English law is unambiguous that legal personality, and with it all legal rights and protections, is assigned at birth. This rule is regarded as a bright line that is easily and consistently applied. The time has come, however, for the rule to be revisited. This article demonstrates that advances in fetal surgery and (anticipated) artificial wombs do not marry with traditional conceptions of birth and being alive in law. These technologies introduce the possibility of ex utero gestation, and/or (...) temporary existence ex utero, and consequently developing human beings that are novel to the law. Importantly, therefore, the concepts of birth and born alive no longer distinguish between human beings deserving of legal protection in the way originally intended. Thus, there is a need for reform, for a new approach to determining the legal significance of birth and what being legally alive actually encompasses. Investigating the law of birth is of crucial importance, because of the implications of affording or denying the subjects of new reproductive technologies rights and protections. A determination of the legal status of the subject of fetal surgery or an artificial womb will determine what can and cannot be done to each entity. Moreover, the status afforded to these entities will drastically impact on the freedoms of pregnant women. (shrink)

Fetal reduction is the practice of reducing the number of fetuses in a multiple pregnancy, such as quadruplets, to a twin or singleton pregnancy. Use of assisted reproductive technologies increases the likelihood of multiple pregnancies, and many fetal reductions are done after in vitro fertilisation and embryo transfer, either because of social or health-related reasons. In this paper, I apply Joe Horton’s all or nothing problem to the ethics of fetal reduction in the case of a twin (...) pregnancy. I argue that in the case of a twin pregnancy, there are two intuitively plausible claims: abortion is morally permissible, and it is morally wrong to abort just one of the fetuses. But since we should choose morally permissible acts rather than impermissible ones, the two claims lead to another highly implausible claim: the woman ought to abort both fetuses rather than only one. Yet, this does not seem right. A plausible moral theory cannot advocate such a pro-death view. Or can it? I suggest ways to solve this problem and draw implications for each solution. There are no data in this work. (shrink)

In this open peer commentary, we concur with the three target articles’ analysis and positions on abortion in the special issue on Roe v. Wade as the exercise of reproductive liberty essential for the bioethical commitment to patient autonomy and self-determination. Our proposed OPC augments that analysis by explicating more fully the concept crucial to Roe of fetal personhood. We explain that the development and use of predictive reproductive technologies over the fifty years since Roe has changed the literal (...) image, and thereby the epistemological landscape, through which a prospective parent comes to know the fetus. The logic of Roe required a legal and ethical denial of fetal personhood to prioritize maternal autonomy over claims to fetal moral personhood. Our claim is that such a denial may be more complicated today. The fetal person genetic testing and reproductive imaging now presents to prospective parents has become an increasingly individualized, distinct medicalized picture of a developing person with which a parent can either identify or differentiate. In contrast, the fetal person of Roe was an abstract and vague figure stripped of most human particulars, a pregnancy rather than the specific individualized human entity reproductive technology now presents as a person to prospective parents. We discuss the implications of this shift and call for a more capacious analysis of reproductive ethics that works towards both reproductive and disability justice. (shrink)

A basic criticism of Perry Hendrick's "Even if the fetus is not a person, abortion is immoral: The Impairment Argument," is offered, namely that the reasons why intentionally causing fetal alcohol syndrome is wrong simply do not apply to fetuses and so the "Impairment Argument" against abortion fails.

Is the “act itself” of separating a pregnant woman and her previable child neither good nor bad morally, considered in the abstract? Recently, Maureen Condic and Donna Harrison have argued that such separation is justified to protect the mother’s life and that it does not constitute an abortion as the aim is not to kill the child. In our article on maternal–fetal conflicts, we agree there need be no such aim to kill (supplementing aims such as to remove). However, (...) we argue that to understand “abortion” as performed only where the death of the child is intended is to define the term too narrowly. Respect for the mother, the fetus, and the bond between them goes well beyond avoiding any such aim. We distinguish between legitimate maternal treatments simply aimed at treating or removing a damaged part of the woman and illegitimate treatments that focus harmfully on the fetal body and its presence within the mother’s body. In obstetrics as elsewhere, not all side effects for one subject of intervention can be outweighed by intended benefits for another. Certain side effects of certain intended interventions are morally conclusive. (shrink)

In the article, Twin pregnancy, fetal reduction and the ‘all or nothing problem’, I argued that there is a moral problem in multifetal pregnancy reduction from a twin to a singleton pregnancy. Drawing on Horton’s original version of the ‘all or nothing problem’, I argued that there are two intuitively plausible claims in 2-to-1 MFPR: aborting both fetuses is morally permissible, aborting only one of the twin fetuses is morally wrong. Yet, with the assumption that one should select permissible (...) choice over impermissible choice, the two claims lead to a counter-intuitive conclusion: the woman ought to abort both fetuses rather than only one. It would be odd to promote such a pro-death view. Begović _et al_ discuss my article and offer insightful criticism, claiming, that there is no ‘all or nothing problem’ present in 2-to-1 MFPR. In this short reply, I respond to some of their criticism. (shrink)

in In Harm’s Way: Essays in Honor of Joel Feinberg, edited by Allen Buchanan and Jules Coleman (Cambridge: Cambridge University Press, 1994), pp. 324-343.

Until very recently the question of who owns embryonic or fetal tissue was of limited importance to clinicians, but advances in stem cell research have made such tissue commercially valuable. This chapter examines the legal and ethical basis of claims to property in embryonic or fetal tissue, taking a critical stance.

T.H. Irwin characterizes the reflective equilibrium procedure as one which should not involve ruthless surgery, in a metaphorical sense. I argue that many people will find avoiding this difficult, because they do not conceive or go in for subtle options.

Transoral laser microsurgery applies to the piecemeal removal of malignant tumours of the upper aerodigestive tract using the CO2 laser under the operating microscope. This method of surgery is being increasingly popularised as a single modality treatment of choice in early laryngeal cancers (T1 and T2) and occasionally in the more advanced forms of the disease (T3 and T4), predomi- nantly within the supraglottis. Thomas Kuhn, the American physicist turned philosopher and historian of science, coined the phrase ‘paradigm shift’ (...) in his groundbreaking book The Structure of Scientific Revolutions. He argued that the arrival of the new and often incompatible idea forms the core of a new paradigm, the birth of an entirely new way of thinking. This article discusses whether Steiner and col- leagues truly brought about a paradigm shift in oncological surgery. By rejecting the principle of en block resection and by replacing it with the belief that not only is it oncologically safe to cut through the substance of the tumour but in doing so one can actually achieve better results, Steiner was able to truly revolutionise the man- agement of laryngeal cancer. Even though within this article the repercussions of his insight are limited to the upper aerodigestive tract oncological surgery, his willingness to question other peoples’ dogma makes his contribution truly a genuine paradigm shift. (shrink)

With the current improvement of development towards pharmaceutical, distinctive ultrasound methodologies are open to find the fetal prosperity. It is analyzed with diverse clinical parameters with 2-D imaging and other test. In any case, prosperity desire of fetal heart still remains an open issue due to unconstrained works out of the hatchling, the minor heart appraise and inadequate of data in fetal echocardiography. The machine learning strategies can find out the classes of fetal heart rate which (...) can beutilized for earlier evaluating. With this background, we have utilized Cardiotocographic Fetal heart rate dataset removed from UCI Machine Learning Store for predicting the fetal heart rate health classes. The Prediction of fetal health rate are achieved in six ways. Firstly, the data set is preprocessed with Feature Scaling and missing values. Secondly, exploratory data investigation is done and the dispersion of target feature is visualized. Thirdly, the raw data set is fitted to all the classifiers and the performance is analysed before and after feature scaling. Fourth, the raw data set is subjected to undersampling methods like ClusterCentroids, RepeatedENN, AllKNN, CondensedNearestNeighbour, EditedNearestNeighbours, InstanceHardnessThreshold and NearMiss. Fifth, the undersampled dataset by above mentioned methods are fitted to all the classifiers and the performance is analyzed before and after feature scaling. Sixth, performance analysis is done using metrics like Precision, Recall, F-score, Accuracy and running time. The execution is done using python language under Spyder platform with Anaconda Navigator. Experimental results shows that the Decision Tree classifier tends to retain 98% before and after feature scaling for the underrsampling with EditedNearestNeighbours, RepeatedENN and AllKNN methods. (shrink)

Objective: During the pandemic, elective cases other than those requiring emergency thoracic surgery were postponed. Depending on the magnitude of the impact the pandemic posed on hospitals and clinics, there have been changes in the number and variety of cases of thoracic surgery. The intention behind conducting this study was to share the experiences gained by a thoracic surgery clinic during the pandemic period. Methods: Altogether, 214 patients were included in the study. Patient data that were recorded (...) included those on age, gender, lung pathology, duration of hospital stay, positivity for COVID-19, survival, and causes of death. Results: Of the 214 patients operated on, 12 died during the postoperative period. Eight of these patients died due to their primary disease and one died due to gastrointestinal bleeding, whereas the remaining three patients died due to COVID-19 infection. Conclusions: If opportunities and facilities favorable for the administration of surgical treatment are made available, surgical treatment services can be offered safely to all patients. (shrink)

In this paper I take up (what I call) the pregnancy loss objection to defenses of abortion that deny fetal moral status. Though versions of this objection have been put forth by others—particularly Lindsey Porter’s in a 2015 paper—I argue that the existing versions of the objection are unsuccessful in various ways: failing to explain the ground of moral considerability that would apply to embryos/fetuses in very early pregnancy, lack of clarity about what it means to take grief after (...) miscarriage seriously, and implausible implications regarding pre-embryo and infertility cases. I go on to offer a more plausible version of the objection, which I apply only to mid-pregnancy and fetuses, by drawing on personal narratives of later pregnancy loss and abortion and emphasizing practices that indicate the relevant kind of mourning. I then take up the question of how experience of the sort I have in mind can function as evidence, by situating my version of the objection in a pragmatist ethical view. Finally I consider and respond to some worries about the very idea of taking experience of pregnancy loss to be evidence regarding fetal moral status. (shrink)

The paper identifies the phenomenal rise of increasingly invasive forms of elective cosmetic surgery targeted primarily at women and explores its significance in the context of contemporary biotechnology. A Foucauldian analysis of the significance of the normalization of technologized women's bodies is argued for. Three "Paradoxes of Choice" affecting women who "elect" cosmetic surgery are examined. Finally, two utopian feminist political responses are discussed: a Response of Refusal and a Response of Appropriation.

This review aims to identify (1) sources of knowledge and (2) important themes of the ethical debate related to surgical alteration of facial features in East Asians. This article integrates narrative and systematic review methods. In March 2014, we searched databases including PubMed, Philosopher’s Index, Web of Science, Sociological Abstracts, and Communication Abstracts using key terms “cosmetic surgery,” “ethnic*,” “ethics,” “Asia*,” and “Western*.” The study included all types of papers written in English that discuss the debate on rhinoplasty and (...) blepharoplasty in East Asians. No limit was put on date of publication. Combining both narrative and systematic review methods, a total of 31 articles were critically appraised on their contribution to ethical reflection founded on the debates regarding the surgical alteration of Asian features. Sources of knowledge were drawn from four main disciplines, including the humanities, medicine or surgery, communications, and economics. Focusing on cosmetic surgery perceived as a westernising practice, the key debate themes included authenticity of identity, interpersonal relationships and socio-economic utility in the context of Asian culture. The study shows how cosmetic surgery of ethnic features plays an important role in understanding female identity in the Asian context. Based on the debate themes authenticity of identity, interpersonal relationships, and socio-economic utility, this article argues that identity should be understood as less individualistic and more as relational and transformational in the Asian context. In addition, this article also proposes to consider cosmetic surgery of Asian features as an interplay of cultural imperialism and cultural nationalism, which can both be a source of social pressure to modify one’s appearance. (shrink)

Qualitative evidence concerning the relationship between QoL and a wide range of disabilities suggests that subjective judgments regarding other people’s QoL are wrong more often than not and that such judgments by medical practitioners in particular can be biased. Guided by their desire to do good and avoid harm, surgeons often rely on "the eyeball test" to decide whether a patient will or will not benefit from surgery. But the eyeball test can easily harbor a range of implicit judgments (...) and biases against patients with disabilities, including erroneous assumptions about QoL. We critique the use of the "eyeball" test and offer suggestions to reduce bias and ensure that patients’ values are more consistently prioritized in surgical decision-making. (shrink)

Animal-derived constituents are frequently used in anaesthesia and surgery, and patients are seldom informed of this. This is problematic for a growing minority of patients who may have religious or secular concerns about their use in their care. It is not currently common practice to inform patients about the use of animal-derived constituents, yet what little empirical data does exist indicates that many patients want the opportunity to give their informed consent. First, we review the nature and scale of (...) the problem by looking at the groups who may have concerns about the use of animal-derived constituents in their care. We then summarise some of the products used in anaesthesia and surgery that can contain such constituents, such as anaesthetic drugs, surgical implants and dressings. Finally, we explore the problem of animal-derived constituents and consent using Beauchamp and Childress’ four principles approach, examining issues of autonomy, beneficence, nonmaleficence and justice. Disclosing the use of animal-derived constituents in anaesthesia and surgery is warranted under Beauchamp and Childress’ four principles approach to the problem. Although there exist systemic and practical challenges to implementing this in practice, the ethical case for doing so is strong. The Montgomery ruling presents additional legal reason for disclosure because it entails that patients must be made aware of risks associated with their treatment that they attach significance to. (shrink)

In this article I propose to reframe debates about ideals of emotion in medicine, abandoning the current binary setup of this debate as one between ‘clinical detachment’ and empathy. Inspired by observations from my own field work and drawing on Sky Gross’ anthropological work on rituals of practice as well as Henri Lefebvre’s notion of rhythm, I propose that the normative drive of clinical practice can be better understood through the notion of attunement. In this framework individual types of emotions (...) are not, as such, appropriate or inappropriate, but are evaluated depending on their synchronicity with the specific rhythms of the practice. To set up this proposal, I show how typical arguments about emotions in medicine—what I call emotion-entity focused frameworks—are insufficient. I then draw on ethnographic observations from two orthopaedic departments and interviews with medical practitioners to show (1) how clinical practice is driven by rhythmicity, shaped in the case of orthopaedic surgery by a clinical aim of efficient, controlled intervention, and (2) how clinicians continuously refer to this drive and the flow of rhythms when evaluating inappropriate or problematic emotion. I argue that the use of a rhythm framework rather than ideals of detachment or empathy allows for a sensitivity to the complexity and situation-dependent elements of emotional ideals in clinical practice; and I end by proposing the term ‘attuned concern’—which stresses the importance of regulation and adjustment to circumstances rather than of maintaining a constant distance/involvement—as a more fitting alternative to ‘clinical detachment’. (shrink)

Female Genital Cosmetic Surgery (FGCS) is an umbrella term referring to different procedures including labiaplasty (reducing the length of the labia minora), clitoral hood reduction (reducing excess folds of the clitoral hood), hymenoplasty (building the hymen), labia majora augmentation (reducing the labia majora), vaginoplasty (tightening the vagina), and G-spot amplification (increasing the size and sensitivity of the G-spot). This paper is concerned with “all-or-nothing” approaches to FGCS procedures in women’s healthcare, i.e., those that overemphasize either women’s autonomy so as (...) to defend total accessibility to the procedures, or the oppressive social context affecting women as to defend the total banning of the procedures. What is missing in the literature, however, is an articulation of how both approaches ignore that the practice of autonomy can coexist and coincide with facing up to oppression. This paper first provides an articulation of how these attitudes – seemingly in disagreement – have underlying normative assumptions in common. This articulation further helps frame the so-called tension between oppression and autonomy in a way that highlights unique aspects of FGCS procedures. By contrast, I argue in favor of an “in-between” approach, which takes both phenomena into consideration. I argue that merely emphasizing psychophysical harm is not sufficient to justify the total banning of an FGCS procedure. Instead, identifying patterns of false consciousness, as a form of epistemic injustice and weighing those against other forms of potential harm done to a patient provides a moral basis for a doctor to possibly deny a patient’s consent at face value. This also requires a substantial shift in the doctor patient relationship such that it centers around moral deliberations between the two parties. This deliberative model of the doctor patient relationship is intended as a first step toward a feminist model for women’s healthcare; by grounding an “in-between” approach to FGCS where the denial or acceptance of the patient’s consent to an FGCS procedure relies on their epistemic situatedness, and whether the doctor considers that situatedness to justify their motivation to undergo the surgery. (shrink)

When the benefits of surgery do not outweigh the harms or where they do not clearly do so, surgical interventions become morally contested. Cutting to the Core examines a number of such surgeries, including infant male circumcision and cutting the genitals of female children, the separation of conjoined twins, surgical sex assignment of intersex children and the surgical re-assignment of transsexuals, limb and face transplantation, cosmetic surgery, and placebo surgery.

A simple definition of consciousness is sensory awareness of the body, the self, and the world. The fetus may be aware of the body, for example by perceiving pain. It reacts to touch, smell, and sound, and shows facial expressions responding to exter- nal stimuli. However, these reactions are probably preprogrammed and have a subcortical nonconscious origin. Furthermore, the fetus is almost continuously asleep and unconscious partially due to endog- enous sedation. Conversely, the newborn infant can be awake, exhibit sensory (...) awareness, and process memorized mental representations. It is also able to differentiate between self and nonself touch, express emotions, and show signs of shared feelings. Yet, it is unreflective, present oriented, and makes little reference to concept of him/herself. Newborn infants display features characteristic of what may be referred to as basic consciousness and they still have to undergo considerable maturation to reach the level of adult consciousness. The preterm infant, ex utero, may open its eyes and establish minimal eye contact with its mother. It also shows avoidance reactions to harmful stimuli. However, the thalamocortical connections are not yet fully established, which is why it can only reach a minimal level of consciousness. (shrink)

The laws and principles which predict how perceptual qualities can be extracted from the most elementary visual signals were discovered by the Gestalt psychologists(e.g., Wertheimer,1923; Metzger,1930, translated and re-editedbySpillmann in 2009 and2012, respectively). Their seminal work has inspired visual science ever since, andhas led to exciting discoveries which have confirmed the Gestalt idea that the human brain would have an astonishing capacity for selecting and combining critical visual signals to generate output representations for decision making and action. This capacity of (...) selection and integration enables the perception of form and space, and the correct estimation of relative positions, trajectories, and distances of objects represented in planar images. This paper addresses problems of perceptual organization with critical implications for visual interfaces, and the design of surgical simulator platforms in particular. (shrink)

Objective: Acceptable preoperative psychosocial indicators of weight loss after obesity surgery in morbidly obese(MO) patients are still unknown. In this study, the association between personality traits, multidimensional perceived social support, and the percentage of excess weight loss (EWL) following obesity surgery was researched in MO patients. -/- Methods: Participants in this prospective study were recruited from MO patients who applied to the hospital’s obesity unit between July 2021 and June 2022. The study comprised 84 MO individuals. The Temperament (...) and Personality Inventory (TCI) was used to evaluate the personality traits of the MO. Perceived social support was measured using the multidimensional perceived social support scale. The percentage of weight loss after obesity surgery was compared with personality traits and perceived social support scores. Results: The mean age of the patients who were MO was 36.7 ±8.7 years. There were 22 men (25.3%) and 62 women (74.7%). The mean preoperative BMI was 46.2 ±63. The perceived social support score was 68.0±16.4. A univariate analysis found a positive relationship between 6 months and one year’s EWL and Self-Transcendence, a TCI subcategory (p=0.011,p=0.023). -/- Conclusion: Obesity treatment is a complex situation that requires a multidisciplinary approach. Given the potential physiological and psychological consequences of obesity surgery, it is critical to uncover psychological predictive factors such as personality traits that boost the success of obesity surgery and are connected with weight loss. As a result, knowing the individuals who self-transcendence before obesity surgery may be useful in predicting the success of obesity surgery and planning treatment. This requires large-scale research. (shrink)

Objective: microRNAs (miRNAs) have important potential as biomarkers in the diagnosis and prognosis of ischemia/reperfusion (I/R) injury in coronary artery bypass grafting surgery (CABG). This study investigated the relationship between preoperative (preop) and postoperative (post-op) cardiac parameters and miRNA expressions in CABG. -/- Methods: We analyzed a total of 94 individuals (CABG, n= 46 and healthy control, n=48). Quantitative real-time polymerase chain reaction (qRT) was performed to determine plasma miRNA expressions (miR-21, miR-181a, miR-199a, miR-199b, and miR-320a-5p) in triplicates: before (...) surgery, 1 hour after surgery, and 24 hours after surgery. The target genes and pathways of miRNA were determined using bioinformatic analysis. The biomarker potentials of miRNAs were evaluated with receiver operating characteristic (ROC) curve analysis. -/- Results: All miRNAs were significantly downregulated (p < 0.05). Troponin I, LVEF, CPK, and CK-MB were found to be statistically significant for operation groups (p < 0.05). miRNA expressions and cardiac markers were associated with troponin I and/or CK-MB. In ROC analyses, miR-199a was a good diagnostic marker. CREBRF and ZNF704 genes may be a target for these miRNAs. -/- Conclusions: Downregulation of miR-199a has a regulatory role in ischemia/reperfusion. They may contribute to CABG pathology through these two genes involved in signaling cascades to turn on protein response and ion binding. (shrink)

The new protocol for information distribution amongst scientists within the CERN, once slightly refined and publicly announced as the Worldwide Web in the August of 1991, has led to impressive achievements beyond the starting plan.

Browne 1 (this issue ) argues that what may appear to be a benevolent practice-disclosing the sex of a fetus to expecting parents who wish to know-is in fact an epistemically problematic and, as a result, ethically questionable medical practice. Browne worries that not only will the disclosure of fetal sex encourage sex-selective abortions (an issue we will not take up here), but also that it will convey a misleading and pernicious message about the relationship between sex and gender. (...) More specifically, she contends that the practice of disclosure is problematic because (1) it purports to establish the gender of the developing baby based on information about the baby's sex, whereas this is not a warranted inference because while sex is determined by biological factors, gender is determined by social factors and (2) it conflates (biological) sex with (social) gender or encourages such conflation or reduction and thereby promotes 'essentialistic' thinking about gender that is closely linked to sexism and social injustice. If (1) is true, then disclosing fetal sex amounts to misinforming or misleading prospective parents-and since misinforming patients is wrong, the act of disclosing is also wrong. However, beyond the wrongs of misinforming patients, the practice also perpetuates the harms associated with a rigidly gendered society through endorsing the message in (2), thus lending the authority of the medical profession to the gender-essentialist ideas that have underpinned, and continue to drive, sexism and social injustice. This analysis leads Browne to recommend that clinicians be prohibited from informing parents about the sex of their developing fetus. -/- We agree with Browne that gender essentialism-the notion that 'femaleness' and 'maleness' carve out distinct natural classes with innate, immutable properties-is not only a false metaphysical thesis, but also a pernicious idea insofar as the sexist attitudes it fosters motivate policies that systematically violate the human rights of women, as well as those of the LGBTQ community. However, we do not think that the disclosure of fetal sex misinforms prospective parents about the gender of their baby, nor do we believe that such disclosure presupposes or promotes gender essentialism properly understood. (shrink)

Disagreements about abortion are often assumed to reduce to disagreements about fetal personhood (and mindedness). If one believes a fetus is a person (or has a mind), then they are “pro-life.” If one believes a fetus is not a person (or is not minded), they are “pro-choice.” The issue, however, is much more complicated. Not only is it not dichotomous—most everyone believes that abortion is permissible in some circumstances (e.g. to save the mother’s life) and not others (e.g. at (...) nine months of a planned pregnancy)—but scholars on both sides of the issue (e.g. Don Marquis and Judith Thomson) have convincingly argued that fetal personhood (and mindedness) are irrelevant to the debate. To determine the extent to which they are right, this article will define “personhood,” its relationship to mindedness, and explore what science has revealed about the mind before exploring the relevance of both to questions of abortion’s morality and legality. In general, this article does not endorse a particular answer to these questions, but the article should enhance the reader’s ability to develop their own answers in a much more informed way. (shrink)

Our present day knowledge in the area of medicine in Ancient Egypt has been severally sourced from medical papyri several of which have been deduced and analyzed by different scholars. For educational purposes it is always imperative to consult different literature or sources in the teaching of ancient Egypt and medicine in particular. To avoid subjectivity the author has found the need to re-engage the efforts made by several scholars in adducing evidences from medical papyri. In the quest to re-engage (...) the efforts of earlier writers and commentaries on the medical papyri, we are afforded the opportunity to be informed about the need to ask further questions to enable us to construct or reconstruct both past and modern views on ancient Egyptian medical knowledge. It is this vocation the author sought to pursue in the interim, through a preliminary review, to highlight, comment and reinvigorate in the reader or researcher the need for a continuous engagement of some pertinent documentary sources on Ancient Egyptian medical knowledge for educational and research purposes. The study is based on qualitative review of published literature. The selection of those articles as sources was based on the focus of the review, in order to purposively select and comment on articles that were published based either on information from a medical papyrus or focused on medical specialization among the ancient Egyptians as well as ancient Egyptian knowledge on diseases and medicine. It was found that the Egyptians developed relatively sophisticated medical practices covering significant medical fields such as herbal medicine, gynecology and obstetrics, anatomy and physiology, mummification and even the preliminary form of surgery. These practices, perhaps, were developed as remedies for the prevailing diseases and the accidents that might have occurred during the construction of their giant pyramids. It must be stated that they were not without flaws. Also, the key issues raised from these literatures are but a few among the Egyptian medical corpus across the academic and publishing world. It should therefore afford researchers, students and readers the opportunity to continue the educational dialogue on the medical practices of the Ancient Egyptians. (shrink)

Important achievements were obtained in the fields of mathematics, medicine, chemistry, astronomy, physics, optics, mechanics, zoology, botanic, mineralogy, geography and etc. in the Turkish-Islamic world between the ninth and thirteenth centuries. According to the leading historians of science, scholars living in different parts of the TurkishIslamic world not only surpassed their Greek and Byzantine predecessors. They also paved the way for development of these fields of science for following centuries. It is possible to mention many physicians that left non-erasable marks (...) in the medicine history among these distinguished scholars. One of these names is an Andalusian surgeon-physician called Abul-Qāsim alZahrāwī. He is known for his solid and unique contributions to the surgical world and regarded as the founder of surgery in the TurkishIslamic world. al-Zahrāwī wrote many books. One of these books, called al-Taṣrīf (The Method of Medicine) regarded as a medical encyclopedia has reached until today. The book attracted more attention in the European countries than in the Turkish-Islamic world and had an impact on Europe. Different chapters from the book were translated into languages such as Hebrew, French, English and especially Latin. al-Zahrāwī’s scientific heritage has also been discussed with all its aspects in Russia where scientists in the Turkish-Islamic world have especially been studied. Even though it was translated at a later period than Avicenna’s al-Qānūn fī al-Ṭibb (The Canon of Medicine), al-Taṣrīf was translated into Russian. The aim of this study is to identify Russian studies on Zahrawi and his main work, al-Taṣrīf -within the framework of available opportunitiesand to present prominent ones among these. In conclusion, this article also aims to contribute to the Turkish literature on al-Zahrāwī and al-Taṣrīf. Therefore, the author wishes to assist the relevant ongoing studies and the ones to be conducted in the future in terms of bibliography and material index. (shrink)

In recent years there has been an explosion of interest in Artificial Intelligence (AI) both in health care and academic philosophy. This has been due mainly to the rise of effective machine learning and deep learning algorithms, together with increases in data collection and processing power, which have made rapid progress in many areas. However, use of this technology has brought with it philosophical issues and practical problems, in particular, epistemic and ethical. In this paper the authors, with backgrounds in (...) philosophy, maternity care practice and clinical research, draw upon and extend a recent framework for shared decision-making (SDM) that identified a duty of care to the client's knowledge as a necessary condition for SDM. This duty entails the responsibility to acknowledge and overcome epistemic defeaters. This framework is applied to the use of AI in maternity care, in particular, the use of machine learning and deep learning technology to attempt to enhance electronic fetal monitoring (EFM). In doing so, various sub-kinds of epistemic defeater, namely, transparent, opaque, underdetermined, and inherited defeaters are taxonomized and discussed. The authors argue that, although effective current or future AI-enhanced EFM may impose an epistemic obligation on the part of clinicians to rely on such systems' predictions or diagnoses as input to SDM, such obligations may be overridden by inherited defeaters, caused by a form of algorithmic bias. The existence of inherited defeaters implies that the duty of care to the client's knowledge extends to any situation in which a clinician (or anyone else) is involved in producing training data for a system that will be used in SDM. Any future AI must be capable of assessing women individually, taking into account a wide range of factors including women's preferences, to provide a holistic range of evidence for clinical decision-making. (shrink)

Jeremy Williams has argued that if we are committed to a liberal pro-choice stance with regard to selective abortion for disability, we will be unable to justify the prohibition of sex selective abortion. Here, I apply his reasoning to selective abortion based on other traits pregnant women may decide are undesirable. These include susceptibility to disease, level of intelligence, physical appearance, sexual orientation, religious belief and criminality—in fact any traits attributable to some degree to a genetic component. Firstly, I review (...) Williams’ argument, which claims that if a woman is granted the right to abort based on fetal impairment, then by parity of reasoning she should also be granted the right to choose sex selective abortion. I show that these same considerations that entail the permissibility of sex selective abortion are also applicable to genetic selection abortion. I then examine the objections to sex selective abortion that Williams considers and rejects, and show that they also lack force against genetic selection abortion. Finally, I consider some additional objections that might be raised, and conclude that a liberal pro-choice stance on selective abortion for disability entails the permissibility of selective abortion for most genetic traits. (shrink)

In liberal moral theory, interfering with someone’s deliberate engagement in a self-harming practice in order to promote their own good is often considered wrongfully paternalistic. But what if self-harming decisions are the product of an oppressive social context that imposes harmful norms on certain individuals, such as, arguably, in the case of cosmetic breast surgery? Clare Chambers suggests that such scenarios can mandate state interference in the form of prohibition. I argue that, unlike conventional measures, Chambers’ proposal recognises that (...) harmful, discriminatory norms entail a twofold collective moral obligation: to eliminate the harmful norm in the long run, but also to address unjust harm that is inflicted in the meantime. I show that these two obligations tend to pull in opposite directions, thus generating a serious tension in Chambers’ proposal which eventually leads to an undue compromising of the second obligation in favour of the first. Based on this discussion, I develop an alternative proposal which, instead of prohibiting breast implant surgery, offers compensation for the disadvantages suffered by individuals who decide not to have surgery. (shrink)

This paper addresses two related topics: 1. The disanalogies between elective cosmetic practices and sex reassignment surgery. Why does it seem necessary for me – an aging professional woman – to ignore the blandishments of hairdressers wielding dyes and dermatologists wielding acids and scalpels? Why does it not seem equally necessary for a transgendered person to repudiate sex reassignment procedures? 2. The role of the body in identity and agency. How do phenomenological insights regarding the constitution of selfhood in (...) relation to the interplay between the body image and corporeal know-how contribute to an account of the agency of transgendered individuals? Studying several paintings by contemporary feminist artist Jenny Saville has advanced my thinking on these topics. Saville’s imagery is an invaluable aid to reflection on these issues because she uses her painterly technique, which critics often dub “virtuoso,” to represent lived human bodies. In her work, viewers encounter representations of subjectivized, agentic corporeity, as distinct from inert, objectified flesh. Moreover, her sympathetic engagement with nonconformist, devalued bodies helps to reconfigure the standard gestalts of the human body that viewers typically carry with them and thus to convert fear and/or disgust into appreciation and understanding. In this paper, I consider three of Saville’s paintings. Plan, Saville’s self-portrait as a nude female whose body has been prepped for liposuction, conveys the pathos of this procedure. Matrix is a nude portrait of self-described “gender variant visual artist” Del LaGrace Volcano. In the words of one critic Saville’s depiction of Volcano’s nude intersexed body “restores beauty to the primitive [female] genital organ.” Passage, another nude portrait of an intersexed individual, is an image of vibrant sexuality despite the presumptively jarring juxtaposition of breasts and a penis. I argue that conceiving the agentic subject as a rational deliberative capability that uses a conjoined body as the instrument of its will makes it impossible to theorize the agency of transgendered people. In contrast, when agentic subjects are understood as embodied subjects and embodiment is understood as a dimension of practical intelligence, the agency of transgendered individuals is intelligible. (shrink)

Recent developments in neuroscience create new opportunities for understanding the human brain. The power to do good, however, is also the power to harm, so scientific advances inevitably foster as many dystopian fears as utopian hopes. For instance, neuroscience lends itself to the fear that people will be forced to reveal thoughts and feelings which they would not have chosen to reveal, and of which they may be unaware. It also lends itself to the worry that people will be encouraged (...) to submit to medication or surgery which, even if otherwise beneficial, alters their brain in ways that undermine their identity and agency. As Kenneth Foster notes, neural implants can have surprising and unintended adverse effects, even when they help to mitigate the loss of bodily control associated with Parkinson’s disease, or help to provide hearing for children who would otherwise be profoundly deaf. While the risk of adverse outcomes are scarcely specific to neuroscience, he thinks that ‘These issues are perhaps more acute’ with the latter than with other medical interventions, ‘because they are intimately and fundamentally related to a person’s communication with the outside world’. [ 2006 196] -/- Neuroscience, like genomic science, then, is likely to create new ways of harming people. Many of these will involve violations of privacy. However, these are unlikely fundamentally to challenge the reasons to value privacy, or our ability to protect it in the foreseeable future. Rather, I would suggest, the major threat to privacy comes from the difficulty of determining its nature and value and when, if ever, efforts to protect it are justified. So I will start by examining some threats to privacy, and their implications for neuroscience, before turning to philosophical problems in understanding the nature and value of privacy, and the practical consequences of those philosophical difficulties. (shrink)

The mythical bronze creature Talos (Greek: Τάλως) was worshiped initially as the god of light or the sun in the Hellenic Island of Crete. He is supposed to have lived in the peak Kouloukona of the Tallaia Mountains in the Gerontospelio cave. His relation towards bronze and fire and his continuous voyage circling the island of Crete most probably introduces the concept of the change of the four seasons. The sun was considered in the area of the South-East Mediterranean nations (...) as just judge, a guardian who monitors and judges from above all the actions of the commoners, a controller for the faithful application of laws in Crete [1]. Hesychios in his Lexicon notes that talos means sun and that the name Tallaios was initially attributed to Zeus [2]. The birth of the Olympian gods forged a new Pantheon and nomenclature forcing some of the old gods to fell into lower deities. This happened to Talos who soon became a mythical hero [1]. According to Apollodorus, the bronze creature was forged by the magnificent constructor Hephaestus as a gift to the mythical King Minoa to help him guard the island [3]. Although the verb “peritrohazo” (Greek: περιτροχαζω) was used, meaning a movement in a steady orbit (track), some depictions image him as a winged being. To protect the island, he was throwing rocks into unknown ships or in the case of a foreign landing he was burning with fire or with his flamed bronze body the intruders. He was holding copper plates with the laws of the island and his circle allowed him to pass all island sores three times daily [1,4-6]. Plato, speaks of him as a real person, suggesting he was the brother of King Rhadamanthys, thus a son of Zeus [5]. Talos may be considered as the token of the Cretan power, a symbol of technological development in the field of metalworking in prehistoric and Minoan times. An animated, programmed gigantic android to enforce its will. A primitive robot for basic actions having a power source, fire and ichor (Greek: ιχώρ) the sacred fluid in the vessels of the gods. The first manufactured being with his individual intelligence, a primary concept of artificial intelligence (AI) [7]. -/- Homer was the first to introduce the term automata (Greek: αυτόματα), to describe ingenious machines built by the supreme blacksmith god of invention and technology, God of metal and fire, Hephaestus, manufactured devices “acting of one’s own will” as the Hellenic word indicates [8]. Eons later, the humanoid automaton the “Automa cavaliere” (English: Automaton knight) appeared in the court of the nobleman and Duke of Milan Ludovico Maria Sforza. It was the year 1495, when Leonardo da Vinci presented his robotic knight, an innovative construction operated by a series of pulleys and cables, presenting though no individual mind. Although it was manufactured by a highly intelligent polymath, it could only be operated through an outer intelligence [9]. Advancements made during the Fourth Industrial Revolution allowed modern technology to manufacture intelligent machines to aid the field of invasive surgery. One of those most sophisticated devises is the da Vince Surgical Tower. -/- Launched in the setting of the 21st century, the DaVinci System is one of the most commonly employed tools/systems, which has prevailed in the field of robotic-assisted surgery [10]. One could claim that it practically reshaped the concept of surgery, providing doctors with immense capabilities, aiming towards the optimal post-operative outcome. Through visual augmentation, high resolution 3D video, enhanced precision and reduced complication rates [11] the DaVinci Si and the latest DaVinci Xi system have been implemented in a variety of surgeries, including but not limited to general, urologic, gynecologic, thoracic and even cardiac procedures; valve and coronary artery bypass graft operations [12,13]. Da Vinci is cleared globally for cardiosurgery and came in vogue to fulfill the dream of cardiac surgeons to operate in closet chest. It offers in patients the same benefits as those that open chest incision surgery procedures do [14]. -/- The more recent DaVinci Xi model was introduced to counteract commonly known drawbacks of the Si system, such as the inability to simultaneously manipulate the different abdominal quadrants [10]. It consists of four boom mounted robotic arms along with a mobile platform and a master console. The latter with the adaptable intraocular distance, the cushioned headrest, the modifiable arm bars and the flexible finger loops, is meticulously designed to meet the surgeon´s “demands” [12]. Every robotic arm has three degrees of freedom, which combined with the EndoWrist technology to imitate the delicate motion of the surgeon´s hand, acquires an extra seven degrees of freedom. Evidently, the combination of the user-friendly interface, the high-quality 3D intraoperative images, the multiple joints and sensors, as well as the surgeon himself, who can learn to handle the DaVinci Xi Surgical System in a relatively short period of time, has established the model in the surgical armamentarium, paving the way towards a continuously progressive future of minimally invasive and robotic surgery (Figure 1) [12]. -/- History testifies that the nomination of the AI surgical tower as da Vinci was wrongfully given to commemorate a majestic historical figure. It is clear that the mythical creature Talos which was fabricated by the ingenious god Hephaestus was the first true automaton in the line of AI origins. (shrink)

Orlan is a French performance artist whose work on beauty elicits shock and disgust. Beginning in 1990, she began a series of nine aesthetic surgeries entitled The Reincarnation of St. Orlan that altered her face and body, placed her at risk in the operating room, and centered her within certain controversy in the art world. Undergoing only epidural anaesthesia and controlling the performance to the greatest degree possible, she "choreographs" and documents the events. This enhanced interview I conducted with Orlan (...) cites her own words and offers commentary and explanation on her complex and conceptual works of art. I offer a concept of "virtual beauty" and locate her aesthetic intentionality within the realm of traditional art history (works by the great "masters" of art) and traditional aesthetics, rejecting any possibility of a viewer's disinterested stance toward Orlan's visual representations. (shrink)

Much of the discussion surrounding the ethics of abortion has centered around the notion of personhood. This is because many philosophers hold that the morality of abortion is contingent on whether the fetus is a person - though, of course, some famous philosophers have rejected this thesis (e.g. Judith Thomson and Don Marquis). In this article, I construct a novel argument for the immorality of abortion based on the notion of impairment. This argument does not assume that the fetus is (...) a person - indeed, I concede (for the sake of argument) that the fetus is not a person - and hence the morality of abortion is not contingent on whether the fetus is a person. I finish by answering a plethora of objections to my argument, concluding that none of them are successful. (shrink)

Fetuses and their mothers (and other adults) share many objective interests. These include interests in disjunctive ways of achieving human well-being, including the formation and success of good projects such as particular friendships. Pursuing such good projects is in the individual’s interests and is what growing up is all about. Some interests are time-sensitive, and determining which interests apply at what stages in life requires asking which benefits are in some sense appropriate to the individual and still in his/her actual (...) or possible or even hypothetical future. Human individuals not only have interests in unconditional benefits to them, including the welfare of existing family members, but in conditional benefits to them, including the welfare of possible future family members. Even if not all interests apply to the individual at every stage, if an adult-type benefit is still in the (long-term) future, the young individual including the fetus has a stake in that benefit, conditional as the benefit may sometimes be. Fulfilment is enhanced by pursuit and conscious enjoyment of ‘human goods’, but as with adults, the stake in these remains strong even if psychological links with the long-term future in which this happens are tenuous or non-existent. (shrink)

Medicine is increasingly subject to various forms of criticism. This paper focuses on dominant forms of criticism and offers a better account of their normative character. It is argued that together, these forms of criticism are comprehensive, raising questions about both medical science and medical practice. Furthermore, it is shown that these forms of criticism mainly rely on standards of evaluation that are assumed to be internal to medicine and converge on a broader question about the aim of medicine. Further (...) work making medicine’s internal norms explicit and determining the aim of medicine would not only help to clarify to what extent the criticism is justified, but also assist an informed deliberation about the future of medicine. To illustrate some of the general difficulties associated with such a task, the paper concludes by critically engaging Edmund Pellegrino’s account of the aim of medicine as well as the Hastings Center’s consensus report. (shrink)

In this article, an account of the architecture of the cognitive contamination system is offered, according to which the contamination system can generate contamination represen- tations in circumstances that do not satisfy the norms of contamination, including in cases of mere visual contact with disgusting objects. It is argued that this architecture is important for explaining the content, logic, distribution, and persistence of maternal impression beliefs – according to which fetal defects are caused by the pregnant mother’s experiences and (...) actions – which in turn provide important evidence of the architecture of the cognitive contamination system. (shrink)

Perry Hendricks’ impairment argument for the immorality of abortion is based on two premises: first, impairing a fetus with fetal alcohol syndrome is immoral, and second, if impairing an organism to some degree is immoral, then ceteris paribus, impairing it to a higher degree is also immoral. He calls this the impairment principle. Since abortion impairs a fetus to a higher degree than FAS, it follows from these two premises that abortion is immoral. Critics have focussed on the ceteris (...) paribus clause of TIP, which requires that the relevant details surrounding each impairment be sufficiently similar. In this article, we show that the ceteris paribus clause is superfluous, and by replacing it with a more restrictive condition, the impairment argument is considerably strengthened. There are no data in this work. (shrink)

A 2017 Nature report was widely touted as hailing the arrival of the artificial womb. But the scientists involved claim their technology is merely an improvement in neonatal care. This raises an under-considered question: what differentiates neonatal incubation from artificial womb technology? Considering the nature of gestation—or metaphysics of pregnancy—(a) identifies more profound differences between fetuses and neonates/babies than their location (in or outside the maternal body) alone: fetuses and neonates have different physiological and physical characteristics; (b) characterizes birth as (...) a physiological, mereological and topological transformation as well as a (morally relevant) change of location; and (c) delivers a clear distinction between neonatal incubation and ectogestation: the former supports neonatal physiology; the latter preserves fetal physiology. This allows a detailed conceptual classification of ectogenetive and ectogestative technologies according to which the 2017 system is not just improved neonatal incubation, but genuine ectogestation. But it is not an artificial womb, which is a term that is better put to rest. The analysis reveals that any ethical discussion involving ectogestation must always involve considerations of possible risks to the mother as well as her autonomy and rights. It also adds a third and potentially important dimension to debates in reproductive ethics: the physiological transition from fetus/gestateling to baby/neonate. (shrink)

Ectogenesis, or “artificial womb technology,” has been heralded by some, such as prominent feminist Shulamith Firestone, as a way to liberate women. In this chapter, we challenge this view by offering an alternative analysis of the technology as relying upon and perpetuating a problematic model of pregnancy which, rather than liberating women, serves to devalue them. We look to metaphysics as the abstract study of reality to elucidate how the entities in a pregnancy are related to one another. We consider (...) two models of the metaphysics of pregnancy: (1) the Parthood Model, whereby the fetus is a part of what/who gestates it; and (2) and the Fetal Container Model, whereby the gestator is a container for the fetus. We suggest that under the assumption of the Fetal Container Model, we are more likely to think that any container will suffice for gestation, even an artificial one. In contrast, under the assumption of the Parthood Model, we are less likely to treat the gestator as interchangeable or replaceable, given the parthood relationship between gestator and fetus. This chapter argues that ectogenesis is conceptually linked to the Fetal Container Model and advocates a more cautious approach in promoting ectogenesis as a tool for women’s liberation. (shrink)

A few decades from now, it might become possible to gestate fetuses in artificial wombs. Ectogestation as this is called, raises major legal and ethical issues, especially for abortion rights. In countries allowing abortion, regulation often revolves around the viability threshold—the point in fetal development after which the fetus can survive outside the womb. How should viability be understood—and abortion thus regulated—after ectogestation? Should we ban, allow or require the use of artificial wombs as an alternative to standard abortions? (...) Drawing on Cohen, I evaluate three possible positions for the post-ectogestative abortion laws: restrictive, conservative and liberal. While the restrictive position appears untenable, I argue that the liberal and conservative positions can be combined to form a legally and morally coherent basis for post-ectogestative abortion legislation, offering an improvement from the point of both prolife and prochoice positions. (shrink)

Calum Miller recently argued that a commitment to a very modest form of egalitarianism—equality between non-disabled human adults—implies fetal personhood. Miller claims that the most plausible basis for human equality is in being human—an attribute which fetuses have—therefore, abortion is likely to be morally wrong. In this paper, I offer a plausible defence for the view that equality between non-disabled human adults does not imply fetal personhood. I also offer a challenge for Miller’s view.

Perry Hendricks’ original impairment argument for the immorality of abortion is based on the impairment principle (TIP): if impairing an organism to some degree is immoral, then ceteris paribus, impairing it to a higher degree is also immoral. Since abortion impairs a fetus to a higher degree than fetal alcohol syndrome (FAS) and giving a fetus FAS is immoral, it follows that abortion is immoral. Critics have argued that the ceteris paribus is not met for FAS and abortion, and (...) so we proposed the Modified Impairment Principle (MIP) to avoid these difficulties. Dustin Crummett has responded, arguing that MIP is open to various counterexamples which show it to be false. He also shows that MIP can generate moral dilemmas. Here, we propose a modification to MIP that resolves the issues Crummett raises. Additionally, Alex Gillham has criticized our appropriation of Don Marquis’ ‘future like ours’ reasoning about the wrongness of impairment. We show that his objections have minimal implications for our argument. (shrink)

In an article of this journal, Perry Hendricks makes a novel argument for the immorality of abortion. According to his impairment argument, abortion is immoral because: (a) it is wrong to impair a fetus to the nth degree, such as causing the fetus to have fetal alcohol syndrome (FAS); (b) it is wrong to impair a fetus to the n+1 degree (to cause the fetus to be more impaired than to have FAS); (c) killing the fetus impairs the fetus (...) to the n+1 degree (causes it to be more impaired than to have FAS); (d) abortion kills the fetus; (e) therefore, abortion is immoral. The impairment argument is a promising account for the wrongness of abortion because it does not rely on the controversial metaphysical premise that a fetus is a person. This article aims to show, that despite some immediate advantages over the rival theories of the immorality of abortion there is a reason to believe that the impairment argument is untenable. That is because there are goods that can be achieved by abortion but that cannot be achieved by impairing the fetus. (shrink)

Background: The time before surgery is a traumatic period for patients. Despite this fact, no research has been conducted on nurses’ preoperative patient education in Ethiopia. This study aimed to assess preoperative patient education practices and associated factors among nurses working in East Amhara comprehensive specialized hospitals, Ethiopia, 2022. Methods: A hospital-based cross-sectional study was conducted with 416 nurses. Pretested, structured questionnaires were used to collect the data. Bivariable analysis was performed for each independent variable with a P-value < (...) 0.25 on the data imported to multivariate logistic regression analysis. AOR with a 95% CI and a P-value < 0.05 at a 5% level of significance were considered. Results: Only 38.5% of nurses were found to have good practices for preoperative patient education, with a response rate of 98%. Nurses with 6 years of work experience (AOR = 3.15, 95% CI: 1.692– 5.874), adequate time (AOR = 2.33, 95% CI: 1.119– 4.889), training (AOR = 4.27, 95% CI: 1.548– 11.796), age 25– 29 (AOR = 0.15, 95% CI: 0.070– 0.331), age 30– 34 (AOR = 0.25, 95% CI: 0.137– 0.479), and knowledge (AOR = 3.73, 95% CI: 2.222– 6.273) were significantly associated. Conclusion: Preoperative patient education practices among nurses were poor. Work experience, knowledge, training, and adequate time were found to be significant. Organize preoperative patient education programs for nurses that share experiences and provide ongoing training. (shrink)