal-explanatory hypotheses and spells out why unjustified ontological surplus carries epistemic, clinical, ethical, and institutional costs. It then identifies four modes of diagnostic reification: explanatory, threshold, nominal-institutional, and looping. Prediabetes, ADHD, and long COVID serve as stress tests for the framework. Phenomenologically, the test protects the lived complexity of illness against both objectifying reduction and epistemic dismissal. Ethically, it offers a participatory audit for clinicians, guideline panels, researchers, and patient communities deciding when diagnostic names should coordinate care, justify intervention, or carry stronger ontological commitments.

This article examines gynecological decision-making in clinical contexts where interventions carry significant implications for fertility and future reproductive possibilities. Conditions such as uterine fibroids, endometriosis, and ovarian cysts are commonly managed through treatments that differ in their potential impact on reproductive capacity, introducing an ethical dimension beyond immediate symptom management. This proposes a theological-bioethical framework of clinical discernment as a conceptual supplement to shared decision-making in reproductive healthcare. Drawing primarily on Karol Wojtyla's personalist philosophy, it advances an account of the human person as an irreducible moral subject whose embodied life carries existential and relational significance. Clinical discernment is understood as a structured ethical orientation that enhances standard biomedical reasoning by integrating attention to value-laden dimensions of fertility-related care. The framework articulates hope as an ethically relevant category referring to the openness of the patient's future possibilities, and fertility as a dimension of embodied personhood with relational meaning beyond biological function. On this basis, the article outlines a fertility-sensitive approach to gynecological care emphasizing proportionality in intervention, clarity and responsibility in risk communication, and holistic patient accompaniment. The paper concludes that integrating clinical discernment into gynecological decision-making offers a philosophically and theologically grounded enrichment of contemporary reproductive healthcare by aligning biomedical practice with a personalist account of moral agency, embodied dignity, and future-oriented care.

Therapeutic transition is commonly framed within biomedical discourse as an instrumental modification aimed at optimizing clinical outcomes. While this perspective is indispensable for clinical decision-making, it captures only a limited dimension of what therapeutic change entails. This article proposes a symbolic-theoretical framework for understanding therapeutic transition as a meaningful reconfiguration of embodied experience rather than as a purely technical adjustment. Drawing on phenomenology, medical anthropology, narrative theory, and medical humanities, the paper reconceptualizes the body as an interpretative field through which therapeutic change is lived, negotiated, and integrated into personal identity. It argues that symbolic interpretation is not an optional supplement to biomedical explanation, but a structural necessity for articulating dimensions of therapeutic experience that resist outcome-based evaluation. On this basis, the article identifies a symbolic architecture of therapeutic transition composed of modulation, regulation, suspension, and persistence. These dimensions do not describe stages or trajectories, but recurring structural patterns through which change is experienced. Their configuration reveals the inherently asymmetrical and partial nature of therapeutic transformation, challenging totalizing models of healing. By foregrounding asymmetry, limits, and finitude, the paper reframes therapeutic transition as a process of meaningful adjustment rather than comprehensive resolution. It argues that attention to symbolic frameworks enriches medical understanding by clarifying the human limits within which therapeutic intervention operates, without opposing empirical medicine or undermining its epistemic authority.

This article investigates the complicated and at times antagonistic meeting of indigenous medical traditions, namely Ayurveda, Unani Tibb and Siddha, with Western biomedicine in British colonial India (c. 1757-1947). Using historiographical arguments, written in conjunction with primary colonial records and postcolonial studies, the article outlines how colonialism undermined indigenous healing traditions through policies that, across the board, excluded them, while taking up those aspects considered useful, economically or scientifically. It analyses the responses of Indian medical practitioners and reformers who engaged with colonial institutions, drew upon classical texts, and created hybrid medical identities. It contends that the colonial medical encounter was not simply a matter of translating information but of negotiating, resisting, and perpetrating forms of knowledge-based violence, the effects of which continue to inform health policy and medical pluralism in present-day South Asia.

Brain pioneering research investigates the clinical utility of implantable neural devices that acquire, process, and translate brain signals to enable individuals to produce actions or effects. There is a scholarly consensus that researchers, funders, and organizations have post-trial obligations to provide participants continued access to and support for implanted neural devices that benefit them. In this paper, we examine the case for post-trial obligations by critically assessing the current limitation that participation in brain-pioneering research be restricted to individuals with debilitating conditions who lack clinically acceptable or proportionate therapeutic alternatives. We consider the possibility of broadening eligibility to include anyone who meets the study's clinical and safety criteria regardless of therapeutic alternatives. Expanding inclusion criteria in this way may help address concerns about the practical feasibility of meeting post-trial obligations and obtaining valid informed consent, while affirming the equal moral respect owed to all prospective participants.

In a recent commentary, Alcalay argues that the concept of epistemic disadvantage provides a useful framework for understanding forms of epistemic harm that may arise even in the absence of epistemic injustice. We agree that this concept identifies an important category of harms associated with warranted asymmetries of expertise and offers valuable insights into both clinical and nosological practices. However, we suggest that, in some clinical situations, clinicians may intentionally maintain interpretative distance from a patient's explicit narrative while fully recognizing its sincerity, meaning, and experiential value. We argue that psychiatric care frequently involves what we call therapeutic asymmetry, i.e., situations in which interpretative distance forms part of the therapeutic process itself. Using examples based on suicidality, loyalty conflicts, mania and AI sycophancy, we aim to show that clinicians may sometimes refrain from accepting patient narratives at face value because suffering can affect capacities for self-understanding, self-deliberation and decision-making. Therapeutic asymmetry highlights the role of alterity, interpretation, and clinical judgment in situations where patients seek assistance precisely because they struggle to understand, interpret, or transform aspects of their own experience.

During the recent years, ISPOR has proposed a number of values that could be taken into account in health technology assessments, for instance when doing an evaluation of what determines society's price for pharmaceutical treatments. These includes values that are not usually considered in health economic evaluation of pharmaceutical pricing, for instance option value, the value of hope and knowing, insurance value, the value of avoiding contagion, and scientific spillover. If these values were included in assessments of pricing of pharmaceutical, it would lead to broadening the cost-effectiveness analysis. We scrutinize the these suggested new value petals of the so-called value flower from two points of views: ethical value theory and the practical implications for a public healthcare system of a European kind, which factors in considerations of traditional cost-effectiveness (primarily in terms of net cost and quality-adjusted life years) and justice (primarily in terms of severity) from the outset. We argue that some of the suggested value petals should not be included in the health economic assessment for several reasons related to value theory or practical considerations in the welfare state: some are mutually conflicting, some do not point out unequivocally positive values, some entails double counting, some are already included in healthcare systems with universal coverage, or can be better handled by other means than by affecting pharmaceutical pricing. A few new petals have potential merit, for instance equity, but much work, both normative and empirical, is required if they should be included in the assessment of pharmaceuticals.

Many nurses fear empathizing too much with patients. They worry that empathy requires letting their guard down, which, when caring for a potentially violent patient, will make them vulnerable to the risk of assault. They worry that as empathy leads the nurse to reckon with who the other is, it will draw out prejudices the nurse might have toward some categories of persons. And nurses worry that empathy will cause them to experience and be burdened too much by the patient's suffering. These fears are perhaps most distilled in nurses' relationships with prisoner/patients, and situating our analysis within such relationships, this paper asks how philosopher Edith Stein's accounts of empathy and community address nurses' fears when caring for patients who may pose danger to them. We argue first that empathy for the prisoner/patient permits nurses to anticipate the patient's future actions, including violent ones. Second, what Stein calls reiterated empathy allows nurses to discern prisoner/patients' appraisal of the nurse's care and to self-correct, as needed, any stigmatizing care. Finally, though the suffering of patients is indeed too much for the nurse to bear alone, following Stein we suggest that through relationships of solidarity the nurse may meaningfully bear that suffering in community, and the community may meaningfully bear that suffering in the nurse. In Edith Stein, who, in addition to studying philosophy, had worked briefly as a nurse, we find resources to address nurses' misconceptions and fears of empathy and to enliven nurses' care.