Health

Christopher Boorse’s Biostatistical Theory of Health has been the main contender among naturalistic accounts of health for the last 40 years. Yet, a recent criticism of this theory, presented by Elselijn Kingma, identifies a dilemma resulting from the BST’s conceptual linking of health and statistical typicality. Kingma argues that the BST either cannot accommodate the situation- specificity of many normal functions or cannot account for many situation-specific diseases. In this article, we expand upon with Daniel Hausman’s response to Kingma’s dilemma. (...) We propose that recalling Boorse’s specification that health is an intrinsic property of its bearers and explicating this intrinsic property in relation to the concept of homeostasis can illuminate how proponents of naturalistic accounts of health should deal with the situation- specificity of normal functions. We argue that beyond what Boorse and Hausman have delineated, the situation- specificity of normal function cannot be fully captured in a simple dichotomy between normal and abnormal environment or between relevant and irrelevant situations. By bringing homeostasis to the fore of the analysis of health, we set out a richer picture of what the various situations that affect living organisms’ functional performance can be. Accordingly, we provide a broader classification of these various situations which, we contend, better accounts for the main intuitions that philosophers of medicine have sought to accommodate than previous naturalistic theories of health. (shrink)

In medical sciences, health is measured by reference to our species-typical anatomy and functional integrity – the objective standard of human health. Proponents of transhumanism are committed to biomedical enhancement of human beings by augmenting our species-typical anatomy and functional integrity. I argue that this normative impasse is not only a problem for the transhumanist movement, but also undermines the rationale for some common medical interventions.

This paper combines considerations from ethics, medicine and public health policy to articulate and defend a systematic case for mask wearing mandates. The paper argues for two main claims of general interest in favour of these mandates. First, mask wearing mandates provide a more effective, just and fair way to tackle the ongoing COVID-19 pandemic than policy alternatives such as laissez-faire approaches, mask wearing recommendations and physical distancing measures. And second, the proffered objections against mask wearing mandates may justify some (...) exemptions for specific categories of individuals, but do not cast doubt on the justifiability of these mandates. Hence, unless some novel decisive objections are put forward against mask wearing mandates, governments should adopt such mandates. (shrink)

Insofar as value theory is relevant to the philosophy of medicine, two goods have dominated reflection: well-being (particularly health) and morality. This essay casts doubt on whether those values are sufficient to resolve an array of important debates about medical practice, maintaining that the value of what makes a life meaningful should play a much larger role. After first indicating how meaningfulness differs from happiness and rightness, the essay argues that meaningfulness cannot reasonably be ignored when thinking comprehensively about the (...) proper aims of medicine, the appropriate constraints on their pursuit, and the effective means by which to realize them. The essay’s goal is not to draw any firm conclusions about the suitable ends, constraints, and means of medical practice, but rather to show that, in order to arrive at any, one has to consider the category of life’s meaning, which has not been prominent in the philosophy of medicine. (shrink)

Due to the intricate nature of its subject matter, medicine is always threatened by speculations and disagreements about which among its entities exist, e.g., any specific biological structures, substructures or substances, pathogenic agents, pathophysiological processes, diseases, psychosomatic relationships, therapeutic effects, and other possible and impossible things. To avoid confusion, and to determine what entities an item of medical knowledge presupposes to exist if it is to be true, we need medical ontology. The term “medical ontology” we understand to mean the (...) study that seeks to ascertain what entities exist in the world of medicine, which formal relations hold between them, and whether there are any relatioships between types of medical research and practice, on the one hand; and the new worlds they create, on the other. (shrink)

This dissertation explores the idea and ethics of vaccination for the sake of others. It conceptually distinguishes four different kinds of vaccination—self-protective, paternalistic, altruistic, and indirect—based on who receives the primary benefits of vaccination and who ultimately makes the vaccination decision. It describes the results of focus group studies that were conducted to investigate what people who might get vaccinated altruistically think of this idea. It also applies the different kinds of vaccination to ethical issues surrounding COVID-19, such as lockdown (...) measures, routine or mandatory vaccination of healthy children, and the ethical justification of restrictive measures for unvaccinated people. A more general philosophical account of vaccination ethics is ultimately developed, which is based not on moral duties, but on the moral reasons that people may have to get vaccinated for the sake of others. It is argued that such reasons may be stronger or weaker, depending on various factors related to the vaccines in question and the specific epidemiological circumstances. (shrink)

In the last decades it has become clear that medicine must find some way to combine its scientific and humanistic sides. In other words, an adequate notion of medicine requires an integrative position that mediates between the analytic-reductionist and the normative-holistic tendencies we find therein. This is especially important as these different styles of reasoning separate “illness” (something perceived and managed by the whole individual in concert with their environment) and “disease” (a “mechanical failure” of a biological element within the (...) body). While the demand for an integrative view has typically been motivated by ethical concerns, we claim that it is also motivated, perhaps even more fundamentally, by epistemological and methodological reasons. Evidence-based bio-medicine employs experimental and statistical techniques which eliminate important differences in the ways that conscious humans evaluate, live with, and react to disease and illness. However, it is precisely these experiences that underpin the concepts and norms of bio-medicine. Humanistic disciplines, on the other hand, have the resources to investigate these experiences in an intersubjectively testable way. Medicine, therefore, cannot afford to ignore its nature as a human science; it must be concerned not only with disease and illness, but also with the ways in which patients as persons respond to malady. Insofar as attitudes and expectations influence the criteria of illness and disease, they must be studied as part of the genuine subject matter of medicine as a human science. In general, we urge that this is a necessary step to overcome today's trend to split evidence-based and clinical medicine. (shrink)

Nietzsche assesses values, moralities, religions, cultures, and persons in terms of health. He argues that we should reject those that are unhealthy and develop healthier alternatives. But what is Nietzsche’s conception of health, and why should it carry such normative force? In this paper I argue for reading Nietzsche’s concept of health as the overall ability to meet the demands of one’s motivational landscape. I show that, unlike other interpretations, this reading accounts for his rejection of particular features of a (...) prevailing, then as now, model of health; for his association of health with strength and with psychic unity; and for his claim that health is compatible with, and can even be enhanced by, functional impairments such as those from which he personally suffered. Throughout I draw connections to recent literature on health and disability. (shrink)

In this paper, I argue that a modified version of well-being subjectivism can avoid the standard, yet unintuitive, conclusion that morally horrible acts may contribute to an agent’s well-being. To make my case, I argue that “Modified Subjectivists” need not accept such conclusions about well-being so long as they accept the following three theoretical addenda: 1) there are a plurality of values pertaining to well-being, 2) there are some objective goods, even if they do not directly contribute to well-being, and (...) 3) some of these values and goods are bound-up with one another. (shrink)

In the recent literature across philosophy, medicine and public health policy, many influential arguments have been put forward to support the use of randomization procedures to allocate scarce life-saving resources. In this paper, I provide a systematic categorization and a critical evaluation of these arguments. I shall argue that those arguments justify using RAND to allocate SLSR in fewer cases than their proponents maintain and that the relevant decision-makers should typically allocate SLSR directly to the individuals with the strongest claims (...) to these resources rather than use RAND to allocate such resources. (shrink)

ABSTRACT What kind of basic minimum do we owe to others? This paper defends a new procedure for answering this question. It argues that its minimally good life account has some advantages over the main alternatives and that neither the first-, nor third-, person perspective can help us to arrive at an adequate account. Rather, it employs the second-person perspective of free, reasonable, care. There might be other conditions for distributive justice, and morality certainly requires more than helping everyone to (...) secure a basic minimum. Still, if the minimally good life account is correct, and we owe everyone a basic minimum, we must ensure that everyone lives well enough. (shrink)

We live in tragic times. Millions are sheltering in place to avoid exacerbating the Coronavirus (COVID-19) pandemic. How should we respond to such tragedies? This paper argues that the human right to health can help us do so because it inspires human rights advocates, claimants, and those with responsibility for fulfilling the right to try hard to satisfy its claims. That is, the right should, and often does, give rise to what I call_ the virtue of creative resolve_. This resolve (...) embodies a fundamental commitment to finding creative solutions to what appear to be tragic dilemmas. Contra critics, we should not reject the right even if it cannot tell us how to ration scarce health resources. Rather, the right gives us a response to apparent tragedy in motivating us to search for ways of fulfilling everyone’s basic health needs. (shrink)

Lockdown measures in response to the COVID-19 pandemic involve placing huge burdens on some members of society for the sake of benefiting other members of society. How should we decide when these policies are permissible? Many writers propose we should address this question using cost-benefit analysis, a broadly consequentialist approach. We argue for an alternative non-consequentialist approach, grounded in contractualist moral theorising. The first section sets up key issues in the ethics of lockdown, and sketches the apparent appeal of addressing (...) these problems in a CBA frame. The second section argues that CBA fundamentally distorts the normative landscape in two ways: first, in principle, it allows very many morally trivial preferences—say, for a coffee—might outweigh morally weighty life-and-death concerns; second, it is insensitive to the core moral distinction between victims and vectors of disease. The third section sketches our non-consequentialist alternative, grounded in Thomas Scanlon’s contractualist moral theory. On this account, the ethics of self-defence implies a strong default presumption in favour of a highly restrictive, universal lockdown policy: we then ask whether there are alternatives to such a policy which are justifiable to all affected parties, paying particular attention to the complaints of those most burdened by policy. In the fourth section, we defend our contractualist approach against the charge that it is impractical or counterintuitive, noting that actual CBAs face similar, or worse, challenges. (shrink)

Innovation is progressively needed in responding to global challenges. Moreover, the increasing complexity of challenges implies demand for the usage of multisectoral and policy mix approaches. Wicked problems can be tackled by "integrated innovation" that combines the coordinated implementation of social, technological, and health innovation co-created by entities of the public sector, the private sector, the non-governmental sector, and the informal sector. This Research Topic focuses on filling the knowledge gaps about the selected types of innovation. First, regarding social innovation (...) that can be understood as new strategies, concepts, products, services, and organizational forms that allow the satisfaction of human needs. Second, a technological innovation that refers to new or remarkably improved products, goods, or services in terms of their technical specifications, components, materials, software, design, or other functional features. Third, health innovation that focuses on novel or enhanced health policies, systems, products, technologies, services, and care delivery schemes to improve people’s health. Finally, this Research Topic highlights attempts to develop integrated innovation that can add value to social policy, health policy, and environmental policy by improving efficiency, effectiveness, quality, sustainability, safety, and affordability. (shrink)

Vaccination can protect vaccinated individuals and often also prevent them from spreading disease to other people. This opens up the possibility of getting vaccinated for the sake of others. In fact, altruistic vaccination has recently been conceptualized as a kind of vaccination that is undertaken primary for the benefit of others. In order to better understand the potential role of altruistic motives in people’s vaccination decisions, we conducted two focus group studies with a total of 37 participants. Study 1 included (...) three focus groups on the subject of HPV vaccination for boys. Study 2 included three focus groups on the subject of pertussis and measles vaccination for childcare workers. We found substantial evidence of other-regarding motives across all focus groups, which suggests that altruistic motives could be an important factor when it comes to people’s vaccination decisions. We address the significance of these findings for vaccination policy surrounding HPV vaccination for boys and vaccination for childcare workers. We also extend the findings to normative work on vaccination for the sake of others more generally. (shrink)

[In Czech] This article aims to explain how Merleau-Ponty’s phenomenological account of embodiment contributes to the theory and practice of physiotherapy. The mechanistic conception of the body, to which physiotherapy usually refers, assumes a universal model of its functioning and interprets its relationship to the environment causally. In fact, however, it does not allow a satisfactory explanation of the efficiency of the therapeutic methods used in practice. In contrast, Merleau-Ponty’s concept of motor intentionality points to the fact that the body (...) “understands” the practical meaning of a situation. Bodily understanding is then manifested in particular by the ability to adequately differentiate, adapt or vary motor and postural responses to environmental challenges. This change in the conception of embodiment also has important implications for understanding the therapist-patient relationship and the intervention itself. Physiotherapists should draw more on the fact that they are themselves a body and, on this basis, guide the patient’s bodily intentionality towards a more developed understanding of the practical meaning of situations. (shrink)

The 1948 constitution of the World Health Organization (WHO) defines health as ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’. It was a bold and revolutionary health idea to gain international consensus in a period characterized by fervent anti-communism. This article explores the genealogy of the health definition and demonstrates how it was possible to expand the scope of health, redefine it as ‘well-being’, and overcome ideological resistance to progressive and (...) international health approaches. The first part of the article demonstrates how the health definition was composed through a trajectory of draft ideas from scholars in the history of medicine, as well as political actors working to promote national health insurance. The definition was authored by League of Nations veteran Raymond Gautier, but secretly drew heavily on medical historian Henry E. Sigerist’s controversial book Socialized Medicine in the Soviet Union (1937). The second part analyses how it was possible to resist the ideological pushback against the WHO and secure US ratification. The WHO’s progressive constitution was not simply a deviation from dominant health ideas, but a direct outcome of the entrenched health conflict. The genealogy is based on original archival material from international organizations and US government archives. The article contributes to understandings of the political controversies surrounding the WHO and to scholarship on understandings of health. It also illustrates how influential health ideas cross the boundaries between politics and health sciences, as well as the boundaries between domestic health policy and global health. (shrink)

The definitions and conceptualizations of health, and the management of healthcare have been challenged by the current global scenarios (e.g., new diseases, new geographical distribution of diseases, effects of climate change on health, etc.) and by the ongoing scholarship in humanities and science. In this paper we question the mainstream definition of health adopted by the WHO—‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’ (WHO in Preamble to the constitution of (...) the World Health Organization as adopted by the international health conference, The World Health Organization, 1948)—and its role in providing tools to understand what health is in the contemporary context. More specifically, we argue that this context requires to take into account the role of the environment both in medical theory and in the healthcare practice. To do so, we analyse WHO documents dated 1984 and 1986 which define health as ‘coping with the environment’. We develop the idea of ‘coping with the environment’, by focusing on two cardinal concepts: adaptation in public health and adaptivity in philosophy of biology. We argue that the notions of adaptation and adaptivity can be of major benefit for the characterization of health, and have practical implications. We explore some of these implications by discussing two recent case studies of adaptivity in public health, which can be valuable to further develop adaptive strategies in the current pandemic scenario: community-centred care and microbiologically healthier buildings. (shrink)

Objective: Deficits in affective processing are associated with impairments in both mental and physical health. The role of affective processing in patients with functional somatic complaints such as irritable bowel syndrome remains unclear. Most studies have focused on the capacity for emotional awareness and expression, but neglect other dimensions of affective processing. Therefore, this study aimed to systematically analyze differences in six different dimensions of affective processing between patients with IBS and healthy controls. Additionally, we exploratively investigated the impact of (...) IBS symptom severity, psychological distress, and attachment styles on affective processing in IBS. Methods: A controlled cross-sectional multi-center study was conducted. Overall, 127 patients with IBS were compared with 127 matched HCs using multivariate analysis of variances. Affective processing was operationalized in line with the affect cascade model on six specific dimensions: emotional experience, emotional awareness, affect tolerance, affect differentiation, affect regulation, and emotional communication. They were measured using two subscales of the Mentalizing Questionnaire and four subscales of the Operationalized Psychodynamic Diagnosis–Structure Questionnaire. Linear regression analysis was used to investigate the influence of IBS symptom severity, depression, anxiety, and anxious and avoidant attachment styles on the different dimensions of affective processing in IBS. Results: Patients with IBS compared to HCs showed deficits in all six dimensions of affective processing. Deficits were largest for affect tolerance and lowest for emotional experience and emotional awareness. Moderate effect sizes were found for affect differentiation, emotional communication, and affect regulation. Moreover, explorative analyses indicated that affective processing in patients with IBS was significantly influenced by levels of anxiety and insecure attachment. Conclusion: The results indicate a specific pattern of affective processing abilities in patients with IBS. The deficits in affective processing are more prominent in the area of understanding and tolerating difficult affective states than experiencing affective states. This opens interesting perspectives for the development of specific psychotherapeutic interventions. (shrink)

Cardiovascular disease is a major complication of type 2 diabetes mellitus. In addition to traditional risk factors, psychological determinants play an important role in CVD risk. This study applied Deep Neural Network to develop a CVD risk prediction model and explored the bio-psycho-social contributors to the CVD risk among patients with T2DM. From 2017 to 2020, 834 patients with T2DM were recruited from the Department of Endocrinology, Affiliated Hospital of Harbin Medical University, China. In this cross-sectional study, the patients' bio-psycho-social (...) information was collected through clinical examinations and questionnaires. The dataset was randomly split into a 75% train set and a 25% test set. DNN was implemented at the best performance on the train set and applied on the test set. The receiver operating characteristic curve analysis was used to evaluate the model performance. Of participants, 272 were diagnosed with CVD. The developed ensemble model for CVD risk achieved an area under curve score of 0.91, accuracy of 87.50%, sensitivity of 88.06%, and specificity of 87.23%. Among patients with T2DM, the top five predictors in the CVD risk model were body mass index, anxiety, depression, total cholesterol, and systolic blood pressure. In summary, machine learning models can provide an automated identification mechanism for patients at CVD risk. Integrated treatment measures should be taken in health management, including clinical care, mental health improvement, and health behavior promotion. (shrink)

Children’s reasoning on food properties and health relationships can contribute to healthier food choices. Food properties can either be positive (“gives strength”) or negative (“gives nausea”). One of the main challenges in public health is to foster children’s dietary variety, which contributes to a normal and healthy development. To face this challenge, it is essential to investigate how children generalize these positive and negative properties to other foods, including familiar and unfamiliar ones. In the present experiment, we hypothesized that children (...) might rely on cues of food processing (e.g., signs of human intervention such as slicing) to convey information about item edibility. Furthermore, capitalizing on previous results showing that food rejections (i.e., food neophobia and picky eating) are a significant source of inter-individual variability to children’s inferences in the food domain, we followed an individual approach. We expected that children would generalize the positive properties to familiar foods and, in contrast, that they would generalize more often the negative properties to unfamiliar foods. However, we expected that children would generalize more positive and less negative properties to unfamiliar sliced foods than to whole unfamiliar foods. Finally, we expected that children displaying higher levels of food rejections would generalize more negative properties than children displaying lower levels of food rejections. One-hundred and twenty-six children, aged 3–6 years, performed an induction task in which they had to generalize positive or negative health-related properties to familiar or unfamiliar foods, whole or sliced. We measured children’s probability of generalization for positive and negative properties. The children’s food rejection score was assessed on a standardized scale. Results indicated that children evaluated positively familiar foods (regardless of processing), whereas they tend to view unfamiliar food negatively. In contrast, children were at chance for processed unfamiliar foods. Furthermore, children displaying higher levels of food rejections were more likely to generalize the negative properties to all kinds of foods than children displaying lower levels of food rejections. These findings entitle us to hypothesize that knowledge-based food education programs should take into account the valence of the properties taught to children, as well as the state of processing of the food presented. Furthermore, one should take children’s interindividual differences into account because they influence how the knowledge gained through these programs may be generalized. (shrink)

How the sense of smell is involved in human health has been the subject of increasing inquiry over the past several decades. The two main avenues of investigation are: “aromatherapy” – how the inhalation of various odors can produce positive effects on psychological and physiological wellness; how abnormal decreases in olfactory sensitivity are linked to various disease states and an increased risk of premature mortality. In this chapter, I evaluate pertinent aspects of both of these topics. First, with regard to (...) aromatherapy, popular accounts for underlying mechanisms are debunked and scientific explanations provided; I then present a focused review of the empirical literature on scent and pain management and discuss why pain may be especially well suited to aromatherapeutic approaches. Second, the clinical significance of abnormal olfactory loss as a harbinger for premature mortality and as a prodromal maker for Alzheimer’s disease, Parkinson’s disease, and most recently Covid-19, is examined. Following from this, I suggest how simple do-at-home smell tests can be implemented and should become a standard part of basic healthcare screenings. (shrink)

The devastating impact of the COVID‐19 (coronavirus disease 2019) pandemic is prompting renewed scrutiny of practices that heighten the risk of infectious disease. One such practice is refusing available vaccines known to be effective at preventing dangerous communicable diseases. For reasons of preventing individual harm, avoiding complicity in collective harm, and fairness, there is a growing consensus among ethicists that individuals have a duty to get vaccinated. I argue that these same grounds establish an analogous duty to avoid buying and (...) eating most meat sold today, based solely on a concern for human welfare. Meat consumption is a leading driver of infectious disease. Wildlife sales at wet markets, bushmeat hunting, and concentrated animal feeding operations (CAFOs) are all exceptionally risky activities that facilitate disease spread and impose immense harms on human populations. If there is a moral duty to vaccinate, we also should recognize a moral duty to avoid most meat. The paper concludes by considering the implications of this duty for policy. (shrink)

Michael Ondaatje’s Warlight (2018), his latest novel to-date, contains nostalgic elements of strangeness and cartography. In this paper, I short-circuit such themes with health under medical humanities, which heeds a Nietzschean counsel of close reading in literature. To do so, I explore the case of Rachel's illness, namely her epileptic seizures, as an instance that drives her impetus for active forgetting and eventual convalescence. A close hermeneutical reading of the novel can reveal that both of Nietzsche’s ideas on active forgetting (...) and convalescence provide traction in terms of what this paper constructs as Rachel’s pathography or narration of illness. Shifting the focus from the main narrator, Nathaniel, I argue that it is not the novel's reliance on memory but the subplot events of Nathaniel's sister and her epilepsy that form a substantial case of medical or health humanities. (shrink)

Managing cardiac illness is not easy because it dramatically disrupts people’s daily life and both the patient and his/her spouse are at risk for experiencing distress, which, in turn, may affect the support provided by the partner as caregiver. The partner, in fact, is the main source of support, but his/her support may sometimes be inadequate. In addition, dyadic coping could likely be a moderating factor. The main aim of the present study was to examine the role that dyadic coping (...) plays in moderating the link between patient and partner cardiac illness-related distress and partner support. The study included 100 married couples faced with cardiac illness who completed a self-report questionnaire. We analyzed our data in PROCESS using multiple regressions in order to assess the moderating effects of DC responses in the relationship between the couple’s cardiac illness-related distress and partner support. With regard to patient distress, results showed that higher levels of patient anxiety and depression were linked with ineffective partner support. With regard to partner distress, higher levels of partner depression were linked with hostility; higher levels of partner depression and anxiety were associated with less partner support for patient engagement. Moreover, the association between distress and partner support was moderated by the quality of DC. In particular, low positive DC represented a risk factor for both the patient and the partner during a cardiac illness, as low positive DC exacerbated the link between patient and partner distress and less effective partner support styles. Also, higher levels of negative DC were risky for couples: The association between distress and less adequate partner supportive behaviors was stronger in the case of higher negative DC. These results imply a need for psychosocial interventions for couples in cardiac illness, especially for couples lacking relational competences, such as positive dyadic coping. (shrink)

In this article, we develop a measure of complete well-being. The framework is derived from the theoretical model of human flourishing understood as a state in which all aspects of a human life are favorable. The approach extends beyond psychological well-being and reflects the World Health Organization definition of health that not only considers the health of body and mind but also embraces the wholeness of the person. The Well-Being Assessment is a comprehensive instrument designed to assess holistic well-being in (...) six domains: emotional health, physical health, meaning and purpose, character strengths, social connectedness, and financial security. Although each of these domains is distinct, all of them are nearly universally desired, and all but financial security constitute ends in themselves. Data were collected from a representative sample of working adults. A sample of 276 employees participated in the pilot, 2,370 participated in the first wave and 1,209 in the second wave of the survey. The WBA showed a good fitting, satisfactory reliability, test–retest correlation, and convergent/discriminant validity in relation to stability over time and relevant health measures, as well as a good fit to the data that were invariant over time, gender, age, education, and marital status. The instrument can be of use for scientists, practitioners, clinicians, public health officials, and patients. Adoption of more holistic measures of well-being that go beyond psychological well-being may help to shift the focus from health deficiencies to health and well-being promotion. (shrink)

As governments around the world imposed lockdowns or stay-at-home measures, people began to feel the stress as time dragged on. There were already reports on some individuals committing suicide. How do governments respond to such a phenomenon? Our main focus is the Philippine government and how it responded to the COVID-19 pandemic. In this paper, we argue that the problem with COVID-19 went forth just dealing with physical health. First, people suffer not just from being infected but the psychological stress (...) of possibly getting the virus and the toll of the government lockdown or quarantine. Second, the Philippine Bayanihan ‘We Heal As One Act’ lacks focus on mental health issues while the government's response seemed to focus on security issues. Third, there are countries around the world that have acted effectively in protecting people’s mental health. Lastly, we propose appropriate measures to help address the people's mental health while still in the pandemic and for a future one. (shrink)

In this paper, two central questions will be addressed: ought we to implement medical AI technology in the medical domain? If yes, how ought we to implement this technology? I will critically engage with three options that exist with respect to these central questions: the Neo-Luddite option, the Assistive option, and the Substitutive option. I will first address key objections on behalf of the Neo-Luddite option: the Objection from Bias, the Objection from Artificial Autonomy, the Objection from Status Quo, and (...) the Objection from Inscrutability. I will thereafter present the Demographic Trends Argument and the Human Enhancement Argument in support of alternatives to the Neo-Luddite option. In the second half of the paper, I will argue against the Substitutive option and in favour of the Assistive option, given the existence of two chief formal deficits in medical AI technology: the causality deficit and the care deficit. (shrink)

Background: Depressive disorder is one of the main health problems worldwide. Many risk factors have been associated with this pathology. However, while the association between risks factors and adult depression is well established, the mechanisms behind its impact remains poorly understood. A possible, yet untested explanation is the mediating impact of levels of personality functioning, i.e., impairments with regard to self and interpersonal.Method: Around 162 patients were assessed at the beginning of their therapy, with regard to risk factors, such as (...) sociodemographic, physical, hereditary, and adverse childhood experiences. Depressive symptoms and personality functioning were also measured. Associations between the related variables as well as other possible covariates were examined by means of zero-order correlations and bootstrapping-based mediation analysis.Results: Of all the risk factors taken into account, level of education and physical illness were associated with depression. On the other hand, the most significant predictor of depressive symptomatology was ACE, and this relationship was mediated by personality functioning. This indicates that patients presenting adverse childhood experiences are more likely to develop deficiencies in personality functioning, which in turn increases their likelihood of developing depressive symptomatology.Conclusion: These results reaffirm the importance of incorporating risk and vulnerability factors such as personality functioning in understanding depression. (shrink)

This paper defends the hypothesis of a potential causal link between increased usage of hormonal contraceptives (HCs) and significant rises in instances of Autism Spectrum Disorders (ASDs) worldwide. It develops a background theory that supports this hypothesis through analysis of: observed correlations between increased usage of HCs and increased instances of ASDs; consistent evidence from independent studies linking “birth spacing” intervals and ASD-risk; evidence from studies on the effects of HCs on folate and B12 absorption; and hypotheses concerning disruptions to (...) mechanisms of delivery of folate and B12 during periods of in utero brain development. The proposed theory is then defended through discussion of how it may explain numerous puzzling correlations with increased instances of ASDs documented in certain demographics. (shrink)

Nicole Hassoun here makes a philosophical argument for health, and access to essential medicines, as essential human rights, and she proposes the Global Health Impact system as a way to ensure those rights. She reports how life-saving medicines are inaccessible and costly for the global poor, and that rather than focusing on treatments for critical, deadly global health problems, pharmaceutical companies instead invest in more profitable drugs. To address this problem, Hassoun's proposal will rate pharmaceutical companies based on their medicines' (...) impact on the improvement of global health, and will reward highly-rated medicines with a Global Health Impact label. (shrink)

The novel coronavirus has not only brought along disruptions to daily socio-economic activities, but sickness and deaths due to its high contagion. With no widely acceptable pharmaceutical cure, the best form of prevention may be precautionary measures which will guide against infections and curb the spread of the disease. This study explored the relationship between COVID-19 knowledge, risk perception, and precautionary behavior among Nigerians. The study also sought to determine whether this relationship differed for men and women. A web-based cross-sectional (...) design approach was used to recruit 1,554 participants from all geopolitical zones in Nigeria, through social media platforms using a snowball sampling technique. Participants responded to web-based survey forms comprising demographic questions and adapted versions of the Ebola knowledge scale, SARS risk perception scale, and precautionary behavior scale. Moderated mediation analysis of the data showed that risk perception mediated the association between COVID-19 knowledge and precautionary behavior and this indirect effect was in turn moderated by gender. Results indicate that having adequate knowledge of COVID-19 was linked to higher involvement in precautionary behavior through risk perception for females but not for males. It was also noted that awareness campaigns and psychological intervention strategies on COVID-19 related activities may be particularly important for males more than females. Drawing from the health belief model, we recommend that COVID-19 awareness campaigns should target raising more awareness of the risks associated with the infection to make individuals engage more in precautionary behaviors. (shrink)

Hynek Bartos does the field of ancient philosophy a great service by detailing the influence of early Greek thinkers (such as Heraclitus, Empedocles, Anaxagoras, Democritus, and Diogenes of Apollonia) on the Hippocratic work On Regimen, and by demonstrating that work’s innovative engagement with contemporary scientific and philosophical concepts as well as its direct influence on Plato and Aristotle. His study usefully counteracts the lamentable tendency among ancient philosophers to ignore or downplay the influence of medical literature on philosophy in general, (...) and to heap scorn on this text in particular, which Kirk, Raven, and Schofield considered ‘an eclectic and very superficial quasi- philosophical treatise’ and Barnes famously called ‘a silly farrago of ill-digested Presocratic opinions’. (shrink)

We argue that pandemic and lockdown can be usefully interpreted as transformative experiences, albeit of a sort with interestingly different features to those discussed by L.A. Paul.

Debates about obesity in bioethics tend to unfold in predictable epicycles between individual choices and behaviours and the oppressive socio-economic structures constraining them. Here, we argue that recent work from two cutting-edge research programmes in microbiology and social psychology can advance this conceptual stalemate in the literature. We begin in section 1 by discussing two promising lines of obesity research involving the human microbiome and relationship partners. Then, in section 2, we show how this research has made viable novel strategies (...) for fighting obesity, including microbial therapies and dyad-level interventions. Finally, in section 3, we consider objections to our account and conclude by arguing that attention to the most immediate features of our biological and social environment offers a middle ground solution, while also raising important new issues for bioethicists. (shrink)

Появление человека, говорящего о себе Ἐγώ εἰμι, люди воспринимают в той же логике абсурда, к которой они привыкли. То, что кто-то может не играть и не носить маску, а реально быть, жить настоящей, а не выдуманной жизнью, для них немыслимо, невозможно, невыносимо и недопустимо. Но такой человек был, есть, и будет, и именно он преображает всё остальное человечество своим Ἐγώ εἰμι.

Wie jedes Krankenhaus hat Charité ihre Geschichte, die mit dem Erlaß des preußischen Königs Friedrich I. vom 14. November 1709 zur Gründung von Lazareth-Häusern anfing, um der Ausbreitung der Pest entgegenzuwirken, wozu es allerdings in Berlin nie gekommen ist. Am 9. Januar 1727 verfügte König Friedrich Wilhelm I. die Umwandlung des vor dem Spandowischen Tor errichteten Lazareth in ein Hospital und nannte es „das Haus die Charité“ nach dem Vorbild von Hôpital de la Charité in Paris. -/- Das Wort und (...) der Begriff Charité ist wesentlich älter als das Krankenhaus. Das Französische charité ist äquivalent dem Englischen charity und dem Deutschen Barmherzigkeit, während ihre Ursprünge im Griechischen zu finden sind: χάρις bedeutet Gnade, Gunst, χαριτόω Gnade oder Gunst zeigen oder empfangen, favorisieren oder favorisiert werden, gnädig oder begnadet sein. Das Krankenhaus ist ein Ort der Gnade, welche den Kranken und Bedürftigen zusteht aufgrund allgemeiner Verpflichtung, seinen Nächsten so zu lieben wie sich selbst. Die Gunst und die Gnade zu erweisen heißt auch, sich zu erbarmen und mitleidig sein, eigenes Herz für fremdes Leid zu offnen. -/- Seit ihrer Gründung weichte Charité von diesem Grundgedanke mehrmals ab, was bisher in ihrer Geschichtsschreibung mehr oder weniger wahrheitsgetreu festgehalten wurde. Dieser Tradition des Festhaltens und der Wiedergabe der Wahrheit bin ich verpflichtet, weil offizielle Geschichtsschreibung erneut beginnt, von der Realität abzuweichen und die Tatsachen zu leugnen, die sowohl unzweifelhaft sind als auch unzweifelhaft würdig sind, erzählt zu werden, weil es dabei um die Frage des Auftrags der Charité geht. -/- Charité wurde gegründet, um das Unheil abzuwenden, dennoch war ihre Geschichte keine Heilsgeschichte, wie ich bereits feststellte. Das Unheil setzte sich im 21. Jahrhundert fort, was ich zu unterbinden suche. Einziges Heilmittel dagegen ist die Wahrheit, daran besteht kein Zweifel, und der Weg, um die Wahrheit zu erkennen, ist die Barmherzigkeit. (shrink)

Philosophy of immunology is a subfield of philosophy of biology dealing with ontological and epistemological issues related to the studies of the immune system. While speculative investigations and abstract analyses have always been part of immune theorizing, until recently philosophers have largely ignored immunology. Yet the implications for understanding the philosophical basis of organismal functions framed by immunity offer new perspectives on fundamental questions of biology and medicine. Developed in the context of history of medicine, theoretical biology, and medical anthropology, (...) philosophy of immunology differs from these related branches of study in its focus on traditional philosophical questions concerning identity, individuality, ecology, cognition, scientific methodology and theory construction. This broad agenda derives from immunology’s multifaceted research program that has developed from its initial clinical challenges of host defense, transplantation, autoimmunity, tumor immunology, and allergy. In addition to these well-established research areas, immunity is now understood to play a central role in other physiological functions, development, ecology, and evolutionary mechanics. Holding together these diverse domains of inquiry lie philosophical commitments oriented by organismal identity. In this regard, pertinent issues are raised concerning cognition (organization of immune perception and information processing), the character of individuality (framed by the ecological context of immune-mediated assimilation and rejection), and the dynamics of complex systems (understood as holistic systems biology). Indeed, immunology, in the context of cognitive science, evolutionary biology, environmental sciences, and development provides multi-focal perspectives for philosophy of science. (shrink)

Medical and Taoist sources written or compiled during the Han dynasty provide the first accounts, reflections, and theories on the self, on disease, and on the relationships between humans and the world in which they live. This chapter focuses on this particular period of time which, in fact, lays important foundations for Chinese society and culture. Relying mainly on medical and Taoist sources, it firstly sheds light on how the self was thought of and represented at this time and examines (...) how the links between human beings and their environment were conceived of. It then focuses on what, for humans and in the environment, were thought of as potential threats to health and how the image of an ideal landscape was thus constructed, that is, a landscape into which humans could fit perfectly and live healthy lives. Finally, we analyze how this ideal landscape was supposed to work to preserve good health in humans. (shrink)

While many public health threats are now widely appreciated by the public, the risks from asbestos exposure remain poorly understood, even in high-risk groups. This article makes the case that asbestos exposure is an important, ongoing global health threat, and argues for greater policy efforts to raise awareness of this threat. It also proposes the extension of asbestos bans to developing countries and increased public subsidies for asbestos testing and abatement.

Analyzing two harm reduction comics campaigns—one early in the AIDS crisis and one more recent, I explore tensions between queer safer sexual erotics and national discourses of sexual norms/deviation raised by Cindy Patton and William Haver at the height of AIDS discourse theory in 1996, approximately halfway between the comics. Using these theorists’ reflections on the history of AIDS activism/representation as a hinge, I explore the manifestation/transformation a decade later of the ethical, educational, and erotic issues they raise. Both foreground (...) the ways that HIV, safer sex, and/or eroticism pose difficulties for systems of linguistic and visual representation. Combining text and image, comics—a common harm reduction medium—epitomize this representational issue. While the GMHC addresses an immediate need for information about safer sex, Alex attempts to tackle the unrepresentability/unthinkability of safer and/or seropositive sex. Safer Sex Comix, while largely prioritizing directness above formal experimentation, employ strategies of transgressing the borders of the comics panel to emphasize a plethora of lower-risk sexual acts. The most visually inventive moments in Alex represent Alex’s feelings of unintelligbility post-diagnosis, but the comic restricts its representation of sex only to anal intercourse, and it proves unable to visualize alternative formulations of the erotic, turning to more normative narratives and images as earlier, visually explicit unsafe sexual encounters are replaced with more a/illusive representations post-conversion, literalizing the unrepresentability of seropositive erotic life. (shrink)

The “One Health” initiative promises to combine different health-related issues concerning humans and animals in an overarching concept and in related practices to the benefit of both humans and animals. Far from dismissing One Health, this paper nevertheless argues that different veterinary interventions are determined by social practices and connected expectations and are, thus, hardly compliant with only one single conceptualization of health, as the One Health concept suggests. One Health relies on a naturalistic understanding of health focusing on similar (...) bodies that show a similar etiology. However, logics, normativity, and practices exhibit differences when it comes to combatting infectious diseases, maintaining productivity of livestock animals or preventing companion animals from suffering. Therefore, drawing from Charles Rosenberg’s groundbreaking texts on framing disease, we suggest to conceive of health as dispersed in different frames. Thus, this paper proposes to interpret health as complex and multi-layered concept. We distinguish and introduce an objectivist, a functional, and a sentientistic frame of health. Instead of reducing the differential veterinary practices to one paradigmatic understanding, health is seen as a model case of Wittgenstein’s concept of family resemblance. Different and distinct perspectives on veterinary medicine show sufficient overlapping that allows for a common conceptualization, but there is not one single underlying logic suitable to understand and ethically reflect all veterinary interventions. This differentiability promises to reduce moral stress in veterinary professionals since it allows the interpretation of various, seemingly contradicting practices as dependent on multi-layered and socially determined scopes of responsibility. (shrink)

Geleneksel tıptaki büyük ilerlemelere rağmen tamamlayıcı ve alternatif tıp (TAT) uygulamaları hala yaygın olarak kullanılmaktadır. TAT, geleneksel tıbbın bir parçası olarak görülmeyen, çeşitli tıbbi ve sağlık sistemlerini ve ürünlerini içeren uygulamalardır. Bu derlemede kalp hastalıklarında sıklıkla kullanılan TAT yöntemleri, hasta ve hastalık üzerine etkilerinden bahsedilecektir.

A growing body of research emphasises the role of ‘social determinants of health’ in generating inequalities in health outcomes. How, if at all, should primary care providers respond? In this paper, I want to shed light on this issue by focusing on the role that ‘big data’ might play in allowing primary care providers to respond to the social determinants that affect individual patients’ health. The general idea has been proposed and endorsed by the Institute of Medicine, and the idea (...) has been developed in more detail by Bazemore et al.. In Bazemore et al.’s proposal, patients’ addresses are used to generate information about the patients’ neighbourhood; this information is then included in patients’ health care records and made available to providers. This allows primary care providers to take this information into account when interacting with, and providing care to, patients. I explore three issues arising from this proposal. First, while questions of privacy have been central to discussions about big data, Bazemore et al.’s proposal also allows us to see that there might be costs to not making certain information available. Second, I consider some of the questions arising for primary care from the influence of social factors on health outcomes: given that we know these factors to be significant contributors to social inequalities in health, what precisely should be done about this in the primary care context? Finally, I address problems arising from the use of population level data when dealing with individuals. (shrink)