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  1.  1
    Bioethics and the Rule of Law: A Classical Liberal Theory.Michael Brodrick - 2020 - Journal of Medicine and Philosophy 45 (3):277-296.
    Heated debates over healthcare policy in the United States point to the need for a legal framework that can sustain both moral diversity and peaceful cooperation. It is argued that the classical liberal Rule of Law, with its foundation in the ethical principle of permission, is such a framework. The paper shows to what extent the current healthcare policy landscape in the United States diverges from the rule of law and suggests how the current framework could be modified in order (...)
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  2.  3
    Nine Months.Elselijn Kingma - 2020 - Journal of Medicine and Philosophy 45 (3):371-386.
    When did we begin to exist? Barry Smith and Berit Brogaard argue that a new human organism comes into existence neither earlier nor later than the moment of gastrulation: 16 days after conception. Several critics have responded that the onset of the organism must happen earlier; closer to conception. This article makes a radically different claim: if we accept Smith and Brogaard’s ontological commitments, then human organisms start, on average, roughly nine months after conception. The main point of contention is (...)
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  3.  62
    Autonomy, Consent, and the “Nonideal” Case.Hallvard Lillehammer - 2020 - Journal of Medicine and Philosophy 45 (3):297-311.
    According to one influential view, requirements to elicit consent for medical interventions and other interactions gain their rationale from the respect we owe to each other as autonomous, or self-governing, rational agents. Yet the popular presumption that consent has a central role to play in legitimate intervention extends beyond the domain of cases where autonomous agency is present to cases where far from fully autonomous agents make choices that, as likely as not, are going to be against their own best (...)
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  4.  1
    The Irrelevance of Harm for a Theory of Disease.Dane Muckler & James Stacey Taylor - 2020 - Journal of Medicine and Philosophy 45 (3):332-349.
    Normativism holds that there is a close conceptual link between disease and disvalue. We challenge normativism by advancing an argument against a popular normativist theory, Jerome Wakefield’s harmful dysfunction account. Wakefield maintains that medical disorders are breakdowns in evolved mechanisms that cause significant harm to the organism. We argue that Wakefield’s account is not a promising way to distinguish between disease and health because being harmful is neither necessary nor sufficient for a dysfunction to be a disorder. Counterexamples to the (...)
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  5.  1
    Bioethics in the Ruins.Allen Porter - 2020 - Journal of Medicine and Philosophy 45 (3):259-276.
    In The Foundations of Bioethics, former senior editor of The Journal of Medicine and Philosophy H. Tristram Engelhardt, Jr. radically reassessed the nature and scope of bioethics, as well as the possibilities for this still-young field that he helped found, in light of the prevailing sociohistorical context, which he argued had been inadequately considered by bioethicists. This issue of The Journal of Medicine and Philosophy provides a snapshot of how bioethics is developing in the wake of Engelhardt’s critique. Topics covered (...)
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  6.  3
    Do We Need Rights in Bioethics Discourse?Julius Sim - 2020 - Journal of Medicine and Philosophy 45 (3):312-331.
    Moral rights feature prominently and are relied on substantially in debates in bioethics. Conceptually, however, duties can perform the logical work of rights, but not vice versa, and reference to rights is therefore inessential. Normatively, rights, like duties, depend on more basic moral values or principles, and attempts to establish the logical priority of rights over duties or the reverse are misguided. In practical decision making, however, an analysis in terms of duties is more fruitful than one based on rights. (...)
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  7.  1
    Harm as a Necessary Component of the Concept of Medical Disorder: Reply to Muckler and Taylor.Jerome C. Wakefield & Jordan A. Conrad - 2020 - Journal of Medicine and Philosophy 45 (3):350-370.
    Wakefield’s harmful dysfunction analysis asserts that the concept of medical disorder includes a naturalistic component of dysfunction and a value component, both of which are required for disorder attributions. Muckler and Taylor, defending a purely naturalist, value-free understanding of disorder, argue that harm is not necessary for disorder. They provide three examples of dysfunctions that, they claim, are considered disorders but are entirely harmless: mild mononucleosis, cowpox that prevents smallpox, and minor perceptual deficits. They also reject the proposal that dysfunctions (...)
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  8.  3
    The Practice of Pharmaceutics and the Obligation to Expand Access to Investigational Drugs.Michael Buckley & Collin O’Neil - 2020 - Journal of Medicine and Philosophy 45 (2):193-211.
    Do pharmaceutical companies have a moral obligation to expand access to investigational drugs to patients outside the clinical trial? One reason for thinking they do not is that expanded access programs might negatively affect the clinical trial process. This potential impact creates dilemmas for practitioners who nevertheless acknowledge some moral reason for expanding access. Bioethicists have explained these reasons in terms of beneficence, compassion, or a principle of rescue, but their arguments have been limited to questions of moral permissibility, leaving (...)
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  9. On the Epistemic Status of Prenatal Ultrasound: Are Ultrasound Scans Photographic Pictures?Maddalena Favaretto, Danya F. Vears & Pascal Borry - 2020 - Journal of Medicine and Philosophy 45 (2):231-250.
    Medical imaging is predominantly a visual field. In this context, prenatal ultrasound images assume intense social, ethical, and psychological significance by virtue of the subject they represent: the fetus. This feature, along with the sophistication introduced by three-dimensional ultrasound imaging that allows improved visualization of the fetus, has contributed to the common impression that prenatal ultrasound scans are like photographs of the fetus. In this article we discuss the consistency of such a comparison. First, we investigate the epistemic role of (...)
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  10.  7
    Transhumanism, Moral Perfection, and Those 76 Trombones.Tom Koch - 2020 - Journal of Medicine and Philosophy 45 (2):179-192.
    Transhumanism advances an ideology promising a positive human advance through the application of new and as yet unrealized technologies. Underlying the whole is a libertarian ethos married to a very Christian eschatology promising a miraculous transformation that will answer human needs and redress human failings. In this paper, the supposedly scientific basis on which transhumanist promises are built is critiqued as futurist imaginings with little likelihood of actualization. Transhumanists themselves are likened to the affable con man Professor Harold Hill who, (...)
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  11.  5
    The Ends of Medicine and the Experience of Patients.D. Robert MacDougall - 2020 - Journal of Medicine and Philosophy 45 (2):129-144.
    The ends of medicine are sometimes construed simply as promotion of health, treatment and prevention of disease, and alleviation of pain. Practitioners might agree that this simple formulation captures much of what medical practice is about. But while the ends of medicine may seem simple or even obvious, the essays in this issue demonstrate the wide variety of philosophical questions and issues associated with the ends of medicine. They raise questions about how to characterize terms like “health” and “disease”; whether (...)
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  12.  8
    Book Review: Fourie, C., and A. Rid (Eds) 2017. What Is Enough: Sufficiency, Justice, and Health. New York: Oxford University Press. [REVIEW]Benjamin Sachs - 2020 - Journal of Medicine and Philosophy 45 (2):251-258.
    This review uses the excellent recent anthology, What Is Enough: Sufficiency, Justice, and Health, edited by Carina Fourie and Annette Rid, as a springboard for a discussion of a little-noticed problem for sufficientarian principles governing the distribution of health or health care. All sufficientarian principles must be assigned a scope: the set of individuals who are to be brought up to the level of sufficiency. When it comes to health and health care, sufficientarians will, rightly, want to reject broad scopes, (...)
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  13.  8
    Strategies in Abduction: Generating and Selecting Diagnostic Hypotheses.Donald E. Stanley & Rune Nyrup - 2020 - Journal of Medicine and Philosophy 45 (2):159-178.
    We distinguish three aspects of medical diagnosis: generating new diagnostic hypotheses, selecting hypotheses for further pursuit, and evaluating their probability in light of the available evidence. Drawing on Peirce’s account of abduction, we argue that hypothesis generation is amenable to normative analysis: physicians need to make good decisions about when and how to generate new diagnostic hypothesis as well as when to stop. The intertwining relationship between the generation and selection of diagnostic hypotheses is illustrated through the analysis of a (...)
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  14.  3
    Health and Reference Classes.Sander Werkhoven - 2020 - Journal of Medicine and Philosophy 45 (2):145-158.
    In this article, I address two objections developed by Kingma against Boorse’s bio-statistical theory of health, the objections that choice of reference classes renders the theory both circular and problematically value-laden. These objections not only apply to the bio-statistical theory of health but also to other naturalistic theories, like the dispositional theory of health. I present three rejoinders. First, I argue that the circularity objection arises from excessive methodological demands. Second, I argue that naturalists can resist the normativist claim that (...)
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  15.  6
    Scientific Practice in Modeling Diseases: Stances From Cancer Research and Neuropsychiatry.Marta Bertolaso & Raffaella Campaner - 2020 - Journal of Medicine and Philosophy 45 (1):105-128.
    In the last few decades, philosophy of science has increasingly focused on multilevel models and causal mechanistic explanations to account for complex biological phenomena. On the one hand, biological and biomedical works make extensive use of mechanistic concepts; on the other hand, philosophers have analyzed an increasing range of examples taken from different domains in the life sciences to test—support or criticize—the adequacy of mechanistic accounts. The article highlights some challenges in the elaboration of mechanistic explanations with a focus on (...)
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  16.  2
    Free to Choose: A Moral Defense of the Right-to-Try Movement.Michael Brodrick - 2020 - Journal of Medicine and Philosophy 45 (1):61-85.
    The claim that individuals legitimately differ with respect to their values seems to be uncontroversial among bioethicists, yet many bioethicists nevertheless oppose right-to-try laws. This seems to be due in part to a failure to recognize that such laws are intended primarily to be political, not legal, instruments. The right-to-try movement seeks to build political support for increasing access to newly developed drugs outside of clinical trials. Opponents of right-to-try laws claim that increasing access outside of clinical trials would undermine (...)
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  17. Ethical Issues in Physician Billing Under Fee-For-Service Plans.Joseph Heath - 2020 - Journal of Medicine and Philosophy 45 (1):86-104.
    Medical ethics has become an important and recognized component of physician training. There is one area, however, in which medical students receive little guidance. There is practically no discussion of the financial aspects of medical practice. My objective in this paper is to initiate a discussion about the moral dimension of physician billing practices. I argue that physicians should expand their conception of professional responsibility in order to recognize that their moral obligations toward patients include a commitment to honest and (...)
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  18.  1
    Pathocentric Health Care and a Minimal Internal Morality of Medicine.David B. Hershenov - 2020 - Journal of Medicine and Philosophy 45 (1):16-27.
    Christopher Boorse is very skeptical of there being a pathocentric internal morality of medicine. Boorse argues that doctors have always engaged in activities other than healing, and so no internal morality of medicine can provide objections to euthanasia, contraception, sterilization, and other practices not aimed at fighting pathologies. Objections to these activities have to come from outside of medicine. I first argue that Boorse fails to appreciate that such widespread practices are compatible with medicine being essentially pathocentric. Then I contend (...)
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  19.  1
    Why DCD Donors Are Dead.John P. Lizza - 2020 - Journal of Medicine and Philosophy 45 (1):42-60.
    Critics of organ donation after circulatory death argue that, even if donors are past the point of autoresuscitation, they have not satisfied the “irreversibility” requirement in the circulatory and respiratory criteria for determining death, since their circulation and respiration could be artificially restored. Thus, removing their vital organs violates the “dead-donor” rule. I defend DCD donation against this criticism. I argue that practical medical-ethical considerations, including respect for do-not-resuscitate orders, support interpreting “irreversibility” to mean permanent cessation of circulation and respiration. (...)
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  20.  2
    Conceptual Clarity in Clinical Bioethical Analysis.J. Clint Parker - 2020 - Journal of Medicine and Philosophy 45 (1):1-15.
    Conceptual clarity is essential when engaging in dialogue to avoid unnecessary disagreement and to promote mutual understanding. In this issue devoted to clinical bioethics, the authors exemplify the virtue of careful conceptual analysis as they explore complex clinical questions regarding the essential nature of medicine, the boundaries of killing and letting die, the meaning of irreversibility in definitions of death, the argument for a right to try experimental medications, the ethical borders in complex medical billing, and the definition and modeling (...)
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  21.  4
    Treating or Killing? The Divergent Moral Implications of Cardiac Device Deactivation.Bryan C. Pilkington - 2020 - Journal of Medicine and Philosophy 45 (1):28-41.
    In this article, I argue that there is a moral difference between deactivating an implantable cardioverter defibrillator and turning off a cardiac pacemaker. It is, at least in most cases, morally permissible to deactivate an ICD. It is not, at least in most cases, morally permissible to turn off a pacemaker in a fully or significantly pacemaker-dependent patient. After describing the relevant medical technologies—pacemakers and ICDs—I continue with contrasting perspectives on the issue of deactivation from practitioners involved with these devices: (...)
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  22.  4
    Narratively Shaped Emotions: The Case of Borderline Personality Disorder.Anna Bortolan - 2020 - Journal of Medicine and Philosophy (2):jhz037.
    In this article, I provide a phenomenological exploration of the role played by narrativity in shaping affective experience. I start by surveying and identifying different ways in which linguistic and narrative expression contribute to structure and regulate emotions, and I then expand on these insights by taking into consideration the phenomenology of borderline personality disorder. Disruptions of narrative abilities have been shown to be central to the illness, and I argue that these disruptions are at the origin of a number (...)
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