Systems medicine, which is based on computational modelling of biological systems, is emerging as an increasingly prominent part of the personalized medicine movement. It is often promoted as ‘P4 medicine’. In this article, we test promises made by some of its proponents that systems medicine will be able to develop a scientific, quantitative metric for wellness that will eliminate the purported vagueness, ambiguity, and incompleteness—that is, normativity—of previous health definitions. We do so by examining the most concrete and relevant evidence (...) for such a metric available: a patent that describes a systems medicine method for assessing health and disease. We find that although systems medicine is promoted as heralding an era of transformative scientific objectivity, its definition of health seems at present still normatively based. As such, we argue that it will be open to influence from various stakeholders and that its purported objectivity may conceal important scientific, philosophical, and political issues. We also argue that this is an example of a general trend within biomedicine to create overly hopeful visions and expectations for the future. (shrink)

The nonreductionistic theory of the multiple aspects of reality offered by the Dutch philosopher Herman Dooyeweerd is employed to illuminate the status of bodies and biological entities in relation to attached and incorporated technological devices. I first present a review of the interpretations of the mechanization of biology and then argue from a Dooyeweerdian viewpoint that this mechanization also amounts to a reduction of the biotic aspect to previous aspects, such as the physical and the regulatory or cybernetic aspect. Next, (...) the irreducible meaning of the biotic aspect is defined as the vital life cycle and generational continuity that delineate the form of a species. Finally, I show how this definition helps us identify a normativity and a respect for living things, and I discuss its implications for bioengineering practices. (shrink)

Diagnoses in medicine are often taken to serve as explanations of patients’ symptoms and signs. This article examines how they do so. I begin by arguing that although some instances of diagnostic explanation can be formulated as covering law arguments, they are explanatory neither in virtue of their argumentative structures nor in virtue of general regularities between diagnoses and clinical presentations. I then consider the theory that medical diagnoses explain symptoms and signs by identifying their actual causes in particular cases. (...) While I take this to be largely correct, I argue that for a diagnosis to function as a satisfactory causal explanation of a patient’s symptoms and signs, it also needs to be supplemented by understanding the mechanisms by which the identified cause produces the symptoms and signs. This mechanistic understanding comes not from the diagnosis itself, but rather from the theoretical framework within which the physician operates. (shrink)

The merit of Plato’s Laws remains largely untapped by those seeking genuinely collaborative models of the doctor–patient tie as alternatives to paternalism and autonomy. A persistent difficulty confronting proposed alternatives has been surpassing the notion of pronounced intellectual and values asymmetry favoring the doctor. Having discussed two prominent proposals, both of which evince marked paternalism, I argue that reflection on Plato yields four criteria that a genuinely collaborative model must meet and suggest how the Laws addresses them. In the process, (...) the Laws’ doctor–patient tie is shown to be far more nuanced than interpreters have previously observed. Although Plato’s account will not solve our own quandaries, it illustrates how one might retain asymmetry of a kind without capitulating to familiar oppositional modalities. Through this account, I hope to show that the Laws merits fuller inclusion in contemporary discussions than it has heretofore received. (shrink)

We have never been so aware of masks. They were in short supply in the early days of COVID-19, resulting in significant risk to health care workers. Now they are highly politicized with battles about mask-wearing protocols breaking out in public. Although masks have obtained a new urgency and ubiquity in the context of COVID-19, people have thought about both the literal and metaphorical role of masks in medicine for generations. In this paper, we discuss three such metaphors—the masks of (...) objectivity, of infallibility, and of benevolence—and their powerful role in medicine. These masks can be viewed as inflexible barriers to communication, contributing to the traditional authoritarian relationship between doctor and patient and concealing the authenticity and vulnerability of physicians. COVID masks, by contrast, offer a more nuanced and morally complex metaphor for thinking about protecting people from harm, authentic and trustworthy communication, and attention to potential inequities both in and beyond medical settings. We highlight the morally relevant challenges and opportunities that masks evoke and suggest that there is much to be gained from rethinking the mask metaphor in medicine. (shrink)

This paper outlines and criticises two models of terrorism, the Rational Agent Model (RAM) and the Radicalisation Model (RAD). A different and more plausible conception of the turn to violence is proposed. The proposed account is Moderate Epistemic Particularism (MEP), an approach partly inspired by Karl Jaspers’ distinction between explanation and understanding. On this account there are multiple idiosyncratic pathways to cognitive and behavioural radicalisation, and the actions and motivations of terrorists can only be understood (rather than explained) by engaging (...) with their subjectivity in a way that depends on a degree of empathy. Scepticism is expressed about attempts to model radicalisation and predict political violence. This scepticism is based on reflections concerning the nature of complex particulars. The implications of MEP for counterterrorism are briefly discussed. (shrink)