The philosophy of engineering is, in the first instance, concerned to make sense of what we do and how we do it as agents in the world. It is also concerned with understanding the nature of inquiry and exploration in the engineering enterprise. In these latter concerns, the philosophy of engineering constitutes the more general framework for understanding the nature of reality and the role of engineering in it. The philosophy of engineering and the engineering worldview supersede and subsume the (...) philosophy of science and the scientific worldview. (shrink)

CAPPE LPO Box 8260 ANU Canberra ACT 2601 Australia Tel: +61 (0)2 6125 4355, Fax: +61 (0)2 6125 6579; Email: michael.selgelid{at}anu.edu.au ' + u + '@' + d + ' '//--> Abstract This article reviews ethically relevant history of tuberculosis and recent developments regarding extensively drug resistant tuberculosis (XDR-TB). It argues that tuberculosis is one of the most important neglected topics in bioethics. With an emphasis on XDR-TB, it examines a range of the more challenging ethical issues associated with tuberculosis: (...) individual obligations to avoid infecting others, coercive social distancing measures, third-party notification, health workers' duty to treat contagious patients, and international justice. In each of these cases, key philosophical questions are highlighted and the need for empirical research/information is demonstrated. CiteULike Connotea Del.icio.us What's this? (shrink)

Der Aufsatz widmet sich dem Wohlfahrtseffekt öffentlicher Ausgaben unter besonderer Berücksichtigung der Bereiche Gesundheitswesen und Bildungswesen. Ausgangspunkt ist die Feststellung des bemerkenswert geringen Ertrags hoher Aufwendungen für öffentliche Gesundheit, der insbesondere im Vergleich von Ländern mit teils deutlich variierenden Gesundheitsbudgets auffällt. Da das Gesundheitswesen aufgrund der Opportunitätskostenproblematik mit anderen Bereichen sozialpolitischer Sicherheitsgewähr um knappe öffentliche Mittel konkurriert, ist darauf zu achten, dass deren Allokation bestmöglich optimiert wird. Im deutschen Fall mit seinem ungewöhnlich hohen Anteil öffentlicher Gesundheitsausgaben legt das eine Verschiebung (...) der Prioritäten zugunsten des Bildungswesens nahe, wofür neben potentiellen Verbesserungen des Gesundheitsstatus der Bevölkerung und funktionalen, die gesellschaftliche Integration betreffenden Erwägungen auch solche der sozialen Gerechtigkeit sprechen. Ein Programm zur Reformierung des Gesundheitswesens, das diesen Leitlinien folgt, wird skizziert. (shrink)

What is medicine? One obvious answer in the context of the contemporary clinical tradition is that medicine is the process of curing sick people. However, this “curative thesis” is not satisfactory, even when “cure” is defined generously and even when exceptions such as cosmetic surgery are set aside. Historian of medicine Roy Porter argues that the position of medicine in society has had, and still has, little to do with its ability to make people better. Moreover, the efficacy of medicine (...) for improving population health has been famously doubted by historians and epidemiologists. The curative thesis demands that we have mostly been stupid, duped, or staggeringly hopeful, given that medicine has not until recently offered more than a handful of effective cures. I suggest, in this article, that the core medical competence is neither to cure, nor to prevent, disease, but to understand and to predict it. I argue that this approach does a better job than the curative thesis at explaining why not all medicine is concerned with curative efforts and that it enjoys historical support from the ancient entanglement of prophecy and medicine and from the fact that medicine thrived for centuries with almost no effective cures and continues to thrive today in various forms that are mostly without curative efficacy. I suggest that this approach grounds a fairer approach to alternative, traditional, and other medical practices, as well as some fresh lessons for the development of mainstream medicine. (shrink)

It is one of the remarkable and significant consequence of the AIDS epidemic that out of the context of enormous suffering and death there emerged a forceful set of ideas linking the domains of health and human rights. At first, the effort centered on the observation that protecting individuals from discrimination and unwarranted intrusions on liberty were, contrary to previous epidemics, crucial to protecting the public health and interrupting the spread of HIV But in fairly short order, the scope of (...) the health and human rights perspective expanded dramatically to focus on the ways in which the most fundamental social arrangements rendered individuals and communities vulnerable to HIV Racial and ethnic minorities, those who were marginalized, and women were at risk because of their subordinate status. In the face of such an understanding, nothing short of social change could be adequate to the challenge posed by the AIDS epidemic. (shrink)

It is one of the remarkable and significant consequence of the AIDS epidemic that out of the context of enormous suffering and death there emerged a forceful set of ideas linking the domains of health and human rights. At first, the effort centered on the observation that protecting individuals from discrimination and unwarranted intrusions on liberty were, contrary to previous epidemics, crucial to protecting the public health and interrupting the spread of HIV But in fairly short order, the scope of (...) the health and human rights perspective expanded dramatically to focus on the ways in which the most fundamental social arrangements rendered individuals and communities vulnerable to HIV Racial and ethnic minorities, those who were marginalized, and women were at risk because of their subordinate status. In the face of such an understanding, nothing short of social change could be adequate to the challenge posed by the AIDS epidemic. (shrink)

In confronting the insalubrious ramifications of globalization, human rights scholars and activists have argued for greater national and international responsibility pursuant to the human right to health. Codified seminally in Article 12 of the International Covenant on Economic, Social and Cultural Rights, the right to health proclaims that states bear an obligation to realize the “highest attainable standard” of health for all. However, in pressing for the highest attainable standard for each individual, the right to health has been ineffective in (...) compelling states to address burgeoning inequalities in underlying determinants of health, focusing on individual medical treatments at the expense of public health systems. This article contends that the paradigm of individual health, focused on a right to individual medical care, is incapable of responding to health inequities in a globalized world and thereby hampers efforts to operationalize health rights through public health systems. While the right to health has evolved in international discourse over time, this evolution of the individual right to health cannot address the harmful societal ramifications of economic globalization. Rather than relying solely upon an individual right to medical care, envisioning a collective right to public health – a right applied at the societal level to address underlying determinants of health – would alleviate many of the injurious health inequities of globalization. (shrink)

The right to health was codified in Article 12 of the International Covenant on Economic, Social and Cultural Rights as an individual right, focusing on individual health services at the expense of public health systems. This article assesses the ways in which the individual human right to health has evolved to meet collective threats to the public's health. Despite its repeated expansions, the individual right to health remains normatively incapable of addressing the injurious societal ramifcations of economic globalization, advancing individual (...) rights to alleviate collective inequalities in underlying determinants of health. By examining modern changes to underlying determinants of health, this article concludes that responding to globalized health threats necessitates a collective right to public health. (shrink)

This report explores the relationship between philosophy and medicine in the U.K. We note that medical training involves very little formal instruction in philosophy and ethics, and that, with few exceptions, philosophers in the U.K. do not contribute to the instruction of physicians or the philosophy of medicine. However, reviewing the problems arising out of recent developments within scientific medicine we find a pressing need for future philosophical analysis in the following areas: psychiatry, organ transplantation, abortion, euthanasia, experiments on living (...) subjects, consent, confidentiality, the relationship between medicine and political authority, and the provisions for social justice in medicine. (shrink)

This paper looks at how the strategies of mediaand cultural studies can be applied to thehealth studies field. This relationship,however, has been met with resistance due to anumber of status debates. We argue theimportance of fostering links between these`disciplines' namely because the definition ofwhat constitutes `health' has been broadenedand is inscribed in most forms of popularmedia. Using the example of the `health andlifestyle' debate, we argue that the mediainforms cultural understandings aboutrequirements for living and is therefore acrucial area of analysis (...) for health studies(and cultural/media studies) students. We arealso concerned with analysing how the mediacontributes to the construction and regulationof `healthy' subjects making links with publichealth discourses and current debates in thefield of media and health. (shrink)

This brief review of the efficacy, safety, and costs of IVF demonstrates that this procedure has become accepted medical practice without adequate scientific assessment. Its rapid proliferation especially in the market-oriented USA system, has preceded the type of outcomes research that is essential in order to protect both individual patients and the health care system. In addition, concern over the psychological costs borne by the vast majority of women who unsuccessfully pursue pregnancy through these techniques should warrant a level of (...) caution which to date has not been forthcoming. The demand for pregnancy, the organisation of medical specialties surrounding these procedures, the open-ended reimbursement and incentive structure, and powerful market forces make it unlikely that IVF and a whole range of medical technologies can be regulated without some semblance of a national health system. These findings clearly reinforce the themes raised by the Radical Statistics Health Group and illustrate some of the weaknesses of a market approach to medical care. (shrink)

Both gender and the law are significant determinants of health and well-being. Here, we put forward evidence to unpack the relationship between gender and outcomes in health and well-being, and explore how legal determinants interact and intersect with gender norms to amplify or reduce health inequities across populations. The paper explores the similarities between legal and health systems in their response to gender—both systems portray gender neutrality but would be better described as gender-blind. We conclude with a set of recommendations (...) to address both law and gender in implementing the work of the Lancet Commission on the legal determinants of health to improve health outcomes for all, irrespective of gender. (shrink)

Last year (1998) saw the celebration of the 50th Anniversaryof the British National Health Service (NHS). One ofthe few completely nationalised systems of health carein the world, the NHS is seen by many as a moralbeacon of what it means to provide equitable medicaltreatment to all citizens on the basis of need andneed alone. However, others argue that it has failedto achieve the overall goals for which it was created.Because of scarce resources, some urgently needed careis not available at all, (...) while that which is receivedis sometimes second class. For these reasons, it isclaimed that the NHS should be scrapped and replacedby other systems of health care delivery.This paper outlines the history of the NHS,indicating some of the problems and innovations whichhave led to its current organization and structure.The philosophical foundations of the NHS are then articulated and defended on the grounds that it stillrepresents a morally coherent and economicallyefficient approach to the delivery of health care.Scarce resources are the key problem facing the NHS,making rationing inevitable and it is shown thatthis is not incompatible with the moral foundations ofthe service. However, there can be little doubt thatthe NHS is now becoming dangerously under-funded. Thepaper concludes with arguments about why this is soand what might be done about it. (shrink)

It is an axiom of contemporary conversations about austerity and health care that the relationship between the two is essentially direct. Cutting funds damages health care systems and hurts the health of individuals who rely on them. Though this premise has provoked necessary discussion about global politics, the global economy and their impact on individual well-being, it is nonetheless intrinsically problematic. Assigning health and health care as objects of austerity not only obscures the complexity of health care systems and the (...) opacity of health’s definitional borders, but also misunderstands austerity, its manifestations and its significance. The ambition of this essay is to bring health care back into the debate, in order to establish the greater dynamism of the contemporary austerity and health care relationship. This historical reconstruction will challenge the significance of our current situating of austerity as health care’s bogeyman, press for a reconsideration of our contemporary definitions of the key factors involved here and finally conclude with some thoughts on how we might more productively approach the problem of health now. (shrink)

In this article the various descriptions and interpretations ofprofessional autonomy, as have been given in the articles from Belgium,Italy and the UK are subjected to a further analysis. The implicit claimthat professional autonomy of physicians is beneficial for the health ofpatients is scrutinized and is proven to be untrue and invalid. Theconclusion is that professional autonomy is more directed at theinterests of physicians than of those of patients and deserves nospecial place in health care.

Buddhism has always produced epistemological systems, and those of the Mahāyāna, in particular, always showed knowledge and perception to be inherently delusive. “Higher” forms of Buddhism have a degenerative philosophy of history according to which a sort of Golden Age was disrupted by the rise and gradual development of knowledge and the delusion inherent in it, which have reached their apex in our time – the final phase of the “Era of Darkness.” From this standpoint, this paper intends to show (...) science, in which Marcuse saw an inherent instrumental/technological interest, to have been developed by delusion and to have simultaneously furthered the development of delusion, to the point at which they begot the deadly ecological crisis proper to this concluding phase of the Era of Darkness – which reveals as such the delusion at its root, achieving the latter’s empirical reductio ad absurdum and offering us the possibility of eradicating it and thus healing our minds and, hopefully, our world. (shrink)

Medical Ethics has many unsung heros and heroines. Here we celebrate one of these and on telling part of her story hope to place modern medical ethics and bioethics in the UK more centrally within its historical and human contex.

Health care systems, irrespective of how they are financed, present the paradox that to some observers they appear as a major component of social benefits, while to other observers they seem both excessively costly and limited in their effectiveness. These differing perceptions may be explained in part by the diversity of the determinants of health and disease, only some of which are amenable to those preventive or therapeutic measures encompassed in a health care system--the majority of determinants being genetic, societal, (...) or else uninfluenced by those interventions at present available within a health service. The share of national resources which should be devoted to health care, and the method of raising resources, are primarily matters for political decision; but a national system has advantages both of economy and of comprehensiveness. But when it comes to allocation of resources within the established health budget, the knowledge and skills of health professionals are essential to informed decision-making. The possibilities depend critically on the 'state of the art' at a given time, as is illustrated by the radical changes over time in what could be done for patients with renal failure; and health professionals are likely to be most aware of current options, and of how to choose between them. More speculatively, they are also less likely to confuse the attitudes appropriate to providing a service with those required to run a business. (shrink)

As it has historically been the case with many pandemics, the Covid-19 experience will induce many philosophers to reconsider the value of medical practice. This should be a good opportunity to critically scrutinize the way medical research and medical interventions are carried out. For much of its history, medicine has been very inefficient. But, even in its contemporary forms, a review of common protocols in medical research and medical interventions reveal many shortcomings, especially related to methodological flaws, and more importantly, (...) conflicts of interests due to profit incentives. In the face of these problems, we propose a program of “gentle medicine”. This term, originally formulated by philosopher Jacob Stegenga, describes a form of medicine in which physicians intervene less than they currently do. As part of this general program, we advance a series of reform recommendations that could be enacted both by medical staff in their everyday practice, but also by public health officials and policymakers. (shrink)

This thesis explores the concept of "Sanctity of Life" from the perspective of what "life," in particular human life, means today. With the rapid advances in science and modern medical practice, the concept of life has undergone many changes, shaking the foundations of what before made us view life as sacred. Modern thought has brought new forms of understanding to the concept of life.

The authoritarian standpoint in medicine has been under challenge by various groups and researchers since the 1980s. The challenges have been ethical, political and medical, with patient movements at the forefront. Over the past decade, however, a deep challenge has been posed by evidence-based medicine (EBM), which has challenged the entire strategy of medical treatment from the point of view of a self-critical, anti-authoritarian and hereby also (it has been claimed) a more democratic medical practice. Previously, the challenges arose out (...) of the patient rights perspective. EBM, by contrast, was taken to challenge the way doctors consider their medical practice as a whole. The present paper puts this claim of democratization into a historical context. Two dimensions of the democratization hypothesis are discussed and it is argued that they are insufficient to capture the substantial changes going on in the intersection between medical practice, biomedical science and citizens. (shrink)