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)

In this paper, we argue that promoting patient values is a legitimate goal of medicine. Our view offers a justification for certain current practices, including birth control and living organ donation, that are widely accepted but do not fit neatly within the most common extant accounts of the goals of medicine. Moreover, we argue that recognising value promotion as a goal of medicine will expand the scope of medical practice by including some procedures that are sometimes (...) rejected as being outside the scope of acceptable medical practice, such as certain forms of physician-assisted death. We then rebut some common and possible objections to this view. Our aim is not to argue that other accounts are mistaken—except when they argue for a single goal that does not include patient values—but rather to show that value promotion should play a more central role in discussions about the goals of medicine. (shrink)

While largely agreeing with Ruiping Fan, Chenyang Li makes three points regarding the handling of COVID-19. First, in addition to state capacity, social trust, and leadership, as identified by Francis Fukuyama, factors responsible for successful pandemic responses include the value of individual freedom upheld by citizens. A high level of individual freedom can make it difficult to implement strict measures even when they are objectively necessary. Second, a strong state can be effective in handling a pandemic, but without checks and (...) balances it also runs the risk of leading a country into a major catastrophe. Third, Confucian ethics and other ethics can aid in coping with the pandemic. However, their efficacy is not unlimited, and ultimately, human survival overrides other concerns. (shrink)

Physicians frequently ask whether they should give patients what they want, usually when there are considerations pointing against doing so, such as medicine’s values and physicians’ obligations. It has been argued that the source of medicine’s values and physicians’ obligations lies in what has been dubbed “the internal morality of medicine”: medicine is a practice with an end and norms that are definitive of this practice and that determine what physicians ought to do qua (...) physicians. In this paper, I defend the claim that medicine requires a morality that is internal to its practice, while rejecting the prevalent characterization of this morality and offering an alternative one. My approach to the internal morality of medicine is constructivist in nature: the norms of medicine are constructed by medical professionals, other professionals, and patients, given medicine’s end of “benefitting patients in need of prima facie medical treatment and care.” I make the case that patients should be involved in the construction of medicine’s morality not only because they have knowledge that is relevant to the internal morality of medicine—namely, their own values and preferences—but also because medicine is an inherently relational enterprise: in medicine the relationship between physician and patient is a constitutive component of the craft itself. The framework I propose provides an authoritative morality for medicine, while allowing for the incorporation, into that very morality, of qualified deference to patient values. (shrink)

As opposed to a ‘one size fits all’ approach, precision medicine uses relevant biological, medical, behavioural and environmental information about a person to further personalize their healthcare. This could mean better prediction of someone’s disease risk and more effective diagnosis and treatment if they have a condition. Big data allows for far more precision and tailoring than was ever before possible by linking together diverse datasets to reveal hitherto-unknown correlations and causal pathways. But it also raises ethical issues relating (...) to the balancing of interests, viability of anonymization, familial and group implications, as well as genetic discrimination. This article analyses these issues in light of the values of public benefit, justice, harm minimization, transparency, engagement and reflexivity and applies the deliberative balancing approach found in theEthical Framework for Big Data in Health and Research to a case study on clinical genomic data sharing. Please refer to that article for an explanation of how this framework is to be used, including a full explanation of the key values involved and the balancing approach used in the case study at the end. Our discussion is meant to be of use to those involved in the practice as well as governance and oversight of precision medicine to address ethical concerns that arise in a coherent and systematic manner. (shrink)

In this article, part of a special issue on meaning in life and medical ethics, I argue that several issues encountered in a bioethical context are not adequately addressed only with values such as morality and welfare. I maintain, more specifically, that the value of what makes a life meaningful is essential to being able to provide conclusive judgements about which decisions to make. After briefly indicating how meaningfulness differs from rightness and happiness, I point out how it is (...) plausibly central to making decisions in six ‘life and death’ matters. My aim is not to draw any firm conclusions about what to do when it comes to these topics, but rather to show that in order to arrive at any, one cannot plausibly ignore the category of life’s meaning that has, until recently, been nearly absent from Western bioethics since its inception. (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)

Precision medicine functions by grouping patients along genetic, molecular, and related ‘-omics’ factors. This stratification relies on large, growing databases of patient-volunteered information. Both private companies and government bodies incentivize patients to volunteer this genetic information appealing to the creation of collaborative patient partnerships and the concept of empowerment. This paper aims to address two related questions: (1) what is the actual nature of patient participation in precision medicine research? And (2) is this participation in precision medicine (...) research really that empowering for the average patient? I contend that firstly, the nature of this participation is best conceived of as merely contributory. Contributory participation, as it will be shown, falls short of collaboration. The partnership created by participation in precision medicine research is not one of sharing values, equal say in decisions, or shared benefit. Secondly, I contend that there are important caveats to claims that patient participation in precision medicine is empowering. Empowerment is hindered by the type of participation, the practical use or actionability of genetic data, genetic literacy, the cost of precision drugs for patients that qualify for them, and bioethical considerations of informed consent. (shrink)

Mainstream views of medical research tell us it should be a fact-based, value-free endeavor: what a scientist (or her funding source) wants or cares about should not influence her findings. At the same time, we also sometimes criticize medical research for failing to embody certain values, e.g. when we criticize pharmaceutical companies for largely ignoring the diseases that affect the global poor. This chapter seeks to reconcile these perspectives by distinguishing appropriate from inappropriate influences of values on medical (...) research. It divides this broad question into two narrower ones, the Role Question (at what points in the research process is value influence potentially acceptable?) and the Content Question (when value influence is potentially acceptable, what specific values should researchers use?), and then draws on the philosophical literature on values in science to explore answers to each of them. (shrink)

The dominant approach to assessing decision-making capacity in medicine focuses on determining the extent to which individuals possess certain core cognitive abilities. Critics have argued that this model delivers the wrong verdict in certain cases where patient values that are the product of mental disorder or disordered affective states undermine decision-making without undermining cognition. I argue for a re-conceptualization of what it is to possess the capacity to make medical treatment decisions. It is, I argue, the ability to (...) track one’s own personal interests at least as well as most people can. Using this idea, I demonstrate that it is possible to craft a solution for the problem cases—one that neither alters existing criteria in dangerous ways (e.g. does not open the door to various kinds of abuse) nor violates the spirit of widely accepted ethical constraints on decision-making assessment. (shrink)

Racial disparities in health outcomes have recently become a flashpoint in the debate about the value of race as a biological concept. What role, if any, race has in the etiology of disease is a philosophically and scientifically contested topic. In this article, I expand on the insights of the new mechanistic philosophy of science to defend a mechanism discovery approach to investigating epidemiological racial disparities. The mechanism discovery approach has explanatory virtues lacking in the populational approach typically employed in (...) the study of race and biomedicine. The explanatory constraints that form an integral part of the new mechanistic approach enable mechanism discovery to avoid the epistemic and normative shortcomings of the populational approach. The methodology of mechanism discovery can fruitfully be extended to the treatment and reversal of epidemiological racial disparities. (shrink)

The success of precision medicine depends on obtaining large amounts of information about at-risk populations. However, getting consent is often difficult. Why? In this commentary I point to the differentials in social status involved. These differentials are inevitable once personal information is surrendered, but are particularly intense when the studied populations are socioeconomically or socioculturally disadvantaged and/or ethnically stigmatized groups. I suggest how the deep distrust of the latter groups can be partially justified as a lack of confidence that (...) their core values or interests will sufficiently be taken into account. Hence, the ethical challenge here lies not in avoiding status differentials, but in dealing with them appropriately. Scientists should not assume trust from others but adopt a norm of “demonstrating trustworthiness”. (shrink)

With twentieth- and twenty-first-century philosophy of science’s unfolding acceptance of the nature of scientific inquiry being value-laden, the persistent worry has been that there are no means for legitimate negotiation of the social or non-epistemic values that enter into science. The rejection of the value-free ideal in science has thereby been coupled with the spectres of indiscriminate relativism and bias in scientific inquiry. I challenge this view in the context of recently expressed concerns regarding Canada's death of evidence controversy. (...) The worry, raised by Stathis Psillos, is that as constructivist accounts of science demoted the previously secure status of evidence for drawing justified conclusions in science, we were left with no rational delineation between the right and wrong values for science. The implication for the death of evidence controversy is that we may have no rational grounds for claiming that the Canadian Government is wrong to interfere with scientific enterprise. But he does offer another avenue for reaching the conclusion that the wrong social values are directing the current stifling of some sectors of Canadian science. Psillos draws from standpoint epistemologies to devise a salient defence of ‘valuing evidence’ as a universalizable social value. That is, government bodies ought to enable scientific research via adequate funding as well as political non-interference. In this paper, I counter that non-epistemic values can be rationally evaluated and that standpoint epistemology’s universalizable standpoint provides an inadequate framework for negotiating social values in science. Regarding, I draw from the evidence-based medicine debate in philosophy of medicine and from feminist empiricist investigations into the science–values relationship in order to make the argument for empirically driven value arbitration. If social values can be rationally chosen in the context of justification, then we can have grounds for charging the Canadian leadership with being ‘at war with science’. I further argue that my recommended empiricist methodology is preferable to Psillos’s search for universalizable perspectives for negotiating social values in science because the latter method permits little more than the trivial conclusion that evidence is valuable to science. (shrink)

Default positions, predetermined starting points that aid in complex decision-making, are common in clinical medicine. In this article, we identify and critically examine common default positions in clinical ethics practice. Whether default positions ought to be held is an important normative question, but here we are primarily interested in the descriptive, rather than normative, properties of default positions. We argue that default positions in clinical ethics function to protect and promote important values in medicine—respect for persons, utility, (...) and justice. Further, default positions in clinical ethics may also guard against harm. Where default positions exist, there are epistemic burdens to overturn them. The person wishing to reject the default position, rather than the person endorsing it, bears this burden. The person who bears the burden of meeting the epistemic requirements must provide evidence proportional to the degree of harm the default position protects against. Default positions that protect against significant harm impose significant epistemic requirements to overturn. This asymmetry not only makes medical decision-making more economical but also serves to promote and protect certain values. The identification and analysis of common and recognizable default positions can help to identify other default positions and the conditions under which their associated epistemic requirements are met. The article concludes with considerations of potential problems with the use of default positions in clinical ethics. (shrink)

Medicine is a space to meet the weak and the defenseless. Its environment,professional object and the agents that participate directly or indirectly in the exercise of medicine have a potential generator of culture of life opposing the prevailing culture of death in today's world. In this paper we have described how the exercise of a profession, in this case of medicine, has the potential to evangelize culture. To do this, we delved into the concept of culture, its (...) current context, the generalities of the evangelization of culture, andthen to consider different angles in which medicine demonstrates its potential to evangelize culture. This potential is highlighted to sensitize young people who want to be doctors, who by being fully integrated, scientifically sound and based on ethical, moral and evangelical principles, have a significant impact on society. On the other hand, by generating a culture of solidarity, always seeking to heal escape from pain and suffering, attending mainly to the poorest and most needy. Finally, by generating spaces and initiatives to transmit ideas,reflections, knowledge and disseminating values in the exercise of the profession. -/- La medicina es un espacio para salir al encuentro del débil y el indefenso. Su entorno, objeto profesional y los agentes que participan directa o indirectamente en el ejercicio de la medicina posee un potencial generador de cultura de vida oponiéndose a la cultura de muerte imperante en el mundo de hoy. En este trabajo hemos descrito de qué manera el ejercicio de una profesión, en este caso de la medicina, tiene potencial para evangelizar la cultura. Para ello, se ahondó en el concepto de cultura, su contexto actual, las generalidades de la evangelización de la cultura, para luego al considerar diferentes ángulos en los que la medicina evidencia su potencial para evangelizar la cultura. Se destaca dicho potencial para sensibilizar a los jóvenes que quieren ser médicos, quienes, al formarse integralmente, científicamente sólidos y fundamentados en principios éticos, morales yevangélicos, ejercen un impacto significativo en la sociedad. Por otro lado, al generar una cultura de solidaridad, buscando salir siempre al encuentro del dolor y el sufrimiento,atendiendo principalmente a los más pobres y necesitados. Finalmente, al generar espacios e iniciativas para trasmitir ideas, reflexiones, conocimientos y difundiendo valores en el ejercicio de la profesión. (shrink)

Contemporary knowledge is centered on the research on human dimensions. Philosophy should particularly appeal to values in the process of understanding the human nature. The valuable “becoming” of each human person requires growing ever more aware of his/her personal identity and of his/her role in this lifetime. In ethics, especially, values suppose moral choices or criteria on which a moral behavior is based. Max Scheler based his ethical theory on the distinction between goods and values. The “goods” (...) are things to which we attach some physical worth, and the “values” are the object of emotional perception, of the “sentiment of value” and of the place they have in the hierarchy of values. Even if the human being attributes a certain worth to individual things, he/she is always searching for a universal value, which should exceed the contingency of that thing. This universal validity is a kind of ideal measure of the value of all empiric realities and it is articulated by a normative rationality. It forms a system of universal norms that contribute to the foundation of critical axiological judgments. What values are the most enhanced by our post-modern society? Are they the same as during the modern period? What would distinguish them from the values of other cultural periods of humankind? How do we react to the new challenges generated by technological progress and the media? How do the classical disciplines such as philosophy, religion, anthropology, and art respond to these new challenges? And how could they help us to better adapt the writings of certain significant personalities to the modern and contemporary culture? These are only a few questions this volume will address. It contains a large number of articles by authors from various countries and continents: philosophers, and theologians, as well as researchers in medicine, anthropology, and new scientific technologies. As the variety of topics is impressive, we tried to organize them into three thematic parts: “Part I: Fundamental Human Values. Contemporary Challenging Globalization,” “Part II: New Axiological Challenges in Technologies and Scientific Thinking,” and “Part III: Cultural and Spiritual Personalities: Possible Answers to Our Contemporary Changes.” In the following pages, we shall make a short presentation of each article in order to facilitate a quick familiarization with the entire volume. (shrink)

Contents: Danuta Ługowska, Incommensurability of Paradigms Exemplified by the Differences Between the Western and Eastern European Image of the Human Person ; Maria-Magdalena Weker, Light, Body and Soul – the Issues Fundamental for Theories of Vision. A Historical Survey ; Dariusz Kucharski, The Conception of Sensory Perception and Scientific Research. (The Theory of Sign within Philosophy of G. Berkeley and T. Reid) ; Grzegorz Bugajak, Causality and Determinism in Physics ; Anna Lemańska, Truth in Mathematics ; Anna Latawiec, Troubles with (...) the Philosophy of Medicine ; Adam Świeżyński, Values, Axiological Experience, and Scientific Research ; Grzegorz Bugajak, Fears of Science. Nature and Human Actions ; Adam Świeżyński, Some Remarks on the Human Search for Sense in the Context of Human Actions. (shrink)

In this chapter, I propose that conceptions of justice in bioethics must be feminist, meaning they must be able to capture how the domains of health, healthcare and medicine exacerbate the subordination of those perceived to be women and girls and how injustice impacts their health. After providing context in the first section, I identify three problems with conceptions of justice in the bioethics literature that interfere with their potential to be feminist. They tend to adopt the ahistoricism and (...) distributivism characteristic of theories of justice that have been dominant in political philosophy, and they often rely on gendered conceptions of health that result in troubling comparisons of men and women’s health. My argument is primarily “negative”: it is a critique of generalist conceptions of justice in bioethics. However, in the final section I present characteristics of what a feminist conception of justice needs to look like and indicate how feminist bioethicists are using such a conception in assessing issues of injustice in bioethics. I emphasize the centrality of actual structural injustices, relational egalitarianism, and the assessment of values in conceptions of health and the health sciences. (shrink)

Since its introduction just over two decades ago, evidence-based medicine (EBM) has come to dominate medical practice, teaching, and policy. There are a growing number of textbooks, journals, and websites dedicated to EBM research, teaching, and evidence dissemination. EBM was most recently defined as a method that integrates best research evidence with clinical expertise and patient values and circumstances in the treatment of patients. There have been debates throughout the early 21st century about what counts as good research (...) evidence between EBM proponents and philosophical critics and even within the EBM community itself. Similar controversy arises about the relative worth of patient values and clinical expertise (and how these can be integrated). EBM has also evolved in ways that have come under scrutiny. Specifically, policymakers have used EBM research methodology to increase the relative importance of clinical guidelines that some clinicians have argued are tyrannical. Philosophers have addressed all of these controversies, and with very few exceptions have been critical of EBM. In addition most philosophical attention has been on the epistemic role of Randomization and evidence hierarchies, with relatively little attention being paid to the role of Diagnosis, expertise, patient values, and Systematic Reviews within EBM. (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)

The orientation of this paper is that there is no special science of "business ethics" any more than there is one of "medical ethics" or "legal ethics". While there may be issues that arise in medicine or law that require special treatment, the ways of relating to such issues are derived from a basic ethical stance. Once one has evolved such an ethical stance and thus has incorporated a fundamental mode of relating to her or his fellow human beings, (...) the "how" to deal with various ethical "issues" will follow as a natural consequence of one's ethical stance or modality. It is not necessary, in the formation of one's fundamental ethical stance to know if one is a utilitarian or a deontologist. It is doubtful whether Buddha knew what kind of ethics he was practising. If one conceives of ethics as something extrinsic to various disciplines and attempts to first practise a discipline and then to apply ethics to modify the results of that discipline it is entirely possible that conflicts will result between what is perceived of as the proper pursuit of that discipline and the ethical considerations. The argument of this paper is that it is more efficacious (in addition to being more true) to take ethical considerations into account in the construction of the definition of the discipline. This paper is devoted to showing that business and ethics are not two different and competing fields of interest (thus requiring a discipline of business ethics to be grafted onto the study of business enterprise), but that ethical concerns are part and parcel of the very concept of a business enterprise and the internal operation of a business organization. (shrink)

Narratives have come to influence medicine, giving rise to a new approach called "narrative medicine". In this paper, we consider the patient as a text, an open book in which physicians and healthcare professionals, but also from which they can and should learn a great deal. By delving into the narrative perspective of understanding the patient and their situation, we discover how the patient is the object of the physician's compassion, but also how he or she becomes the (...) subject of that compassion. We conclude that it is important for physicians to spend time in their undergraduate and graduate medical education exploring and using the value of narratives to help them categorize their lived experiences and those of patients. -/- As narrativas estão chegando a influenciar na medicina, dando origem a uma nova abordagem chamada " medi-cina narrativa ". Neste trabalho consideramos o paciente como um texto, em outras palavras, um livro aberto que o médico intervém, mas também, que deve aprender muito. Aprofundar-se um pouco na perspectiva narrativa da compreensão do paciente e de sua situação ajuda a descobrir como o paciente é objeto da compaixão dos médicos, embora também como se converte em sujeito desta compaixão. Concluímos que é importante que os médicos dediquem mais tempo em sua formação médica inicial, bem como em sua formação permanente, para explorar o valor das narrativas que ajudam a categorizar suas experiências e a dos pacientes. -/- Las narraciones han llegado a influir en la medicina, dando lugar a un nuevo enfoque llamado " medicina narrativa ". En este trabajo consideramos al paciente como un texto, es decir, un libro abierto que el médico interviene, pero también del que el médico puede y necesita mucho aprender. Ahondar un poco en la perspectiva narrativa de la comprensión del paciente y de su situación nos ayuda a descubrir cómo el paciente es objeto de la compasión de los médicos, pero también cómo se convierte en sujeto de esa compasión. Concluimos que es importante que los médicos dediquen tiempo en su formación médica inicial, así como en su formación permanente, a explorar y explotar el valor de las narraciones, que les ayuden a categorizar sus experiencias vividas y las de los pacientes. (shrink)

As a way to make medical decisions, Evidence-Based Medicine (EBM) has failed. EBM's failure arises from not being founded on real-world decision-making. EBM aspires to a scientific standard for the best way to treat a disease and determine its cause, but it fails to recognise that the scientific method is inapplicable to medical and other real-world decision-making. EBM also wrongly assumes that evidence can be marshaled and applied according to an hierarchy that is determined in an argument by authority (...) to the method by which it has been obtained. If EBM had valid theoretical, practical or empirical foundations, there would be no hierarchy of evidence. In all real-world decision-making, evidence stands or falls on its inherent reliability. This has to be and can only be assessed on a case-by-case basis applying understanding and wisdom against the background of all available facts—the "factual matrix." EBM's failure is structural and was inevitable from its inception. EBM confuses the inherent reliability and probative value of evidence with the means by which it is obtained. -/- EBM is therefore an ad hoc construct and is not a valid basis for medical decision-making. This is further demonstrated by its exclusion of relevant scientific and probative real-world decision-making evidence and processes. It draws upon a narrow evidence base that is itself inherently unreliable. It fails to take adequate account of the nature of causation, the full range of evidence relevant to its determination, and differing approaches to determining cause and effect in real-world decision-making. EBM also makes a muddled attempt to emulate the scientific method and it does not acknowledge the role of experience, understanding and wisdom in making medical decisions. (shrink)

Conscientious objection in health care is a form of compromise whereby health care practitioners can refuse to take part in safe, legal, and beneficial medical procedures to which they have a moral opposition (for instance abortion). Arguments in defense of conscientious objection in medicine are usually based on the value of respect for the moral integrity of practitioners. I will show that philosophical arguments in defense of conscientious objection based on respect for such moral integrity are extremely weak and, (...) if taken seriously, lead to consequences that we would not (and should not) accept. I then propose that the best philosophical argument that defenders of conscientious objection in medicine can consistently deploy is one that appeals to (some form of) either moral relativism or subjectivism. I suggest that, unless either moral relativism or subjectivism is a valid theory—which is exactly what many defenders of conscientious objection (as well as many others) do not think—the role of moral integrity and conscientious objection in health care should be significantly downplayed and left out of the range of ethically relevant considerations. (shrink)

Recent bioethical issues that have emerged in the field of medicine include, but are not limited to, eugenics (artificial insemination), palliative care (end of life care), euthanasia (medical resuscitation), abortion, and the development of enhanced human body parts. These bioethical issues have raised ethical questions related to the use of modern technology and how it may affect the future of society. These questions consider issues such as: what is the identity of future children? Have human beings become a commodity (...) exchanged by those who have the ability to own them? What is the meaning of justice in medical treatment? How can physicians and nurses perform humanitarian work? -/- Discussions of these questions should begin by determining their relationships with typical social and cultural values in society, such as life and death, marriage, family, fatherhood, motherhood, relatives, and next-of-kin. -/- This paper presents a review of the important Arabic literature that has been written on these bioethical issues to show the contributions of Arab scholars in this field. Arabic studies in bioethics can be classified into three types: original Arabic writings, translated studies, and congresses held in the Arab region. (shrink)

Editors' introduction to 3rd thematic issue on philosophy of medicine.

On Don Marquis’s future of value account of the wrongness of killing, ‘what makes it wrong to kill those individuals we all believe it is wrong to kill, is that killing them deprives them of their future of value’. Marquis has recently argued for a narrow interpretation of his future of value account of the wrongness of killing and against the broad interpretation that I had put forward in response to Carson Strong. In this article I argue that the narrow (...) view is problematic because it violates some basic principles of equality and because it allows for some of the very killing that Marquis sets out to condemn; further, I argue that the chief reason why Marquis chooses the narrow view over the broad view – namely that the broad view would take the killing of some nonhuman animals to be also wrong – should rather be considered a welcome upshot of the broad view. (shrink)

Evidence-based medicine is a clinical decision-making framework which makes claims about what physicians ought to do. Though heralded as the cutting edge of medical science, evidence-based medicine is a value-laden normative theory which implicitly depends on substantive views regarding what is morally good or right. In this paper, I provide an ethical analysis of evidence-based medicine. I consider its normative underpinnings in three ethical theories: utilitarianism, Kantian deontology, and virtue ethics. In the face of uncertainty, evidence-based (...) class='Hi'>medicine endorses expected utility theory using the best available evidence in order to avoid doing more harm than good. In accordance with the Kantian respect for individuals as ends in themselves, evidence-based medicine calls for integrating the values and preferences of the patient. De-emphasizing intuition, clinical expertise, and pathophysiologic rationale emphasizes the need for the intellectual virtues of curiosity, critical thinking, and courage. Evidence-based medicine is a successful clinical practice that can be morally justified by all three major ethical theories. Although its focus on maximizing good health outcomes and integrating respect for individual patients has been emphasized, the role of the intellectual virtues in evidence-based medicine remains highly under-explored. (shrink)

Evidence-based medicine is a clinical decision making framework which makes claims about what physicians ought to do. Though heralded as the cutting edge of medical science evidence-based medicine is a value laden normative theory which implicitly depends on substantive views regarding what is morally good or right. In this paper, I provide an ethical analysis of evidence-based medicine. I consider its normative underpinnings in three ethical theories: utilitarianism, Kantian deontology, and virtue ethics. In the face of uncertainty, (...) evidence-based medicine endorses expected utility theory using the best available evidence in order to avoid doing more harm than good. In accordance with the Kantian respect for individuals as ends in themselves, evidence-based medicine calls for integrating the values and preferences of the patient. De-emphasizing intuition, clinical expertise, and pathophysiologic rationale emphasizes the need for the intellectual virtues of curiosity, critical thinking, and courage. Evidence-based medicine is a successful clinical practice that can be morally justified by all three major ethical theories. Although its focus on maximizing good health outcomes and integrating respect for individual patients has been emphasized, the role of the intellectual virtues in evidence- based medicine remains highly under-explored. (shrink)

In this paper we focus on some new normativist positions and compare them with traditional ones. In so doing, we claim that if normative judgments are involved in determining whether a condition is a disease only in the sense identified by new normativisms, then disease is normative only in a weak sense, which must be distinguished from the strong sense advocated by traditional normativisms. Specifically, we argue that weak and strong normativity are different to the point that one ‘normativist’ label (...) ceases to be appropriate for the whole range of positions. If values and norms are not explicit components of the concept of disease, but only intervene in other explanatory roles, then the concept of disease is no more value-laden than many other scientific concepts, or even any other scientific concept. We call the newly identified position “value-conscious naturalism” about disease, and point to some of its theoretical and practical advantages. (shrink)

This dissertation explores the influence of time constraints on different research practices. The first two parts present case studies, which serve as a basis for discussing the epistemological and ethical implications of temporal limitations in scientific research. Part I is a case study on gravitational wave research, conducted by the LIGO Scientific Collaboration. This exemplifies fundamental research – without immediate societal applications, open-ended in terms of timeline and in terms of research goals. It is based, in part, on qualitative interviews (...) conducted with gravitational wave physicists. I show that considerations about time and speed play a role in every stage of research: goal setting, method design, and the evaluation and communication of results. Part II provides a case study on translational medicine, an approach explicitly dedicated to accelerating research in order to develop and implement new therapies. This epitomizes applied research with high social stakes, motivated by non-epistemic goals. Here, epistemic trade-offs between speed and reliability intersect with ethical trade-offs between different types of harms. In Part III, the insights from both of these case studies are used as the basis for a more general discussion concerning the pragmatic aspects of epistemic practices, especially in relation to current debates centered on the role of values in science. A particular focus is on the value of speed and the ability to generate reliable results, either via choice of methods, or via decisions about which goals to set, as well as decisions about when to stop further testing. The primary thesis of the dissertation is that pragmatic considerations stemming from limitations of resources are a necessary feature of the pursuit of epistemic aims, and that the epistemic is thus inherently pragmatic. (shrink)

There is a lot of conceptual engineering going on in medical research. I substantiate this claim with two examples, the medical debate about cancer classification and about obesity as a disease I also argue that the proper target of conceptual engineering in medical research are experts’ conceptions. These are explicitly written down in documents and guidelines, and they bear on research and policies. In the second part of the chapter, I propose an externalist framework in which conceptions have both the (...) explanatory power of psychological concepts and that of semantic concepts. It is likely, however, that human activities and practices distinct from medical research, and regulated by different practices and epistemic rules, call for different targets for conceptual engineering. I conclude with indicating an open agenda of problems for philosophers of medicine interested in conceptual engineering. (shrink)

Built-in decision thresholds for AI diagnostics are ethically problematic, as patients may differ in their attitudes about the risk of false-positive and false-negative results, which will require that clinicians assess patient values.

Traditional medicine, particularly in rural Indonesia, plays a crucial role in healthcare, especially for older adults. These remedies, deeply rooted in cultural heritage, offer accessible and affordable alternatives to modern medicine. However, integrating them into formal healthcare systems faces challenges such as quality control, safety, and cultural sensitivity. This study investigates how traditional health practices influence healthcare behaviors and proposes culturally sensitive frameworks to bridge the gap between traditional and modern healthcare. This study employs a literature-based methodology, combining (...) relational design and sensory-dialogical approaches to explore inclusivity and cultural sensitivity in healthcare research. Data from peer-reviewed articles, case studies, and ethnographic reports from 2010 to 2024, focusing on rural Indonesian communities, were analyzed. Thematic analysis identified patterns regarding healthcare preferences, cultural significance, barriers to inclusivity, and ethical challenges in validating traditional remedies. The study highlights the importance of traditional remedies, especially herbal medicine, in maintaining health and cultural identity among older adults. These remedies serve both practical healthcare and cultural purposes. Community-based practices, such as preparing herbal remedies, emphasize their symbolic and therapeutic value. However, challenges like herb-drug interactions, a decline in ethnobotanical knowledge, and the integration of traditional medicine with modern healthcare remain prevalent. Culturally sensitive healthcare research is essential to address disparities in rural and marginalized populations in Indonesia. Approaches like relational design and sensory-dialogical frameworks promote inclusivity and ethical rigor. Integrating traditional medicine requires balancing cultural preservation with scientific validation, fostering equitable healthcare solutions that harmonize with contemporary needs. (shrink)

This paper considers the view that medicine is both “science” and “art.” It is argued that on this view certain clinical knowledge – of patients’ histories, values, and preferences, and how to integrate them in decision-making – cannot be scientific knowledge. However, by drawing on recent work in philosophy of science it is argued that progress in gaining such knowledge has been achieved by the accumulation of what should be understood as “scientific” knowledge. I claim there are varying (...) degrees of objectivity pertaining to various aspects of clinical medicine. Hence, what is often understood as constituting the “art” of medicine is amenable to objective methods of inquiry, and so, may be understood as “science”. As a result, I conclude that rather than endorse the popular philosophical distinction between the art and science of medicine, in the future a unified, multifaceted epistemology of medicine should be developed to replace it. (shrink)

Drug regulation is fraught with inductive risk. Regulators must make a prediction about whether or not an experimental pharmaceutical will be effective and relatively safe when used by typical patients, and such predictions are based on a complex, indeterminate, and incomplete evidential basis. Such inductive risk has important practical consequences. If regulators reject an experimental drug when it in fact has a favourable benefit/harm profile, then a valuable intervention is denied to the public and a company’s material interests are needlessly (...) thwarted. Conversely, if regulators approve an experimental drug when it in fact has an unfavourable benefit/harm profile, then resources are wasted, people are needlessly harmed, and other potentially more effective treatments are underutilized. Given that such regulatory decisions have these practical consequences, non-epistemic values about the relative importance of these consequences impact the way such regulatory decisions are made (similar to the analysis of laboratory studies on the toxic effects of dioxins presented in Douglas [2000]). To balance the competing demands of the pertinent non-epistemic values, regulators must perform what I call an “inductive risk calculus.” At least in the American context this inductive risk calculus is not well-managed. (shrink)

The aim of this commentary is to discuss the axiology of the cost–benefit approach assumed by Travis Rieder (2017) to analyze medical decision making in the case of extremely preterm infants.

Last year saw the 20th anniversary edition of JECP, and in the introduction to the philosophy section of that landmark edition, we posed the question: apart from ethics, what is the role of philosophy ‘at the bedside’? The purpose of this question was not to downplay the significance of ethics to clinical practice. Rather, we raised it as part of a broader argument to the effect that ethical questions – about what we should do in any given situation – are (...) embedded within whole understandings of the situation, inseparable from our beliefs about what is the case, what it is that we feel we can claim to know, as well as the meaning we ascribe to different aspects of the situation or to our perception of it. Philosophy concerns fundamental questions: it is a discipline requiring us to examine the underlying assumptions we bring with us to our thinking about practical problems. Traditional academic philosophers divide their discipline into distinct areas that typically include logic: questions about meaning, truth and validity; ontology: questions about the nature of reality, what exists; epistemology: concerning knowledge; and ethics: how we should live and practice, the nature of value. Any credible attempt to analyse clinical reasoning will require us to think carefully about these types of question and the relationships between them, as they influence our thinking about specific situations and problems. So, the answers to the question we posed, about the role of philosophy at the bedside, are numerous and diverse, and that diversity is illustrated in the contributions to this thematic edition. (shrink)

The Pros and Cons of Religion in Human Society -/- Religion has been a central part of human civilization for thousands of years, shaping moral values, cultural traditions, and social structures. While it has inspired great acts of kindness, unity, and artistic expression, it has also been a source of conflict, division, and oppression. The impact of religion on society is complex, with both positive and negative aspects that influence human behavior and progress. This essay explores the benefits and (...) drawbacks of religion, examining how it has shaped societies throughout history. -/- The Pros of Religion In Society -/- 1. Moral and Ethical Guidance -/- One of the primary functions of religion is to provide a moral framework that guides human behavior. Many religious teachings promote values such as compassion, honesty, justice, and respect for others. Throughout history, religious principles have served as the foundation for legal systems and ethical standards. For example, the Ten Commandments in Christianity and Judaism, the Five Precepts in Buddhism, and the moral teachings of Islam have all contributed to the development of societal laws and norms. -/- 2. Community and Social Support -/- Religious institutions create a sense of belonging and social cohesion. They bring people together through shared beliefs, rituals, and traditions. In times of crisis, religious communities provide emotional and financial support to those in need. Churches, mosques, temples, and other religious centers often serve as safe spaces where individuals can seek guidance and assistance. This sense of community strengthens social bonds and provides comfort during difficult times. -/- 3. Psychological and Emotional Comfort -/- Faith offers hope, meaning, and purpose to people, especially when facing hardship, grief, or uncertainty. Many individuals turn to religion to find solace in times of illness, loss, or personal struggles. Prayer, meditation, and religious rituals provide psychological relief and help people develop resilience against life’s challenges. The belief in a higher power or an afterlife can give individuals a sense of peace, reducing anxiety and fear of the unknown. -/- 4. Charity and Humanitarian Efforts -/- Many religious organizations engage in charitable work, helping the poor, sick, and marginalized. Religious teachings often encourage acts of kindness, generosity, and service to others. For example, Christian missionary groups build schools and hospitals, Islamic charities provide food and shelter to those in need, and Buddhist monks dedicate their lives to helping the less fortunate. This commitment to charity has led to the establishment of numerous non-profit organizations that improve lives worldwide. -/- 5. Cultural and Artistic Contributions -/- Religion has played a crucial role in inspiring some of the greatest artistic, literary, and architectural achievements in history. Religious themes are evident In the works of Michelangelo, Leonardo da Vinci, and many other artists. Cathedrals, temples, and mosques showcase the architectural brilliance of different civilizations. Sacred texts, hymns, and poetry have enriched literature and music across cultures. Without religion, many of these masterpieces might not exist. -/- 6. Social Cohesion and Stability -/- Shared religious beliefs help unify societies by fostering cooperation, mutual understanding, and social order. Many religious teachings emphasize peace, forgiveness, and reconciliation, which can prevent conflicts and promote harmony within communities. Religious institutions often encourage people to live virtuous lives and contribute positively to society, reinforcing stability and reducing crime. -/- 7. Influence on Personal Discipline and Growth -/- Religious practices encourage self-discipline, self-improvement, and mindfulness. Fasting, prayer, meditation, and other spiritual exercises help individuals cultivate patience, humility, and inner peace. Many religions promote the idea of lifelong learning and personal development, urging followers to strive for a better version of themselves. -/- The Cons of Religion in Society -/- 1. Dogmatism and Resistance to Change -/- While religion provides moral guidance, some religious institutions resist change and scientific progress. Throughout history, religious groups have opposed advancements in medicine, education, and human rights. The rejection of scientific discoveries, such as heliocentrism and evolution, demonstrates how religious dogma can hinder intellectual progress. -/- 2. Division and Conflict -/- Religious differences have been a source of wars, persecution, and social divisions. The Crusades, religious wars in Europe, and conflicts between different faiths have resulted in immense suffering. Even today, religious extremism and sectarian violence continue to fuel tensions in many parts of the world. Instead of uniting people, religion can sometimes create barriers between different groups. -/- 3. Suppression of Individual Freedom -/- Some religious doctrines impose strict rules on personal behavior, limiting individual freedom and self-expression. In certain religious societies, people face restrictions on their dress, career choices, and even personal relationships. Gender inequality, discrimination against LGBTQ+ individuals, and restrictions on freedom of thought are often justified using religious texts. This suppression of freedom can prevent people from living fulfilling lives according to their own beliefs. -/- 4. Exploitation and Corruption -/- Religious institutions have been used as tools for personal and political gain. Corrupt leaders have exploited followers for financial and political power. Cases of sexual abuse, fraud, and manipulation within religious organizations have damaged trust in religious institutions. When religious leaders misuse their influence for selfish purposes, it harms believers and weakens the moral authority of religion. -/- 5. Psychological Fear and Guilt -/- Some religious teachings instill fear of punishment, such as eternal damnation or divine wrath. This can create guilt and anxiety in individuals, leading to feelings of unworthiness or depression. The emphasis on sin and repentance can sometimes lead people to develop an unhealthy relationship with their own desires and emotions. -/- 6. Impediment to Scientific Thinking -/- In some cases, religious beliefs conflict with scientific knowledge, discouraging rational inquiry and critical thinking. Many religious traditions reject evidence-based theories like evolution and the Big Bang, promoting faith over reason. This resistance to scientific understanding can slow progress in fields such as medicine, environmental science, and technology. -/- 7. Overpopulation and Societal Issues -/- Certain religious teachings discourage birth control and family planning, leading to overpopulation and resource scarcity. In countries where religious beliefs strongly influence policy, restrictions on contraception contribute to high poverty rates and environmental degradation. Without proper population control, societal issues such as hunger, unemployment, and lack of healthcare become more severe. -/- Conclusion -/- Religion has been both a unifying force and a source of division in human history. It provides moral guidance, community support, and psychological comfort, while also inspiring charity and cultural achievements. However, it can also contribute to conflict, suppression of individual freedoms, and resistance to progress. -/- A balanced approach—one that respects religious traditions while promoting critical thinking and secular governance—can help societies maximize the benefits of religion while minimizing its negative effects. By encouraging open-mindedness and ethical responsibility, humans can ensure that religion continues to serve as a positive force in the modern world. -/- . (shrink)

Techniques from behavioral economics—nudges—may help physicians increase pediatric vaccine compliance, but critics have objected that nudges can undermine autonomy. Since autonomy is a centrally important value in healthcare decision-making contexts, it counts against pediatric vaccination nudges if they undermine parental autonomy. Advocates for healthcare nudges have resisted the charge that nudges undermine autonomy, and the recent bioethics literature illustrates the current intractability of this debate. This article rejects a principle to which parties on both sides of this debate sometimes seem (...) committed: that nudges are morally permissible only if they are consistent with autonomy. Instead, I argue that, at least in the case of pediatric vaccination, some autonomy-undermining nudges may be morally justified. This is because parental autonomy in pediatric decision-making is not as morally valuable as the autonomy of adult patients, and because the interests of both the vaccinated child and other members of the community can sometimes be weighty enough to justify autonomy-infringing pediatric vaccination nudges. This article concludes with a set of worries about the effect of pediatric vaccination nudges on parent-physician relationships, and it calls on the American Academy of Pediatrics to draw on scientific and bioethics research to develop guidelines for the use of nudges in pediatric practice and, in particular, for the use of pediatric vaccination nudges. (shrink)

In this article, I explore the ethical dimensions of same-sex reproduction achieved through epigenome editing—an innovative and transformative technique. For the first time, I analyse the potential normativity of this disruptive approach for reproductive purposes, focusing on its implications for lesbian couples seeking genetically related offspring. Epigenome editing offers a compelling solution to the complex ethical challenges posed by traditional gene editing, as it sidesteps genome modifications and potential long-term genetic consequences. The focus of this article is to systematically analyse (...) the bioethical issues related to the use of epigenome editing for same-sex reproduction. I critically assess the ethical acceptability of epigenome editing with reproductive purposes from multiple angles, considering harm perspectives, the comparison of ethical issues related to gene and epigenome editing, and feminist theories. This analysis reveals that epigenome editing emerges as an ethically acceptable means for lesbian couples to have genetically related children. Moreover, the experiments of a reproductive use of epigenome editing discussed in this article transcend bioethics, shedding light on the broader societal implications of same-sex reproduction. It challenges established notions of biological reproduction and prompts a reevaluation of how we define the human embryo, while poses some issues in the context of gender self-identification and family structures. In a world that increasingly values inclusivity and diversity, this article aims to reveal a progressive pathway for reproductive medicine and bioethics, as well as underscores the need for further philosophical research in this emerging and fertile domain. (shrink)

Evidence-based medicine (EBM) calls for medical practitioners to “integrate” our best available evidence into clinical practice. A significant amount of the literature on EBM takes this integration to be unproblematic, focusing on questions like how to interpret evidence and engage with patient values, rather than critically looking at how these features of EBM can be implemented together. Other authors have also commented on this gap in the literature, for example, identifying the lack of clarity about how patient preferences (...) and evidence from trials is supposed to be integrated in practice. In this paper, I look at this issue from an epistemological perspective, (looking at how different types of knowledge in EBM can be used to make sounds judgements). In particular, I introduce an epistemological issue for this integration problem, which I call the epistemic integration problem. This is essentially the problem of how we can use information that is both general (eg, about a population sample) and descriptive (eg, about what expected outcomes are) to reach clinical judgements that are individualized (applying to a particular patient) and normative (about what is best for their health). (shrink)

Health care systems can positively influence our personal decision-making and health-related behavior only if we trust them. I propose a conceptual analysis of the trust relation between the public and a healthcare system, drawing from healthcare studies and philosophical proposals. In my account, the trust relation is based on an epistemic component, epistemic authority, and on a value component, the benevolence of the healthcare system. I argue that it is also modified by the vulnerability of the public on healthcare matters, (...) and by the system’s credibility. I apply my proposed analysis of public trust in health care systems to the phenomenon of vaccine hesitancy, a tendency to question vaccine policies, and to seek alternative vaccine schedules or to refuse vaccination. Understanding the role of trust and its components can be key to understanding the phenomenon. (shrink)

To clarify the proper role of values in science, focusing on controversial expert responses to Covid-19, this article examines the status of (in)convenient hypotheses. Polarizing cases like health experts downplaying mask efficacy to save resources for healthcare workers, or scientists dismissing “accidental lab leak” hypotheses in view of potential xenophobia, plausibly involve modifying evidential standards for (in)convenient claims. Societies could accept that scientists handle (in)convenient claims just like nonscientists, and give experts less political power. Or societies could hold scientists (...) to a higher bar, by expecting them not to modify evidential standards to avoid costs only incidentally tied to error. (shrink)

We argue that the prudential benefits of long-distance leisure travel can justify such trips even though there are strong and important reasons against long-distance flying. This is because prudential benefits can render otherwise impermissible actions permissible, and because, according to dominant theories about wellbeing, long-distance leisure travel provides significant prudential benefits. However, this ‘wellbeing argument’ for long-distance leisure travel must be qualified in two ways. First, because travellers are epistemically privileged with respect to knowledge about what is good for them, (...) they must look critically at their own assessment of the prudential benefits of a trip. Second, the wellbeing argument is unlikely to support prudential arguments for long-distance leisure trips made by frequent flyers. (shrink)

Celem tego artykułu jest przebadanie i objaśnienie platońskiego wpływu na rady Williama Oslera dla wszystkich lekarzy, które dotyczą ich autonomii, charakteru i stosunku do prawdy i fałszu w medycynie. W sugestiach „Ojca współczesnej medycyny” wprawne ucho może dosłyszeć echo niektórych opinii ucznia Sokratesa. Jego ideały i wartości powinny kształtować nie tylko lekarski etos, lecz i wiedzę o zasadach zdrowego życia i zwalczania choroby. Zwłaszcza dzisiaj to jest niesłychanie istotne w obliczu zagrożeń i nieszczęść, jakie stwarza farmakracja. -/- *** -/- Platonic (...) reminiscences in Osler’s advice about physicians’ autonomy, character and relation to truth and falsehood in medicine The aim of this article is to examine and explain Plato’s influence on William Osler’s advice to all physicians about their autonomy, character and relation to truth and falsehood in medicine. In the suggestions of “the Father of Modern Medicine” an experienced ear can detect an echo of certain opinions propagated by the pupil of Socrates. His ideals and values should shape not only the medical ethos, but also knowledge on the principles of a healthy life and overcoming disease. This is extremely important especially today, in the face of the threats represented – and the misfortunes caused – by pharmacracy. (shrink)

Temporal Changes in Ovarian Gonadotropin-Releasing Hormone mRNA Levels by Gonadotropins in the Rat Sung Ho Lee, Eun-Seob Song, Sun Kyeong Yu, Changmee Kim, Dae Kee Lee, Wan Sung Choi l and Kyungjin Kim* Department of Molecular Biofogy and SRC for Cell Differentiation, Seoul National University, Seoul 150-742, Korea; IDepartment of Anatomy, College of Medicine, Gyeongsanf; National University, Chinju 660-280, Korea (Recei·. cd on December 29, 1993) The present study examines whether gonadotropins are involved in the regulation of ovarian GnRH (...) gene expression and how ovarian GnRH gene expression temporalJy correlates with alterations in hypothalamic GnRH, pituitary LH~ gene expression in respons to gonadotropins. Hypothalamic and ovarian GnRH mRNA and pituitary LH~ mRNA levels were determined by respective RNA-blot hybridizations, and ovarian GnRH and estradiol contents and serum LH levels were measured by respective radioimmunoassays. Three animal models such as 1) PMSG-treated, 2) PMSG and heG-treated immature rats and 3) proestrous stage of adult rats were used. Immature rats (25-days old) were administered with PMSG (10 iu) at 10:00 hand 48 h later with heG (10 iu) to induce ovulation. In the PMSG-injected model, hypothalamic GnRH mRNA levels were markedly augmented about 9-fold at 50 h, and pituitary LH mRNA 3-fold at 52 h after PMSG administration. Serum LH levels were increased to the preovulatory surge levels at 56 h, and ovarian GnRH mRNA levels were augmented 4-fold at 60 h after PMSG injection. Administration of heG also induced a marked enhancement in ovarian GnRH mRNA levels in comparison to the values shown in both intact and PMSGtreated rats at 52 hand 54 h, respectively. In the proestrous stage of normal adult rats, pituitary LH~ mRNA levels were peaked at 16:00 h. The preovulatory LH surge was evident at 4 h before increment in ovarian GnRH mRNA levels as shown in PMSG-treated rats. The present study clearly showed the sequential increase in hypothalamic GnRH mRNA, pituitary LH~ mRNA and ovarian GnRH mRNA levels, indicating that ovarian GnRH may play a possible role in the control of follicular maturation and the ovulation process. (shrink)

As national and state health care policy -making becomes contentious and complex, there is a need for a forum to debate and explore public concerns and values in health care, give voice to local citizens, to facilitate consensus among various stakeholders, and provide feedback and direction to health care institutions and policy makers. This paper explores the role that regional health care ethics committees can play and provides two contrasting examples of Networks involved in facilitation of public input into (...) and the development of health care policies and adoption of state-wide practices. (shrink)

Philosophical investigation in synthetic biology has focused on the knowledge-seeking questions pursued, the kind of engineering techniques used, and on the ethical impact of the products produced. However, little work has been done to investigate the processes by which these epistemological, metaphysical, and ethical forms of inquiry arise in the course of synthetic biology research. An attempt at this work relying on a particular area of synthetic biology will be the aim of this chapter. I focus on the reengineering of (...) metabolic pathways through the manipulation and construction of small DNA-based devices and systems synthetic biology. Rather than focusing on the engineered products or ethical principles that result, I will investigate the processes by which these arise. As such, the attention will be directed to the activities of practitioners, their manipulation of tools, and the use they make of techniques to construct new metabolic devices. Using a science-in-practice approach, I investigate problems at the intersection of science, philosophy of science, and sociology of science. I consider how practitioners within this area of synthetic biology reconfigure biological understanding and ethical categories through active modelling and manipulation of known functional parts, biological pathways for use in the design of microbial machines to solve problems in medicine, technology, and the environment. We might describe this kind of problem-solving as relying on what Helen Longino referred to as “social cognition” or the type of scientific work done within what Hasok Chang calls “systems of practice”. My aim in this chapter will be to investigate the relationship that holds between systems of practice within metabolic engineering research and social cognition. I will attempt to show how knowledge and normative valuation are generated from this particular network of practitioners. In doing so, I suggest that the social nature of scientific inquiry is ineliminable to both knowledge acquisition and ethical evaluations. (shrink)