Philosophy of Medicine

Since Cannon, inspired by Bernard’s discussion of the conditions required for free and independent life, introduced the term homeostasis, many have embraced it as the main theoretical principle guiding physiology and medicine. Nonetheless, critics have argued that homeostasis is too limiting and have advanced a variety of alternative concepts such as heterostasis, rheostasis, and allostasis. We argue that the critics target a much narrower understanding of homeostasis put forward by the cyberneticists and that Bernard and Cannon embraced a far broader (...) understanding that can accommodate the alternatives advanced by the critics and provide an integrated theoretical framework for physiology. (shrink)

Nietzsche repeatedly criticizes traditional morality for having ruined our health. This raises three questions: (1) How does Nietzsche understand human health? (2) Why are health-impacts evaluatively significant? (3) Why should these impacts override the weight of our traditional moral values? By addressing these questions, I bring clarity to Nietzsche’s ethics and new insight to contemporary philosophy of medicine. First, Nietzsche conceives of health as a balance between one’s abilities and the demands placed upon them by one's motivations. One is healthier (...) the more one is able to meet those demands; less healthy, the less so. This view is similar to “embedded instrumentalism” in current philosophy of medicine. Second, the value health has for Nietzsche is closely related to that of “power.” Power involves the confrontation of difficulty in one’s pursuits. Nietzsche is especially interested in the diachronic value of upward trends in difficult confrontations. One is better off to the extent that one tackles more difficult versions of a task than before. Such upward trends are valuable because they prevent a form of human despair of special concern to Nietzsche. Striving after a prized goal one feels unable to realize is deeply distressing and, Nietzsche argues, leads to a form of self-alienation, resentment of others, evaluative instability, and a sense of futility in acting. This cluster of attitudes diminishes one’s welfare and undermines one’s agency. Upward trends in power contribute to one’s sense that one is able to carry out one’s dearest aims (i.e. to a sense of good health) and so prevent this dissatisfaction. Downward trends contribute to a sense of one’s impotence (of ill health). The value of avoiding this dissatisfaction and its consequences accounts for the value of health. Third, drawing on recent scholarship, I argue that Nietzsche affords health normative force for its being a constitutive aim of genuine agency. Constitutive of genuine action is the realization of a condition in which we act and do not see ourselves as impotent in acting. Therefore we have reason to avoid conditions that eradicate our (sense of our own) health, grounded in the aim of realizing genuine agency. (shrink)

As much contemporary work in biology and philosophy has shown, disagreements between biological race realists and biological race anti-realists are primarily normative. Yet despite the well-recognized normative nature of the debate, contemporary versions of biological race realism continue to be built on empirically questionable background assumptions that are centrally motivated by historical ideologies of racial pseudoscience rather than by pragmatic or normative considerations. I consider the case studies of Andreasen’s (2000, 2004) and Spencer’s (2018) arguments, showing how some of their (...) background assumptions stem from pseudoscientific racial ideologies. Even when philosophers and biologists purport to accept the normative nature of the question of race as a genetic population-level category, their views remain susceptible to the influence of said ideologies in ways that may continue to uphold their harmful legacies. The stakes of these positions are significant, as they connect to contemporary issues of racial equity in science and medicine. (shrink)

Philosophers have become increasingly aware of the difficulties that plague accounts of kinds with objectively determined boundaries, and generally recognise that scientific taxonomies are shaped by human pragmatic interests and non-epistemic values. Against this trend, we propose an account of kinds conceived as dynamic entities, characterised by qualitatively distinct and robust trajectories originating from bifurcation events in the development of complex systems. We argue that the Homeorhetic Dynamic Kinds account (HDK) can be applied to systems investigated in a variety of (...) disciplinary contexts, ranging from biology, medicine, and the social sciences. Shifting the focus from a synchronic (homeostatic) to a dynamic and processual (homeorhetic) perspective, we show that HDK allows a better characterisation of discontinuities among kinds. We then outline its implications for pluralism, particularly how HDK can help us understand how scientific categories are shaped both by ontological aspects of developmental trajectories and by pragmatic, value-laden considerations. (shrink)

The analysis of citation flow from a collection of scholarly articles might provide valuable insights into their thematic focus and the genealogy of their main concepts. In this study, we employ a topic model to delineate a subcorpus of 1,360 papers representative of bioethical discussions on enhancing human life. We subsequently conduct an analysis of almost 11,000 references cited in that subcorpus to examine quantitatively, from a bird’s-eye view, the degree of openness of this part of scholarship to the specialized (...) knowledge produced in biosciences. Although almost half of the analyzed references point to journals classified as Natural Science and Engineering (NSE), we do not find strong evidence of the intellectual influence of recent discoveries in biosciences on discussions on human enhancement. We conclude that a large part of the discourse surrounding human enhancement is inflected with “science-fictional habits of mind.” Our findings point to the need for a more science-informed approach in discussions on enhancing human life. (shrink)

“Classic,” serotonergic psychedelic drugs such as LSD and psilocybin are the objects of renewed attention in science and psychiatry. A recent spate of research has produced evidence that psychedelics might be safe and effective adjuncts to the treatment of mood and addictive disorders, agents of positive psychological change in healthy subjects, and valuable tools for studying the neural mechanisms of perception and cognition. This chapter surveys three philosophical debates that have arisen in response to this “renaissance” of psychedelic research. The (...) first concerns the mechanisms of psychedelic-assisted psychotherapy (“psychedelic therapy”): How, exactly, does psychedelic administration in controlled conditions cause lasting psychological benefits? The second concerns the implications of psychedelic research for the philosophy of mind: Does psychedelic evidence show that there can be conscious mental states lacking all forms of self-consciousness? The third concerns the epistemic status of the psychedelic state: Is it possible that certain kinds of knowledge, or other epistemic benefits, could be gained by undergoing a psychedelic experience? (shrink)

Although scholars acknowledged that Avicenna’s science of the soul stands at the crossroads between natural philosophy and metaphysics, thus combining an overall physical investigation of all sublunary souls with a trans-physical (or proto-metaphysical) inquiry into the human rational soul, this paper aims to show a further disciplinary entanglement within Avicenna’s science of the soul, which features in the aforementioned physical investigation and helps to frame it, that is, the interaction between natural philosophy and medicine. Despite the strict division between these (...) two disciplines in Avicenna’s system of science, medicine seems to decisively contribute to accounting for the bodily functions of living beings. For this reason, Avicenna refers to medicine several times in his exposition on the soul. This paper approaches the disciplinary entanglement between natural philosophy and medicine in psychology by focusing on the medical concept of pneuma (rūḥ), which prominently features in the exposition of three main issues in psychology, i.e., body ensoulment, powers differentiation, and emotions. (shrink)

An AI-based “patient preference predictor” (PPP) is a proposed method for guiding healthcare decisions for patients who lack decision-making capacity. The proposal is to use correlations between sociodemographic data and known healthcare preferences to construct a model that predicts the unknown preferences of a particular patient. In this paper, I highlight a distinction that has been largely overlooked so far in debates about the PPP–that between algorithmic prediction and decision-making–and argue that much of the recent philosophical disagreement stems from this (...) oversight. I show how three prominent objections to the PPP only challenge its use as the sole determinant of a choice, and actually support its use as a source of evidence about patient preferences to inform human decision-making. The upshot is that we should adopt the evidential conception of the PPP and shift our evaluation of this technology towards the ethics of algorithmic prediction, rather than decision-making. (shrink)

The slogan “Do Your Own Research” (DYOR) is often invoked by people who are distrustful, even downright sceptical, of recognized expert authorities. While this slogan may serve various rhetorical purposes, it also expresses an ethic of inquiry that valorises independent thinking and rejects uncritical deference to recognized experts. This paper is a qualified defence of this ethic of inquiry in one of the central contexts in which it might seem attractive. I use several case studies of patient activist groups to (...) argue that these groups often engage in valuable independent research that advances biomedical knowledge. In doing so they demonstrate the value of “lay expertise” and the epistemic as well as political necessity of not simply deferring to recognized experts. I also give some reasons why patient activist groups often produce valuable biomedical knowledge: they are examples of what I call “research collectives”. Research collectives are research communities that differ from the traditional research communities we find in universities and research institutes in that their members typically lack formal relevant scientific credentials and training. But they are similar in that they have internal structures—training procedures, norms of discussion, venues for holding discussions—that facilitate the production of knowledge. I finish by suggesting that future research into the differences and similarities between research collectives and traditional research communities is required. (shrink)

Immanuel Kant (1724-1804) had not been a close friend of Johann Daniel Metzger (1739-1805), the most productive professor at the Medical Faculty of Königsberg and specialist for social and forensic medicine. Kant felt, that many somatic diseases needed philosophical support, while severe mental illness should exclusively and safely be treated with the veterinary procedures of medicine as all rational, sensible interventions were in vain. According to Kant, Metzger's outstanding domain, forensic issues, could only be resolved by philosophy. Metzger used his (...) anonymous obituary on Kant to set several things straight. (shrink)

I argue that generic generalizations expressed in language (i.e., “generics”) are apt for good clinical reasoning. I begin by introducing what generics are in language and describe two problems in the use and interpretation of generics: Generics can license inaccurate judgements about the frequency of events or properties within a group (i.e., a problem with the “truth-aptness” of generics) and can facilitate problematic beliefs about social kinds (e.g., prejudice or essentializing). I provide an account of clinical reasoning and describe some (...) features of what I call “good” clinical reasoning. I offer examples of generics in clinical contexts and examine how the two problems with generics (i.e., of truth-aptness and social generics) can be harmful to patients and impair clinical reasoning. However, I ultimately argue that generics are important for good clinical reasoning because they track “conspicuous” features of disease processes (e.g., severe possible outcomes). Further, I argue that prejudicial generics are often irrational to believe, and social generics that are rational to believe need not lead to problematic implicatures about social kinds and can, in principle, instead facilitate meaningfully articulating societal injustices. I then argue that statistical statements, which are tempting alternatives to generics in clinical reasoning, are no better than generics for good clinical reasoning, even with respect to the two problems identified in the use of generics. (shrink)

This commentary responds to the article “What Is the Aim of Pediatric ‘Gender‐Affirming’ Care?,” by Moti Gorin, in the same issue of the journal. Gender‐affirming care is often treated as exceptional and subject to heightened scrutiny. This exceptionalization results in its being held to stricter evidentiary standards than other forms of medical interventions are. But values and value judgments are inextricable from the practice of evidence‐based medicine. For gender‐affirming care, values shape what counts as “strong” evidence, whether the legitimacy of (...) transgender identity is assumed versus treated as something to be investigated, how to characterize the testimonial accounts of trans and gender‐nonconforming patients, and more. We argue that these kinds of questions are part of the practice of medicine, not exceptional to transgender people and gender‐affirming care. However, litigation of evidence for gender‐affirming care in state and national policy underscores the moral urgency of thinking carefully about what values ought to guide evidence. (shrink)

After an intensive 4-year process, the World Medical Association (WMA) has revised its International Code of Medical Ethics (ICoME). In their report outlining this process, Parsa-Parsi et al not only describe how the WMA sought to ‘cultivat[e] international agreement’ on a ‘global medical ethos’, but also outline the philosophical framework of the ICoME: how the WMA, as the ‘global representation of the medical profession’, created and revised the ICoME through the process of international professional self-regulation.1 However, there is a significant (...) tension to be found in this framework—one which contrasts the international scope of the ICoME with the supposed source of its legitimacy. Here, we seek to characterise this tension and the doubt which it casts on the legitimacy of the ICoME. (shrink)

“Classic”, serotonergic psychedelic drugs such as LSD and psilocybin are the objects of renewed attention in science and psychiatry. A recent spate of research has produced evidence that psychedelics might be safe and effective adjuncts to the treatment of mood and addictive disorders, agents of positive psychological change in healthy subjects, and valuable tools for studying the neural mechanisms of perception and cognition. This chapter surveys three philosophical debates that have arisen in response to this “renaissance” of psychedelic research. The (...) first concerns the mechanisms of psychedelic-assisted psychotherapy (“psychedelic therapy”): How, exactly, does psychedelic administration in controlled conditions cause lasting psychological benefits? The second concerns the implications of psychedelic research for the philosophy of mind: Does psychedelic evidence show that there can be conscious mental states lacking all forms of self-consciousness? The third concerns the epistemic status of the psychedelic state: Is it possible that certain kinds of knowledge, or other epistemic benefits, could be gained by undergoing a psychedelic experience? (shrink)

Mechanisms, in the prominent biological sense of the term, are historical entities. That is, whether or not something is a mechanism for something depends on its history. Put differently, while your spontaneously-generated molecule-for-molecule double has a heart, and its heart pumps blood around its body, its heart does not have a mechanism for pumping, since it does not have the right history. My argument for this claim is that mechanisms have proper functions; proper functions are historical entities; so, mechanisms are (...) historical entities, too. This thesis runs against the mainstream new mechanist way of thinking about mechanisms, where mechanisms are generally thought of in an ahistorical way. After arguing for this thesis, I draw out some consequences for philosophy of science and metaphysics. (shrink)

One of the key factors that contributes to global political, social, and economic inequality is the lack of adequate scientific and technological resources in the Global South. A desideratum for a coherent program for a New International Economic Order is to end the Global South’s scientific and technological dependency on the Global North. The end of the unipolar era brings with it opportunities for many countries in the Global South to improve their bargaining position in a manner that would enable (...) them to take substantial steps towards ending scientific and technological dependency. (shrink)

How do philosophers and psychologists receive paradigmatic cases from pathology? More specifically, how are some essential features of ‘normal’ cognitive, affective or perceptual functions derived from these pathological cases? In this paper, I argue that Maurice Merleau-Ponty offers a fecund answer to this question by putting forth a logic of supplementation in pathology that distinguishes the coping behavior of the organic world in contrast to an inorganic one. Supplementation, instead of substitution, marks the world of the living, particularly in its (...) higher forms, as it denotes a persistence through impairment governed by an organic norm. A prominent example of this appears in his reading of the patient Schneider case, a classic example from Goldstein and Gelb’s Gestalt psychology. While earlier commentators were interested in underlying whether or not Merleau-Ponty used this example to denote the persistence of a key function or the disruption of another, what has been missed, on my view, is a far more consequential point about pathologies and how they structure our relation to our world. -/- . (shrink)

A lively topic of debate in decision theory over recent years concerns our understanding of the different risk attitudes exhibited by decision makers. There is ample evidence that risk-averse and risk-seeking behaviours are widespread, and a growing consensus that such behaviour is rationally permissible. In the context of clinical medicine, this matter is complicated by the fact that healthcare professionals must often make choices for the benefit of their patients, but the norms of rational choice are conventionally grounded in a (...) decision maker’s own desires, beliefs and actions. The presence of both doctor and patient raises the question of whose risk attitude matters for the choice at hand and what to do when these diverge. Must doctors make risky choices when treating risk-seeking patients? Ought they to be risk averse in general when choosing on behalf of others? In this paper, I will argue that healthcare professionals ought to adopt a deferential approach, whereby it is the risk attitude of the patient that matters in medical decision making. I will show how familiar arguments for widely held anti-paternalistic views about medicine can be straightforwardly extended to include not only patients’ evaluations of possible health states, but also their attitudes to risk. However, I will also show that this deferential view needs further refinement: patients’ higher-order attitudes towards their risk attitudes must be considered in order to avoid some counterexamples and to accommodate different views about what sort of attitudes risk attitudes actually are. (shrink)

There have recently been novel applications of medical systematic review guidelines to economic policy interventions which contain controversial methodological assumptions that require further scrutiny. A landmark 2017 Cochrane review of unconditional cash transfer (UCT) studies, based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE), exemplifies both the possibilities and limitations of applying medical systematic review guidelines to UCT and universal basic income (UBI) studies. Recognizing the need to upgrade GRADE to incorporate the differences between medical and policy interventions, (...) the GRADE Public Health Project Group (PHPG) was convened to enumerate and address these methodological challenges. However, in light of our analysis of additional methodological challenges that arise for UCT and UBI studies, we argue that the adaptation of medical systematic review guidelines to economic methodology is far from straightforward and is in fact more challenging than claimed by the PHPG. (shrink)

The underreporting of suspected adverse drug reactions hinders pharmacovigilance. Solutions to underreporting are oftentimes directed at clinicians and health care professionals. However, given the recent rise of public inclusion in medical science, solutions may soon begin more actively involving patients. I aim to offer an evaluative framework for future possible proposals that would engage patients with the aim of mitigating underreporting. The framework may also have value in evaluating current reporting practices. The offered framework is composed of three criteria that (...) are bioethical, social-epistemic, and pragmatic: (i) patients should not be exposed to undue harms, e.g., nocebo effects; (ii) data should be collected, analyzed, and communicated prioritizing pharmacovigilance’s aims, i.e., free from industry bias; and (iii) proposals should account for existing and foreseeable pragmatic constraints like clinician ‘buy in’ and existing reporting infrastructure. Proposals to engage patients in pharmacovigilance that fulfil or address these criteria are preferable to those that do not. (shrink)

Dysmenorrhea, or menstrual pain, is regularly suffered by 45 to 95% of menstruating women. Despite its prevalence, and despite the philosophical importance of pain as a general phenomenon, dysmenorrhea has been all but completely overlooked in contemporary analytic philosophy of mind. This paper aims at rectifying this situation. We single out three properties of what is often considered the paradigmatic case of painful experience, what we call injury-centered pains, and argue that dysmenorrhea does not have any of them, and hence (...) that it does not neatly conform to the injury-centered model of pain. This calls into question the centrality of the injury-centered model, and suggests novel research avenues within theoretical debates on affectivity. (shrink)

Imam Kazim's [Imam Musa al-Kazim (seventh Imam in Twelver Shia Islam)] medicine consists of: 1. Foeniculum Vulgare 2. Mastic 3. Terminalia Chebula 4. Brown Sugar or the sugar, prepared from Saccharum Officinarum (Sugarcane).

In this chapter, I discuss the contents of the now lost academic dictata of Henricus Regius, embodying one of the first comprehensive teachings of natural philosophy inspired by René Descartes at a university. These contents are partially extant in Martin Schoock’s Admiranda methodus (1643), and can be reconstructed from Regius’s early texts and correspondence with Descartes. They reveal that Regius was original with respect to Descartes especially in his account of magnetism, which was functional to his medical physiology, and discussion (...) of the powers of plants, out of which he developed such a physiology. (shrink)

Introduction: The paper investigates the impact of the use of metaphors in reasoning tasks concerning vaccination, especially for defeasible reasoning cases. We assumed that both metaphor and defeasible reasoning can be relevant to let people understand vaccination as an important collective health phenomenon, by anticipating possible defeating conditions. -/- Methods: We hypothesized that extended metaphor could improve both the argumentative and the communicative effects of the message. We designed an empirical study to test our main hypotheses: participants (N = 196, (...) 78% females; Meanage = 27.97 years, SDage = 10.40) were presented with a text about vaccination, described in either literal or metaphorical terms, based on uncertain vs. safe reasoning scenarios. -/- Results: The results of the study confirmed that defeasible reasoning is relevant for the communicative impact of a text and that an extended metaphor enhances the overall communicative effects of the message, in terms of understandability, persuasion, perceived safety, and feeling of control over the health situation, collective trust in expertise and uptake of experts' advice. However, the results show that this effect is significantly nuanced by the type of defeasible reasoning, especially in the case of participants' trust in expertise and commitment to experts' advice. -/- Conclusion: Both communicative and defeasible reasoning competences are needed to enhance trust in immunization, with possible different outcomes at an individual and collective level. (shrink)

Topic modeling—a text‐mining technique often used to uncover thematic structures in large collections of texts—has been increasingly frequently used in the context of the analysis of scholarly output. In this study, we construct a corpus of 19,488 texts published since 1971 in seven leading journals in the field of bioethics and philosophy of medicine, and we use a machine learning algorithm to identify almost 100 topics representing distinct themes of interest in the field. On the basis of intertopic correlations, we (...) group the content‐based topics into eight clusters, thus providing a novel, fine‐grained intellectual map of bioethics and philosophy of medicine. Moreover, we conduct a number of diachronic analyses, examining how the “prominence” of different topics has changed across time. In this way, we are able to observe the distinct patterns in which bioethics and philosophy of medicine have evolved and changed their focus over the past half a century. (shrink)

The medical use of computing and information and communication technologies (ICTs) has a history of several decades, but the emergence of the internet, and especially the web and social media, created a new situation. As a result, currently the term eHealth is widely used – and the usage of the internet (and mobile) “technologies” in healthcare (among the patients and professionals, too) tends to be usual practice. There are more and more signs of the institutionalization of this new sub-disciplinary field (...) of medicine, such as social organizations, healthcare institutes, scientific journals, regular conferences, etc. In this paper, collecting the most relevant developments we will try to characterize this state of affairs in the field. Moreover, as it is well-known, the use of the internet has an enormous impact on society, social systems and subsystems, and even on the everyday life of people. This extended practice also influences medicine and healthcare as social subsystems, and fundamentally transforms some of their characteristics. In this paper, we try to show several important dimensions of these changes. (shrink)

I propose an approach that expands philosophical views of scientific change, on the basis of an analysis of contemporary biomedical research and recent developments in the philosophy of scientific change. Focusing on the establishment of the exposome in epidemiology as a case study and the role of data as a context for contrasting views on change, I discuss change at conceptual, methodological, material, and social levels of biomedical epistemology. Available models of change provide key resources to discuss this type of (...) change, but I present the need for an approach that models transfer, alignment, and influence as key processes of change. I develop this as a pragmatic approach to scientific change, where processes might change substantially depending on specific circumstances, thus contributing to and complementing the debate on a crucial epistemological issue. (shrink)

At the core of medicine is the idea to help fellow human beings by improving or even restoring their health. Let us call this the auxiliary stance of medicine—the motivation of medical intervention by reference to a moral obligation to guide our peers in their attempt to live a healthy and productive life. In parallel, the auxiliary stance is also central to public health, with a focus on prevention and health promotion. Taken together, we can view medicine and public health (...) as the two main human auxiliary endeavors to protect individuals and populations from health risks and help them to heal when sick. (shrink)

Hippocrate a contribué à l’évolution de la médecine grecque de son temps par ses observations détaillées sur les maladies et leurs effets, en insistant sur l’importance du régime et de l’environnement en ce qui concerne la santé des patients. Il s’est interrogé sur la moralité du praticien, son comportement et son attitude avec son patient afin de produire des normes éthiques solides pour départager sa médecine des conceptions magico-religieuses, des pratiques qu’il estimait douteuses, trompeuses. Certains aspects des textes du Corpus (...) Hippocratique ont été largement considérés pertinents par la médecine moderne, tout particulièrement en ce qui concerne les rapports médecin-patient. Dans l’article qui suit, nous nous intéressons au rôle de la confiance dans la relation médecin-patient au sein du Corpus Hippocratique : comment le corps des médecins hippocratiques joue-t-il un rôle dans la construction de la confiance avec le patient ? Nous soutenons que le corps du médecin agit comme élément essentiel dans l’établissement de la confiance et comme support de sa réputation. Or, si la relation de confiance médecin-patient est une condition fondamentale pour la pratique de l’art médical, la confiance est un facteur important et s’inscrit dans une approche où le malade est l’allié du médecin afin de combattre la maladie. Plus le patient a confiance en son médecin, plus le médecin hippocratique est apte à pratiquer son art médical et prêt à aider le patient dans son combat contre la maladie. Ainsi, pour répondre à la question posée, nous présenterons, en premier lieu, le contexte dans lequel le médecin hippocratique pratique son art. Cette présentation nous aidera à comprendre l’importance de la confiance, notamment en ce qui concerne son impact dans la relation médecin-patient, ainsi que de la quantité de données indispensables transmises par le patient au médecin. Nous serons alors en mesure, en deuxième lieu, de démontrer que le corps du médecin et le corps du patient sont des éléments fondamentaux dans l’élaboration de la confiance : corps comme vecteur de l’image du médecin et corps comme instrument. (shrink)

Hippocrate de Cos, médecin et philosophe, est souvent considéré comme le père de la médecine. Si la représentation d’un Hippocrate comme « père de la médecine » relève de l’inflation mythique, elle est néanmoins révélatrice de l’importance de son héritage. L’objectif de cet article est de rendre compte des différentes versions du Serment d’Hippocrate, ainsi que des versions professionnelles subséquentes, afin de souligner certaines difficultés inhérentes à ce texte. Nous souhaitons également avancer l’idée selon laquelle les idéaux hippocratiques ne sont (...) pas à considérer comme un ensemble de principes aujourd’hui caduques, mais plutôt comme un cadre conceptuel pertinent pour comprendre certains des enjeux propres à la relation médecin-patient.e aujourd’hui. (shrink)

Dans cet article, j’étudie la représentation faite par la médecine hippocratique des principaux organes du corps et du système vasculaire en souhaitant montrer que l’anatomie hippocratique n’est ni le produit de l’observation rigoureuse, ni celui de la pure fantaisie, mais qu’elle a toujours pour fonction de soutenir une théorie physiologique ou une pratique thérapeutique. Je mets d’abord en évidence la correspondance étroite entre certaines descriptions anatomiques parmi les plus détaillées du Corpus hippocratique et la physiologie humorale défendue par plusieurs auteurs. (...) J’analyse ensuite quelques schémas du système vasculaire dans le but d’exposer leur dépendance à l’égard de l’étiologie et de la thérapie. (shrink)

Le traité Du Régime se démarque des autres traités du corpus hippocratique à bien des égards. Aucun autre texte de ce corpus n’a poussé aussi loin le lien entre le corps humain en tant que microcosme et le cosmos, son macrocosme. Ce lien se manifeste notamment dans de multiples analogies, dans des expressions communes utilisées pour les décrire, ainsi que dans des explications identiques des phénomènes qui les caractérisent. Le présent article enquêtera sur une expression spécifique liant l’homme et le (...) cosmos : le terme περίοδος. Dans la continuité des travaux de Luc Brisson et Jacques Jouanna qui ont signalé plusieurs traits communs au Timée de Platon et au traité Du Régime, il s’agira de mettre en lumière l’importance du terme περίοδος, du concept de rotation/révolution, dans l’association microcosme-macrocosme, autant d’un point de vue structurel que fonctionnel. (shrink)

Policies that require male-female sex comparisons in all areas of biomedical research conflict with the goal of improving health outcomes through context-sensitive individualization of medical care. Sex, like race, requires a rigorous, contextual approach in precision medicine. A “sex contextualist” approach to gender-inclusive medicine better aligns with this aim.

Kunstmatige intelligentie (AI) en systemen die met machine learning (ML) werken, kunnen veel onderdelen van het medische besluitvormingsproces ondersteunen of vervangen. Ook zouden ze artsen kunnen helpen bij het omgaan met klinische, morele dilemma’s. AI/ML-beslissingen kunnen zo in de plaats komen van professionele beslissingen. We betogen dat dit belangrijke gevolgen heeft voor de relatie tussen een patiënt en de medische professie als instelling, en dat dit onvermijdelijk zal leiden tot uitholling van het institutionele vertrouwen in de geneeskunde.

We generally accept that medicine’s conceptual and ethical foundations are grounded in recognition of personhood. With patients in vegetative state, however, we’ve understood that the ethical implications of phenomenal consciousness are distinct from those of personhood. This suggests a need to reconsider medicine’s foundations. What is the role for recognition of consciousness (rather than personhood) in grounding the moral value of medicine and the specific demands of clinical ethics? I suggest that, according to holism, the moral value of medicine is (...) secured when conscious states are recognized in everyday medical science. Moreover, consciousness fully motivates traditional principles of clinical ethics if we understand respect for autonomy as respect for the dominion of an experiencer in the private, inescapable realm of bodily experience. When medicine’s foundations are grounded in recognition of consciousness, we understand how patients fully command respect even when they lack capacity to exercise their bodily dominion through decision-making. (shrink)

Environmental health research produces scientific knowledge about environmental hazards crucial for public health and environmental justice movements that seek to prevent or reduce exposure to these hazards. The environment in environmental health research is conceptualized as the range of possible social, biological, chemical, and/or physical hazards or risks to human health, some of which merit study due to factors such as their probability and severity, the feasibility of their remediation, and injustice in their distribution. This paper explores the ethics of (...) identifying the relevant environment for environmental health research, as judgments involved in defining an environmental hazard or risk, judgments of that hazard or risk's probability, severity, and/ or injustice, as well as the feasibility of its remediation, all ought to appeal to non-epistemic as well as epistemic values. I illustrate by discussing the case of environmental lead, a housing-related hazard that remains unjustly distributed by race and class and is particularly dangerous to children. Examining a controversy in environmental health research ethics where researchers tested multiple levels of lead abatement in lead-contaminated households, I argue that the broader perspective on the ethics of environmental health research provided in the first part of this paper may have helped prevent this controversy. (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)

In this paper, we aim at rethinking the concept of obesity in a way that better captures the connection between underlying medical aspects, on the one hand, and an individual’s developmental history, on the other. Our proposal rests on the idea that obesity is not to be understood as a phenotypic trait or character; rather, obesity represents one of the many possible states of a more complex phenotypic trait that we call ‘energy metabolism.’ We argue that this apparently simple conceptual (...) shift can help solve important theoretical misconceptions regarding the genetics, epigenetics, and development of obesity. In addition, we show that our proposal can be fruitfully paired with the concept of developmental channeling of a trait, which connects to the study of the plasticity and canalization of complex traits. Finally, we discuss the potential impact of our approach on the assessment, treatment, and social narratives of obesity. (shrink)

While practitioners think highly of randomized studies, some philosophers argue that there is no epistemic reason to randomize. Here I show that their arguments do not entail their conclusion. Moreover, I provide novel reasons for randomizing in the context of interventional studies. The overall discussion provides a unified framework for assessing baseline balance, one that holds for interventional and observational studies alike. The upshot: practitioners’ strong preference for randomized studies can be defended in some cases, while still offering a nuanced (...) approach to evidence-appraisal, one where not all non-randomized studies are treated equally. (shrink)

Summary Background Self-binding directives instruct clinicians to overrule treatment refusal during future severe episodes of illness. These directives are promoted as having potential to increase autonomy for individuals with severe episodic mental illness. Although lived experience is central to their creation, service users’ views on self-binding directives have not been investigated substantially. This study aimed to explore whether reasons for endorsement, ambivalence, or rejection given by service users with bipolar disorder can address concerns regarding self-binding directives, decision-making capacity, and human (...) rights. Methods This study used qualitative data from an internet-based survey distributed to the mailing list of the UK charity Bipolar UK, which contained multiple closed and open questions on advance decision-making in bipolar disorder. Quantitative analysis of a closed question about self-binding directives had already demonstrated endorsement amongst a very high proportion of participants with bipolar disorder who completed the survey. We conducted thematic analysis of responses from those participants who answered a subsequent open question about reasons for their view. Research was co-produced within a multi-disciplinary team, with clinical, legal, and ethical expertise, and lived experience of bipolar disorder. Ideas and methodologies associated with all these areas of expertise were used in the analysis of these reasons and to gain insight into the thoughts of individuals with bipolar disorder about self-binding directives and associated issues. Findings Between Oct 23 and Dec 5, 2017, 932 individuals with a self-reported clinical diagnosis of bipolar disorder completed the internet survey, with 565 (154 men; 400 women; 11 transgender or other) providing free text answers to the open question. A large majority of respondents endorsed self-binding directives, nearly all describing a determinate shift to types of distorted thinking and decision-making when unwell as their key justification. Responses indicating ambivalence were dominated by logistical concerns about the drafting and implementation of self-binding directives, while those who rejected self-binding directives also cited logistical concerns, validity of their thinking when unwell, and potential contravention of human rights. Interpretation This study is, to our knowledge, the first large study of reasons why mental health service users might endorse or reject the use of self-binding directives. The findings provide empirical support for introducing self-binding directives into mental health advance decision-making practice and policy and may help to address enduring ethical concerns surrounding possible implementation of the directive while a person retains decision-making capacity. The opinions expressed here in responses given by multiple service users with bipolar disorder challenge a prominent view within international disability rights debates that involuntary treatment and recognition of impaired mental capacity constitute inherent human rights violations. Funding The Wellcome Trust . (shrink)

This academic paper on Ethical issues of using umbilical cord blood stem cell therapy of John Stuart Mill perspective aim to investigate the new approaches in the treatment of diseases by using umbilical cord blood stem cells. And also to study ethical issues from the use of umbilical cord blood stem cells in the treatment of diseases considered by Mill’s utilitarianism. 21st century, the medical industry was interested in organ transplantation from stem cells especially stem cells from the umbilical cord (...) to treat chronic and degenerative organ diseases, blood cancer and organ transplantation which successful and widespread throughout the world. Thailand has about 900 new children with Leukemia every year. About 50 percent are leukemia which needs to be treated correctly and urgently. In general Standardized chemotherapy but if the cancer patient has a bad prognosis Or have recurrent cancer Patients need to be treated with bone marrow transplants or stem cells to have a chance to heal. According to Mill’s Utilitarianism, the ethical concepts that determine what is the basic criterion used to determine whether it should or should not concern with the popular benefit that the criterion used is the amount of happiness that results from actions. Treating the disease using stem cells will make the patient recover from the disease, healthier and happier in life. As Mill said "The correctness of an action depends on the tendency that the action will lead to happiness. (shrink)

This thesis is a philosophical examination of the explanatory roles of diagnoses in psychiatry. In medicine, diagnoses normally serve as causal explanations of patients’ symptoms. Given that psychiatry is a discipline whose practice is shaped by medical traditions, it is often implied that its diagnoses also serve such explanatory functions. This is evident in clinical texts that portray psychiatric diagnoses as referring to diseases that cause symptoms. However, there are problems which cast doubt on whether such portrayals are justified. I (...) address these problems and examine whether psychiatric diagnoses provide explanations of symptoms. The first problem is conceptual. In diagnostic manuals, psychiatric diagnoses are defined by their symptoms. This suggests that invoking them as explanations of the symptoms amounts to circularity. I argue that this can be resolved with an appropriate conceptual framework that captures the complex semantic values of diagnostic terms and their different uses in clinical discourse. I put forward such a framework based on two-dimensional semantics. The second problem is ontological. Empirical research suggests that diagnostic categories in psychiatry do not correspond to invariant causal types, but are associated with variable combinations of diverse causes that interact across biological, psychological, and social levels. Given this heterogeneity, I argue that psychiatric diagnoses fall short of paradigmatic cases of causal explanation, but that some can still provide other sorts of useful causal explanatory information. The original contribution of this thesis is the illumination of the conceptual relations between diagnoses and symptoms. This philosophical work is important, because it can be brought to valuable application in modifying psychiatric practice. (shrink)

Diagnoses are central to the practice of medicine, where they serve a variety of functions for clinicians, patients, and society. They aid communication, explain symptoms, inform predictions, guide therapeutic interventions, legitimize sickness, and authorize access to resources. Insofar as psychiatry is a discipline whose practice is shaped by medical conventions, its diagnoses are sometimes presented as if they serve the same sorts of function as diagnoses in bodily medicine. However, there are philosophical problems that cast doubt on whether the functions (...) of psychiatric diagnoses can legitimately be considered to be equivalent to those of medical diagnoses. The aim of this chapter is to explicate some of these problems, particularly conceptual and epistemological problems pertaining to the roles of diagnoses as explanations. I begin with an overview of the various functions that medical diagnoses normally serve and suggest that many of these functions receive justificatory support from the explanatory roles of the diagnoses. I then present issues regarding the epistemic functions of psychiatric diagnoses and how these issues have featured in the arguments of prominent critics of psychiatry. (shrink)

Aujourd’hui délaissées, parfois devenues gênantes, les collections médicales furent pourtant à l’avant-garde du renouveau de la médecine au début du XIXe siècle, avant que celle-ci ne devienne la médecine telle que nous la connaissons aujourd’hui. Selon une vision courante de l’histoire de la médecine, les collections médicales auraient perdu de leur utilité lorsque la médecine a accédé au statut de science expérimentale, les musées d’anatomie faisant alors place aux laboratoires. Les collections d’anatomie-pathologie comme le musée Dupuytren ne seraient que le (...) reliquat de cette histoire, le témoignage d’un échec méthodologique à opposer aux succès de la physiologie expérimentale. Cette narration de l’histoire de la médecine est-elle cependant correcte ? Dans quels buts épistémologiques les médecins ont-ils créé ces collections ? Quelles connaissances cherchaient-ils à obtenir par ce biais ? Plus généralement, pourquoi collecter en médecine – et en science – et pourquoi collectionner ? Pour répondre à ces questions, je m’intéressai principalement dans cette contribution aux pratiques de collecte et de collection chez les médecins de la Société Anatomique de Paris au XIXe siècle et au rôle joué par ces pratiques dans la construction de la collection Dupuytren. (shrink)

The public discussion on artificial intelligence for public health often revolves around future applications like drug discovery or personalized medicine. But already deployed artificial intelligence for content recommendation, especially on social networks, arguably plays a far greater role. After all, such algorithms are used on a daily basis by billions of users worldwide. In this paper, we argue that, left unchecked, this enormous influence of recommendation algorithms poses serious risks for public health, e.g., in terms of misinformation and mental health. (...) But more importantly, we argue that this enormous influence also yields a fabulous opportunity to provide quality information and to encourage healthier habits at scale. We also discuss the philosophical, technical and socio-economical challenges to seize this immense opportunity, and sketch the outlines of potential solutions. In particular, we argue that it would be extremely helpful if public and private institutions could publicly take a stand, as this may then generate the necessary social, economical and political pressure to massively invest in the research, development and deployment of the potential solutions. (shrink)

In this commentary, I propose a framework for thinking about data quality in the context of scientific research. I start by analyzing conceptualizations of quality as a property of information, evidence and data and reviewing research in the philosophy of information, the philosophy of science and the philosophy of biomedicine. I identify a push for purpose dependency as one of the main results of this review. On this basis, I present a contextual approach to data quality in scientific research, whereby (...) the quality of a dataset is dependent on the context of use of the dataset as much as the dataset itself. I exemplify the approach by discussing current critiques and debates of scientific quality, thus showcasing how data quality can be approached contextually. (shrink)

In this paper, Isuggest that placebo effects, as we know them today, should be understood as experimental phenomena, low-level regularities whose causal structure is grasped through particular experimental designs with little theoretical guidance. Focusing on placebo interventions with needles for pain reduction -one of the few placebo regularities that seems to arise in meta-analytical studies- I discuss the extent to which it is possible to decompose the different factors at play through more fine-grained randomized clinical trials. My sceptical argument is (...) twofold. On the one hand, I argue that experiments alone are not enough to standardize interventions, and that it is necessary to include theories. On the other hand, I argue that the social interactions that seem to be part of placebo effects are difficult, if not impossible, to blind. Therefore, the measurement biases arising from the participants’ reactivity to the experimental setup cannot be controlled for. Further decomposition of placebo effects requires a theoretical account of the existing experimental regularities that may guide further tests. (shrink)

Why scientists reach an agreement on new experimental methods when there are conflicts of interest about the evidence they yield? I argue that debiasing methods play a crucial role in this consensus, providing a warrant about the impartiality of the outcome regarding the preferences of different parties involved in the experiment. From a contractarian perspective, I contend that an epistemic pre-requisite for scientists to agree on an experimental method is that this latter is neutral regarding their competing interests. I present (...) two medical experiments (on smallpox inoculation and Mesmerism) in which debiasing procedures such as blinding and data tabulation provided warrants of impartiality that made people agree on the experimental design even if they disagreed on the outcome. (shrink)

Recently, it has been argued that the use of Big Data transforms the sciences, making data-driven research possible and studying causality redundant. In this paper, I focus on the claim on causal knowledge by examining the Big Data project EXPOsOMICS, whose research is funded by the European Commission and considered capable of improving our understanding of the relation between exposure and disease. While EXPOsOMICS may seem the perfect exemplification of the data-driven view, I show how causal knowledge is necessary for (...) the project, both as a source for handling complexity and as an output for meeting the project’s goals. Consequently, I argue that data-driven claims about causality are fundamentally flawed and causal knowledge should be considered a necessary aspect of Big Data science. In addition, I present the consequences of this result on other data-driven claims, concerning the role of theoretical considerations. I argue that the importance of causal knowledge and other kinds of theoretical engagement in EXPOsOMICS undermine theory-free accounts and suggest alternative ways of framing science based on Big Data. (shrink)