Gender-medicine has been very successful in discovering gaps in medical knowledge, disclosing biases in earlier research, and generating new results. It has superseded a more androcentric and sexist medicine. Yet, its development should not be understood in terms of a further approximation of value-freedom. Rather, it is a case of better value-laden science due to an enhanced pluralism in medicine and society. This interpretation is based on an account of the origins of gender-medicine in the feminist (...) women’s health movement and an analysis of the debate on inclusion of women in clinical trials. Consequently, the history of gender-medicine provides support for a procedural account of objectivity that stresses the importance of a diversity of perspectives. (shrink)

In Medical Sexism: Contraception Access, Reproductive Medicine, and Health Care, Jill B. Delston uses a feminist lens to examine the overwhelmingly common gynecological practice of declining to write prescriptions for oral contraceptives unless a woman agrees to an annual Pap smear, which is used to detect precancerous changes, as well as cancer of the cervix. Employing a comprehensive evaluation of the medical literature, Delston methodically builds a strong argument that these measures not only do not follow evidence-based medical (...) guidelines, but they also carry a significant potential of harm to the patient. Furthermore, cervical cancer prevention has absolutely nothing to do with... (shrink)

Why do some doctors routinely deny birth control refills without additional tests, and why do some doctors disrespect patient autonomy in decisions about abortions, labor and delivery, organ transplants, and more? This book argues that medical sexism is a major cause of this pervasive mistreatment.

ABSTRACT: Since the invention of hormonal contraceptives, there has been disagreement between users and providers about the existence of side effects and their implications for care. The lack of consideration for cisgender women, and other people who may become pregnant, has often been explained by sexist bias in the philosophy of medicine. My goal is to contribute additional elements to this discussion. I will argue that there are structurally embedded assumptions about the responsibilities and goals of medicine that (...) open the door to this sexism in the first place. While we tend to accept that contraception is part of medicine for pragmatic reasons, we do not exhibit the same form of pragmatism when it comes to dealing with side effects. This is an unjustified double standard that fails to recognize the goals of contraception and the fact that it relies on medical expertise to achieve them. (shrink)

This chapter examines truthfulness, or veracity, in the context of health care services within prisons, jails, and detention facilities in the United States. Mainstream discussions of bioethics often highlight the general importance of veracity within the patient-provider relationship, including providers’ obligations and constraints with respect to telling the truth to their patients, and, to a lesser extent, patients’ responsibilities and concerns regarding truthful reporting to their providers. However, a great deal of this literature largely overlooks how structural barriers to health (...) care impact the functions of veracity in the provision of health care—including racist and sexist biases in clinical judgment, inadequate staffing, infrastructure, and accessibility in medical facilities, and institutionally specific constraints. Through an analysis of Assata Shakur’s political autobiography, this chapter focuses on such structural barriers to health care in carceral facilities with a focus on the institutionally specific constraints that arise through the punitive aims of carceral facilities. By focusing on the intersection between punishment and health, this chapter argues that bioethicists and clinicians alike would be better equipped to analyze structural barriers to health care that exist both within and beyond prison walls through a nonideal approach. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hypatia 16.3 (2001) 172-176 [Access article in PDF] Book Review Diagnosis: Difference: The Moral Authority of Medicine Diagnosis: Difference: The Moral Authority of Medicine. By Abby L. Wilkerson. Ithaca: Cornell University Press, 1998. In this compact volume, Abby Wilkerson makes several important contributions to the burgeoning literature of feminist (bio)ethics by providing substantive arguments in support of some of the key intuitive beliefs that are central to (...) much feminist bioethics thinking. Most centrally, she carefully fleshes out a feminist case for re-framing traditional bioethics approaches to the relation between health and justice. Particularly valuable is her richly detailed argument establishing the importance of bringing to the realm of health and health care Iris Marion Young's (1990) important insight that justice involves far more than questions of distribution.At the same time, Wilkerson demonstrates another major feminist tenet: that ethics and epistemology are intimately related. This connection is developed [End Page 172] through a second major theme in which she systematically tracks medicine's tendency to extend its accepted epistemic authority over physical ailments into a general authority over many other aspects of life. She documents examples of medicine's success in leveraging its scientific knowledge about certain aspects of the body into a broader ideological vision through which it claims epistemic authority in the personal and moral realm. By making explicit the gaps between medical knowledge and moral knowledge, she is able to challenge the moral authority and social power that are now granted to medical experts.While these arguments are important, they are not the whole story of the book, for its message is as much about process in bioethics as it is about conclusions. Wilkerson insists that the specific perspective of the theorist affects her/his reasoning. She demonstrates the importance of this fact by using her own distinct position as a bisexual woman to make visible the implicit acceptance and perpetuation of several ideological norms by those in dominant positions in both medicine and bioethics. The central method of the book is what she calls "material-semiotic." It involves the assumption that all human experience is mediated by culture, and the body (specifically the medicalized body) must be recognized as a political site subject to a variety of social values. We must, therefore, attend to the cultural meanings of health and illness and explore the ways that society labels and responds to these conditions. This requires investigation of the specific bodily (material) effects of these meanings in both individual and social experience.The book begins with the epistemological frame of the argument in which Wilkerson claims that medicine is deeply infected by the values and biases of the dominant culture, including its tendencies towards sexist, racist, classist, homophobic, and ablist attitudes. She explores ways in which medical theory and practice stigmatize bodily experiences common to women (in gynecology, obstetrics, and the treatment of victims of sexual or domestic violence). Medicalizing so many aspects of women's experience has the effect of obscuring women's subjective experiences and replacing them with medicine's normative perspectives of appropriate psychological norms. Moreover, the norm of femaleness promoted is a heterosexual, middle class, white variety such that other forms of social difference (e.g., non-white, non-heterosexual) must then also be medicalized and stigmatized; that is, the medical model requires explanations of difference that render pathological most variations on the privileged norm. Hence, alternative sexualities, like differences in class, abilities, race, and gender are interpreted through a medical lens that is thoroughly value-laden. In such ways, the epistemological authority granted to medicine is conflated into an unjustified form of moral authority. Although similar biases are common to every powerful social institution in the United States, they are especially pernicious within medicine because of the enormous influence it exerts in shaping knowledge about the nature of difference between social [End Page 173] groups. This immense social power may be directed towards reducing inequalities and promoting social justice, but, all too often, it is used to convey beliefs and norms that serve the interests of the privileged.Wilkerson's criticism is not reserved... (shrink)

The US Food and Drug Administration (FDA) is fraught with controversies over the role of values and politics in regulatory science, especially with drugs in the realm of reproductive health. Philosophers and science studies scholars have investigated the ways in which social context shapes medical knowledge through value judgments, and feminist scholars and activists have criticized sexism and injustice in reproductive medicine. Nonetheless, there has been no systematic study of values and gender norms in FDA drug regulation. I (...) focus on three questions about values in regulatory science. First, how have societal values and gender norms shaped the way that the FDA regulates drugs in the realm of reproductive health, specifically with drug labels? Second, what are the ethical, epistemic, and social consequences of these influences on regulation for women and other marginalized groups? Third, which societal values and gender norms ought to influence drug regulation about reproductive health, and how ought this happen? Integrating philosophical analysis with historical archival research and in-depth interviews, I conduct three case studies of drug labeling about reproductive health: (1) the “drug fact” about the mechanism of the morning-after pill; (2) the package inserts for patients about the health risks of oral contraceptives; and (3) the special physician labels made for prescribing drugs to pregnant women. I identify three challenges for the FDA and suggest ways to reduce the influence of sexist values and facilitate feminist alternatives. First, across these cases, I have found that there are many ways in which other concerns in reproductive medicine (such as zygotic life, fetal health, and population control) have devalued women’s health. Second, both knowledge and ignorance xvi about their reproductive health have contributed to women’s oppression, especially poor women and women of color. Finally, by avoiding the epistemic dimensions of ethics, powerful, mostly male parties in medicine (such as doctors, pharmaceutical companies, and religious institutions) have misused “informed consent,” “religious freedom,” and “paternalism” for unethical purposes. For improvement, I suggest extracting sexist values and gender norms from regulatory science that cause epistemic injustices, and I point to success stories for reforming sexism with feminism at the FDA. (shrink)

Culver and Gert define ‘malady’ in their book Philosophy in Medicine. It is shown that this definition is sexist in its implication in that it either indirectly contributes to women's oppression or indirectly supports a policy that discriminates against women. This is because, on Culver and Gert's definition of ‘malady’, menopause, menstruation, and pregnancy become maladies. It is also argued that malady claims are normative in a way not recognized by Culver and Gert. Keywords: malady and/or disease, menopause, (...) class='Hi'>sexism, definition, menstruation, pregnancy CiteULike Connotea Del.icio.us What's this? (shrink)

The body is a rich object for aesthetic inquiry. We aesthetically assess both our own bodies and those of others, and our felt bodily experiences have aesthetic qualities. The body features centrally in aesthetic experiences of visual art, theatre, dance and sports. It is also deeply intertwined with one's identity and sense of self. Artistic and media representations shape how we see and engage with bodies, with consequences both personal and political. This volume contains sixteen original essays by contributors in (...) philosophy, sociology, dance, disability theory, critical race studies, feminist theory, medicine, and law. They explore bodily beauty, sexual attractiveness, the role of images in power relations, the distinct aesthetics of disabled bodies, the construction of national identity, the creation of compassion through bodily presence, the role of bodily style in moral comportment, and the somatic aesthetics of racialized police violence. -/- Contents: Maria del Guadalupe Davidson, "Black Silhouettes on White Walls: Kara Walker’s Magic Lantern"; A. W. Eaton, "Taste in Bodies and Fat Oppression"; C. Winter Han, "From 'Little Brown Brothers' to 'Queer Asian Wives': Constructing the Asian Male Body"; Deborah L. Rhode, "Appearance as a Feminist Issue"; Shirley Anne Tate, "A Tale of Two Olympians—Beauty, 'Race,' Nation"; Glenn Parsons, "The Merrickites"; Stephen Davies, "And Everything Nice"; Tobin Siebers, "In/Visible: Disability on the Stage"; Jill Sigman, "Live, Body-Based Performance: An Account from the Field"; Barbara Gail Montero, "Aesthetic Effortlessness"; Peg Brand Weiser and Edward B. Weiser, "Misleading Aesthetic Norms of Beauty: Perceptual Sexism in Elite Women's Sports"; Yuriko Saito, "Body Aesthetics and the Cultivation of Moral Virtues"; George Yancy, "White Embodied Gazing, the Black Body as Disgust, and the Aesthetics of Un-Suturing"; Richard Shusterman, "Somaesthetics and the Fine Art of Eating"; Ann J. Cahill, "Sexual Desire, Inequality, and the Possibility of Transformation"; Sheila Lintott and Sherri Irvin, "Sex Objects and Sexy Subjects: A Feminist Reclamation of Sexiness" -/- . (shrink)

Although more women continue to enter the medical profession, disparities between the sexes in academic medicine persist. This “gender gap” has implications for academic advancement. In 2006, Jagsi and colleagues reported that, although the proportion of women among first and last authors in the United States had significantly increased since 1970, women still represented a minority of the authors of original research and guest editorials in six prominent medical journals.1 In a related 2008 study, Jagsi and colleagues found a (...) substantial increase in women’s representation on editorial boards and as editors-in-chief of several prominent journals.2 We collected more recent data about the gender distribution of authors, members of editorial boards, and peer reviewers for prominent medical journals. Using data from 2010-2011, we determined the proportion of women who were authors of original research or guest editorials, members of editorial boards, or reviewers at six major general medical journals: the Annals of Internal Medicine (Ann Intern Med), the British Medical Journal (BMJ), JAMA, JAMA Internal Medicine, the Lancet, and the New England Journal of Medicine (NEJM). (shrink)

We agree with McCullough, Coverdale and Chervenak1 that ‘medical educators and academic leaders are in a pivotal and powerful position to role model’ to counter ‘incivility’ in medicine, which can include ‘dismissing’ or ‘demeaning others’. They note that ‘women may be at greater risk for experiencing incivility compared with men’, as may other individuals who experience ‘patterns of disrespect based on minority status’. The authors promote ‘professionalism’ and ‘etiquette’ to foster civility within medicine. Yet theory and experience suggest (...) that medical educators and academic leaders are also in powerful positions to mobilise these concepts to perpetuate exclusions from, and biases within, medicine, upholding racist, sexist and ableist norms. Feminist methodology reveals how ethical theorising historically excluded views and experiences of marginalised individuals and groups and provides frameworks for interrogating supposedly universal norms. Presuming dominant values and experiences reflect universal ones can further marginalise already oppressed groups and individuals. A feminist analysis reveals how ‘professionalism’ or ‘etiquette’ are historically shaped by white or male identity and experience, including norms of attire, hair, accessories, speech or behaviour. Part of the hidden curriculum of medicine becomes intuiting how leaders implicitly or explicitly define ‘professionalism’. McCullough et al define ‘professionalism’ in medicine as ‘sustained commitments to scientific and clinical excellence… making the protection and promotion of health-related interest the physician’s primary concern …. (shrink)

This book is a comprehensive and unique text and reference in medical ethics. By far the most inclusive set of primary documents and articles in the field ever published, it contains over 100 selections. Virtually all pieces appear in their entirety, and a significant number would be difficult to obtain elsewhere. The volume draws upon the literature of history, medicine, philosophical and religious ethics, economics, and sociology. A wide range of topics and issues are covered, such as law and (...) medicine, truth-telling by the physician, research, population policy, genetics, abortion, dying, and individual rights in medical care. The selections span the centuries, beginning with material from the works of Hippocrates, continuing through Thomas Percival, John Stuart Mill, and Claude Bernard, down to modern commentators like Henry K. Beecher, Walsh McDermott, David L. Bazelon, Paul Freund, H. L. A. Hart, John Rawls, Paul Ramsey, Richard McCormick, Rashi Fein, and Bernard Barber. The text has eight major divisions, beginning with sections on the ethical dimensions of the physician-patient relationship in history; the moral bases of medical ethics; and regulation, compulsion, and protection of the consumer in clinical medicine and public health. Each of these sections includes key essays that appear for the first time. All of the book's major divisions contain primary documents: codes such as the Hippocratic Oath, Medieval Law for the Regulation of Medicine, and the first as well as the most recent code of the American Medical Association; court decisions, including those on Karen Quinlan and on abortion in the United States and West Germany; government documents such as the statement of the National Commission on the Protection of Human Subjects, the Tuskegee Syphilis Report, the British Parliamentary debate on euthanasia, and the Council of Europe on rights of the sick and dying; and various published guidelines such as the Harvard Medical School brain death criteria, the American Hospital Association on patient's rights, and Pope Pius XII on the prolongation of life. Cases that illustrate moral dilemmas are provided for discussion purposes. Each section is preceded by a succinct editor's introduction. The documents and essays are of practical value for practitioners and students in medicine, law, ethics, and counselling, and for individual patients and groups concerned with medical care. Through encompassing divergent viewpoints, the essays and primary documents were selected to encourage humane practices and deepen understanding of the multiple traditions that shaped and do shape the development of medicine. (shrink)

Intuition in medical and moral reasoning -- Moral intuitionism -- The place of Aristotelian phronesis in clinical reasoning -- Aristotle's practical syllogism: accounting for the individual through a theory of action and cognition -- Individual and statistical physiognomy: the art and science of making the invisible visible -- Clinical intuition versus statistical reasoning -- Contingency and correlation: the significance of modeling clinical reasoning on statistics -- Abduction: the intuitive support of clinical induction -- Conclusion: medical ethics beyond ontology.

This volume introduces readers to the main philosophical issues of measurement in medicine, illustrating the connections between the natural and social sciences by integrating essays on causation, measuring instruments and issues of measurement and policy.

Battle Hall Davies' brother Nick ran away from home when she was in high school. Now he has found her and she is going to stay with him for the summer before starting college. Battle discovers that neither she nor her brother is the person she thought they were.

It is surely obvious that medicine, like any other rational activity, must be based on evidence. The interest is in the details: how exactly are the general principles of the logic of evidence to be applied in medicine? Focussing on the development, and current claims of the ‘Evidence-Based Medicine’ movement, this article raises a number of difficulties with the rationales that have been supplied in particular for the ‘evidence hierarchy’ and for the very special role within that (...) hierarchy of randomized controlled trials (and meta-analyses of the results of randomized controlled trials). The point is not at all to question the application of a scientific approach to evidence in medicine, but, on the contrary, to indicate a number of areas where philosophers of science can contribute to a proper implementation of exactly that scientific-evidential approach. (shrink)

Loneliness in medicine is a serious problem not just for patients, for whom illness is intrinsically isolating, but also for physicians in the contemporary condition of medicine. We explore this problem by investigating the ideal physician-patient relationship, whose analogy with friendship has held enduring normative appeal. Drawing from Talbot Brewer and Nir Ben-Moshe, we argue that this appeal lies in a dynamic form of companionship incompatible with static models of friendship-like physician-patient relationships: a mutual refinement of embodied virtue (...) that draws both persons together. The ideal physician-patient relationship has a dialectical character that fosters each member's improvement of phenomenologically recognizing and embodying moral virtues. A key component of this dynamic is a commitment to the common goal of the patient's health, realized through joint interactivities and conversations over time. The physician's presence to the patient's suffering—understood best as an alienating phenomenological condition for the patient—orients and discloses possibilities for virtuous caregiving by structuring the meanings of the goals, conversations, and joint narrative constitutive of their relationship. Presence to suffering, paradoxically, is perhaps an important prerequisite for this dynamic partnership. These activities dialectically build an interpretive horizon of understanding through which moral goods and character refinement—in and for the other—may become revealed for both persons in their shared being-in-the-world. This analysis of suffering, mood, and revealing of (possible) moral goods has implications for addressing the modern problem of loneliness for patients and physicians, who are increasingly inhibited from building flourishing relationships with each other. (shrink)

In this chapter, we consider ethical and philosophical aspects of trust in the practice of medicine. We focus on trust within the patient-physician relationship, trust and professionalism, and trust in Western (allopathic) institutions of medicine and medical research. Philosophical approaches to trust contain important insights into medicine as an ethical and social practice. In what follows we explain several philosophical approaches and discuss their strengths and weaknesses in this context. We also highlight some relevant empirical work in (...) the section on trust in the institutions of medicine. It is hoped that the approaches discussed here can be extended to nursing and other topics in the philosophy of medicine. (shrink)

Ethical questions in medicine have become common topics of discussion during the past twenty years. Bitter disputes have arisen regarding abortion, suicide, human experimentation, as well as the management of the dying patient and the severely disabled newborn. These issues are loaded with such emotion that it is sometimes difficult to look at them in a rational manner. Noted neurosurgeon and author Milton D. Heifetz has made the tough decisions in tragic, often anguishing situations. As a member of hospital (...) ethics committees for many years, Dr. Heifetz found that discussions of complex issuesmany involving urgent matters of life and deathwere all too often clouded by tradition, dogma, and gut reactions. A comprehensive moral foundation with the flexibility to respond to often rapidly changing circumstances is desperately needed if health-care professionals are to confront head-on the daily questions of medical ethics. Dr. Heifetz offers this moral grounding to help all who must make difficult medical choices: physicians, nurses, patients, families, and policy makers struggling to develop substantive rules for medical conduct. (shrink)

Despite legislation and public education, racism and sexism are alive and well. Though pre‐conceptive gender selection may enhance procreative liberty, this technology presents two disturbing questions. First, does sex selection represent underlying parental sexism? Second, by performing gender selection, do medical professionals perpetuate sexism? It will be maintained that pre‐conceptive sex selection is sexist as it reflects parental anticipation of stereotypical gender based behavior. Perhaps even more incriminating, sex selection forces parents to prefer one sex over another, (...) to place a value on gender. This emphasis on sex conflicts with societal goals which urge, and often legally require, individuals to ignore gender. We will assert that pre‐conceptive gender selection exemplifies sexism in its purest most blatant form as prior to conception, before parents can possibly know anything about their child, gender dominates the calculus of a child’s worth. We will also emphasize that physicians, by facilitating sex selection, legitimize the motivations of their patients and provide de facto support of sexism. In a similar vein, arguments against pre‐conceptive race selection will be made. (shrink)

While gender and race often are considered socially constructed, this book argues that they are physiologically constituted through the biopsychosocial effects of sexism and racism. This means that to be fully successful, critical philosophy of race and feminist philosophy need to examine not only the financial, legal, political and other forms of racist and sexism oppression, but also their physiological operations. Examining a complex tangle of affects, emotions, knowledge, and privilege, The Physiology of Sexist and Racist Oppression develops (...) an understanding of the human body whose unconscious habits are biological. On this account, affect and emotion are thoroughly somatic, not something "mental" or extra-biological layered on top of the body. They also are interpersonal, social, and can be transactionally transmitted between people.Ranging from the stomach and the gut to the hips and the heart, from autoimmune diseases to epigenetic markers, Sullivan demonstrates the gastrointestinal effects of sexual abuse that disproportionately affect women, often manifesting as IBS, Crohn's disease, or similar functional disorders. She also explores the transgenerational effects of racism via epigenetic changes in African American women, who experience much higher pre-term birth rates than white women do, and she reveals the unjust benefits for heart health experienced by white people as a result of their racial privilege. Finally, developing the notion of a physiological therapy that doesn't prioritize bringing unconscious habits to conscious awareness, Sullivan closes with a double-barreled approach for both working for institutional change and transforming biologically unconscious habits. The Physiology of Sexist and Racist Oppression skillfully combines feminist and critical philosophy of race with the biological and health sciences. The result is a critical physiology of race and gender that offers new strategies for fighting male and white privilege. (shrink)

This study investigates the reactions of graduate students to perceived gender bias in their classes, using survey data from 254 social science graduate students in seven Ph.D.-granting departments in three universities. In addition to summarizing reported rates of gender-biased behavior in classrooms, we test hypotheses connecting perceptions of sexist behavior with students' emotional reactions, levels of distraction, and subsequent performance. Results are mixed, depending on students' perceptions of professors as either sensitive or insensitive to gender issues. Second, we use a (...) model of social influence to test for negative effects of reported sexist behavior on students' perceptions of professors' expertness, attractiveness, and trustworthiness. Strong support is demonstrated for these hypotheses. (shrink)

Over the past decades, public trust in medical professionals has steadily declined. This decline of trust and its replacement by ever tighter regulations is increasingly frustrating physicians. However, most discussions of trust are either abstract philosophical discussions or social science investigations not easily accessible to clinicians. The authors, one a surgeon-turned-philosopher, the other an analytical philosopher working in medical ethics, joined their expertise to write a book which straddles the gap between the practical and theoretical. Using an approach grounded in (...) the methods of conceptual analysis found in analytical philosophy which also draws from approaches to medical diagnosis, the authors have conceived an internally coherent and comprehensive definition of trust to help elucidate the concept and explain its decline in the medical context. This book should appeal to all interested in the ongoing debate about the decline of trust - be it as medical professionals, medical ethicists, medical lawyers, or philosophers. (shrink)

Trust is a core feature of the physician-patient relationship, and risk is central to trust. Patients take risks when they trust their providers to care for them effectively and appropriately. Not all patients take these risks: some medical relationships are marked by mistrust and suspicion. Empirical evidence suggests that some patients and families of color in the United States may be more likely to mistrust their providers and to be suspicious of specific medical practices and institutions. Given both historical and (...) ongoing oppression and injustice in American medical institutions, such mistrust can be apt. Yet it can also frustrate patient care, leading to family and provider distress. In this paper, I propose one way that providers might work to reestablish trust by taking risks in signaling their own trustworthiness. This interpersonal step is not meant to replace efforts to remedy systemic injustice, but is an immediate measure for addressing mistrust in occurrent cases. (shrink)

This paper aims to clarify the nature of understanding in medicine. The first part describes in more detail what it means to understand something and links a type of understanding (i.e., objectual understanding) to explanations. The second part proceeds to investigate what objectual understanding of a disease (i.e., biomedical understanding) requires by considering the case of scurvy from the history of medicine. The main hypothesis is that grasping a mechanistic explanation of a condition is necessary for a biomedical (...) understanding of that condition. The third part of the paper argues that biomedical understanding is necessary, but not sufficient for understanding in a clinical context (i.e., clinical understanding). The hypothesis is that clinical understanding combines biomedical understanding of a _disease_ or pathological condition with understanding _illness,_ which involves some degree of personal understanding of the patient. It is argued that, in many cases, clinical understanding necessitates adopting a particular second-personal stance and using cognitive resources _in addition_ to those involved in biomedical understanding. (shrink)

What is considered normal determines clinical practice in medicine and has implications at an individual level, doctor-patient relationship and health care policies. With the increase in medical information and technical abilities it is urgent to have a clear concept of normality in medicine so that crucial discussions can be held with unequivocal terms.The different meanings for normality were analyzed throughout the literature and grouped according to their relevance in the academic community in models, namely the Biostatistical Theory (BST), (...) Health, Ideal, Process and Biological advantage. The BST is the most established naturalistic approach, however normal variability can arguably constitute a problem. Health is similar and raises the question of setting the boundaries of pathology. Normality as an Ideal is an useful tool but is naturally unrealistic. As a Process it is comprehensible but is hard to frame for practical purposes. If considered as a Biological Advantage, seems intuitive but abnormality should tend to disappear.After, three examples were presented to discuss these models. They were Anemia, Psychiatric diseases and Psychopathy. In the case of Anemia the BST was applied and the arbitrary boundaries but with social impact were exposed. Psychiatric diseases was discussed under the process of self-organization and non-suffering ideal. With Psychopathy the boundaries of biological advantage are questioned.This review appeals to the importance of redesigning of the concept of normality in medicine according to current times and stresses the importance of integrating concepts such as variability and autonomy. (shrink)

The paper contains pedagogical suggestions for addressing issues of racism and sexism in the classroom, in the context of an introductory philosophy survey. It draws on the ideas of Charles Mills, Laurence Thomas, Peggy McIntosh and others.

Table of Contents I. WHO ARE THE SCIENTISTS? Historically. Women in the Origins of Modern Science, Londa Schiebinger. Women of Third World Descent in the Sciences, Sandra Harding. Recently. Women in Science: Half In Half Out, Vivian Gornick.”How Can a Little Girl Like You Teach a Great Big Class of Men?’ the Chairman Said, and Other Adventures of a Woman in Science, Naomi Weisstein. The Anomaly of a Woman in Physics, Evelyn Fox Keller. Currently. Women Join the Ranks of Science (...) but Remain Invisible at the Top, Natalie Angier. Creeping Toward Inclusivity in Science, Phyllis Goldberg. II. WHAT KIND OF ENTERPRISE IS SCIENCE? Science’s Aims, Methods, and Norms of Behavior. Patriarchy, Scientists, and Nuclear Warriors, Brian Easlea. Culturally Inclusive Chemistry, Catherine Hurt Middlecamp. A World of Difference, Evelyn Fox Keller. Interviewing Women: A Contradiction in Terms, Ann Oakley. Science’s Subject Matter. Have Only Men Evolved?, Ruth Hubbard. Empathy, Polyandry, and the Myth of the Coy Female, Sarah Blaffer Hrdy. The Importance of Feminist Critique for Contemporary Cell Biology, The Biology and Gender Study Group. The Engendering of Archaeology: Refiguring Feminist Science Studies, Alison Wylie. Still Seeking Transformation: Feminist Challenges to Psychology, Sue Wilkinson. Science’s Social Effects. Androcentric Bias in Clinical Research, Sue Rosser. Man-Made Medicine and Women’s Health, Nancy Krieger and Elizabeth Fee. The New Procreative Technologies, Ruth Hubbard. A Question of Genius: Are Men Really Smarter Than Women?, Anne Fausto-Sterling. III. WHAT KIND OF ENTERPRISE OUGHT SCIENCE TO BE? Feminist Empiricism. Subjects, Power, and Knowledge: Description and Prescription in Feminist Philosophies of Science, Helen Longino. Epistemological Communities, Lynn Hankinson Nelson. Feminist Standpoint Theory. ”Strong Objectivity’: A Response to the New Objectivity Question, Sandra Harding. Introduction to Tomorrow’s Tomorrow: The Black Woman, Joyce Ladner. Feminist Postmodernism. Situated Knowledges: The Science Question in Feminism and the Privilege of Partial Perspective, Donna Haraway. Though This Be Method, Yet There Is Madness in It: Paranoia and Liberal Epistemology, Naomi Scheman. (shrink)

Trust relations in medicine are argued to be a requisite response to the special vulnerability of persons as patients. Even so, the problem of motivating trust remains a vital concern. On this score, it is argued that a strong motivation can be found in recognizing that professional self-interest actually entails cultivation of patient trust as a means to maintain professional self-governance. And while the initial move to restore trust must be provoked from such narrow concerns, the process of sustaining (...) trust will require educational initiatives aimed at restoring attitudes and skills suggestive of Percival's concept of empathic care. By including such initiatives, future waves of medical professionals are apt to sustain trust with deepened commitments to character, care, and trust as constitutive properties of their professional mission. (shrink)

In this chapter, we consider ethical and philosophical aspects of trust in the practice of medicine. We focus on trust within the patient-physician relationship, trust and professionalism, and trust in Western (allopathic) institutions of medicine and medical research. Philosophical approaches to trust contain important insights into medicine as an ethical and social practice. In what follows we explain several philosophical approaches and discuss their strengths and weaknesses in this context. We also highlight some relevant empirical work in (...) the section on trust in the institutions of medicine. It is hoped that the approaches discussed here can be extended to nursing and other topics in the philosophy of medicine. (shrink)

The use of evidence in medicine is something we should continuously seek to improve. This book seeks to develop our understanding of evidence of mechanism in evaluating evidence in medicine, public health, and social care; and also offers tools to help implement improved assessment of evidence of mechanism in practice. In this way, the book offers a bridge between more theoretical and conceptual insights and worries about evidence of mechanism and practical means to fit the results into evidence (...) assessment procedures. (shrink)

In this thesis, I give a metascientific account of causality in medicine. I begin with two historical cases of causal discovery. These are the discovery of the causation of Burkitt’s lymphoma by the Epstein-Barr virus, and of the various viral causes suggested for cervical cancer. These historical cases then support a philosophical discussion of causality in medicine. This begins with an introduction to the Russo- Williamson thesis (RWT), and discussion of a range of counter-arguments against it. Despite these, (...) I argue that the RWT is historically workable, given a small number of modifications. I then expand Russo and Williamson’s account. I first develop their suggestion that causal relationships in medicine require some kind of evidence of mechanism. I begin with a number of accounts of mechanisms and produce a range of consensus features of them. I then develop this consensus position by reference to the two historical case studies with an eye to their operational competence. In particular, I suggest that it is mechanistic models and their representations which we are concerned with in medicine, rather than the mechanism as it exists in the world. -/- I then employ these mechanistic models to give an account of the sorts of evidence used in formulating and evaluating causal claims. Again, I use the two human viral oncogenesis cases to give this account. I characterise and distinguish evidence of mechanism from evidence of difference-making, and relate this to mechanistic models. I then suggest the relationship between types of evidence presents us with a means of tackling the reference-class problem. This sets the scene for the final chapter. Here, I suggest the manner in which these two different classes of evidence become integrated is also reflected in the way that developing research programmes change as their associated causal claims develop. (shrink)

Are police officers morally justified in issuing unsolicited personal safety advice to women? Such advice often attracts accusations of ‘victim blaming’, although prevention advice remains a common tool used by police to address many crime and safety risks. While some examples of police advice are clearly outrageous, this article considers whether there is a place for ‘sound’ advice, i.e., advice that is proportionate, easy to follow, empirically justified, and objectively likely to reduce harm. To explore this, the article proposes a (...) thought experiment that compares safety advice dealing with threats to women from human sources with safety advice issued in response to natural phenomena, such as flooding. It argues that, despite apparent differences, safety advice addressing risks from humans and natural phenomena are relevantly similar. Consequently, if advice dealing with natural phenomena is morally justified then advice to women about human threats is also morally justifiable. Nevertheless, the article also considers whether the purported prevalence of sexism in policing may make safety advice for women morally problematic. While levels of sexism in policing may vary across time and location, it is argued that safety advice would be morally justified even if sexism was widespread among police officers. Finally, the article considers whether crime prevention advice may backfire by effectively curtailing women’s freedoms. Rather than curtailing freedom, however, it is argued that sound advice may actually enable women to flourish by helping them overcome fear of crime and achieve non-instrumental goals that they have set for themselves. (shrink)

Rationale: In this article, I argue that we need a new perspective in the debate on autonomy in medicine, to understand many of the problems we face today – dilemmas that are situated at the intersection of autonomy and heteronomy, such as why well informed and autonomous people make unhealthy lifestyle choices. If people do not choose what they want, this is not simply caused by their lack of character or capability, but also by the fact that absolute autonomy (...) is impossible; autonomous individuals are ‘contaminated’ by heteronymous aspects, by influences from ‘outside’. Consequently, there are many good reasons to question the widely accepted hierarchical opposition of autonomy (progress) versus heteronomy (paternalism) in medicine. In an earlier article an analysis is made of the neologism ‘oughtonomy’ to support the thesis that when it comes down to human existence, autonomy and heteronomy are intertwined, rather than being merely opposites. Methods: In this article, I reflect upon how social conditions might improve our ‘choice architecture’, what Thaler & Sunstein have called ‘nudging’: how to change individual health choices without being paternalistic? I explore the extent to which both oughtonomy and nudging are able to challenge the question of autonomy in today’s medicine. Results and Conclusions: Autonomy may and should be a shared target in today’s medicine, but we should never forget that it is always intertwined with heteronomy. Starting from this perspective, progress in medicine demands far more than the increase of autonomy. (shrink)

This paper aims to clarify the nature of understanding in medicine. The first part describes in more detail what it means to understand something and links a type of understanding (i.e., objectual understanding) to explanations. The second part proceeds to investigate what objectual understanding of a disease (i.e., biomedical understanding) requires by considering the case of scurvy from the history of medi- cine. The main hypothesis is that grasping a mechanistic explanation of a condi- tion is necessary for a (...) biomedical understanding of that condition. The third part of the paper argues that biomedical understanding is necessary, but not sufficient for understanding in a clinical context (i.e., clinical understanding). The hypothe- sis is that clinical understanding combines biomedical understanding of a disease or pathological condition with understanding illness, which involves some degree of personal understanding of the patient. It is argued that, in many cases, clinical understanding necessitates adopting a particular second-personal stance and using cognitive resources in addition to those involved in biomedical understanding. (shrink)

The article provides an overview of important topics in contemporary medical ethics. Methodologically, it is a literature review. The article addresses only a limited selection of the problematic areas, which are, however, related to each other: digitisation of medicine, genome editing, personalised medicine as well as ethical problems and dilemmas of allocation in healthcare. The global COVID-19 pandemic has emerged as a focus and trigger. Reflections on human rights and justice in medicine are fundamental not only on (...) the individual and social level but also on a global scale. The fundamental question is how society as a whole can be involved in the complex biopolitical and bioethical debate. The social and cultural consequences of life increasingly being understood as a technical product rather than a gift are serious.Contribution: The article also reflects on the specific contribution that Christian theology, and in particular the reformed heritage, can make to bioethical debates in modern society. The distinction between instrumental knowledge [Verfügungswissen] and orientational knowledge [Orientierungswissen] is helpful for its better understanding. A crucial result of this article is that medical treatment is repeatedly faced with ethical dilemmas. Moreover, medical progress not only creates new and better solutions to medical problems, it also raises new ethical questions that did not exist before. The purpose of medical ethics lies in identifying such dilemmas and developing ethical decision-making processes that help us to deal with such dilemmas to some extent. (shrink)

This book involves an in-depth analysis of the ethical, political and philosophical issues related to health-oriented screening programs.

This article investigates five kinds of vagueness in medicine: disciplinary, ontological, conceptual, epistemic, and vagueness with respect to descriptive-prescriptive connections. First, medicine is a discipline with unclear borders, as it builds on a wide range of other disciplines and subjects. Second, medicine deals with many indistinct phenomena resulting in borderline cases. Third, medicine uses a variety of vague concepts, making it unclear which situations, conditions, and processes that fall under them. Fourth, medicine is based on (...) and produces uncertain knowledge and evidence. Fifth, vagueness emerges in medicine as a result of a wide range of fact-value-interactions. The various kinds of vagueness in medicine can explain many of the basic challenges of modern medicine, such as overdiagnosis, underdiagnosis, and medicalization. Even more, it illustrates how complex and challenging the field of medicine is, but also how important contributions from the philosophy can be for the practice of medicine. By clarifying and, where possible, reducing or limiting vagueness, philosophy can help improving care. Reducing the various types of vagueness can improve clinical decision-making, informing individuals, and health policy making. (shrink)

Thomson that the mother would not be morally obliged to consent to the surgery. At any rate, if she refused, she would not have killed the foetus. ...

Intuition is frequently used in medicine. Along with the use of existing medical rules, there is a separate channel that physicians rely on when making decisions: their intuition. To cope with the epistemic problem of using intuition, I use some clues from Wittgenstein's philosophy to illuminate the decision-making process in medicine. First, I point to a connection between intuition as functioning in medicine and Wittgenstein's notions of "seeing as" or noticing "aspects". Secondly, I use Wittgenstein notion of (...) empirical regularities hardened into rules to suggest that there are two stages that should be addressed in the analysis of medical practice: the first concerns the accumulation of cases and the second pertains to the setting a rule based on these cases. I argue further that the medical context is exceptional in that the two stages are intertwined and, and explain the consequences of this fact for the physician's work. Finally, inspired by Wittgenstein's rule-following conundrum, I argue that medicine is particularly prone to difficulties in applying a general rule to a specific case represented by an individual patient. Recourse to intuition is reflects the physicians' efforts to bridge this gap. (shrink)

The article presents specific recommendations for the examination of AI systems in medicine developed by the authors. The recommendations based on the problems, risks and limitations of the use of AI identified in scientific and philosophical publications of 2019-2022. It is proposed to carry out ethical expertise of projects of medical AI, by analogy with the review of projects of experimental activities in biomedicine; to conduct an ethical review of AI systems at the stage of preparation for their development (...) followed by monitoring the testing of the created system; to focus on bioethical principles during the examination of AI systems for medical purposes. (shrink)