The bioethics literature has paid little attention to matters of informed reproductive decision-making among women of childbearing age who have chronic kidney disease (CKD), including women who are on dialysis or women who have had a kidney transplant. Women with CKD receive inconsistent and, sometimes, inadequate reproductive counseling, particularly with respect to information about pursuing pregnancy. We identify four factors that might contribute to inadequate and inconsistent reproductive counseling. We argue that women with CKD should receive comprehensive reproductive counseling, including (...) information about the possibility of pursuing pregnancy, and that more rigorous research on pregnancy in women with CKD, including women on dialysis or who have received a kidney transplant, is warranted to improve informed reproductive decision making in this population. (shrink)

The celebration of thirty years of publication of The Journal of Medicine and Philosophy provides an opportunity to reflect on how medical ethics has evolved over that period. The reshaping of the field has occurred in no small part because of the impact of branches of philosophy other than ethics. These have included influences from Kantian theory of respect for persons, personal identity theory, philosophy of biology, linguistic analysis of the concepts of health and disease, personhood theory, epistemology, and political (...) philosophy. More critically, medicine itself has begun to be reshaped. The most fundamental restructuring of medicine is currently occurring - stemming, in part, from the application of contemporary philosophy of science to the medical field. There is no journal more central to these critical events of the past three decades than The Journal of Medicine and Philosophy. (shrink)

Ludwik Fleck is remembered for his monograph published in German in 1935. Reissued in 1979 as Genesis and development of a scientific fact Fleck’s monograph has been claimed to expound relativistic views of science. Fleck has also been portrayed as a prominent scientist. The description of his production of a vaccine against typhus during World War II, when imprisoned in Buchenwald, is legendary in the scholarly literature. The claims about Fleck’s scientific achievements have been justified by referring to his numerous (...) publications in international scientific journals. Though frequently mentioned, these publications have scarcely been studied. The present article discusses differences in interpretation and evaluation of science in relation to the background of the interpreters. For this purpose Fleck’s scientific publications have been scrutinized. In conjunction with further sources reflecting the desperate situation at the time in question, the results of the study account for a more restrained picture of Fleck’s scientific accomplishments. Furthermore, based on the review of the latter, certain demands characterizing good science could be articulated. The restricted possibilities of those not trained in science or not possessing field specific knowledge, evaluating science are discussed, as are also formal aspects of scientific papers and questions related to research ethics. (shrink)

: Since its almost serendipitous rediscovery in the late seventies, Fleck's monograph, Entstehung und Entwicklung einer wissenschaftlichen Tatsachee, initially published in 1935, translated into English in 1979 (Genesis and Development of a Scientific Fact), has been met with increasing acclaim within the philosophy and the sociology of science. In historizing, sociologizing and relativizing science, Fleck is claimed to have expressed prescient views on the history, philosophy and sociology of science and in deeply influencing Kuhn. Though the neglect of Fleck by (...) his contemporaries has been difficult to account for, the basis of his epistemology has evoked little interest, partly due to the lack of apparent sources. Fleck's philosophical writings, published between 1927 and 1939, indicate, however, a polemic, deeply ingrained in an ongoing debate, on the standing of old established scientific disciplines versus new and emerging ones, occasioned by the rapid changes within the natural sciences. Most obvious to the lay community, and also reflected in the new positivist philosophy, were the revolutionary changes within physics. As a participant in the debate, eagerly striving for recognition, Fleck used modern physic heuristically as the basis of his epistemology. The tracing of his sources, and the voices of other contemporaneous scientists opposing his views, are attempted. (shrink)

It was in the course of one particular clinical encounter that I came to realize the power of narrative, especially for expressing clinically presented ethical matters. In Husserlian terms, the mode of evidence proper to the unique and the singular is the very indirection that is the genius of story-telling. Moreover, the clinical consultant is unavoidably changed by his or her clinical involvement. The individuals whose situation is at issue have their own stories that need telling. Clinical ethics is in (...) this sense a way of helping patients, families, and, yes, health providers to discover and give voice to those stories. In this way, clinical ethics is an evoking of meaning. Kierkegaard understood this well: Indirect communication is the language for the unique and the otherwise inexpressible. (shrink)