Since Andrew Jameton first introduced the concept of moral distress, a growing theoretical literature has attempted to identify its distinctive features. This theoretical work has overlooked a central feature of morally distressing situations: disempowerment. My aim is to correct this neglect by arguing for a new test for theories of moral distress. I call this the disempowerment requirement: a theory of moral distress ought to accommodate the disempowerment of morally distressing situations. I argue for the disempowerment requirement and illustrate how (...) to apply it by showing that recent responsibility-based theories of moral distress fail to pass the test. (shrink)

In interactions characterized by agential epistemic injustice, the interpreter avoids engaging with the speaker’s perspective and challenges or distorts the speaker’s contribution before taking time to explore it. Where the success of the interaction depends on a genuine knowledge exchange between interpreters and speakers, epistemic injustice compromises the success of the interaction. Building on recent qualitative work on communication in youth mental health, I argue that clinical interactions are less likely to achieve their aims when practitioners fail to engage with (...) the perspective of the person seeking support, and challenge or distort the person’s contribution before taking time to explore it. (shrink)

Letters to the editor (LTEs) are a versatile short-format forum with unique characteristics to allow for cross-pollination of different kinds of philosophical reflection about medicine. Philosophical LTEs have both benefits and possible drawbacks. We draw on a case study to warn against misuse through “CV inflation,” where low-quality ideas may favor a scholar’s publishing metrics more than scholarly debate. Factual inaccuracies in LTEs have implications for authors, publishing, and indexing, and we argue for prudence by editors and restraint by scholars, (...) inviting them to focus on quality, rather than the quantity of LTEs published. When writing LTEs, rigor, readability, and relevance are needed. (shrink)

In On Madness: Understanding the Psychotic Mind, published in 2022, Richard G.T. Gipps embarks on a philosophical exploration of psychosis. Generally speaking, Gipps’s book presents an approach he calls “apophatic psychopathology,” (Gipps 2022, 2) borrowing from negative (that is, apophatic) theology and its method of understanding God’s nature by seeing how it defeats the predication of even those most supreme qualities we are drawn to predicate of Him. Gipps’s central insight regarding psychotic phenomena is that we best come to understand (...) them not positively, by predicating of the psychotic subject this or that rationally intelligible, intentional state, but instead negatively, through seeing how such predications are here defeated. Sitting down with a person suffering from psychosis requires that we develop the capacity to stay with them in their brokenness, rather than projecting onto them an intentional structure that their illness has abrogated. Gipps comments critically on relativistic tendencies we encounter these days, concluding that people suffering from severe psychosis are not happily thought of as just living in an “alternative reality” as good as the one populated by nonpsychotic people. (shrink)

Philosophers interested in medicine and healthcare research should focus on the choice of health concepts. Conceptual choice is akin to conceptual engineering but, in addition to assessing whether a concept suits an objective, or offering a better one, it evaluates objectives, ranks them, and discusses stakeholders’ entitlement. To show the importance of choosing health concepts, I summarize the internal debate in medicine, showcasing definitions, constructs, and scales. To argue it is a philosophical task, I analyze the medical controversy over health (...) as adaptation and self-management. I conclude with a to-do list of conceptual choice tasks, generalizable beyond medicine. (shrink)

Due to an oversight, Ilana Raburn's article “Intrinsic Kinds in Internal Medicine,” Philosophy of Medicine 5, no. 1 (2024), https://doi.org/10.5195/pom.2024.189, failed to acknowledge the influence of Harriet Fagerberg’s characterisation of diseases as Millikanian natural kinds in “Reactive Natural Kinds and Varieties of Dependence,” European Journal for Philosophy of Science 12, article 72 (2022), https://doi.org/10.1007/s13194-022-00500-x.

This paper argues that biostatistical theory (BST) cannot categorically exclude pregnancy from pathology. Common harmful conditions in typical pregnancies are integral to the notion of pregnancy per se. Given this definition, there are two potential ways to classify pregnancy as non-pathological within the BST: (i) most common conditions in pregnancy are not pathological within the appropriate reference class; or (ii) pregnancy’s reproductive value counterbalances its pathological survival harms, rendering it non-pathological. I challenge both views, arguing that non-pregnant women of the (...) same age should be the reference class, making pregnancy a survival pathology that cannot be offset by reproductive value. (shrink)