This study attempts an exposition of different perceptions of obligation to medical treatment that have emerged from the Islamic theological understanding and how they contribute to diversity of options and flexibility in clinical practice. Particularly, an attempt is made to formulate an Islamic perspective on ordinary and extraordinary means of medical treatment. This distinction is of practical significance in clinical practice, and its right understanding is also important to public funded healthcare authorities, guardians of the patients, health and (...) life insurance institutions, and employers who provide health care coverage to their employees. Not only these parties, but also lawyers and justice administration functionaries such as public prosecutors and judges are in need of understanding this distinction to deal with relevant litigations. The distinction could be made regarding terminally ill patients and non-terminally ill patients separately. The essential factors that matter in making the distinction between ordinary and extraordinary means of treatment are: (1) patient capacity (2) expert advice, and (3) nature of medication. Regarding terminally ill patients, medical treatment can become extraordinary because of (1) patient capacity and (2) nature of medication. In both these case the deciding condition applies: the expert advice taken from a group of physicians. In regards to non- terminally ill patients, extraordinary medical treatment includes three cases: (1) treatment that is known to be useless and futile, (2) treatment that endangers the life or cause more harm than what it removes, and (3) useful treatment, but the patient is unable to bear the cost. (shrink)

Discussion of the behaviour of pregnant women and mothers, in academic literature, medical advice given to mothers, mainstream media and social media, assumes that a mother who fails to do something to benefit her child is liable for moral criticism unless she can provide sufficient countervailing considerations to justify her decision. I reconstruct the normally implicit reasoning that leads to this assumption and show that it is mistaken. First, I show that the discussion assumes that if any action (...) might benefit her child, the mother has a defeasible duty to perform that action. I suggest that this assumption is implicitly supported by two arguments but that each argument is unsound. The first argument conflates moral reasons and defeasible duties; the second misunderstands the scope of a defeasible duty to benefit. This argument has important practical and theoretical implications: practically, it provides a response to a highly damaging discourse on maternal behaviour; theoretically, it provides the framework for a clearer understanding of the scope and nature of defeasible duties to benefit. (shrink)

Wearable and mobile technology has advanced in leaps and bounds in the last decade with technological advances creating a role from enhancing healthy living to monitoring and treating disease. However, the discussion about the ethical use of such commercial technology in the community, especially in minors, is lacking behind. In this paper, we first summarize the major ethical concerns that arise from the usage of commercially available wearable technology in children, with a focus on smart watches, highlighting issues around the (...) consent process, mitigation of risk and potential confidentiality and privacy issues, as well as the potential for therapeutic misconceptions when used without medical advice. Then through a relevant thought experiment we move on to outline some further ethical concerns that are connected to the use of wearables by minors, to wit the issue of informed consent in the case of minors, forcing them to live in the spotlight, and compromising their right to an open future. We conclude with the view that mitigating potential pitfalls and enhancing the benefits of wearable technology especially for minors requires brave and comprehensive moral debates. (shrink)

Background : Menopause is an important period of women life .it is a normal physiological process, defined as the permanent cessation of menses for 12 months or more. Our study assess the awareness and perception of Saudi women aged from 30 to 65 years towards menopause and to Address the health needs of women to improve the quality of life of menopausal Saudi women. Methods: Cross sectional study by using survey distributed electronically through kingdom of Saudi Arabia for Saudi women (...) between ages of 30-65 years old. Results: The number of participant were total of 738 women, 130 women were menopause already. Most of participant were from southern region (67%). Study shows that 51-55 years old is the average age of menopause. Our participant (41.9%) they choose the answer of “inability of ovary to produce egg “as definition of menopause while (17.6 %) choose “cessation of mensuration for more than 1 year), most of women (31.9 %) they though that psychological symptoms will be more prominent with significant p value (0.003), while among menopause group they choose hot flush as the most prominent symptoms (38.5%). About 70% of our sample they mention that they don’t have enough background about menopause. Conclusion: Heath education with proper medical advices should be a part of primary health clinics projects. Media and menopause groups play important role to help health providers . (shrink)

“I am still in despair over losing my identity,” said a blog comment in a discussion about post-menopause weight gain. Instead of recovering an identity, for some of us, as women age, our attitudes toward fitness may require forging new identities. But the challenge in coming to desire fitness, post-menopause, is a project of actually changing my desires. Habituating a good practice can lead to a change in our appetites, so that instead of losing our identities, we may become the (...) characters that we set goals to be. (shrink)

This article highlights the limitations of the tendency to frame health- and wellbeing-related digital tools (mHealth technologies) as empowering devices, especially as they play an increasingly important role in the National Health Service (NHS) in the UK. It argues that mHealth technologies should instead be framed as digital companions. This shift from empowerment to companionship is advocated by showing the conceptual, ethical, and methodological issues challenging the narrative of empowerment, and by arguing that such challenges, as well as the risk (...) of medical paternalism, can be overcome by focusing on the potential for mHealth tools to mediate the relationship between recipients of clinical advice and givers of clinical advice, in ways that allow for contextual flexibility in the balance between patiency and agency. The article concludes by stressing that reframing the narrative cannot be the only means for avoiding harm caused to the NHS as a healthcare system by the introduction of mHealth tools. Future discussion will be needed on the overarching role of responsible design. (shrink)

Looking to Scripture through the eyes of contemporary medical experience, I analyze the meaning of the criteria used for determining death, specifically in the light of Jesus’ final moments and the resurrection of the Shunammite’s son in 2 Kings, chapter 4. I argue that four theses are consistent with, and informed by, these passages that can help guide Christian belief and decision-making about how death is determined in the clinical context: (1) death is neither permanent nor irreversible; (2) something (...) like the “brain dead” state is, at best, a confounding state that requires one to “pace and pray” or let go; (3) that the case for determining death by neurologic criteria depends on the “working togetherness” of the body's parts for the sake of impacting its environment; and (4) that the practice of neurologically-based death determination is a response to the problem of disaggregation of the human form into its organ systems that modern critical care medicine makes possible. I end with advice about how Christians might approach the debates over the law and practice even if they cannot come to a consensus. (shrink)

What does Artificial Intelligence (AI) have to contribute to health care? And what should we be looking out for if we are worried about its risks? In this paper we offer a survey, and initial evaluation, of hopes and fears about the applications of artificial intelligence in medicine. AI clearly has enormous potential as a research tool, in genomics and public health especially, as well as a diagnostic aid. It’s also highly likely to impact on the organisational and business practices (...) of healthcare systems in ways that are perhaps under-appreciated. Enthusiasts for AI have held out the prospect that it will free physicians up to spend more time attending to what really matters to them and their patients. We will argue that this claim depends upon implausible assumptions about the institutional and economic imperatives operating in contemporary healthcare settings. We will also highlight important concerns about privacy, surveillance, and bias in big data, as well as the risks of over trust in machines, the challenges of transparency, the deskilling of healthcare practitioners, the way AI reframes healthcare, and the implications of AI for the distribution of power in healthcare institutions. We will suggest that two questions, in particular, are deserving of further attention from philosophers and bioethicists. What does care look like when one is dealing with data as much as people? And, what weight should we give to the advice of machines in our own deliberations about medical decisions? (shrink)

We sometimes seek expert guidance when we don’t know what to think or do about a problem. In challenging cases concerning medical ethics, we may seek a clinical ethics consultation for guidance. The assumption is that the bioethicist, as an expert on ethical issues, has knowledge and skills that can help us better think about the problem and improve our understanding of what to do regarding the issue. The widespread practice of ethics consultations raises these questions and more: -/- (...) • What would it take to be a moral expert? • Is anyone a moral expert, and if so, how could a non-expert identify one? • Is it in any way problematic to accept and follow the advice of a moral expert as opposed to coming to moral conclusions on your own? • What should we think and do when moral experts disagree about a practical ethical issue? -/- In what follows, we address these theoretical and practical questions about moral expertise. (shrink)

In this paper, I examine the ethics of e - trust and e - trustworthiness in the context of health care, looking at direct computer-patient interfaces (DCPIs), information systems that provide medical information, diagnosis, advice, consenting and/or treatment directly to patients without clinicians as intermediaries. Designers, manufacturers and deployers of such systems have an ethical obligation to provide evidence of their trustworthiness to users. My argument for this claim is based on evidentialism about trust and trustworthiness: the idea (...) that trust should be based on sound evidence of trustworthiness. Evidence of trustworthiness is a broader notion than one might suppose, including not just information about the risks and performance of the system, but also interactional and context-based information. I suggest some sources of evidence in this broader sense that make it plausible that designers, manufacturers and deployers of DCPIs can provide evidence to users that is cognitively simple, easy to communicate, yet rationally connected with actual trustworthiness. (shrink)

A dilemma exists when a doctor is faced with a child or young person who refuses medically indicated treatment. The Gillick case has been interpreted by many to mean that a child of sufficient age and intelligence could validly consent or refuse consent to treatment. Recent decisions of the Court of Appeal on a child's refusal of medical treatment have clouded the issue and undermined the spirit of the Gillick decision and the Children Act 1989. It is now the (...) case that a child patient whose competence is in doubt will be found rational if he or she accepts the proposal to treat but may be found incompetent if he or she disagrees. Practitioners are alerted to the anomalies now exhibited by the law on the issue of children's consent and refusal. The impact of the decisions from the perspectives of medicine, ethics, and the law are examined. Practitioners should review each case of child care carefully and in cases of doubt seek legal advice. (shrink)

Reasons internalism holds that reasons for action contain an essential connection with motivation. I defend an account of reasons internalism based on the advisor model. The advisor model provides an account of reasons for action in terms of the advice of a more rational version of the agent. Contrary to Pettit and Smith's proposal and responding to Sobel's and Johnson's objections, I argue that the advisor model can provide an account of internal reasons and that it is too caught (...) up in the psychology of the actual agent to be able to account for anything other than internal reasons. (shrink)

Voting Advice Applications (VAAs) are interactive online tools designed to assist voters by improving the basis on which they decide how to vote. In recent years, they have been widely adopted, but their design is the subject of ongoing and often heated criticism. Most of these debates focus on whether VAAs accurately measure the standpoints of political parties and the preferences of users and on whether they report valid results while avoiding political bias. It is generally assumed that if (...) their methodology is sound, then VAAs can be seen as strengthening the democratic process. But as we argue in this chapter, the setup of VAAs raises basic questions of normative democratic theory as well. Insofar as VAAs are supposed to improve the functioning of the democratic process, it must be clarified in what sense they aim to make a contribution, before it even makes sense to discuss their effectiveness at doing so. -/- VAAs are often intended to enhance the democratic process by one or all of the following: (I) informing voters about the policy standpoints of political parties (or individual candidates), (2) increasing voter turnout, and (3) ensuring that the composition of parliaments more accurately reflects the political attitudes of the electorate. In the next three sections, we discuss three central bones of contention in current democratic theory that are crucial to these ways in which VAAs typically take themselves to contribute to strengthening the democratic process: -/- 1. Questions about citizen competence: What forms of competence do citizens need to have, and to what extent, for a democracy to function properly? -/- 2. Questions about political participation: What forms and extent of participation are vital to democracy? -/- 3. Questions about democratic representation: How should the relation between the elected and the electorate be understood? -/- For each issue we aim to show, first, how the design and setup of mainstream VAAs are tacitly structured by a specific conception of the democratic aim at issue and, second, what some alternative positions on these questions are within contemporary political theory. In the final section, we will discuss some of the implications of this analysis for the responsibilities of VAA developers, and particularly for the procedural neutrality to which they are typically committed. Our conclusion will be that once these issues are identified, developers of VAAs should either argue in favour of their views on democratic competence, participation and representation, or they should rethink the design of VA As in ways that move beyond their current assumptions, or both. (shrink)

What is the state of play for science advice to the government and Parliament? After almost ten years with a prime minister’s chief science advisor, are there lessons to be learnt? How can we continue to ensure that science advice is effective, balanced, transparent and rigorous, while at the same time balancing the need for discretion and confidentiality? In this article, we suggest that the hallmarks of good science – transparency and peer review – can be balanced against (...) the need to provide confidential advice in an Aotearoa New Zealand context. To complement the advice to the prime minister, an expanded role for the Royal Society Te Apärangi would support public and parliamentary understanding of science and science issues relevant to policy. (shrink)

There are philosophers and literary figures who write on a variety of topics. I suppose I do as well. Here I present two personal worries about the advice to become a narrow specialist.

In this paper I argue against Analytic Normative Naturalism by suggesting that the view cannot capture the way that normative concepts figure in advice. To establish this conclusion, I identify several links between normative concepts and advice and argue that, if Analytic Normative Naturalism were true, these links would not obtain.

There are many alleged problems with trusting another person’s moral testimony, perhaps the most prominent of which is that it fails to deliver moral understanding. Without moral understanding, one cannot do the right thing for the right reason, and so acting on trusted moral testimony lacks moral worth. This chapter, however, argues that moral advice differs from moral testimony, differs from it in a way that enables a defender of moral advice to parry this worry about moral worth. (...) The basic idea is that an advisor and an advisee can together constitute a joint agent, and that this joint agent’s action can indeed have moral worth. So while the advisee himself might not do the right thing for the right reason (this because all alone he lacks the right reason), and while the advisor herself might not do the right thing for the right reason (this because all alone she does not do the right thing), they together do the right for the right reason. (shrink)

Monists, pluralists, and particularists disagree about the structure of the best explanation of the rightness (wrongness) of actions. In this paper I argue that the availability of good moral advice gives us reason to prefer particularist theories and pluralist theories to monist theories. First, I identify two distinct roles of moral theorizing—explaining the rightness (wrongness) of actions, and providing moral advice—and I explain how these two roles are related. Next, I explain what monists, pluralists, and particularists disagree about. (...) Finally, I argue that particularists and pluralists are better situated than monists to explain why it is a good idea to think before we act, and that this gives us reason to favor particularism and pluralism over monism. (shrink)

Organizational learning can be described as a transfer of individuals’ cognitive mental models to shared mental models. Employees, seeking the same colleagues for advice, are structurally equivalent, and the aim of the paper is to study if the concept can act as a conduit for organizational learning. It is argued that the mimicking of colleagues’ advice seeking structures will induce structural equivalence and transfer the accuracy of individuals’ cognitive mental models to shared mental models. Taking a dyadic level (...) of analysis authors revisit a classical case and present novel data analyses.The empirical results indicate that the mimicking of advice seeking structures can alter cognitive accuracy. It is discussed the findings’ implications for organization learning theory and practice, addressed the study’s limitations, and suggested avenues for future research. (shrink)

In Advice to Christian philosophers Alvin Plantinga suggested that Christians who propose to be philosophers should not limit themselves to being philosophers who happen, incidentally, to be Christians. Instead, they should develop a Christian philosophy. From this, however, a problem followed, which is still seen as a reason to deny that a Christian philosophy is possible. It seems implausible that the outcome of the interaction between faith and philosophy is, really, philosophy and not merely theology. Plantinga did not deal (...) with this problem. Unlike him, thinkers of various orientations, especially scholars of Thomas Aquinas, had discussed it during the French querelle in the 1930s. In this article, I argue that they did not solve this problem because they did not examine the relationship between faith and philosophy by considering what faith requires in order to relate to reason. Instead, this consideration was suggested by Plantinga’s Advice and, long before, it had been developed in detail by Thomas Aquinas. It is, therefore, time to propose Thomist Advice to Christian Philosophers. (shrink)

Voting Advice Applications (VAAs) are online tools designed to help citizens decide how to vote. They typically offer their users a representation of what is at stake in an election by matching user preferences on issues with those of parties or candidates. While the use of VAAs has boomed in recent years in both established and new democracies, this new phenomenon in the electoral landscape has received little attention from political theorists. The current academic debate is focused on epistemic (...) aspects of the question how a VAA can adequately represent electoral politics. We argue that conceptual and normative presuppositions at play in the background of the tool are at least as important. Even a well-developed VAA does not simply reflect what is at stake in the election by neutrally passing along information. Rather, it structures political information in a way that is informed by the developers’ presuppositions. Yet, these presuppositions remain hidden if we interpret the tool as a mirror that offers the user a reflection of him/herself situated within the political landscape. VAAs should therefore be understood as electoral dioramas, staged according to a contestable picture of politics. (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)

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)

Standard decision theory, or rational choice theory, is often interpreted to be a theory of instrumental rationality. This dissertation argues, however, that the core requirements of orthodox decision theory cannot be defended as general requirements of instrumental rationality. Instead, I argue that these requirements can only be instrumentally justified to agents who have a desire to have choice dispositions that are stable over time and across different choice contexts. Past attempts at making instrumentalist arguments for the core requirements of decision (...) theory fail due to a pervasive assumption in decision theory, namely the assumption that the agent’s preferences over the objects of choice – be it outcomes or uncertain prospects – form the standard of instrumental rationality against which the agent’s actions are evaluated. I argue that we should instead take more basic desires to be the standard of instrumental rationality. But unless agents have a desire to have stable choice dispositions, according to this standard, instrumental rationality turns out to be more permissive than orthodox decision theory. (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)

Charging others with hypocrisy often acts as a way of rejecting the practical reasons they attempt to give (Herstein, 2017). There are some merits to a practice of rejecting reasons. To accept others’ provided reasons as valid is to affirm their authority in the relevant normative domain (Isserow and Klein, 2017). Conversely, to reject these reasons as invalid is to undermine the reason-givers’ authority in the domain. However, this practice can be rife with abuse—if we allow charges of ‘Hypocrite!’ to (...) take hold too broadly, we risk compromising the entire enterprise of reason-giving. I propose that one form of such abuse has already entered into our normative vocabulary with the concept of ‘hypocritical advice.’ At best, this term plays a superfluous role in our normative vocabulary; at worst, its vagueness perpetuates a vicious practice of reason-rejecting. Regardless of the severity of its impact on normative discourse, I will argue herein that we should do away with talk of ‘hypocritical advice.’ -/- I begin by echoing a standard distinction between second- and third-personal reasons and the corresponding types of authority that ground agents’ abilities to give reasons of each kind (sec. 2). After briefly discussing the connection between authority and hypocrisy (sec. 3), I argue that most purported cases of hypocritical advice-giving rest on a confusion between an utterance as communicating second- or third-personal reasons (sec. 4). Against recent suggestions that reasons given unambiguously as advice can be hypocritical, I demonstrate that the basis for rejecting third-personal reasons given in hypocritical advice is an interestingly different one than for rejecting second-personal reasons given through blame (sec. 5). I close with some final considerations against keeping ‘hypocritical advice’ in our normative vocabulary. (shrink)

The pandemic significantly raised the stakes for the translation of bioethics insights into policy. The novelty, range and sheer quantity of the ethical problems that needed to be addressed urgently within public policy were unprecedented and required high‐bandwidth two‐way transfer of insights between academic bioethics and policy. Countries such as the United Kingdom, which do not have a National Ethics Committee, faced particular challenges in how to facilitate this. This paper takes as a case study the brief career of the (...) Ethics Advisory Board (EAB) for the NHS Covid‐19 App, which shows both the difficulty and the political complexity of policy‐relevant bioethics in a pandemic and how this was exacerbated by the transience and informality of the structures through which ethics advice was delivered. It analyses how and why, after EAB's demise, the Westminster government increasingly sought to either take its ethics advice in private or to evade ethical scrutiny of its policies altogether. In reflecting on EAB, and these later ethics advice contexts, the article provides a novel framework for analysing ethics advice within democracies, defining four idealised stances: the pure ethicist, the advocate, the ethics arbiter and the critical friend. (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)

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)

This paper examines how science advice can provide policy recommendations in a trustworthy manner. Despite their major political importance, expert recommendations are understudied in the philosophy of science and social epistemology. Matthew Bennett has recently developed a notion of what he calls recommendation trust, according to which well-placed trust in experts’ policy recommendations requires that recommendations are aligned with the interests of the trust-giver. While interest alignment might be central to some cases of public trust, this paper argues against (...) the significance of interest-alignment to meritorious public trust. First, political bodies and citizens can have a basic kind of well-placed recommendation trust in science advice based on an all-things-considered judgement regarding the possession of relevant competencies, responsible conduct, and a proper institutional design. Moreover, scientists’ policy recommendations can be seen as open-ended and as dynamic proposals that enable inter-institutional reasoning and political deliberation. Finally, by providing conditional recommendations, scientists can expand the scope of feasible policy options from which political bodies can choose, thus making the condition of interest alignment even less significant to the trustworthy provision of recommendations. (shrink)

Eleaticism ties ontology to causality by denying the impossibility of causally inert entities. This paper examines some challenges regarding the proper formulation and general plausibility of Eleaticism. After suggesting how Eleatics ought to respond to these challenges, I consider the prospects for extending Eleaticism from ontology to ideology by requiring all primitive ideology to be causal in nature. Surprisingly enough, the resulting view delivers an eternalist and possibilist metaphysical picture in the neighborhood of Lewisian modal realism.

Epicurus thought that the conventional values of Greek society—in particular, its celebration of luxury and wealth—often led people astray. It is by rejecting these values, reducing our desires, and leading a moderately ascetic life that we can attain happiness. But Epicurus’ message is also pertinent for those of us in modern Western culture, with an economy based on constant consumption and an advertising industry that molds us to serve that economy by enlarging our desires. This paper begins with an outline (...) of some of the basic tenets of Epicurean ethics, followed by an explanation of how these tenets lead to an Epicurean diagnosis of what ails modern consumers and of the cure they would propose. The paper closes with a consideration of recent psychological research in well-being and how it supports the Epicurean position. (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 his critical notice entitled ‘An Improved Whole Life Satisfaction Theory of Happiness?’ focusing on my article that was previously published in this journal, Fred Feldman raises an important objection to a suggestion I made about how to best formulate the whole life satisfaction theories of happiness. According to my proposal, happiness is a matter of whether an idealised version of you would judge that your actual life corresponds to the life-plan, which he or she has constructed for you on (...) the basis of your cares and concerns. Feldman argues that either the idealised version will include in the relevant life-plan only actions that are possible for you to do or he or she will also include actions and outcomes that are not available for you in the real world. He then uses examples to argue that both of these alternatives have implausible consequences. In response to this objection, I argue that what it is included in the relevant life-plan depends on what you most fundamentally desire and that this constraint is enough to deal with Feldman’s new cases. (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)

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)

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)

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)

This paper argues that the concept of paternalism is currently overextended to include a variety of actions that, while resembling paternalistic actions, are importantly different. I use the example of Japanese physicians’ non-disclosures of cancer diagnoses directly to patients, arguing that the concept of maternalism better captures these actions. To act paternalistically is to substitute one's own judgement for that of another person and decide in place of that person for his/her best interest. By contrast, to act maternalistically is to (...) decide for another person based on a reasonable understanding of that person's own preferences. The concept of maternalism allows for a more thorough assessment of the moral justification of these types of actions. I conclude that it is possible, at least in principle, to justify Japanese physicians’ non-disclosures, and that this justification must be based on an understanding of these actions as maternalistic. (shrink)

The paper explores the question of the relationship between the practice of original philosophical inquiry and the study of the history of philosophy. It is written from my point of view as someone starting a research project in the history of philosophy that calls this issue into question, in order to review my starting positions. I argue: first, that any philosopher is sufficiently embedded in culture that her practice is necessarily historical; second, that original work is in fact in part (...) a reconstruction by reinterpretation of the past and that therefore it bears some relation to historiographic techniques for the restoration of damaged objects and texts; and third that the special oddities of the relations of present and past do not fail to ensnare the philosopher, who must restore the past but freely break from it. I describe this relationship as proleptic. Finally, I argue that this is a moral imperative in writing philosophy, derived from the imperative to be honest. (shrink)

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)

Moral philosophy has traditionally aimed for correct or appropriate moral judgments. Consequently, when asked for moral advice, the moral philosopher first tries to develop a moral judgment and then informs the advisee. The focus is on what the advisee should do, not on whether any advice should be given. There may, however, be various kinds of reasons not to morally judge, to be ‘morally modest’. In the first part of this article, I give some reasons to be morally (...) modest when moral advice is asked for. Second, I show how Wittgenstein radicalizes these reasons to such an extent that the very possibility of giving moral advice seems threatened. Third, I argue that taking Wittgenstein and the need for moral modesty seriously does not make moral advice impossible, but rather asks for a notion of moral advice in which moral advice is not necessarily linked to the ideal of a moral judgment. Fourth, I highlight some advantages of a Wittgensteinian notion of moral advice over traditional notions. (shrink)

One of the deepest and longest-lasting debates in ethics concerns a version of the Euthyphro question: are choiceworthy things choiceworthy because agents have certain attitudes toward them or are they choiceworthy independent of any agents’ attitudes? Reasons internalists, such as Bernard Williams, Michael Smith, Mark Schroeder, Sharon Street, Kate Manne, Julia Markovits, and David Sobel answer in the first way. They think that all of an agent’s normative reasons for action are grounded in facts about that agent’s pro-attitudes (e.g., her (...) desires, valuing states, normative judgments). According to the most popular brand of internalism, idealizing internalism, an agent’s reasons are grounded, not in her actual pro-attitudes, but rather in what her pro-attitudes would be in suitably idealized conditions. Idealizing internalists presuppose that, for any agent with an irrational set of attitudes, there is one uniquely rational set that that agent would have if she were to undergo the relevant idealizing process. I argue that this assumption is false and that it raises two puzzles for idealizing internalism: one about the existence of practical reasons and another about their normative weight. I argue that idealizing internalists have an adequate solution to the first puzzle but not the second. Indeed, when they try to solve the second puzzle, they confront a dilemma. This second puzzle and the associated dilemma thus constitutes a powerful, but so far unnoticed, difficulty for idealizing internalism. (shrink)

Consensus statement by UK teachers of medical ethics and law.

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)

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)

Philosophy of religion is dominated by Christianity and by Christians. This, in conjunction with the historically anti-LGBTQIA bent of Christian thinking, has resulted in the exclusion of less dominant and often marginalized perspectives, including queer ones. This essay charts a normative direction for Christian philosophers and for philosophy of religion, a subfield they dominate. First, given some of the unique ways Christian philosophy and philosophers have unjustly harmed queers, Christian philosophers as a group have a responsibility to communities their group (...) has oppressed to prioritize the interests of the oppressed. Second, Christian philosophers must prioritize queer voices by creating or furthering academic space for those who publicly and professionally identify as queer. Third, Christian philosophers must mitigate their criticisms of queers and queerness where such criticisms would undermine their efforts toward compensatory/reparative justice. (shrink)