Health

[Excerpt]: German philosopher Martin Heidegger argued that humans are defined by care. The term he used, “Sorge,” picks out a wide range of caring relations, including sorrow, worry, the making of arrangements, and even fending for another. Since coming to The Hastings Center, I've been struck by the genuine care definitive of its scholars’ relationship to their work. Care about newborns, the elderly, and nonhuman animals. Care about doctors, nurses, and health care institutions. Care expressed in the panoply of ways (...) biomedical knowledge and practices inform our havings, doings, and beings in the world. Perhaps in its better moments, bioethics just is care work. (shrink)

Review of the book Feral: Rewilding the Land, Sea, and Human Life by George Monbiot, Penguin Books, London 2014.

Private health insurance is a domain of mutually conflicting models of healthcare systems. Most European healthcare systems are built upon the principles of solidarity and equality, and are provided by public entities. But the private health insurance market can threaten these values, limiting solidarity, equality and universality for the sake of cost effectiveness, consumer choice and market competition. The aim of this article is to analyse these risks and present mechanisms for their mitigation, which would allow the construction of effective (...) and socially acceptable models, or private-public partnerships, in this domain. (shrink)

This paper aims to discuss selected issues related to the effect exerted by the financial aspects of psychotherapy on a psychotherapeutic relationship. At the beginning, I consider the effect that remuneration received by the therapist directly from the customer can have on their therapeutic relationship. Then I discuss the issues related to the compensation for psychotherapy services and show the consequences which the criteria of compensating for specific therapeutic methods have for the quality of psychotherapeutic relationships, as well as the (...) influence which the requirement to study the effectiveness of psychotherapy in the natural science paradigm has on psychotherapeutic services. The arguments I put forward lead to the conclusion that the criteria of the compensation for psychotherapeutic services can change the psychotherapeutic relationship into a business relationship and, as a result, the therapist can start to treat the customer instrumentally. (shrink)

The paper discusses the possibility that the benefits of pharmacogenomics will not be distributed equally and will create orphan populations. I argue that since these inequalities are not substantially different from those produced by ‘traditional’ drugs and are not generated with the intention to discriminate, their production needs not be unethical. Still, the final result is going against deep-seated moral feelings and intuitions, as well as broadly accepted principles of just distribution of health outcomes and healthcare. I thus propose two (...) provisos that would prevent the most offensive outcomes and moderate the scope of the produced inequalities. The first proviso rejects pharmacogenomics innovations that worsen existing group inequalities and aggravate the disadvantage of communities with a history of discrimination. The second proviso requires that there is a strategy in place to even out as much as possible the distribution of benefits in the future and that a system of compensations is in place for pharmacogenomic orphans. Given that only one moral problem generated by pharmacogenomics has been tackled, the list of provisos might be expanded when other issues are considered. (shrink)

In the last two decades, WORDNET has evolved as the most comprehensive computational lexicon of general English. In this article, we discuss its potential for supporting the creation of an entirely new kind of information resource for public health, viz. MEDICAL WORDNET. This resource is not to be conceived merely as a lexical extension of the original WORDNET to medical terminology; indeed, there is already a considerable degree of overlap between WORDNET and the vocabulary of medicine. Instead, we propose a (...) new type of repository, consisting of three large collections of (1) medically relevant word forms, structured along the lines of the existing Princeton WORDNET; (2) medically validated propositions, referred to here as medical facts, which will constitute what we shall call MEDICAL FACTNET; and (3) propositions reflecting laypersons’ medical beliefs, which will constitute what we shall call the MEDICAL BELIEFNET. We introduce a methodology for setting up the MEDICAL WORDNET. We then turn to the discussion of research challenges that have to be met in order to build this new type of information resource. (shrink)

The article describes the problem of the consistency of the medical conscience clause in the Polish legal system. In the first part of the paper, I outline an account of conscience as the ultimate norm of morality. In its second part, I discuss the meaning of conscience clause and its legal status. Part three examines some criticisms of the clause in its present form. The main criticism is that the clause is self-referential, which in some cases leads to absurdity.

Patients with advanced dementia suffer from severe cognitive and functional impairment, including eating disorders. The focus of our research is on the issue of life-sustaining treatment, specifically on the social and ethical implications of tube feeding. The treatment decision, based on values of life and dignity, involves sustaining lives that many people consider not worth living. We explore the moral approach to caring for these patients and review the history of the debate on artificial nutrition and hydration showing the impact (...) of the varying perceptions of the value of these patients' lives on changing norms. We argue that in light of the value of solidarity, decisions about life-sustaining treatment for patients with advanced dementia should be made on a case by case basis, as with any other patient, in consideration of the medical implications of the intervention which might best serve the goals of care for the individual patient. (shrink)

Patients suffering from advanced dementia present ethicists and caregivers with a difficult issue: we do not know how they feel or how they want to be treated, and they have no way of telling us. We do not know, therefore, whether we ought to prolong their lives by providing them with nutrition and hydration, or whether we should not provide them with food and water and let them die. Since providing food and water to patients is considered to be basic (...) care that is morally required, it is usually only the provision of nutrition and hydration by artificial means that is considered to require ethical justification. Building on what I call a virtue-based conception of autonomy, I argue that, at least for some patients suffering from advanced dementia, even providing food and liquid by hand is morally wrong. (shrink)

This polemical note looks at the ethical issue of providing artificial nutrition and hydration to patients with advanced dementia from the perspective of an Aristotelian and naturalist ethics. I argue that this issue may be considered in terms of the Aristotelian notion of eudaimonia, well-being. I present a number of facts about the conditions of human life that contribute to eudaimonia. In addition, I present a number of facts about advanced dementia as well as clarify the goals of medicine. From (...) these facts, I argue that we are not ethically obligated to provide ANH to this class of patients. (shrink)

This comment on Professor ter Meulen's paper, "Solidarity and Justice in Health Care," offers additional perspectives on solidarity's importance for health. Noting the findings of social epidemiology, the paper explains that health has important public good dimensions. It is both non-rivlalrous because one person's health does not diminish another's, and it is largely determined by non-excludable access goods, including social networks, social determinants, and public health efforts. The public good dimension of health underscores the mutual dependence and shared stake that (...) people have with respect to health, and highlights the importance of coming together in solidarity for the sake of health. This is not to say that solidarity cannot also foster exclusionary tendencies; however, the recognition of mutual dependency with respect to health can foster an inclusive solidarity for the health of all people. (shrink)

Trust is a fundament of decent and just health care. In a subtle relation between patient and physician trust not only fuels the process of therapy but also plays a therapeutic role itself. Trust is a precondition of successful cooperation – it lowers its costs, increases efficiency and brings satisfaction to the partners. Only altruistic trust acts as such. Philosophical arguments as well as experiments analysing birth of trust in health care praxis prove the validity of the altruistic model. Distinction (...) between these two models casts light on the contemporary health care crisis. Many of todays’ reforms improve only cognitive side of trust by increasing predictability and efficiency of the health care system, while neglecting its crucial – ethical side. Article analyses also ambivalent influence of new technologies on these processes. (shrink)

The essential objective of the paper is to demonstrate the complexity of issues related to justice in the medical profession. The author claims that the virtue of justice as the foundation of a good doctor's moral attitude and the concept of justice in allocating medical goods are of primary importance. The most important thesis presented in the paper is that even if the so-called social justice needs to be complied with in the public healthcare system, it has nothing to do (...) with the virtue of justice applicable to the medical profession. The idea of social justice is the foundation of the public healthcare system. However, burdening doctors with the necessity to make decisions about rationing access to medical services increases neither their job satisfaction, nor the well-being of patients. Thus, joint efforts of doctors, economists, ethicists and politicians are required in this area. (shrink)

This essay on “The Status of Health in Plato’s Theory of Goods” discusses how health figures as a “good” in the framework of Plato’s general theory of human goods. It starts with meta-ethical distinctions regarding how things can be classified as “good,” including the conceptual distinctions between intrinsic, final, and constitutive goods. I then discuss passages in Plato that shed light on the function of health as an “instrumental good” that contributes to an undisturbed mode of existence free to pursue (...) truly valuable goals. Against Stoicising interpretations, I show that Plato maintains that health, as an instrumental good, makes a difference with respect to the quality of a virtuous person’s life. I then turn to the famous classification of goods introduced at the beginning of Republic II. The main concern there is the controversial status of justice as a good, but the division also mentions health as a good worthy to be pursued in its own right and not just on account of its causal consequences. Since this classification and how it is used create serious problems for the interpretation, I first try to work out a solution, focusing on the status of justice as an intrinsic, final and constitutive good. In my concluding segment, I then explain on what basis Plato can classify health as not only an instrumental, but also a (weak) constitutive good. This requires a discussion of how Plato views the relation of the body to the human ‘self.’ My answer credits him with a more differentiated understanding of this relation than is usually assumed. (shrink)

Population health has recently grown from a series of loosely connected critiques of twentieth-century public health and medicine into a theoretical framework with a corresponding field of research—population health science. Its approach is to promote the public’s health through improving everyday human life: affordable nutritious food, clean air, safe places where children can play, living wages, etc. It recognizes that addressing contemporary health challenges such as the prevalence of type 2 diabetes will take much more than good hospitals and public (...) health departments. -/- Blending philosophy of science/medicine, public health ethics and history, this book offers a framework that explains, analyses and largely endorses the features that define this relatively new field. Presenting a philosophical perspective, Valles helps to clarify what these features are and why they matter, including: searching for health’s “upstream” causes in social life, embracing a professional commitment to studying and ameliorating the staggering health inequities in and between populations; and reforming scientific practices to foster humility and respect among the many scientists and non- scientists who must work collaboratively to promote health. -/- Featuring illustrative case studies from around the globe at the end of all main chapters, this radical monograph is written to be accessible to all scholars and advanced students who have an interest in health—from public health students to professional philosophers. (shrink)

Health Care Ethics Health care ethics is the field of applied ethics that is concerned with the vast array of moral decision-making situations that arise in the practice of medicine in addition to the procedures and the policies that are designed to guide such practice. Of all of the aspects of the human body, and … Continue reading Health Care Ethics →.

The Government uses various policy tools to reduce alcohol consumption. There are restrictions on promotions, information campaigns, and pricing policies. These policies do not stand unchallenged. Restrictions on promotions irk business, information campaigns fail to reach the less educated, and pricing policies hurt responsible but poor consumers. So what about Thaler and Sunstein’s Nudge? Nudges keep choices open but change the “choice architecture” so as to help those who would like to drink less, and they do so in ways that (...) constructively engage business. Let us focus on one choice environment here, namely beer consumption in British pubs. (shrink)

This chapter argues that standard accounts of health are ill-suited to constructing a plausible theory of health justice, particularly a sufficientarian theory. The problem in these accounts is revealed by their treatment of disability. Theorists of health justice need to define “health” more narrowly to capture the legitimate claims of people with disabilities. Following Ronald Amundson and Peter Hucklenbroich, this chapter proposes such a definition. Health, as defined in this chapter, is the absence of conditions that directly cause, or threaten (...) to directly cause, certain kinds of bodily harm, such as pain and premature death. It is concluded that on a plausible sufficientarian theory of health justice, a society that achieves health justice is one that ensures that none of its members face too much of those kinds of bodily harm. (shrink)

This anthology provides a collection of new essays on ethical and philosophical issues that concern the development, dispensing, and use of pharmaceuticals. It brings together critical ethical issues in pharmaceutics that have not been included in any collection (e.g., the ethics of patients as researchers). In addition, it includes philosophical issues that are not within the traditional domain of applied ethics. For example, a game-theoretic approach to combating the emergence of antibiotic-resistent pathogens by spreading altruism. A tripartite distinction provides an (...) organized series of discussions that shows the interrelatedness of philosophical issues from the creation of pharmaceuticals, the creation of demand for them, through their delivery to their ultimate consumption. (shrink)

Orthorexia is a condition in which the subject becomes obsessed with identifying and maintaining the ideal diet, rigidly avoiding foods perceived as unhealthy or harmful. In this paper, I examine widespread cultural factors that provide particularly fertile ground for the development of orthorexia, drawing out social and historical connections between religion and orthorexia (which literally means “righteous eating”), and also addressing how ambiguities in the concept of “health” make it particularly prone to take on quasi-religious significance. I argue that what (...) makes this sort of disordered eating destructive to both men and women is ultimately a common urge to transcend rather than to embrace the realities of embodiment. In sum, I believe that orthorexia is best understood as a manifestation of age-old anxieties about human nitude and mortality—anxieties which current dominant sociocultural forces prime us to experi- ence and express in unhealthy attitudes toward healthy eating. (shrink)

We address the issue of whether, why and under what conditions, quarantine and isolation are morally justified, with a particular focus on measures implemented in the developing world. We argue that the benefits of quarantine and isolation justify some level of coercion or compulsion by the state, but that the state should be able to provide the strongest justification possible for implementing such measures. While a constrained form of consequentialism might provide a justification for such public health interventions, we argue (...) that a stronger justification is provided by a principle of State Enforced Easy Rescue: a state may permissibly compel individuals to engage in activities that entail a small cost to them but a large benefit to others, because individuals have a moral duty of easy rescue to engage in those activities. The principle of State Enforced Easy Rescue gives rise to an Obligation Enforcement Requirement: the state should create the conditions such that submitting to coercive or compulsive measures becomes a fundamental moral duty of individuals, i.e. a duty of easy rescue. When the state can create such conditions, it has the strongest justification possible for implementing coercive or compulsive measures, because individuals have a moral duty to temporarily relinquish the rights that such measures would infringe. Our argument has significant implications for how public health emergencies in the developing world should be tackled. Where isolation and quarantine measures are necessary, states or the international community have a moral obligation to provide certain benefits to those quarantined or isolated. (shrink)

In this paper, we focus on the most efficacious AI applications for life extension and anti-aging at three expected stages of AI development: narrow AI, AGI and superintelligence. First, we overview the existing research and commercial work performed by a select number of startups and academic projects. We find that at the current stage of “narrow” AI, the most promising areas for life extension are geroprotector-combination discovery, detection of aging biomarkers, and personalized anti-aging therapy. These advances could help currently living (...) people reach longevity escape velocity and survive until more advanced AI appears. When AI comes close to human level, the main contribution to life extension will come from AI integration with humans through brain-computer interfaces, integrated AI assistants capable of autonomously diagnosing and treating health issues, and cyber systems embedded into human bodies. Lastly, we speculate about the more remote future, when AI reaches the level of superintelligence and such life-extension methods as uploading human minds and creating nanotechnological bodies may become possible, thus lowering the probability of human death close to zero. We suggest that medical AI based superintelligence could be safer than, say, military AI, as it may help humans to evolve into part of the future superintelligence via brain augmentation, uploading, and a network of self-improving humans. Medical AI’s value system is focused on human benefit. (shrink)

Whether in vitro fertilization is medically necessary determines, in many jurisdictions, whether it ought to be funded through public health insurance. This is certainly the case in Canada, where the Canada Health Act requires that provinces pay for all medically necessary health care services. Debate raged recently in Ontario, my own province, over whether IVF should be deemed medically necessary and therefore covered under Ontario’s Health Insurance Plan. Advocates for public funding insisted that Ontario, along with most other provinces in (...) Canada, was behind the times in not having such funding, given how many governments around the world, including most European... (shrink)

The results of empirical research show that people prefer to help identified individuals rather than unidentified ones. This preference has an important influence on many private and public decisions, for example concerning vaccination or the distribution of healthcare resources. The aim of this article is to define the terms: “identified”, “unidentified”, “statistical”, and then to analyze three philosophical arguments concerning the normative implications of this preference: 1) contractualism ex ante ; 2) fair distribution of chances and risks; 3) principles regarding (...) the concentration of good effects and the distribution of bad effects. I will demonstrate that these arguments, which are related to interesting philosophical problems, such as counterfactuals, are not convincing. (shrink)

A common critique of nudges is that they reduce someone's of choices or elicit behavior through means other than rational persuasion. In this paper, I argue against this form of critique. I argue that, if there is anything distinctively worrisome about nudges from the standpoint of morality, it is is their tendency to hide the amount of social control that they embody, undermining democratic governance by making it more difficult for members of a political community to detect the social architect’s (...) pulling of the strings. This concern is particularly salient as to choices where it is important for people to directly engage with a certain set of values, “big personal decisions” (to use a simplifying phrase). Many healthcare decisions are exactly these kinds of choices. (shrink)

Objective To study how doctors care for their patients, both medically and as fellow humans, through observing their conduct in patient–doctor encounters. Design Qualitative study in which 101 videotaped consultations were observed and analysed using a Grounded Theory approach, generating explanatory categories through a hermeneutical analysis of the taped consultations. Setting A 500-bed general teaching hospital in Norway. Participants 71 doctors working in clinical non-psychiatric departments and their patients. Results The doctors were concerned about their patients' health and how their (...) medical knowledge could be of service. This medical focus often over-rode other important aspects of the consultations, especially existential elements. The doctors actively directed the focus away from their patients' existential concerns onto medical facts and rarely addressed the personal aspects of a patient's condition, treating them in a biomechanical manner. At the same time, however, the doctors attended to their patients with courteousness, displaying a polite and friendly attitude and emphasising the relationship between them. Conclusions The study suggests that the main failing of patient–doctor encounters is not a lack of courteous manners, but the moral offence patients experience when existential concerns are ignored. Improving doctors' social and communication skills cannot resolve this moral problem, which appears to be intrinsically bound to modern medical practice. Acknowledging this moral offence would, however, be the first step towards minimising the effects thereof. (shrink)

BACKGROUND: Little is known about how hospitalized patients share decisions with physicians. METHODS: We conducted an observational study of patient-doctor communication on an inpatient medicine service among 18 hospitalized patients and 9 physicians. A research assistant (RA) approached newly hospitalized patients and their physicians before morning rounds and obtained consent. The RA audio recorded morning rounds, and then separately interviewed both patient and physician. Coding was done using integrated analysis. RESULTS: Most patients were white (61%) and half were female. Most (...) physicians were male (66%) and of Southeast Asian descent (66%). All physicians explained the plan of care to the patients; most believed that their patient understood. However, many patients did not. Physicians rarely asked the patient for their opinion. In all those cases, the decision had been made previously by the doctors. No decisions were made with the patient. Patients sometimes disagreed. CONCLUSIONS: Shared decision-making may not be the norm in hospital care. Although physicians do explain treatment plans, many hospitalized patients do not understand enough to share in decisions. When patients do assert their opinion, it can result in conflict. PRACTICE IMPLICATIONS: Some hospitalized patients are interested in discussing treatment. Improving hospital communication can foster patient autonomy. (shrink)

Medicine seeks to overcome one of the most fundamental fragilities of being human, the fragility of good health. No matter how robust our current state of health, we are inevitably susceptible to future illness and disease, while current disease serves to remind us of various frailties inherent in the human condition. This article examines the relationship between fragility and uncertainty with regard to health, and argues that there are reasons to accept rather than deny at least some forms of uncertainty. (...) In situations of current ill health, both patients and doctors seek to manage this fragility through diagnoses that explain suffering and provide some certainty about prognosis as well as treatment. However, both diagnosis and prognosis are inevitably uncertain to some degree, leading to questions about how much uncertainty health professionals should disclose, and how to manage when diagnosis is elusive, leaving patients in uncertainty. We argue that patients can benefit when they are able to acknowledge, and appropriately accept, some uncertainty. Healthy people may seek to protect the fragility of their good health by undertaking preventative measures including various tests and screenings. However, these attempts to secure oneself against the onset of biological fragility can cause harm by creating rather than eliminating uncertainty. Finally, we argue that there are good reasons for accepting the fragility of health, along with the associated uncertainties. (shrink)

I argue that a parental prerogative to sometimes prioritize the interests of one’s children over the interests of others is insufficient to make the parental refusal of routine childhood vaccines morally permissible. This is because the moral permissibility of vaccine refusal follows from such a parental prerogative only if the only (weighty) moral reason in favor of vaccination is that vaccination is a means for promoting the interests of others. However, there are two additional weighty moral reasons in favor of (...) routine vaccination: fairness and concern for the vulnerable. These moral reasons in favor of vaccination are not defeated by a parental prerogative to prioritize the interests of one’s children over the interests of others. (shrink)

An essay review of Havi Carel, 'Phenomenology of Illness' (OUP 2015).

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This is an early volume from a much respected psychedelic psychotherapist. He has written several other books since this one but until recently none of his books were on Amazon and still you can only find a German edition and a Spanish one (from 1993) but no English one (except a couple used copies). This is sad since these drugs have enormous therapeutic potential but afaik government suppression still prevents their use. The most interesting and readable parts are the case (...) histories of drug therapy, especially his own-e.g., on pages 114, 166 and 178. Though a very advanced therapist compared to many, he is far from finished with his intellectual growing up and clings to his psychoanalytic background even though he often mentions its extreme shortcomings. The often painfully awkward text is full of insights from his own therapeutic voyages and those of his patients interspersed with psychoanalytic nonsense. Part of the awkwardness may be due to bad translation from the German but the lack of a rational spiritual framework is a major problem (as with most therapy-or most life for that matter) that he only occasionally seems to recognize. He also sometimes veers off into the ozone-e.g., after many pages of sensible dialog he can opine that varicose veins and cancer are a result of the splitting of a psychosis (p99)! He quotes Zen and Sufi stories, Krishnamurti and Al Ghazali and even Castenada (seemingly unaware of his exposure as a fraud 20 years ago!), yet he seems oblivious to the fact that meditation is the most powerful therapy there is and to the presence around him in his own country and all over the globe of the most diverse and effective therapeutic community that has ever existed-that of the students of the great Indian mystic (ie, psychotherapist) Osho. What a great pity! He could have learned so much and advanced his therapy so far. But like most people he deliberately or unconsciously avoids anything which might wake him up too much. It's possible however that he just avoids mentioning Osho as he's radical enough to trigger the control templates in the monkey brain and enlightenment has the power to change one's whole life and not just put a bandaid on as other therapies usually do. Widmer refers repeatedly to the great LSD therapy pioneer Stanislav Grof, whose writings are one of the first that the interested reader may want to consult. Also, anyone who has a serious interest in psychedelic therapy should read Myron Stolaroff´s " The Secret Chief "-an account of the most remarkable clandestine therapist of this type of all time. It tells the story of the late Leo Zeff, who helped thousands to find themselves with the skilled and varied use of a wide variety of psychedelics. As the book is hard to find you may wish to read the info on Zeff on the web. In addition the clinical chapters in the excellent Ecstasy:the complete guide by J. Holland(2001) and her web page www.drholland.com (and elsewhere on the net) provide a broad framework and guide to therapy that is lacking here. A lovely book to add to any drug or therapy library, if you can find it. -/- Those wishing a comprehensive up to date framework for human behavior from the modern two systems view may consult my article The Logical Structure of Philosophy, Psychology, Mind and Language as Revealed in Wittgenstein and Searle 59p(2016). For all my articles on Wittgenstein and Searle see my e-book ‘The Logical Structure of Philosophy, Psychology, Mind and Language in Wittgenstein and Searle 367p (2016). Those interested in all my writings in their most recent versions may consult my e-book Philosophy, Human Nature and the Collapse of Civilization - Articles and Reviews 2006-2016 662p (2016). -/- All of my papers and books have now been published in revised versions both in ebooks and in printed books. -/- Talking Monkeys: Philosophy, Psychology, Science, Religion and Politics on a Doomed Planet - Articles and Reviews 2006-2017 (2017) https://www.amazon.com/dp/B071HVC7YP. -/- The Logical Structure of Philosophy, Psychology, Mind and Language in Ludwig Wittgenstein and John Searle--Articles and Reviews 2006-2016 (2017) https://www.amazon.com/dp/B071P1RP1B. -/- Suicidal Utopian Delusions in the 21st century: Philosophy, Human Nature and the Collapse of Civilization - Articles and Reviews 2006-2017 (2017) https://www.amazon.com/dp/B0711R5LGX -/- . (shrink)

Background: The requirement that animals be used in research and testing in order to protect humans was formalized in the Nuremberg Code and subsequent national and international laws, codes, and declarations.DiscussionWe review the history of these requirements and contrast what was known via science about animal models then with what is known now. We further analyze the predictive value of animal models when used as test subjects for human response to drugs and disease. We explore the use of animals for (...) models in toxicity testing as an example of the problem with using animal models.SummaryWe conclude that the requirements for animal testing found in the Nuremberg Code were based on scientifically outdated principles, compromised by people with a vested interest in animal experimentation, serve no useful function, increase the cost of drug development, and prevent otherwise safe and efficacious drugs and therapies from being implemented. (shrink)

The sunflower seed is the seed of the sunflower (Helianthus annuus). The methanol extract of seeds of Helianthus annuus were screened for analgesic activity in mice model to systematically explore the medicinal values of the plant. Acetic acid induced writhing and hot plate methods were used to confirm the central and peripheral analgesic action. In case of acetic acid-induced writhing test the extract showed significant (P <0.05) analgesic potential at doses 100 and 200 mg/kg body weight (50.35 and 57.85% inhibition, (...) respectively). In the hot plate method, increase (p < 0.05) of latency period was also observed in comparison to standard aspirin. At 60 minutes, the latency period of two different doses (100 and 200 mg/kg body weight) was found at 13 ± 0.91 and 16.5 ± 1.55 second. The results obtained support the use of Helianthus annuus seeds in painful conditions acting both centrally and peripherally. (shrink)

Technological measures meant to change sexual orientation are, we have argued elsewhere, deeply alarming, even and indeed especially if they are safe and effective. Here we point out that this in part because they produce a distinctive kind of ‘clinical collective action problem’, a sort of dilemma for individual clinicians and researchers: a treatment which evidently relieves the suffering of particular patients, but in the process contributes to a practice that substantially worsens the conditions that produce this suffering in the (...) first place. We argue that the role obligations of clinicians to relieve the suffering of their patients put them in a poor position to solve this problem, though they can take measures to avoid complicity in the harms that would result from widespread use of individually safe and effective reorientation biotechnology. But in the end the medical community as a whole still seems obligated to provide these measures, if they become technologically feasible. Medical researchers are in a better position to prevent the harms that would result if reorientation techniques were safe, effective and widely available. We argue that the harms attendant on the development of safe and effective re-orientation techniques give researchers reason to avoid ‘applied‘ research aimed at developing these techniques, and to be careful in the conduct of basic orientation research which might be applied in this way. (shrink)

Vaccine refusers often seem motivated by disgust, and they invoke ideas of purity, contamination and sanctity. Unfortunately, the emotion of disgust and its companion ideas are not directly responsive to the probabilistic and statistical evidence of research science. It follows that increased efforts to promulgate the results of vaccine science are not likely to contribute to increased rates of vaccination among persons who refuse vaccines because of the ‘ethics of sanctity’. Furthermore, the fact that disgust-based vaccine refusal is not monolithic (...) – vaccine refusers manifest disgust at different objects and invoke different ideas about purity and contamination – further complicates public health efforts to increase vaccination rates. (shrink)

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Background Policies to use financial incentives to encourage healthy behaviour are controversial. Much of this controversy is played out in the mass media, both reflecting and shaping public opinion. Objective To describe UK mass media coverage of incentive schemes, comparing schemes targeted at different client groups and assessing the relative prominence of the views of different interest groups. Design Thematic content analysis. Subjects National and local news coverage in newspapers, news media targeted at health-care providers and popular websites between January (...) 2005 and February 2010. Setting UK mass media. Results The study included 210 articles. Fifteen separate arguments favourable towards schemes, and 19 unfavourable, were identified. Overall, coverage was more favourable than unfavourable, although most articles reported a mix of views. Arguments about the prevalence and seriousness of the health problems targeted by incentive schemes were uncontested. Moral and ethical objections to such schemes were common, focused in particular on recipients such as drug users or the overweight who were already stereotyped as morally deficient, and these arguments were largely uncontested. Arguments about the effectiveness of schemes and their potential for benefit or harm were areas of greater contestation. Government, public health and other health-care provider interests dominated favourable coverage; oppo- sition came from rival politicians, taxpayersÕ representatives, certain charities and from some journalists themselves. Conclusions Those promoting incentive schemes for people who might be regarded as ÔundeservingÕ should plan a media strategy that anticipates their public reception. (shrink)

I argue that the right to mental health should be viewed as a universal human right and that the United Nations Convention on the Rights of Persons with Disabilities (CRPD), as an international standard, protects it because it places a positive duty on states to actively promote the mental well-being of its citizens for the purpose of preserving their dignity and allowing them to flourish. I begin by discussing the discrimination that persons with psychiatric disabilities experience, including the systemic barriers (...) and lack of mental health resources which impact the quality of their lives. Because flourishing and dignity are interconnected, protecting the rights of persons with mental illnesses is important because the possession of good mental health provides a firm basis for securing other basic human rights. Consequently, I maintain that the main advantage of a human rights approach for securing the right to mental health is that human rights is the only source of law which is accepted without qualification. I then look at three objections against the CRPD and the idea of the universal right to mental health as a socio-economic entitlement. Finally, I demonstrate how the CRPD can overcome these criticisms and offer suggestions on how states can implement the CRPD into their domestic mental health legislation. (shrink)

Summary measures of health, such as the quality-adjusted life year and disability-adjusted life year, have long been known to incorporate a number of value choices. In this paper, though, I show that the value choices in the construction of such measures extend far beyond what is generally recognized. In showing this, I hope both to improve the understanding of those measures by epidemiologists, health economists and policy-makers, and also to contribute to the general debate about the extent to which such (...) measures should be adjusted to reflect ethical values. (shrink)

To be effective, a medical intervention must improve one's health by targeting a disease. The concept of disease, though, is controversial. Among the leading accounts of disease-naturalism, normativism, hybridism, and eliminativism-I defend a version of hybridism. A hybrid account of disease holds that for a state to be a disease that state must both (i) have a constitutive causal basis and (ii) cause harm. The dual requirement of hybridism entails that a medical intervention, to be deemed effective, must target either (...) the constitutive causal basis of a disease or the harms caused by the disease (or ideally both). This provides a theoretical underpinning to the two principle aims of medical treatment: care and cure. (shrink)

Background: There is a shortage of reports on what potential recipients of implantable cardioverter–defibrillators need to be informed about and what role they can and want to play in the decision-making process when it comes to whether or not to implant an ICD.Aims: To explore how patients with heart failure and previous episodes of malignant arrhythmia experience and view their role in the decision to initiate ICD treatment.Patients and methods: A qualitative content analysis of semistructured interviews was used. The study (...) population consisted of 31 outpatients with moderate heart failure at the time of their first ICD implantation.Setting: The study was performed at Sahlgrenska University Hospital, Göteborg, Sweden.Results: None of the respondents had discussed the alternative option of receiving treatment with anti-arrhythmic drugs, the estimated risk of a fatal arrhythmia, or the expected time of survival from heart failure in itself. Even so, very little criticism was directed at the lack of information or the lack of participation in the decision-making process. The respondents felt that they had to rely on the doctors’ recommendation when it comes to such a complex and important decision. None of them regretted implantation of the ICD.Conclusions: The respondents were confronted by a matter of fact. They needed an ICD and were given an offer they could not refuse, simply because life was precious to them. Being able to give well-informed consent seemed to be a matter of less importance for them. (shrink)

Depuis le célèbre essai de Georges Canguilhem sur le normal et le pathologique publié initialement en 1943 et dont l’un des objectifs était la clarification des concepts de santé et de maladie, une littérature philosophique abondante, principalement anglo-saxonne, s’est attachée à définir ces concepts et à analyser leur statut. Le principal débat de ce domaine émergent de la philosophie de la médecine porte sur la question : peut-on décrire la santé et la maladie comme des phénomènes naturels ou s’agit-il d’états (...) qui sont déterminés par des valeurs?Tous les textes présentés dans ce volume ont participé de cette controverse. Ceux de la première section accordent une part importante à la composante biologique. Ceux de la seconde donnent le primat à la notion d’action. Ceux de la dernière section mettent en question l’utilité ou la possibilité même de définir les deux concepts. (shrink)

Lionel Penrose (1898–1972) was an important leader during the mid-20th century decline of eugenics and the development of modern medical genetics. However, historians have paid little attention to his radical theoretical challenges to mainline eugenic concepts of mental disease. Working from a classification system developed with his colleague, E. O. Lewis, Penrose developed a statistically sophisticated and clinically grounded refutation of the popular position that low intelligence is inherently a disease state. In the early 1930s, Penrose advocated dividing “mental defect” (...) (low intelligence) into two categories: “pathological mental defect,” which is a disease state that can be traced to a distinct genetic or environmental cause, and “subcultural mental defect,” which is not an inherent disease state, but rather a statistically necessary manifestation of human variation in intelligence. I explore the historical context and theoretical import of this contribution, discussing its rejection of typological thinking and noting that it preceded Theodosius Dobzhansky’s better-known defense of human diversity. I illustrate the importance of Penrose’s contribution with a discussion of an analogous situation in contemporary medicine, the controversial practice of using human growth hormone injections to treat “idiopathic short stature” (mere diminutive height, with no distinct cause). I show how Penrose’s contributions to understanding human variation make such treatments appear quite misguided. (shrink)

I propose a clinic-epidemiological concept of health as the best description of what physicians actually think about health within medical practice. Its aim is to be an alternative to the best approach in the philosophy of medicine about health, Christopher Boorse’s biostatistical theory. Contrary to Boorse’s ‘theoretical’ approach, I propose to take health as a practical clinical concept. In the first two parts of the paper, I will present my complaints against Boorse’s view that health is a theoretical concept, a (...) ‘species normal functional ability’. I will claim that Boorse’s view is actually a view on normal physiology. My claim is that health is best described as the state of absence of chronic diseases or disabilities (clinic-epidemiologically associated with a morbimortality index higher than the risk of death, disease and disabilities for individuals of the same population group or reference class free of that chronic clinical conditions). Health, therefore, is not the mere absence of disease. Diseases that do not increase patients’ morbimortality and disability indexes are not incompatible with health; after all, clinical health is compatible with appropriate health care and medical treatments. (shrink)

Ética para la psicología. Filosofía de la Psicología. Ética Aplicada. Psicoética.

Science starts by using terms such as ‘temperature’ or ‘fish’ or ‘gene’ to preliminarily delimitate the extension of a phenomenon, and concludes by giving most of them a technical meaning based on an explanatory model. This transforma- tion of the meaning of the term is an essential part of its naturalization. Debating on the definition of ‘disease’, what most philosophers of medicine have examined is the pre-naturalized meaning of the term: for that reason they have focused on the task of (...) delimiting disease and non-disease (health), mainly used conceptual analysis as a method of choice, and considered the nosological level of ‘disease judgments’ rather than the pathophysiological or psychopathological level of disease mechanisms, thus making them impervious to most scientific discoveries. By focusing instead on the naturalized concept of disease and following some suggestions by philosophers of biology and scientists in cutting-edge fields of biomedical research, they could gar- ner results from a comparison of the mechanisms of diseases. This would ultimately result in a general theory of disease linked with our most general theories on living beings, among them, systems biology and network medicine. Before undertaking such a task, preliminary questions arise: is it likely that there are biological features common to different types of disease? Is it a philosopher’s job to determine what they consist in? What use would such a general theoretical definition of disease be? (shrink)