When are we obligated to believe someone? To what extent are people authorities about their own experiences? What kind of harm might we enact when we doubt? Questions like these lie at the heart of many debates in social and feminist epistemology, and they’re the driving issue behind a key conceptual framework in these debates—gaslighting. But while the concept of gaslighting has provided fruitful insight, it's also proven somewhat difficult to adjudicate, and seems prone to over-application. In what (...) follows, I argue that Katherine Hawley's theory of trust can provide a useful alternative lens for looking at contested testimony. To do this, I focus on a particularly complex—but increasingly popular—application of gaslighting: the physician/patient relationship, and the idea of ‘medical gaslighting’. I argue that, even though patients can experience harm when they are disbelieved, there are nevertheless good reasons for physicians not to trust patients about at least some of their own narratives. (shrink)

There is a growing trend across North America of women being criminalized for their pregnancy outcomes. Rather than being a series of aberrations resulting from institutional failures, we argue that this trend is part of a colonial strategy of administrative violence aimed at women of color and Native women across Turtle Island. We consider a range of medical and legal practices constituting gender-based administrative violence, and we argue that they are the result of non-accidental and systematic production of population-level (...) harms that cannot be disentangled from the goals of ongoing settler occupation and dispossession of Indigenous lands. While white feminist narratives of gender-based administrative violence in Latin America function to distance the places where such violence occurs from the ‘liberal democratic’ settler nation-states of the U.S. and Canada, we hold that administrative forms of reproductive violence against Latin American women are structurally connected to efforts in the U.S. and Canada to criminalize women of color and Indigenous women for their reproductive outcomes. The purpose of these systemically produced harms is to sustain cultures of gender-based violence in support of settler colonial configurations of power. (shrink)

Anger gaslighting is behavior that tends to make someone doubt herself about her anger. In this paper, I analyze the case of anger gaslighting, using it as a paradigm case to argue that gaslighting can be an affective injustice (not only an epistemic one). Drawing on Marilyn Frye, I introduce the concept of “uptake” as a tool for identifying anger gaslighting behavior (persistent, pervasive uptake refusal for apt anger). But I also demonstrate the larger significance of (...) uptake in the study of affective injustice: just as the concept of credibility names the epistemic behavior whereby we take someone seriously as an epistemic being, the concept of uptake names the uniquely affective cooperative behavior whereby we take someone seriously as an affective being. I answer Miranda Fricker’s epistemic notion of a prejudicial credibility economy with the affective notion of prejudicial uptake economies: uptake, like credibility, can be produced in a deficit for one social group relative to a surplus for another. Deviating from the parallels with Fricker, for whom the injustice of epistemic injustice is due to prejudice in the motives or character of individuals, as well as from accounts that ground it in aptness or affective goods, I suggest that the injustice of anger gaslighting behavior can be located at the structural scale of power relationships between social groups, in the tradition of Iris Marion Young. Anger gaslighting behavior counts as unjust wherever it (re)produces prejudicial uptake economies. Adapting sociological concepts of feeling rules and the emotion work they demand, I introduce the concepts of “uptake rules” and “uptake work” to further enable analysis of uptake economies as affective social structures, and to suggest a site for resistant or reparative affective agency. (shrink)

This essay frames systemic patterns of mental abuse against women of color and Indigenous women on Turtle Island (North America) in terms of larger design-of-distribution strategies in settler colonial societies, as these societies use various forms of social power to distribute, reproduce, and automate social inequalities (including public health precarities and mortality disadvantages) that skew socio-economic gain continuously toward white settler populations and their descendants. It departs from traditional studies in gender-based violence research that frame mental abuses such as (...) class='Hi'>gaslighting--commonly understood as mental manipulation through lying or deceit--stochastically, as chance-driven interpersonal phenomena. Building on structural analyses of knowledge in political epistemology (Dotson 2012, Berenstain 2016), political theory (Davis and Ernst 2017), and Indigenous social theory (Tuck and Yang 2012), I develop the notion of cultural gaslighting to refer to the social and historical infrastructural support mechanisms that disproportionately produce abusive mental ambients in settler colonial cultures in order to further the ends of cultural genocide and dispossession. I conclude by proposing a social epidemiological account of gaslighting that a) highlights the public health harms of abusive ambients for minority populations, b) illuminates the hidden rules of social structure in settler colonial societies, and c) amplifies the corresponding need for structural reparations. (shrink)

Existing work on gaslighting ties it constitutively to facts about the intentions or prejudices of the gaslighter and/or his victim’s prior experience of epistemic injustice. I argue that the concept of gaslighting is more broadly applicable than has been appreciated: what is distinctive about gaslighting, on my account, is simply that a gaslighter confronts his victim with a certain kind of choice between rejecting his testimony and doubting her own basic epistemic competence in some domain. I thus (...) hold that gaslighting is a purely epistemic phenomenon—not requiring any particular set of intentions or prejudices on the part of the gaslighter—and also that it can occur even in the absence of any prior experience of epistemic injustice. Appreciating the dilemmatic character of gaslighting allows us to understand its connection with a characteristic sort of epistemic harm, makes it easier to apply the concept of gaslighting in practice, and raises the possibility that we might discover its structure and the associated harm in surprising places. (shrink)

I present a counterexample to Kirk-Giannini’s Dilemmatic Theory of gaslighting.

Structural gaslighting arises when conceptual work functions to obscure the non-accidental connections between structures of oppression and the patterns of harm they produce and license. This paper examines the role that structural gaslighting plays in white feminist methodology and epistemology using Fricker’s (2007) discussion of hermeneutical injustice as an illustration. Fricker’s work produces structural gaslighting through several methods: i) the outright denial of the role that structural oppression plays in producing interpretive harm, ii) the use of single-axis (...) conceptual resources to understand intersectional oppression, and iii) the failure to recognize the legacy of women of color’s epistemic resistance work surrounding the issue of sexual harassment in the workplace. I argue that Fricker’s whitewashed discussion of epistemic resistance to sexual harassment in the United States is a form of structural gaslighting that fails to treat women of color as knowers and exemplifies the strategic forgetting that is a central methodological tactic of white feminism. (shrink)

Structures of oppression and administrative systems in white supremacist settler colonial societies rely on epistemological foundations to orient them toward their goals of containment and land dispossession. Structural gaslighting refers to the justifying stories and mythologies produced in these societies to normalize, obscure, and uphold structures of oppression. Such epistemic legwork often works by naturalizing socially produced inequalities through positing biological or cultural deficiencies in the target populations. This paper develops the concept of structural gaslighting introduced in Berenstain (...) (2020) as “any conceptual work that functions to obscure the non-accidental connections between structures of oppression and the patterns of harm that they produce and license” and explores its relationship to scientific and philosophical knowledge production. Case studies including historical and contemporary forms of scientific racism, philosophical justifications for ableist violence, and the link between disableization and dispossession for the purpose of settler colonial land theft are considered. (shrink)

In this paper I identify a distinctive kind of gaslighting: communicative gaslighting. Communicative gaslighters intentionally misrepresent the communicative properties of an utterance—their own or their target’s—in a way which functions to undermine the target’s confidence in her abilities as a communicator. I argue that we can gaslight people as both speakers and hearers, and about (among other properties) the locutionary, perlocutionary, and illocutionary dimensions of utterances. Communicative gaslighting is concerning because not only does it undermine targets’ communicative (...) agency, but also it can contribute to a general decay of communicative conventions. (shrink)

This paper develops a notion of manipulative gaslighting, which is designed to capture something not captured by epistemic gaslighting, namely the intent to undermine women by denying their testimony about harms done to them by men. Manipulative gaslighting, I propose, consists in getting someone to doubt her testimony by challenging its credibility using two tactics: “sidestepping” and “displacing”. I explain how manipulative gaslighting is distinct from reasonable disagreement, with which it is sometimes confused. I also argue (...) for three further claims: that manipulative gaslighting is a method of enacting misogyny, that it is often a collective phenomenon, and, as collective, qualifies as a mode of psychological oppression. (shrink)

It is commonplace to observe that digital technologies facilitate our access to information on a scale unimaginable in previous eras, leading many to call this the “Information Age.” The vaunted advantages of unprecedented data flow obscure a dark corollary: the more modes of engaging with data are available to a people, the more modes are available for manipulating them. Whether through social media, blogs, email, newspaper headlines, or doctored images and videos, the public is indeed bombarded by information, and much (...) of it is misleading or outright false. Much of it, in fact, is propaganda. As the methods for manipulating mass audiences continue to multiply, a clear understanding of the concept of propaganda has never been more relevant. -/- This Article constructs a precise, novel account of propaganda, incorporating notable scholarly insights into the concept as well as the overlooked lessons of the law’s fragmented efforts to regulate it. To bring this new theoretical framework into focus and demonstrate its importance in the Information Age, the Article connects the underlying theory to contemporary communications practices, many of which are enhanced by the availability of new technology. Notably, in doing so, the Article also develops the first systematic account of political gaslighting, which properly understood (and counterintuitively, perhaps) constitutes a form of propaganda. (shrink)

Social justice demands that we attend carefully to the epistemic terrains we inhabit as well as to the epistemic resources we summon to make our lived experiences tangible to one another. Not all epistemic terrains are hospitable—colonial projects landscaped a good portion of our epistemic terrain long before present generations moved across it. There is no shared epistemicterra firma,no level epistemic common ground where knowers share credibility and where a diversity of hermeneutical resources play together happily. Knowers engage one another (...) on a politically saturated,unlevel knowing fieldwhere members of dominant groups work to forcibly maintain their epistemic home-terrain advantage. I use the metaphor of the unlevel knowing field to capture these oppressive epistemic structures. The unlevel knowing field is a hungry place where all knowledge that fails to nurture and sustain dominant ways knowing risks being dragged onto the dominator's epistemic home turf to be mined, coopted, consumed, or destroyed. Knowledge and willful ignorance circulate with equal vigor in this hungry world. From the standpoint of oppressed/resisting peoples, the unlevel knowing field is a minefield, an epistemic twilight zone, which must be traversed with considerable care and endless attention. The harms epistemic injustice produces are not disembodied harms. Repeated acts of injustice weather our bodies, dull our minds, weaken our hearts, and traumatize the spirit of our communities. They create public-health precarities and invite mental, emotional, physical, and spiritual illness into our being. Epistemic oppression is a cruel thief. It is disorienting, exhausting, and deadly. It triggers anger, anxiety, depression, and resistance. It steals our time, energy, and attention away from more beautiful things. (shrink)

Post-truth politics has been diagnosed as harmful to both knowledge and democracy. I argue that it can also fundamentally undermine epistemic autonomy in a way that is similar to the manipulative technique known as gaslighting. Using examples from contemporary politics, I identify three categories of post-truth rhetoric: the introduction of counternarratives, the discrediting of critics, and the denial of more or less plain facts. These strategies tend to isolate people epistemically, leaving them disoriented and unable to distinguish between reliable (...) and unreliable sources. Like gaslighting, post-truth politics aims to undermine epistemic autonomy by eroding someone’s self-trust, in order to consolidate power. Shifting the focus to the effects on the victim allows for new insights into the specific harms of post-truth politics. Applying the concept of gaslighting to this domain may also help people recognize a pernicious dynamic that was invisible to them before, giving them an important tool to resist it. (shrink)

One of the most insidious consequences of continuous exposure to gaslighting is that agents develop an expectation of further emotional manipulation. Repeated exposure to demeaning and humiliating behavior can make agents prone to interpret any epistemic challenge as a potential instance of gaslighting. Embedded in physiological and affective habits, this expectation become an integral way of interpreting social interactions and other people’s intentions. The concept of gaslighting was originally coined to alleviate a form of hermeneutic injustice, but (...) some applications of the concept paradoxically come to perpetuate exactly this kind of injustice. When agents perceive gaslighting in epistemically ambiguous situations, they foreclose the possibility of benefiting from productive forms of epistemic frictions. (shrink)

In this paper, I provide a novel account of gaslighting according to which gaslighting involves mistakenly failing to see oneself as a source of reasons with respect to some domain. I argue that this account does a nice job of explaining what's gone wrong in various popular examples of gaslighting, and that it captures what different instances of gaslighting have in common even when they are quite different in other respects. I also show how this account (...) of gaslighting explains a common intuition according to which gaslighting is autonomy-undermining--something other accounts, I argue, have failed to do. And finally, I show that this explanation of why gaslighting is autonomy-undermining also shows that certain forms of oppressive socialization are autonomy-undermining as well, thus providing us with an argument in favor of more substantive theories of autonomy according to which a certain kind of self-respect is necessary for autonomy. (shrink)

Pharmaceuticals or other emerging technologies could be used to enhance (or diminish) feelings of lust, attraction, and attachment in adult romantic partnerships. While such interventions could conceivably be used to promote individual (and couple) well-being, their widespread development and/or adoption might lead to “medicalization” of human love and heartache—for some, a source of serious concern. In this essay, we argue that the “medicalization of love” need not necessarily be problematic, on balance, but could plausibly be expected to have either good (...) or bad consequences depending upon how it unfolds. By anticipating some of the specific ways in which these technologies could yield unwanted outcomes, bioethicists and others can help direct the course of love’s “medicalization”—should it happen to occur—more toward the “good” side than the “bad.”. (shrink)

Medicalisation is a social phenomenon in which conditions that were once under legal, religious, personal or other jurisdictions are brought into the domain of medical authority. Low sexual desire in females has been medicalised, pathologised as a disease, and intervened upon with a range of pharmaceuticals. There are two polarised positions on the medicalisation of low female sexual desire: I call these the mainstream view and the critical view. I assess the central arguments for both positions. Dividing the two (...) positions are opposing models of the aetiology of low female sexual desire. I conclude by suggesting that the balance of arguments supports a modest defence of the critical view regarding the medicalisation of low female sexual desire. (shrink)

Many hold that distributing healthcare according to medical need is a requirement of equality. Most egalitarians believe, however, that people ought to be equal on the whole, by some overall measure of well-being or life-prospects; it would be a massive coincidence if distributing healthcare according to medical need turned out to be an effective way of promoting equality overall. I argue that distributing healthcare according to medical need is important for reducing individuals' uncertainty surrounding their future (...) class='Hi'>medical needs. In other words, distributing healthcare according to medical need is a natural feature of healthcare insurance; it is about indemnity, not equality. (shrink)

In recent years, notable figures within the medical community have expressed concerns about the rate of medical progress, suggesting that the rapid advances of medicine’s ‘golden age’ are now giving way to an ‘age of disappointment’. While these pessimistic pronouncements about medical progress must–implicitly if not explicitly–appeal to some criteria for what medical progress would be, the task of explicitly defining medical progress has been notably neglected. We take up this task, drawing on insights from (...) the philosophy of science concerning both scientific progress and the aims of medicine. Among other things, we differentiate between medical scientific progress and progress in medical practice, and suggest that this distinction helps to evaluate the aforementioned concerns about the current rate of medical progress. While it is not our goal to draw conclusions relating to the state of medicine at the present time, we propose a unifying account of medical scientific progress according to which such progress leads, necessarily, to progress in medical practice, and show how this account both plausibly distinguishes between medical scientific progress and other (non-medical) instances of scientific progress, and does justice to the ‘dual character’ of medicine. (shrink)

I introduce a distinction between health need and medical need, and raise several questions about their interaction. Health needs are needs that relate directly to our health condition. Medical needs are needs which bear some relation to medical institutions or processes. I suggest that the question of whether medical insurance or public care should cover medical needs, health needs, or only needs which fit both categories is a political question that cannot be resolved definitionally. I (...) also argue against an overly strict definition of medical need on the grounds that this presupposes, wrongly, that medical intervention should always be a last resort. (shrink)

In this paper, I defend a version of the medical model of disability, which defines disability as an enduring biological dysfunction that causes its bearer a significant degree of impairment. We should accept the medical model, I argue, because it succeeds in capturing our judgments about what conditions do and do not qualify as disabilities, because it offers a compelling explanation for what makes a condition count as a disability, and because it justifies why the federal government should (...) spend hundreds of billions of dollars, annually, on aid and accommodations for disabled people. After responding to a pair of objections Elizabeth Barnes has raised against the medical model, I contrast it with Guy Kahane and Julian Savulescu's welfarist account of disability, and with Barnes's own mere-difference view. Both of these accounts face serious challenges, although elements of Barnes's view can—and, in my opinion, should—be adopted by proponents of the medical model. (shrink)

Most people are completely oblivious to the danger that their medical data undergoes as soon as it goes out into the burgeoning world of big data. Medical data is financially valuable, and your sensitive data may be shared or sold by doctors, hospitals, clinical laboratories, and pharmacies—without your knowledge or consent. Medical data can also be found in your browsing history, the smartphone applications you use, data from wearables, your shopping list, and more. At best, data about (...) your health might end up in the hands of researchers on whose good will we depend to avoid abuses of power.2 Most likely, it will end up with data brokers who might sell it to a future employer, or an insurance company, or the government. At worst, your medical data may end up in the hands of criminals eager to commit extortion or identity theft. In addition to data harms related to exposure and discrimination, the collection of sensitive data by powerful corporations risks the creation of data monopolies that can dominate and condition access to health care. -/- This chapter aims to explore the challenge that big data brings to medical privacy. Section I offers a brief overview of the role of privacy in medical settings. I define privacy as having one’s personal information and one’s personal sensorial space (what I call autotopos) unaccessed. Section II discusses how the challenge of big data differs from other risks to medical privacy. Section III is about what can be done to minimise those risks. I argue that the most effective way of protecting people from suffering unfair medical consequences is by having a public universal healthcare system in which coverage is not influenced by personal data (e.g., genetic predisposition, exercise habits, eating habits, etc.). (shrink)

One of the best-known principles of halakha is that Shabbat is violated to save a life. Who does this saving and how do we know that a life is in danger? What categories of illness violate Shabbat and who decides? A historical-sociological analysis of the roles played by Jew, non-Jew, and physician according to the approach of “medical cosmology” can help us understand the differences in the approach of the Shulchan Aruch compared to later decisors (e.g., the Mishnah Berurah). (...) Such differences illuminate how premodern medical triage coexisted with a different halakhic understanding than that of the biomedical age. (shrink)

Larry Temkin draws on the work of Angus Deaton to argue that countries with poor governance sometimes rely on charitable giving and foreign aid in ways that enable them to avoid relying on their own citizens; this can cause them to be unresponsive to their citizens’ needs and thus prevent the long-term alleviation of poverty and other social problems. I argue that the implications of this “lack of government responsiveness argument” (or LOGRA) are both broader and narrower than they might (...) first appear. I explore how LOGRA applies more broadly to certain types of charitable giving in developed countries, with a focus on medical crowdfunding. I then highlight how LOGRA does not apply to charitable giving aimed at alleviating the suffering of the absolutely politically marginalized, or those especially vulnerable people to whom governments are never responsive. (shrink)

Concerns over medical paternalism are especially salient when there exists a conflict of values between patient and clinician. This is particularly relevant for psychiatry, the field of medicine for which the phenomenon of conflicting values is most present and for which the specter of medical paternalism looms large. Few cases are as glaring as that of anorexia nervosa (AN), a disorder that is considered to be egosyntonic (meaning its symptoms are reflectively endorsed by the patient) and maintained by (...) the presence of pathological values. One might think, given this, that an approach to medicine that foregrounds the role of values in clinical encounters would be particularly well suited to address the problem of medical paternalism in treating AN. As it happens, this is precisely the goal of values-based medicine, an approach to medicine that prioritizes the integration of patients’ unique values into the aims of treatment and that has been touted as being particularly applicable to psychiatric conditions such as AN. Although this strategy may initially appear promising, in this paper I will argue that the directive to incorporate patient values (as dictated by values-based medicine) cannot do the work of mitigating medical paternalism in the treatment of egosyntonic disorders such as AN. Rather than chalking this up as a failure due to AN being a particularly challenging case, I will instead conclude that the failure of values-based medicine in this context cuts to the heart of the limitations of rectifying medical paternalism within psychiatry as it currently exists. (shrink)

Rationale and objectives: Medical humanities are becoming increasingly recognized as positively impacting medical education and medical practice. However, the extent of medical humanities teaching in medical schools is largely unknown. We reviewed medical school curricula in Canada, the UK and the US. We also explored the relationship between medical school ranking and the inclusion of medical humanities in the curricula. -/- Methods: We searched the curriculum websites of all accredited medical schools (...) in Canada, the UK and the US to check which medical humanities topics were taught, and whether they were mandatory or optional. We then noted rankings both by Times Higher Education and U.S. News and World Report and calculated the average rank. We formally explored whether there was an association between average medical school ranking and medical humanities offerings using Spearman's correlation and inverse variance weighting meta-analysis. -/- Results: We identified 18 accredited medical school programmes in Canada, 41 in the UK, and 154 in the US. Of these, nine (56%) in Canada, 34 (73%) in the UK and 124 (80%) in the US offered at least one medical humanity that was not ethics. The most common medical humanities were medical humanities (unspecified), history, and literature (Canada); sociology and social medicine, medical humanities (unspecified), and art (UK); and medical humanities (unspecified), literature and history (US). Higher ranked medical schools appeared less likely to offer medical humanities. -/- Conclusions: The extent and content of medical humanities offerings at accredited medical schools in Canada, the UK and the US varies, and there appears to be an inverse relationship between medical school quality and medical humanities offerings. Our analysis was limited by the data provided on the Universities' websites. Given the potential for medical humanities to improve medical education and medical practice, opportunities to reduce this variation should be exploited. (shrink)

The phenomenon of medical overtesting in general, and specifically in the emergency room, is well-known and regarded as harmful to both the patient and the healthcare system. Although the implications of this problem raise myriad ethical concerns, this paper explores the extent to which overtesting might mitigate race-based health inequalities. Given that medical malpractice and error greatly increase when the patients belong to a racial minority, it is no surprise that the mortality rate similarly increases in proportion to (...) white patients. For these populations, an environment that emphasizes medical overtesting may well be the desirable medical environment until care evens out among races and ethnicities; additionally, efforts to lower overtesting in conjunction with a high rate of racist medical mythology may cause harm by lower testing when it is actually warranted. Furthermore, medical overtesting may help to assuage racial distrust. This paper ultimately concludes that an environment of medical overtesting may be less pernicious than the alternative. (shrink)

In her debate with Michael Blake, Gillian Brock sets out to justify emigration restrictions on medical workers from poor states on the basis of their free-riding on the public investment that their states have made in them in form of a publicly funded education. For this purpose, Brock aims to isolate the question of emigration restrictions from the larger question of responsibilities for remedying global inequalities. I argue that this approach is misguided because it is blind to decisive factors (...) at play in the problem of medical brain drain and consequently distorts the different responsibilities this problem generates. Brock’s strategy, if successful, would effectively lead to punishing emigrating workers from poor states for the free-riding and exploitation that is committed by affluent states – which is a counter-intuitive result. (shrink)

Miracle Max, it seems, is the only remaining miracle worker in all of Florin. Among other things, this means that he (unlike anyone else) can resurrect the recently dead, at least in certain circumstances. Max’s peculiar talents come with significant perks (for example, he can basically set his own prices!), but they also raise a number of ethical dilemmas that range from the merely amusing to the truly perplexing: -/- How much about Max’s “methods” does he need to reveal to (...) his patients? Is it really OK for Max to lie about Valerie’s being a witch, even though she really isn’t? Just how much of the “truth” does Max have to tell his patients? -/- Let’s suppose that Humperdinck had offered Max his old job back. Would it have been OK for Max to accept this offer? What about if Humperdinck wanted him to do experiments at “the Zoo”? -/- Is Max obligated to offer his services to everyone who needs them, such as the (mostly) dead Westley and friends? Or is he free to pick and choose? -/- In this chapter, I’ll consider how these questions might be addressed using concepts of medical ethics. As it turns out, Max’s dilemmas are not too different from the sorts of dilemmas that many medical professionals encounter in their daily lives, and exploring how Max could (or should) respond to them can help us figure out what we can do here in the “real” world. (shrink)

Abstract: The integration of Artificial Intelligence (AI) into medical imaging represents a transformative shift in healthcare, offering significant improvements in diagnostic accuracy, efficiency, and patient outcomes. This paper explores the application of AI technologies in the analysis of medical images, focusing on techniques such as convolutional neural networks (CNNs) and deep learning models. We discuss how these technologies are applied to various imaging modalities, including X-rays, MRIs, and CT scans, to enhance disease detection, image segmentation, and diagnostic support. (...) Additionally, the paper addresses the challenges faced in AI-driven medical imaging, including data quality, model interpretability, and ethical considerations. By examining recent advancements and real-world case studies, this paper provides insights into the current state of AI in medical imaging and its potential future directions. The findings highlight the ongoing evolution of AI technologies and their crucial role in advancing medical diagnostics and treatment strategies. (shrink)

Consensus statement by UK teachers of medical ethics and law.

This paper argues that epistemic errors rooted in group- or identity- based biases, especially those pertaining to disability, are undertheorized in the literature on medical error. After sketching dominant taxonomies of medical error, we turn to the field of social epistemology to understand the role that epistemic schemas play in contributing to medical errors that disproportionately affect patients from marginalized social groups. We examine the effects of this unequal distribution through a detailed case study of ableism. There (...) are four primary mechanisms through which the epistemic schema of ableism distorts communication between nondisabled physicians and disabled patients: testimonial injustice, epistemic overconfidence, epistemic erasure, and epistemic derailing. Measures against epistemic injustices in general and against schema-based medical errors in particular are ultimately issues of justice that must be better addressed at all levels of health care practice. (shrink)

Physicians in Islamic countries might be requested to participate in the Islamic legal code of qiṣāṣ, in which the victim or family has the right to an eye-for-an-eye retaliation. Qiṣāṣ is only used as a punishment in the case of murder or intentional physical injury. In situations such as throwing acid, the national legal system of some Islamic countries asks for assistance from physicians, because the punishment should be identical to the crime. The perpetrator could not be punished without a (...) physician’s participation, because there is no way to guarantee that the sentence would be carried out without inflicting more injury than the initial victim had suffered. By examining two cases of acid throwing, this paper discusses issues related to physicians’ participation in qiṣāṣ from the perspective of medical ethics and Islamic Shari’a law. From the standpoint of medical ethics, physicians’ participation in qiṣāṣ is not appropriate. First, qiṣāṣ is in sharp contrast to the Hippocratic Oath and other codes of medical ethics. Second, by physicians’ participation in qiṣāṣ, medical practices are being used improperly to carry out government mandates. Third, physician participation in activities that cause intentional harm to people destroys the trust between patients and physicians and may adversely affect the patient–physician relationship more generally. From the standpoint of Shari’a, there is no consensus among Muslim scholars whether qiṣāṣ should be performed on every occasion. We argue that disallowing physician involvement in qiṣāṣ is necessary from the perspectives of both medical ethics and Shari’a law. (shrink)

If medical complicity is understood as compliance with a directive to act against the professional's best medical judgment, the question arises whether it can ever be justified. This paper will trace the contours of what would legitimate a directive to act against a professional's best medical judgment (and in possible contravention of her oath) using Joseph Raz's service conception of authority. The service conception is useful for basing the legitimacy of authoritative directives on the ability of the (...) putative authority to enable subjects to comply better with reasons that already apply to them. Hence, the service conception bases the legitimacy of practical authority on a certain kind of greater knowledge or expertise. This helps to focus the conundrum regarding complicity on the clash of expertise between the medical expert and the governing body tasked with coordinating behaviour and otherwise devising rules for the social good. The ethical dilemma presented by a hypothetically legitimate directive to act against a professional's best medical judgment also serves to highlight the moral dimension of one's duty to obey a legitimate authority. (shrink)

In medical settings, machines are in close proximity with human beings: with patients who are in vulnerable states of health, who have disabilities of various kinds, with the very young or very old, and with medical professionals. Machines in these contexts are undertaking important medical tasks that require emotional sensitivity, knowledge of medical codes, human dignity, and privacy. -/- As machine technology advances, ethical concerns become more urgent: should medical machines be programmed to follow a (...) code of medical ethics? What theory or theories should constrain medical machine conduct? What design features are required? Should machines share responsibility with humans for the ethical consequences of medical actions? How ought clinical relationships involving machines to be modeled? Is a capacity for empathy and emotion detection necessary? What about consciousness? -/- The essays in this collection by researchers from both humanities and science describe various theoretical and experimental approaches to adding medical ethics to a machine, what design features are necessary in order to achieve this, philosophical and practical questions concerning justice, rights, decision-making and responsibility, and accurately modeling essential physician-machine-patient relationships. -/- This collection is the first book to address these 21st-century concerns. (shrink)

Without doctors being able to explain medical decisions to patients, I argue their use of black box AIs would erode the effective and respectful care they provide patients. In addition, I argue that physicians should use AI black boxes only for patients in dire straits, or when physicians use AI as a “co-pilot” (analogous to a spellchecker) but can independently confirm its accuracy. I respond to A.J. London’s objection that physicians already prescribe some drugs without knowing why they work.

Medical tourism can be defined as the process of travelling outside of an individual’s country to another to seek medical care. The current research studies medical tourism in Ghana historically, focusing on Korle Bu Teaching Hospital in Accra and Komfo Anokye Teaching Hospital in Kumase. Using a qualitative research approach, the study provides a historical argument on the continuities and discontinuities of medical tourism in Ghana. Indeed, medical tourism has undergone several transitions over time. To (...) emphasize, the current contribution has thoroughly discussed the evolution of medical tourism in Ghana, the pull and push factors of medical tourism, its impact on the local health systems and the need to further promote it. The study concludes among other things that the improvement of medical facilities, personnel and equipment, will enhance the medical tourism prospects of the country. (shrink)

When medical assistance in dying (MAiD) was legalized in Canada in June 2016, the question of allowing decisionally capable persons to make advance requests in anticipation of later incapacity was reserved for further consideration during the mandatory parliamentary review originally scheduled to begin in June 2020 (but since delayed by COVID-19). In its current form the legislation does not permit such requests, since it stipulates that at the time at which the procedure is to be administered the patient must (...) give “express consent” to receiving it. Since express consent presupposes decisional capacity, this requirement rules out administering MAiD to a patient who has lost capacity. Amendments to the legislation passed by Parliament in March 2021 open the door slightly by allowing advance requests by patients after they have been approved for MAiD, if they fear losing capacity before the procedure can be administered. But this provision would apply only to patients whose natural death was deemed to be “reasonably foreseeable”, and would continue to exclude (a) requests made after diagnosis of a “grievous and irremediable medical condition” but in advance of approval for MAiD, and (b) requests made before such a diagnosis. My aim in this paper is twofold: to explore the ethical and legal issues concerning advance requests for MAiD, and to argue for expanding provision for such requests to include both of these further scenarios. (shrink)

Medicalization occurs when a phenomenon comes to be subject to medical study, diagnosis, treatment, or prevention. Whether a phenomenon ought to be medicalized should be decided on a case-by-case basis. Recent moves to remove “bereavement exclusions” from psychiatric diagnostic manuals and to introduce grief-specific medical disorders have elicited criticisms from skeptics about grief’s medicalization, but these criticisms can largely be blunted. This article first clarifies the nature of disputes about medicalization, highlighting how these disputes do not concern whether (...) a condition such as grief is clinically significant or whether it can generate illness, but whether the condition itself is rightfully categorized as potentially pathological. It then offers a stronger, philosophically grounded case against the medicalization of grief, resting on how medicalizing grief is likely to detrimentally alter the moral and political meanings attached to grief. Specifically, medicalizing grief will “normativize” a medical vocabulary for evaluating grief that may impede authentic engagement with grief, validate a suspect “time slice” model of human well-being that overlooks how grief can benefit a person’s life as a whole, and impede desirable sympathy or solidarity with grieving persons. (shrink)

Assumptions about obesity—e.g., its connection to ill health, its causes, etc.—are still prevalent today, and they make up what I call the medical model of fatness. In this paper, I argue that the medical model was established on the basis of insufficient evidence and has nevertheless continued to be relied upon to justify methodological choices that further entrench the assumptions of the medical model. These choices are illegitimate in so far as they conflict with both the epistemic (...) and social aims of obesity research. I conclude the paper with a partial solution to these epistemic and social shortcomings. (shrink)

: The Islamic jurists utilized the discipline of maqāṣid al-sharīʿah,in its capacity as the philosophy of Islamic law, in their legal and ethicalinterpretations, with added interest in addressing the issues of modern times.Aphoristically subsuming the major themes of the Sharīʿah, maqāṣid play apivotal role in the domain of decision-making and deduction of rulings onunprecedented ethical discourses. Ethics represent the infrastructure of Islamiclaw and the whole science of Islamic jurisprudence operates in the lightof maqāṣid to realize the ethics in people’s lives. (...) Scrutinizing the key themesof maqāṣid-based ijtihād and scope of ethics in maqāṣid, this article delvesinto the discourse on the application of maqāṣid to medical ethics. As a casestudy, this research analyses the extent of medical confidentiality in the light ofmaqāṣid and arrives at the conclusion that limited confidentiality goes more inline with the maxims of maqāṣid. (shrink)

The paper offers the concept of reversing the medical humanities. In agreement with the call from Kristeva et al. to recognise the bidirectionality of the medical humanities, I propose moving beyond debates of attitude and aptitude in the application and engagement (either friendly or critical) of humanities to/in medicine, by considering a reversal of the directions of epistemic movement (a reversal of the flow of knowledge). I situate my proposal within existing articulations of the field found in the (...) medical humanities meta-literature, pointing to a gap in the current terrain. I then develop the proposal by unfolding three reasons why we might gain something from exploring a reversed knowledge flow. First, a reversed knowledge flow seems to be an inherent—but still to be articulated—possibility in medical humanities and thus provides an opportunity for more knowledge. Second, the current unidirectionality of the field is founded on an inconsistency in the depiction of the connection between medicine and humanities, which risks creating the very divide that medical humanities set out to bridge. Practising a reversal may help avoid this divide. And third, a reversal might help rebalance the internal epistemic power, so as to motivate less external scepticism and in turn displace more external epistemic power towards medical humanities. I end the paper with a remark on precursors for a reversal, and ideas for where to go from here. (shrink)

This book examines the moral luck paradox, relating it to Kantian, consequentialist and virtue-based approaches to ethics. It also applies the paradox to areas in medical ethics, including allocation of scarce medical resources, informed consent to treatment, withholding life-sustaining treatment, psychiatry, reproductive ethics, genetic testing and medical research. If risk and luck are taken seriously, it might seem to follow that we cannot develop any definite moral standards, that we are doomed to moral relativism. However, Dickenson offers (...) strong counter-arguments to this view that enable us to think in terms of universal standards. (shrink)

In contemporary healthcare, medical image categorization is essential for illness prediction, diagnosis, and therapy planning. The emergence of digital imaging technology has led to a significant increase in research into the use of machine learning (ML) techniques for the categorization of images in medical data. We provide a thorough summary of recent developments in this area in this review, using knowledge from the most recent research and cutting-edge methods.We begin by discussing the unique challenges and opportunities associated with (...) medical image classification, including the complexity of anatomical structures, variability in imaging modalities, and the need for interpretability and reliability in clinical settings. Subsequently, we survey a wide range of ML algorithms and techniques employed for medical image classification, including traditional methods such as support vector machines and k-nearest neighbors, as well as deep learning approaches like convolutional neural networks (CNNs) and recurrent neural networks (RNNs). Furthermore, we examine key considerations in dataset preparation, feature extraction, and model evaluation specific to medical image classification tasks. We highlight the importance of large, annotated datasets, transfer learning, and data augmentation techniques in enhancing model performance and generalization. (shrink)

Self-medication of antibiotics is an irrational use of drugs, contributing to microbial resistance, increasing healthcare costs and higher mortality and morbidity. This study aimed to assess self-medication with antibiotics without a medical prescription in the community of Libya. This is a cross-sectional study conducted from June to December 2022 and the total number of participants was 200. The design of the study and sample size were modified according to the proficiency of pharmacists and the medical and non-medical (...) population of Libya. The questionnaire was developed in English and Arabic language and was distributed through social media platforms. The questions were used after a thorough literature search and assessing the validity and reliability. The significant signs regarding reasons for the treatment by self-medication drugs of antibiotics, because of its various drugs of antibiotic by pharmacist (n=80, 40.0%) and family (n=90, 45.0%) compared with experience and physicians by used prescription was 13 (6.50%) and significant sings regarding by nasal congestion self-medication of various antibiotics (n=100, 50.0%). This sign must be practiced based on a previous physician’s prescription. The antibiotics are often self-administered as patients feel that they will save money and time but this can lead to substantial adverse drug reactions, antibiotic resistance, treatment failure and drug-related toxicity. This study respondent's medical and non-medical public of Libya who should be relatively informed and educated about the risk of treatment by self-medication of antibiotics with the development of resistance. (shrink)

Five reasons why teaching medical humanities in medical schools improves student performance, enhances wellbeing, and ameliorates patient outcomes.

Would compulsory treatment or vaccination for Covid-19 be justified? In England, there would be significant legal barriers to it. However, we offer a conditional ethical argument in favour of allowing compulsory treatment and vaccination, drawing on an ethical comparison with external constraints—such as quarantine, isolation and ‘lockdown’—that have already been authorised to control the pandemic. We argue that, if the permissive English approach to external constraints for Covid-19 has been justified, then there is a case for a similarly permissive approach (...) to compulsory medical interventions. (shrink)

The Medical bot project is built using artificial algorithms that analyses user’s queries and understand user’s message. This System is a web application which provides answer to the query of the patients. Patients just have to query through the bot which is used for chatting. Patients can chat using any format there is no specific format the user has to follow. The System uses built in artificial intelligence to answer the query. The answers are appropriate what the user queries. (...) The User can query any Medical related activities through the system. The user does not have to personally go to the Medical for enquiry. The System analyses the question and then answers to the user. The system answers to the query as if it is answered by the person. With the help of artificial intelligence, the system answers the query asked by the patients. The system replies using an effective Graphical user interface which implies that as if a real person is talking to the user. The user just has to register himself to the system and has to login to the system. After login user can access to the various helping pages. Various helping pages has the bot through which the user can chat by asking queries related to Medical activities. The system replies to the user with the help of effective graphical user interface. The user can query about the Medical related activities through online with the help of this web application. The user can query Medical related activities such as date and timing of annual day, sports day, and other cultural activities. This system helps the patients to be updated about the Medical activities. (shrink)

What I call medically enabled suicides have four distinctive features: 1. They are instigated by actions of a suicidal individual, actions she intends to result in a physiological condition that, absent lifesaving medical interventions, would be otherwise fatal to that individual. 2. These suicides are ‘completed’ due to medical personnel acting in accordance with recognized legal or ethical protocols requiring the withholding or withdrawal of care from patients (e.g., following an approved advance directive). 3. The suicidal individual acts (...) purposefully to ensure that medical personnel will act on these protocols. 4. These suicides do not involve medical personnel providing aid in dying in the standard sense, either through (a) active voluntary euthanasia, or (b) assistance by means of prescriptions, etc. -/- Regardless of how common medically enabled suicides are, they raise compelling questions at the interface of medicine and individual choice. After first clarifying the concept of medically enabled suicide and exploring some of the reasons why it might be attractive to suicidal individuals, I then investigate two apparent dilemmas that medically enabled suicides raise for medical care providers. The first alleges that medical care providers may not contribute to harming their patients, and so they may not contribute to their patients’ suicides. The second alleges that if care providers, as a matter of personal conscience, believe that suicide is wrong, then they may not be compelled to contribute to their patient’s acting wrongly by assenting to the wishes of a patient pursuing medically enabled suicide. Both dilemmas arise from the fact that while medical personnel are bound by widely accepted precepts of medical ethics to honor the competent wishes of their patients, medically enabled suicides entangle them in their patients’ suicidal plans in ways that result in their contributing to those suicides. I conclude that neither dilemma should be resolved in the direction of medical personnel having the right to refrain from involvement in medically enabled suicides. Thus, while we may find medically enabled suicide distasteful or exploitative, a strong case cannot be made that medical personnel refusing to involve themselves in such suicides is ethically permissible. (shrink)