La création récente du diagnostic de trouble dysphorique prémenstruel (TDPM) dans le DSM-5 a été contestée sous de multiples angles. Les principales critiques mettent en avant les lacunes en faveur de la validité du TDPM, ainsi que le risque de pathologisation et de stigmatisation des changements physiques et comportementaux vécus par les femmes pendant leur phase prémenstruelle. Pour éclairer cette controverse, j’emprunte certains outils du cadre conceptuel des injustices épistémiques (IE) développé par Miranda Fricker. Plus précisément, je vais me baser (...) sur de récents travaux qui ont tenté d’appliquer ce cadre aux processus de catégorisation en médecine et en psychiatrie. Cela me permettra de mettre au jour un angle mort du débat actuel sur le TDPM, soit les perspectives des personnes touchées par ces symptômes. Ces points de vue ont été généralement négligés, mais le cadre des IE nous permet de recentrer le débat sur les intérêts et les besoins des personnes affectées par les processus de catégorisation psychiatrique. (shrink)

The purpose of this study is to map the medicalisation of learning difficulties in the remote and mountainous areas in Chania Prefecture, Crete, when pupils are referred to Diagnostic Institutes to be assessed and possibly receive a learning difficulty diagnosis. It provides evidence on the fact that the learning difficulties identification procedure tends to be individually oriented and to neglect contextual dimensions, as well as the interactions between them, particularly in light of the consequences of the socioeconomic crisis in (...) Greece. The remote and mountainous areas in Chania Prefecture, Crete, serve as a case study. Educational documents, archives, newspapers, and laws are examined, and six semi-structured interviews are conducted and analysed. The analysis yields two core themes: a. Exaggerated diagnoses: a compensatory tool and b. The emergence of the environment of the contexts: the impacts of the socioeconomic crisis. As an outcome of the analysis, it occurs that the medicalisation of learning difficulties appears to impose an obstacle to the detection of the deeper systemic, social, and political causes of these difficulties. It may also fail to sufficiently address the needs of the involved parts, namely pupils, parents, and schools. Given the implications arising from the study that indicate the systemic nature and influences of learning difficulties, the necessity for a transition towards a bioecological approach is discussed. (shrink)

Although many studies have previously examined medicalisation, we add a new dimension to the concept as we explore how contemporary oncological medicine shapes the dying self as predominantly medical. Through an analysis of multiple case studies collected within a comprehensive cancer centre in Ontario, Canada, we examine how people with late‐stage cancer and their healthcare providers enacted the process of medicalisation through engaging in the search for oncological treatments, such as experimental drug trials, despite the incurability of their (...) disease. The seven cases included 20 interviews with patients, family, physicians and nurses, the analysis of 30 documents and 5 hr of field observation. A poststructural perspective informed our study. We propose that searching for life extension enacts medicalisation by shaping the dying person afflicted with terminal cancer into new medical subjectivities that are knowledgeable, active, entrepreneurial and curative. Participants initially took up medical thinking from the formal oncology system, but then began to apply and internalise medical rationalities to alter their personhood, thereby generating new curative possibilities for themselves. For people seeking life extension, the embodied and day‐to‐day experiences of suffering and being close to death became expressed and moderated in fundamentally medicalised terms. (shrink)

In 2003, the Food and Drug Administration approved the use of growth hormone treatment for idiopathic short stature children, i.e. children shorter than average due to an unknown medical cause. Given the absence of any pathological conditions, this decision has been contested as a case of medicalisation. The aim of this paper is to broaden the debate over the reasons for and against the treatment, to include considerations of the sociocultural phenomenon of the medicalisation of short stature, by (...) means of a critical understanding of the concept of medicalisation. After defining my understanding of medicalisation and describing both the treatment and the condition of idiopathic short stature, I will problematise two fundamental issues: the medical/non-medical distinction and the debate about the goals of medicine. I will analyse them, combining perspectives of bioethics, medical sociology, philosophy of medicine and medical literature, and I will suggest that there are different levels of normativity of medicalisation. Ultimately, this study shows that: the definition of idiopathic short stature, focusing only on actual height measurement, does not provide enough information to assess the need for treatment or not; the analysis of the goals of medicine should be broadened to include justifications for the treatment; the use of growth hormone for idiopathic short stature involves strong interests from different stakeholders. While the treatment might be beneficial for some children, it is necessary to be vigilant about possible misconduct at different levels of medicalisation. (shrink)

Reproductive autonomy is central to women’s welfare both because childbearing takes place in women’s bodies and because they are generally expected to take primary responsibility for child rearing. In 2005, the factors that influence their autonomy most strongly are poverty and belief systems that devalue such autonomy. Unfortunately, such autonomy is a low priority for most societies, or is anathema to their belief systems altogether. This situation is doubly sad because women’s reproductive autonomy is intrinsically valuable for women and also (...) instrumentally valuable for the welfare of humankind. This paper takes for granted the moral and practical necessity of such autonomy and digs deeper into the question of what such a commitment might entail, focusing on the mid-level policy making that, at least in the US and Canada, plays a significant role in shaping women’s options. This paper examines a large teaching hospital’s policy on reduction of multifetal pregnancies. The policy permits reduction of triplets to twins, but not twins to a singleton. As there is no morally relevant difference between these two types of reduction, it is evident that inappropriate medicalisation can still limit women’s autonomy in undesirable ways. (shrink)

The medicalisation of pregnancy and childbirth has been encouraged by the continuing growth of technology that can be applied to the reproductive journey. Technology now has the potential to fully separate reproduction from the human body with the prospect of ectogenesis—the gestation of a fetus outside of the human body. This paper considers the issues that have been caused by the general medicalisation of pregnancy and childbirth and the impact that ectogenesis may have on these existing issues. The (...) medicalisation of pregnancy and childbirth is criticised for its impact on the relationship between doctors and pregnant women and the way in which doctors treat fetuses. It is argued that ectogenesis may cause more imbalance in the doctor and intended parent relationship and may result in an increased lack of clarity regarding a doctor’s duty to the fetus. This paper finds that extensive guidance and revised legislation will be necessary to minimise the impact of ectogenesis on the existing issues caused by the medicalisation of reproduction. (shrink)

Maternity is a biological process that has increasingly changed into an authoritative medicalized phenomenon and requires techno-medical intervention today. Modern medicine perceives women’s procreative functions as pathological that need medical involvement and control. Medical biologists claim that the female body is destined to procreate in which medical sciences can assist them with techniques. But is a woman’s body biologically evolved merely for procreation? Or is it a sexist interpretation of her socially situated self? How can we justify the idea of (...) universality and neutrality of medical sciences in a social context? Arguing against deterministic biology, existential feminists advocate that female body is not merely a biological fact but rather a social situation under which the maternal act has become the essence of being a woman. Social situations influence medicine in a way that they are used as a rhetorical tool to achieve social desires authoritatively. The present paper explores and examines the increasing medicalization of female body and maternity through the lenses of biological determinism and phenomenological existentialism. I argue that medically supported theories of female body are socially interpreted that perpetuate the traditional role of women as mothers instead of emancipating them from their immanence. The paper discusses how the scientific model of medicine is implicitly influenced by socio-cultural forces and, consequently, tries to reduce social phenomena into biological factors to justify women’s inevitable destiny as motherhood. Thus, we need a de-medicalized model of medicine in order to comprehend the true meaning of maternal body and self. (shrink)

Medicalization in contemporary psychopharmacology is increasingly dominated by commercial interests that threaten the scientific and ethical integrity of psychiatry. At the same time, the proliferation of new social media has altered the manner in which the social groups and institutions that have stakes in medicalization interact. Consumers are at once more powerful than ever before, but also more vulnerable. The upshot of all these developments is that medicalization is no longer simply the professed enemy of anti-psychiatry and its supporters. It (...) is now also an enemy of psychiatry. Once a welcome ally of psychiatry, medicalization appears to have turned into a fearsome enemy. (shrink)

The recently published BMA Guidelines on Withholding and Withdrawing Medical Treatment encourage a balance between deriving maximal benefit from medical treatment, and achieving as natural a death as possible in the circumstances. I argue that the concepts of burdensomeness, natural death and medicalised death are of greater fundamental importance than that of intention, and do not help constitute a moral distinction between withdrawal of treatment and active assistance to die. Nor should they continue to ground the corresponding legal distinction. In (...) the situations of both treatment withdrawal and active assistance to die, disease causation, human agency and moral responsibility are related in the same way. In both situations, we can intend that a person die for the right reasons, based on a concern for natural death.However, the law is reluctant to impose positive obligations on people, in contrast to the protection of negative rights. For example, the Northern Territory’s Rights of the Terminally Ill Act (1996) provided for assisted death as a lawful exception to an otherwise unlawful act, rather than as an enforceable right like the right to refuse unwanted medical treatment. Nevertheless, that the enforceability of a positive right to assisted death is difficult to conceive, is itself the product of a particular historical/moral/religious frame of reference currently under deconstruction. Genuine natural death statutes would consolidate the important principles supported here, and could apply uniform safeguards to all death-hastening decisions. (shrink)

Prenatal Diagnosis (PD) includes diagnostic procedures carried out during the antenatal period, together with Preconception Screening (PS) of prospective parents, and prenatal genetic diagnosis (PGD). The purpose of all these procedures is to provide prospective parents with opportunities to decide whether or not to have a child who will be diseased or disabled. Selection decisions determine what kinds of children are brought into existence; the ability to make these decisions is of huge ethical significance. It raises connected questions about discrimination, (...) the social status of disabled people and the medicalisation of disability; patient vulnerability and the power of the medical and counselling professions to influence decision-making; and the conceptualisation of selection as a public health measure and even as eugenic. In this paper, I outline the ethical issues raised by prenatal diagnosis and describe some of the arguments which have been elaborated in relation to the permissibility of selecting against (and occasionally for) diseases and disabilities. I conclude that there are no good arguments against the prevention of disability through PD but that providing adequate information for decision-making and facilitating uncoerced individual decisions requires further attention. (shrink)

I argue for the view that the scientific model which Plato consistently had in mind when sharpening his main ethical theory was medicine. Moreover, I ascribe to Plato a “medical model of ethics”. A careful examination of this model reveals how Plato appropriates several medical concepts and ideas by employing two central methodological devices in his thought: dialectical transposition and analogical characterisation. In discussing them, I identify different kinds of medical references in the dialogues –not all medical references in Plato (...) have the same methodological status– and draw greater attention to the most recurrent medical analogies in them. More generally, the paper is also meant to provide a case study of the complex relationship between medicine and philosophy in Antiquity by examining in a new light the various ways in which the former served as an epistemological and ethical model for the latter. (shrink)

This article develops loneliness as a political and social justice issue by illustrating the harmful personal and social consequences of the medical jurisdiction over and constitution of variations in sex characteristics. Whilst connections between loneliness, health and illness have been well established, this work customarily identifies the ways illness can lead to, or be caused by, loneliness. Instead, I provide an account of the central role of medicalisation and medical management in producing loneliness. By doing so, I underline the (...) imperative for medical practice to consider its influence upon social and personal, as well as physical, wellbeing. Drawing on stories shared through solicited diaries followed by in-depth interviews with seven people with sex variations and two parents in the UK, I show how accounts of loneliness help to illuminate the violence of abandonment, silencing and marginalisation that often goes unheard, together with hidden or normalised systems of harm. Building on concepts of ethical loneliness and ontological loneliness, I show how structural violations operate to injure trust and self-worth, leading to social unease. I argue for the importance of people with sex variations finding sites of comfort and acceptance, but note the ways that some forms of medicalisation can inhibit alliances and community formation, despite diagnoses also carrying the potential to facilitate informal support structures and collective identities. By bringing together intersex studies with discourses of loneliness, I develop a better understanding of loneliness as a product of social and systemic violence, and the ways in which medical discourses tie in with larger structures of oppression, coercion and control. This article concludes by underlining the need for structural change in our approach to and understanding of sex variations, and with a call for us to become more attentive to these stories of medical harm, to ensure that they are heard and to seek necessary justice. (shrink)

Moralising accounts of depression include the idea that depression is a sin or the result of sin, and/or that it is the result of demonic possession which has occurred because of moral or spiritual failure. Increasingly some Christian communities, understandably concerned about the debilitating effects these views have on people with depression, have adopted secular folk psychiatry’s ‘medicalising’ campaign, emphasising that depression is an illness for which, like (so-called) physical illnesses, experients should not be held responsible. This paper argues that (...) both moralising and medicalising models of depression are intellectually and practically (pastorally and therapeutically) problematic, gesturing towards more promising emphases. (shrink)

When elderly people are ideating on manners to end their lives, because they feel life is over and no longer worth living, it is important to understand their lived experiences, thoughts and behaviour in order to appropriately align care, support and policy to the needs of these people. In the literature, the wish to die in elderly people is often understood from a medical, psychopathological paradigm, referred to as cognitive impairment, depressive disorder, pathological bereavement, and suicidality. In this paper, we (...) evaluate this dominant paradigm by considering three serious limitations, namely: (1) the risk of epistemic transformation; (2) the risk of reduction; and (3) the risk of obscuring the social and cultural embeddedness. Drawing on insights from our empirical–phenomenological research on the issue of elderly and the self-chosen death, this paper argues for a phenomenological perspective to counteract the medicalisation of death wishes in elderly people. (shrink)

The discovery that certain selective serotonin reuptake inhibitors delay ejaculation and the later development and approval of dapoxetine as an on-demand treatment option has led to a dramatic increase in medical interest in premature ejaculation. This paper analyses the diagnostic criteria and the discussion within the medical community about suitable treatments against the backdrop of theories of science, sex and gender. Our conclusion is that the diagnosis itself and the suggested treatments contribute to normative models of sexual conduct and therefore (...) reinforce the norms that cause patients9 distress over ejaculating ‘too soon’. (shrink)

Cet article apporte une réflexion sur l’influence de la médicalisation de l’accouchement sur le lien mère-bébé, dans une époque où les violences obstétricales sont dénoncées et où les femmes aspirent à se réapproprier leur accouchement. L’analyse du discours maternel lors d’entretiens semi-directifs ainsi que les observations cliniques des relations selon le type d’accouchement ont permis d’observer que la majorité des vécus négatifs des mères concernant leur accouchement apparaissent lorsque celui-ci est plus médicalisé (péridurale, césarienne...). Les observations mère-bébé sont généralement congruentes (...) avec le vécu maternel. Les résultats soulignent l’importance de prendre davantage en considération les mères avant et après leur accouchement pour favoriser l’élaboration, mais aussi le repérage de parents souffrant dans leur parentalité. (shrink)

The catch 22 situation in psychiatry is that for precise diagnostic categories/criteria, we need precise investigative tests, and for precise investigative tests, we need precise diagnostic criteria/categories; and precision in both diagnostics and investigative tests is nonexistent at present. The effort to establish clarity often results in a fresh maze of evidence. In finding the way forward, it is tempting to abandon the scientific method, but that is not possible, since we deal with real human psychopathology, not just concepts to (...) speculate over. Search for clear-cut definitions/diagnostic criteria in psychiatry must be relentless. There is a greater need to be ruthless and blunt in this, rather than being accommodative of diverse opinions. Investigative tests - psychological, serum, CSF, or neuroimaging - are only corroborative at present; they need to become definitive. Medicalisation appears most prominent in psychiatry; so, diagnostic proliferation and fuzziness appear inevitable. And yet, the established diagnostic entities need to forward greater and conclusive precision. Also, the need for clarity and precision must outweigh pandering to and mollifying diverse interests, moreso in the upcoming revision of diagnostic manuals. This is specially because the DSM-5, being an Association manual, may need to accommodate powerful member lobbies; and ICD-11 may similarly need to cater to diverse country lobbies. Finding precise biological correlates of psychiatric phenomena, whether through neuroimaging, molecular neurobiology and/or neurogenomics, is the right way forward. It is in the 1.5-kg structure in the cranium that all secrets of psychiatric conditions lie. Social forces, behavioural modification, psychosocial restructuring, study of intrapsychic processes, and philosophical insights are not to be discounted, but they are supplementary to the primary goal - studying and deciphering those brain processes that result in psychiatric malfunction. Experimental breakthroughs, both in psychiatric aetiology and therapeutics, will come mainly from biology and its adjunct, psychopharmacology; while supplementary and complementary breakthroughs will come from the psychosocial, cognitive and behavioural approaches; the support base will come from phenomenology, epidemiology, nosology and diagnostics; while insights and leads can hopefully come from many fields, especially the psychosocial, the behavioural, the cognitive and the philosophical. Major energies must now be marshalled towards finding biomarkers and deciphering the precise phenotype-genotype-endophenotype axis of psychiatric disorders. Energies also need to be focussed on unravelling those critical processes in the brain that tip the scale towards psychiatric disorders. At how those critical processes are set into motion by forces de novo, in utero, in the genes and their expression, by the environment's psychopathological social forces - stress, peer pressure, poverty, deprivation, alienation, malnutrition, discrimination of various types (caste, gender, race, etc.), mass conflicts (war, terror attacks, etc.), disasters (natural and man-made), religious/ideological fascism - or social institutions like marriage, family, work place, political governance, etc. Ultimately, we must decipher how the brain goes into malfunction when such varied forces impinge on it, which precise cortical areas and neuronal cellular and molecular processes are involved in such malfunction and its manifestation, as also which of these are involved when malfunction ceases and health is restored, and the psychosocial processes and institutions which aid such health restoration, as also those which promote well-being and help in primary prevention. Emphasis on the brain and its intimate neurological and molecular mechanisms will not impinge on, or nullify, importance of the 'mind,' wherein subtle and gross brain functions in the form of behaviour, thought and emotions in all their ramifications will continue to be the focus of psychological, cognitive, sociological, psychopharmacological, behavioural and philosophical research. Progress in brain research must move in tandem with progress in 'mind' research. (shrink)

La genèse de la construction médicale de la ménopause est ici appréhendée en croisant des approches empruntées à l’histoire sociale des savoirs. Cela conduit en premier lieu à revenir sur la variété des termes employés pour désigner la « cessation des règles ». Ces évolutions doivent être examinées en regard des nouvelles échelles de la vie humaine élaborées au cours de la période. Est-ce qu’une sexuation des âges de la vie, absente jusque-là, y transparaît? L’expression « âge de retour » (...) désigne-t-elle un âge propre aux femmes comme le laissent penser certains auteurs? La médicalisation de la ménopause peut ainsi être remise en perspective, avant d’étudier de plus près les temps forts de sa construction au cours de la période considérée (1770-1836). Enfin, un dernier volet questionne l’existence d’un discours sur l’âge de retour au masculin et analyse la fabrique des asymétries sexuées dans les dispositifs hygiénistes destinés aux quarantenaires et aux cinquantenaires des deux sexes. (shrink)

The approach to AIDS as a disease and a threat for social discrimination is used as an example to illustrate a conceptual thesis. This thesis is a claim that concerns what we call a medical issue or not, what is medicalised or needs to be demedicalised. In the friction between medicalisation and demedicalisation as discursive strategies the latter approach can only be effected through the employment of discourses or discursive strategies other than medicine, such as those of the law (...) and of economics. These discourses each realise different values, promote a different subject, and have a different concept of man. The concept of discourse is briefly outlined against concepts such as the linear growth concept of science and the growth model of science as changes in paradigm. The issue of testing for AIDS shows a conflict between the medical and the legal discourse and illustrates the title of our contribution: the human body as field of conflict between discourses. (shrink)

Taking care of a hyperactive child at school gives 2 meanings to the word ‘care’: worrying about a vulnerable person and health care with the recognition of his behaviour disorder, the unruly pupil becomes a disabled pupil. But how does an undisciplined pupil become a psychiatric case? How do you recognise a hyperactive child at school, that is, from a medical point of view, a child with ADD/ADHD (Attention Deficient Disorder with or without Hyperactivity)? Teachers contribute to the medical diagnosis (...) by filling in behavioural tests. Then, in order to be taken care of, the child will need to have his hyperactivity recognised as a disability. To help the teacher, the doctor will give them advice on how to teach the child. Nevertheless, this desirable partnership raises difficulties. Between a paramedical support teacher and an educationalist doctor isn’t there a risk of witnessing a dilution of roles? The lifting of doctor-patient confidentiality called for by some teachers is emblematic of this confusion. Canguilhem’s distinction between normal and pathological will guide our reflection on the medical care of the hyperactive child at school. This case arouses an ethical issue about the medicalisation of our society. (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)

L’obésité est aujourd’hui reconnue par de nombreuses associations médicales comme un état pathologique. Dans cet article, je m’intéresse d’abord à la construction des entités nosologiques avant d’aborder les étapes ayant conduit à la médicalisation de l’obésité au siècle dernier. J’examine ensuite les principales approches en philosophie de la médecine pour déterminer si elles offrent des arguments qui sont en faveur ou qui vont à l’encontre de la thèse selon laquelle l’obésité est une maladie. Je soutiens que l’approche naturaliste, plus sensible (...) aux données des sciences biomédicales, échoue à spécifier en quoi l’obésité serait une maladie et que si l’approche normativiste y parvient mieux, c’est au prix d’une permissivité dont on peut craindre les dérives. Néanmoins, cette dernière permet de mettre en évidence la part sociale et biologique des pathologies dans leur identification en tant que pathologies. Ma conclusion rejoindra celle de Hofmann : les raisons avancées pour soutenir que l’obésité constitue une maladie au sens propre sont principalement de nature pragmatique. (shrink)

In this paper I investigate a largely untold chapter in the history of race thinking in Northern Europe and North America: the transition from the form of racism that was used to justify a race-based system of slavery to the medicalising racism which called for segregation, apartheid, eugenics, and, eventually, sterilization and the holocaust. In constructing this history I will employ the notion of biopower introduced by Michel Foucault. Foucault’s account of biopower has received a great deal of attention recently, (...) but because what he actually has to say about race tends to be vague and radically incomplete, many race theorists have been critical of his contribution. However, even if the account of the holocaust in terms of biopower is incomplete, there is still a great deal to be learned from Foucault’s identification of this biologizing, or medicalising racism. (shrink)

La genèse de la construction médicale de la ménopause est ici appréhendée en croisant des approches empruntées à l’histoire sociale des savoirs. Cela conduit en premier lieu à revenir sur la variété des termes employés pour désigner la « cessation des règles ». Ces évolutions doivent être examinées en regard des nouvelles échelles de la vie humaine élaborées au cours de la période. Est-ce qu’une sexuation des âges de la vie, absente jusque-là, y transparaît? L’expression « âge de retour » (...) désigne-t-elle un âge propre aux femmes comme le laissent penser certains auteurs? La médicalisation de la ménopause peut ainsi être remise en perspective, avant d’étudier de plus près les temps forts de sa construction au cours de la période considérée (1770-1836). Enfin, un dernier volet questionne l’existence d’un discours sur l’âge de retour au masculin et analyse la fabrique des asymétries sexuées dans les dispositifs hygiénistes destinés aux quarantenaires et aux cinquantenaires des deux sexes. (shrink)

Debates about the genuine disease status of controversial diseases rely on intuitions about a range of factors. Adopting tools from experimental philosophy, this paper explores some of the factors that influence judgments about whether low sexual desire should be considered a disease and whether it should be medically treated. Drawing in part on some assumptions underpinning a divide in the literature between viewing low sexual desire as a genuine disease and seeing it as improperly medicalized, we investigate whether health and (...) disease judgments are affected by factors such as an individual’s gender, the cause of the low desire, whether the desire is high or low, and both personal and societal valuations of the condition. Our main findings indicate that (a) the cause of a condition influences whether it is judged a disorder, (b) how the individual values the condition influences whether the condition is seen as a proper target of medical intervention, and (c) perceived dysfunction influences judgments regarding health, disorder classification, medicalization, and medical intervention. Our findings help further illuminate the intricate interplay of factors that influence judgments about health and disease in controversial conditions. (shrink)

Disease-mongering, or the medicalisation of aspects of daily life in an attempt to generate commercial profit for a party other than the person whose complaint is medicalised, is a newly recognized and legitimate source of concern for both consumers and deliverers of health care. The interest brought to this area by the academy has the potential to acknowledge and address the consequences of the practice. However, before disease-mongering can establish itself firmly as an area of scholarly concern, researchers must (...) understand that the critique is not just about identifying commercial intent, but also about naming the mechanism through which discourses of health, cure and self-management are positioned. In this paper, I argue that a critical reflection on the construction of disease concepts and the mongering of their cure must include discussions of the foundations of health and the clinical encounter. I identify a number of pivotal issues within these themes that should be explored in order to ensure an unambiguous and productive discussion of disease-mongering and its correlates. (shrink)

ABSTRACT With a particular focus on the experience of young people in higher education, this paper turns to the philosophical work of Cora Diamond to open up new ways of conceptualising mental health. We claim that Diamond offers a compelling insight into that experience of human difficulty so often subsumed by a medicalised vocabulary. We propose that she offers philosophically astute perceptions of the related human attempts at deflection. And we situate this reading of Diamond against a broader understanding of (...) the contemporary university as a place of institutional darkness. In developing this general discussion, we place ourselves within a very particular context. We draw on the narratives of a number of third-level students in Ireland, who shared their experiences as part of a hermeneutic phenomenological study into the lived experience of mental health difficulties. (shrink)

Personal Health Monitoring (PHM) uses electronic devices which monitor and record health-related data outside a hospital, usually within the home. This paper examines the ethical issues raised by PHM. Eight themes describing the ethical implications of PHM are identified through a review of 68 academic articles concerning PHM. The identified themes include privacy, autonomy, obtrusiveness and visibility, stigma and identity, medicalisation, social isolation, delivery of care, and safety and technological need. The issues around each of these are discussed. The (...) system / lifeworld perspective of Habermas is applied to develop an understanding of the role of PHMs as mediators of communication between the institutional and the domestic environment. Furthermore, links are established between the ethical issues to demonstrate that the ethics of PHM involves a complex network of ethical interactions. The paper extends the discussion of the critical effect PHMs have on the patient’s identity and concludes that a holistic understanding of the ethical issues surrounding PHMs will help both researchers and practitioners in developing effective PHM implementations. (shrink)

This article examines the historical construction of depression over about a hundred years, employing the social life of methods as an explanatory framework. Specifically, it considers how emerging methodologies in the measurement of psychological constructs contributed to changes in epistemological approaches to mental illness and created the conditions of possibility for major shifts in the construction of depression. While depression was once seen as a feature of psychotic personality, measurement technologies made it possible for it to be reconstructed as changeable (...) and treatable. Different types of scaling techniques (Likert versus dichotomous scales) enabled the separation of depressive personality from reactive depression, paving the way for measuring the severity and intensity of emotions. Techniques to test sensitivity to change provided a means of demonstrating the efficacy of new psychoactive drug treatments. Later, more advanced techniques of precision scaling enabled the management of a new measurement problem, clinician unreliability, associated with the growing number of professionals involved in mental health care. Through statistical management of unreliability, the construct of depression has dramatically reduced over this period from hundreds of questionnaire items to potentially just two. Exploring the history of depression through this lens produces an alternative narrative to those that have emerged as a result of medicalisation and the actions of individuals and pressure groups. (shrink)

BackgroundHealth data holds great potential for improved treatments. Big data research and machine learning models have been shown to hold great promise for improved diagnostics and treatment planning. The potential is tied, however, to the availability of personal health data. In recent years, it has been argued that data from health records should be available for health research, and that individuals have a duty to make the data available for such research. A central point of debate is whether such secondary (...) use of health data requires informed consent.Main bodyIn response to recent writings this paper argues that a requirement of informed consent for health record research must be upheld. It does so by exploring different contrasting notions of the duty of easy rescue and arguing that none of them entail aperfectduty to participate in health record research. In part because the costs of participation cannot be limited to 1) the threat of privacy breaches, but includes 2) the risk of reduced trust and 3) suboptimal treatment, 4) stigmatization and 5) medicalisation, 6) further stratification of solidarity and 7) increased inequality in access to treatment and medicine. And finally, it defends the requirement of informed consent by arguing that the mere possibility of consent bias provides a rather weak reason for making research participation mandatory, and that there are strong, independent reasons for making.ConclusionArguments from the duty of easy rescue in combination with claims about little risk of harm and potential consent bias fail to establish not only aperfectduty to participate in health record research, but also that participation in such research should be mandatory. On the contrary, an analysis of these arguments indicates that the duty to participate in research is most adequately construed as animperfectduty, and reveals a number of strong reasons for insisting that participation in health records research is based on informed consent. (shrink)

Purpose – This paper aims to present an overview of the various ethical, societal and critical issues that micro- and nanotechnology-based small, energy self-sufficient sensor systems raise in different selected application fields. An ethical approach on the development of these technologies was taken in a very large international, multitechnological European project. The authors approach and methodology are presented in the paper and, based on this review, the authors propose general principles for this kind of work. Design/methodology/approach – The authors’ approach (...) is based on a great amount of experience working together in multi-disciplinary teams. Ethical issues have usually been handled in the authors’ work to some degree. In this project, the authors had the opportunity to emphasise the human view in technological development, utilise the authors’ experience from previous work and customise the authors’ approach to this particular case. In short, the authors created a wide set of application scenarios with technical and application field experts in the authors’ research project. The scenarios were evaluated with external application field experts, potential consumer users and ethics experts. Findings – Based on the authors’ experiences in this project and in previous work, the authors suggest a preliminary model for construction activity within technology development projects. The authors call this model the Human-Driven Design approach, and Ethics by Design as a more focussed sub-set of this approach. As all enabling technologies have both positive and negative usage possibilities, and so-called ethical assessment tends to focus on negative consequences, there are doubts from some stakeholders about including ethical perspectives in a technology development project. Research limitations/implications – The authors argue that the ethical perspective would be more influential if it were to provide a more positive and constructive contribution to the development of technology. The main findings related to the ethical challenges based on the actual work done in this project were the following: the main user concerns were in relation to access to information, digital division and the necessity of all the proposed measurements; the ethics experts highlighted the main ethical issues as privacy, autonomy, user control, freedom, medicalisation and human existence. Practical implications – Various technology assessment models and ethical approaches for technological development have been developed and performed for a long time, and recently, a new approach called Responsible Research and Innovation has been introduced. The authors’ intention is to give a concrete example for further development as a part of the development of this approach. Social implications – The authors’ study in this particular case covers various consumer application possibilities for small sensor systems. The application fields studied include health, well-being, safety, sustainability and empathic user interfaces. The authors believe that the ethical challenges identified are valuable to other researchers and practitioners who are studying and developing sensor-based solutions in similar fields. Originality/value – The authors’ study covers various consumer application possibilities of small sensor systems. The studied application fields include health, well-being, safety, sustainability and empathic user interfaces. The findings are valuable to other researchers and practitioners who are studying and developing sensor-based solutions to similar fields. (shrink)