Perspectives in Biology and Medicine最新文献

Clinicians often focus on measurable health improvements, while patients may prioritize other values, such as autonomy, comfort, and quality of life. This divergence can generate tension between technical excellence and meaningful care. This article introduces "existential competence" as a professional skill for navigating this tension. Existential competence helps patients align health-care decisions with what gives their lives purpose, recognizing health as only one source of human flourishing. Clinicians cultivate this skill by respecting patient choices-healthy or not-that reflect the patient's core values and remain within legal bounds, assuming stable preferences, decision-making capacity, and understanding of the risks. Implementation of existential competence requires expanding health care from risk management to co-stewardship of patients' life narratives, while maintaining clinical accountability. Two approaches are considered: repositioning health as one value among many, versus redefining health to encompass existential well-being. Ultimately, existential competence reorients health care toward helping patients thrive by integrating biomedical expertise with the pursuit of meaningful living.

This article critiques the dominance of chronological age in contemporary society. The first section examines the rise of chronological age, linking it to the development of the modern welfare state. The authors then discuss several alternative non-chronological accounts of age found in anthropological literature and popular culture. This discussion shows that age is malleable and socially produced. Finally, the authors analyze some of the strengths, limitations, and discriminatory potential of chronological age in medicine and education. Just as "gender" and "race" have been redefined, "age" can be reconceptualized as a characteristic that distinguishes individuals by their perceived life course position. This critique of assumptions that age must be chronological and absolute exposes ideological biases underlying assessments of health and normative development.

Drawing on George Saunders's short story "The Semplica-Girl Diaries," this essay explores the concept of degradation in Phase 1 clinical trials. It examines the morality of paying a person to allow themselves to be used instrumentally and how the problem of degradation might be remedied.

This article explores the role in modern medicine for magnanimity, an ancient virtue defined as believing oneself worthy of great things, while being worthy of them. Through analysis of a clinical case involving a seven-month-old infant with congenital heart disease, the authors discuss how hierarchical dynamics in medicine can compromise ethical decision-making and patient care. The case illustrates how some health-care professionals may fail to act in patients' best interests because of an internalized false perception of lower status or authority, a perception that typically emerges in response to domination by others with perceived higher status. The history and concept of magnanimity provides a lens through which to understand what goes wrong in the case and why. The authors suggest how cultivating magnanimity can help health-care professionals meet the ethical challenges of status and hierarchy in medicine more broadly.

Death certificates act as verified records concluding the administrative aspects of a person's life. In the US, the death certificate includes essential biographical information about the decedent, including the manner and cause of death. To some, the cause of death may be a procedural step necessary to obtain a death certificate, and where there is not an ensuing forensic investigation, the cause of death may even seem immaterial. But specificity in determining the cause of death is crucial to epidemiological and public health initiatives and for the maintenance of accurate mortality records. This article argues that inaccuracies in cause of death determinations are harmful: they are detrimental to the professional commitments physicians owe their patients and distort the lived experiences of the deceased. Inaccuracy in vital statistics affects individuals and families by misrepresenting the physiological and biological processes leading to death and potentially altering the deceased person's life story. While there is extensive literature exploring the challenges faced by clinicians in determining the cause of death, this article focuses on modifications made to the cause of death-whether consciously through deliberate intent to conceal, or unconsciously through error or omission-where the death may be socially stigmatizing.

The figure of the "medical clown" is a theologically and anthropologically charged vocation necessary for moral critique and healing in contemporary medicine. Drawing on the Oglala Sioux Heyoka and the circus clown, or holy fool, the authors distinguish between external critics-philosophers and theologians who unmask medicine's principalities through folly-and internal actors-clinicians who subvert dehumanizing logics from within. Against corporate, efficiency-driven models that deform the healing vocation, both roles embody prophetic reversal, exposing absurdities and reorienting practice toward possibilities of redemption that could not otherwise be seen from within the logic of medicine's current priorities and principalities. The holy fool destabilizes the status quo through provocative critique; the Heyoka, grounded in communal trust, rouses through loving contrariness. Together, they witness to medicine's eschatological promises: healing as relational and resistant to commodification. By reclaiming the sacred work of "walking backwards," these clowns and fools invite a re-formation of medical imagination, challenging and shaping practitioners who dwell with suffering to resist the seductions of a system that is forgetting its calling.

This article examines the lived reality of schizophrenia and its treatment as portrayed in Clem and Olivier (Liv) Martini's Bitter Medicine: A Graphic Memoir of Mental Illness (2010), with a focus on how graphic medicine can represent the complexities of subjective experience in the psychiatric health-care system. Drawing on Foucault's critique of disciplinary power in psychiatric institutions, the article explores how the memoir reveals tensions between therapeutic care and systemic control, even after deinstitutionalization. Through El Refaie's idea of visual metaphor and embodiment in comics, Liv's illustrations about his psychiatric suffering are read as more than expressive art that challenges dominant clinical narratives. The article investigates the shift in psychiatric health care in Canada from institutional care to community-based care and the impact of psychopharmaceutical drugs, highlighting the embodied cost of psychiatric treatment. By revealing the social exclusion and economic vulnerability produced by gaps in the implementation of health-care policies, Bitter Medicine critiques the promises of deinstitutionalization. The article illustrates how visual narrative forms can foreground subjective experiences of schizophrenia, while interrogating broader systemic failures in mental health care.

This essay examines the rural mental health crisis through the stories of the author's father, an Iraqi immigrant and sole private psychiatric provider in a rural Michigan town. Moving his clinic in 2023 revealed the strain of practicing where demand far exceeds supply and capacity: long days split between a small hospital and an understaffed clinic, chronic underpayment from Medicaid, and a constant backlog of care. These lived experiences are contextualized through the historic failure of US mental health reform after the 1963 Community Mental Health Act, which has left Community Mental Health Centers (CMHCs) under-resourced and, in many rural counties, the only option. Demographic data on psychiatrist shortages, high suicide and illness burdens, and reimbursement disparities are paired with a patient vignette to illustrate how poverty and insurance work together to hinder treatment and precipitate recurrent crises. The essay argues that incremental workforce expansion alone cannot close rural gaps without such structural fixes as raising Medicaid reimbursement, stabilizing and expanding CMHC financing, aligning residency expansion with rural service incentives, and investing in rural infrastructure that addresses social determinants.

In the 1990s, China experienced an epidemic of HIV/AIDS among poor farmers who sold and were infected by tainted blood and blood product transfusions, not discovered until hundreds of thousands were infected. In 1999, Wuhan University infectious disease physician-scientist Dr. Gui Xi'en visited villages in neighboring Henan province and identified the epidemic. This essay describes how the contributions of one individual-a humble, articulate, and tenacious physician-touched the lives of thousands of patients and health-care providers. His story reveals the virtues of a life that is a compelling call to action in the face of human need and suffering, exemplifying the heart of medicine. Given rampant misinformation and fear surrounding HIV/AIDS, Dr. Gui chose to educate rather than retreat. He welcomed patients whom others turned away, brought real-life cases into classrooms, and trained generations of students to approach medicine with both scientific rigor and human empathy. His work helped shift public understanding and reduce stigma, proving that education is a powerful tool for healing not just bodies, but communities. He is an inspiring figure from whom generations in China and the US could still learn.