Increasingly, contemporary medical ethicists have become aware of the need to explicate a foundation for their various models of applied ethics. Many of these theories are inspired by the apparent incompatibility of patient autonomy and provider beneficence. The principle of patient autonomy derives its current primacy to a large extent from its legal origins. However, this principle seems at odds with the clinical reality. In the bioethical literature, the notion of authenticity has been proposed as an alternative foundational principle to (...) autonomy. This article examines this proposal in reference to various existentialist philosophers (Heidegger, Sartre, Camus and Marcel). It is concluded that the principle of autonomy fails to do what it is commonly supposed to do: provide a criterion of distinction that can be invoked to settle moral controversies between patients and providers. The existentialist concept of authenticity is more promising in at least one crucial respect: It acknowledges that the essence of human life disappears from sight if life's temporal character is reduced to a series of present decisions and actions. This also implies that the very quest for a criterion that allows physicians to distinguish between sudden, unexpected decisions of their patients to be or not to be respected, without recourse to the patient's past or future, is erroneous. (shrink)
This article provides a summary overview of the ideas on medical anthropology and anthropological medicine of the German philosopher-psychiatrist Viktor Emil von Gebsattel (1883–1974), and discusses in more detail his views on the doctor-patient relationship. It is argued that Von Gebsattel''s warning against a dehumanization of medicine when the person of both patient and physician are not explicitly present in their relationship remains valid notwithstanding the modern emphasis on respect for patient (and provider) autonomy.
In order to protect patients against medical paternalism, patients have been granted the right to respect of their autonomy. This right is operationalized first and foremost through the phenomenon of informed consent. If the patient withholds consent, medical treatment, including life-saving treatment, may not be provided. However, there is one proviso: The patient must be competent to realize his autonomy and reach a decision about his own care that reflects that autonomy. Since one of the most important patient rights hinges (...) on the patient's competence, it is crucially important that patient decision making incompetence is clearly defined and can be diagnosed with the greatest possible degree of sensitivity and, even more important, specificity. Unfortunately, the reality is quite different. There is little consensus in the scientific literature and even less among clinicians and in the law as to what competence exactly means, let alone how it can be diagnosed reliably. And yet, patients are deemed incompetent on a daily basis, losing the right to respect of their autonomy. In this article, we set out to fill that hiatus by beginning at the very beginning, the literal meaning of the term competence. We suggest a generic definition of competence and derive four necessary conditions of competence. We then transpose this definition to the health care context and discuss patient decision making competence. (shrink)
The legalization of euthanasia, both in the Netherlands and in other countries is usually justified in reference to the right to autonomy of patients. Utilizing recent Dutch jurisprudence, this article intends to show that the judicial proceedings on euthanasia in the Netherlands have not so much enhanced the autonomy of patients, as the autonomy of the medical profession. Keywords: allowing to die, criminal law, euthanasia, law enforcement, legal aspects, legislation, medical ethics, medical profession, self determination, the Netherlands, voluntary euthanasia, withholding (...) treatment CiteULike Connotea Del.icio.us What's this? (shrink)
This paper seeks to define and delimit the scope of the social responsibilities of health professionals in reference to the concept of a social contract. While drawing on both historical data and current empirical information, this paper will primarily proceed analytically and examine the theoretical feasibility of deriving social responsibilities from the phenomenon of professionalism via the concept of a social contract.
In the literature three mechanisms are commonly distinguished to make decisions about the care of incompetent patients: A living will, a substituted judgment by a surrogate (who may or may not hold the power of attorney ), and a best interest judgment. Almost universally, the third mechanism is deemed the worst possible of the three, to be invoked only when the former two are unavailable. In this article, I argue in favor of best interest judgments. The evermore common aversion of (...) best interest judgments entails a risk that health care providers withdraw from the decision-making process, abandoning patients (or their family members) to these most difficult of decisions about life and death. My approach in this article is primarily negative, that is, I criticize the alleged superiority of the living will and substituted judgment. The latter two mechanisms gain their alleged superiority because they are supposedly morally neutral, whereas the best interest judgment entails a value judgment on behalf of the patient. I argue that on closer inspection living wills and substituted judgments are not morally neutral; indeed, they generally rely on best interest judgments, even if those are not made explicit. (shrink)
This article examines whether cosmetic interventions by dentists and plastic surgeons are medically indicated and, hence, qualify as medical interventions proper. Cosmetic interventions (and the business strategies used to market them) are often frowned upon by dentists and physicians. However, if those interventions do not qualify as medical interventions proper, they should not be evaluated using medical-ethical norms. On the other hand, if they are to be considered medical practice proper, the medical-ethical principles of nonmaleficence, beneficence, justice and others hold (...) true for cosmetic interventions as much as they do for other medical and dental interventions. It is concluded that most cosmetic interventions do not qualify as medical interventions proper because they do not restore or maintain the patient's health (defined as the patient's integrity) by any objective standards. Rather, cosmetic interventions are intended to enhance a person's physical appearance; more specifically, they intend to fulfill the client's subjective perception of an enhanced appearance. (shrink)
In this article, I argue that the relationship between patients and their health care providers need not be construed as a contract between moral strangers. Contrary to the (American) legal presumption that health care providers are not obligated to assist others in need unless the latter are already contracted patients of record, I submit that the presence of a suffering human being constitutes an immediate moral commandment to try to relieve such suffering. This thesis is developed in reference to the (...) French philosopher Levinas and the Dutch theologian Schillebeeckx. An expanded version of the biblical parable of the Good Samaritan serves as test case. (shrink)
BackgroundThe interRAI 0–3 Early Years was recently developed to support intervention efforts based on the needs of young children and their families. One aspect of child development assessed by the Early Years instrument are motor skills, which are integral for the maturity of cognition, language, social-emotional and other developmental outcomes. Gross motor development, however, is negatively impacted by pre-term birth and low birth weight. For the purpose of known-groups validation, an at-risk sample of preterm children using the interRAI 0–3 Early (...) Years was included to examine correlates of preterm risk and the degree of gross motor delay.MethodsParticipant data included children and families from 17 health agencies in Ontario, Canada. Data were collected as part of a pilot study using the full interRAI 0–3 Early Years assessment. Correlational analyses were used to determine relationships between prenatal risk and preterm birth and bivariate analyses examined successful and failed performance of at-risk children on gross motor items. A Kruskal-Wallis test was used to determine the mean difference in gross motor scores for children born at various weeks gestation.ResultsCorrelational analysis indicated that prenatal and perinatal factors such as maternal nicotine use during pregnancy did not have significant influence over gross motor achievement for the full sample, however, gross motor scores were lower for children born pre-term or low birth weight based on bivariate analysis. Gross motor scores decreased from 40 weeks’ gestation, to moderate to late preterm, and to very preterm, however extremely preterm performed comparably to very preterm.InterpretationThe interRAI 0–3 was evaluated to determine its efficacy and report findings which confirm the literature regarding delay in gross motor performance for preterm children. Findings confirm that pre-term and low birth weight children are at greater risk for motor delay via the interRAI 0–3 Early Years gross motor domain. (shrink)
In the face of managed care and market economies infringing on the practice of medicine, reducing its autonomy and determining the moral guidelines for medical practice, many physicians are calling out for a return to what is perceived as a traditional medical ethic. Many religiously motivated critics of certain modern developments in medicine have made similar appeals. These calls are best understood as an attempt to define medicine as a practice that is necessarily ethical in nature, a practice the moral (...) basis of which is internal to that practice. This article examines and assesses this definition of medicine in reference to Aristotle's division of human undertakings into three distinct categories: theory, poieisis (i.e., production), and praxis. It is concluded that medicine can be understood as a praxis (as opposed to a theory or production, both of which are morally neutral), because the practice of medicine, and all of its constitutive acts, can only be explained and assessed in reference to health, which is itself a final good and hence of moral value. Such an understanding would immunize medicine against usurpation by the free market. However, by the same token it would also dissociate medicine from all other moralities external to it, including those grounded in faith and religion. (shrink)
This article starts with a brief historical account of the ongoing debate about the status of clinical ethics: theory of practice. The author goes on to argue that clinical ethics is best understood as a practice. However, its practicality should not be measured by the extent to which clinical-ethical consultants manage to mediate or negotiate resolutions to ethical conflicts. Rather, clinical ethics is practical because it is characterized by a profound concern for the well-being of individual patients as well as (...) the moral parameters of swift and urgent medical action in the face of limited supportive information. (shrink)
Este documento busca revisar el estado actual del pensamiento católico sobre el respeto al agenciamiento del paciente, a la autonomía y al consentimiento. Sin embargo, no se pretende llegar a una revisión definitiva. De hecho, encontraremos un amplio apoyo de estos conceptos dentro de la bioética católica, a pesar de que persiste un importante disenso sobre aspectos específicos. En primer lugar, el artículo ofrece una descripción resumida de algunas diferencias importantes entre el entendimiento prevaleciente de la autonomía del paciente en (...) la bioética secular y en la bioética católica. En la primera, se suele entender que el respeto a la autonomía del paciente considera las necesidades y deseos subjetivos de éste, incluso cuando, o tal vez precisamente, porque quedan fuera del ámbito de comprensión del profesional de la salud. En la segunda, este respeto se fundamenta en la dignidad delpaciente individual, que abarca los deseos y necesidades subjetivas del paciente, pero que es esencialmente un concepto objetivo y, por lo tanto, intersubjetivamente accesible. Para explicar con más detalle cómo puede respetarse el agenciamiento del paciente dentro de ese marco de referencia objetivo, en el documento se examinan diferentes tipos de agenciamiento del paciente dentro de la relación terapéutica. Para que la atención de la salud sea clínicamente óptima y éticamente sólida –como exigen los principios éticos de beneficencia y no maleficencia–, el paciente debe participar activamente en: 1) la evaluación y el diagnóstico; 2) la planificación del tratamiento, y 3) la terapia propiamente dicha. Además –como exige el principio ético del respeto a la autonomía–el proveedor de atención sanitaria debe: 4) proteger la confidencialidad del paciente; 5) proporcionarle información adecuada, y 6) obtener el consentimiento del paciente para cualquier intervención. A continuación, se examinan diferentes tipos de consentimiento. En una sección final, se revisará la cuestión de si es moralmente permisible que los proveedores de atención de la salud obliguen a los pacientes a rechazar los tratamientos que se consideren inmorales. (shrink)
On one side of his sign board, a nineteenth century surgeon depicted a physician operating on a patient's leg; the other side showed the Good Samaritan taking care of the victim's wounds. Christ's parable has often been quoted and depicted as a primary example of human compassion, to be followed by all persons and, a fortiori, by so-called professionals such as physicians and nurses. If we grant that the parable has not lost its narrative power for 20th century “postmodern” readers (...) living in a “pluralistic” society, it merits a closer analysis. (shrink)
There are at present 28 Jesuit colleges and universities in the United States, which together offer more than 50 health sciences degree programs. But as the Society's membership is shrinking and the financial risks involved in sponsoring health sciences education are rising, the question arises whether the Society should continue to sponsor health sciences degree programs. In fact, at least eight Jesuit health sciences schools have already closed their doors. This paper attempts to contribute to the resolution of this urgent (...) question by reexamining Ignatius' own views on health sciences education and, more specifically, his prohibition of the Society's sponsoring medical education. It concludes on the basis of an historical analysis of Ignatius' views that there is insufficient support for today's ,Jesuits to maintain their engagement in medical and health care education. (shrink)
The Patient Self-Determination Act is a fact. Finally, respect for patient autonomy has been guaranteed. At first sight, there seems little reason to object to any measure that intends to increase the autonomy of the patient. Too long, one may argue, physicians have behaved paternalistically; too often, they have been advised to change this habit. If the profession of medicine is unwilling or simply unable to grant the patient the decision-making power that is her due, the law has to step (...) in. One may add, this law in no way hinders professional autonomy; by requiring a hospital official to provide the patient with information about advance directive, the law actually reduces the work load of the physician, who is already overburdened. (shrink)
In the literature three mechanisms are commonly distinguished to make decisions about the care of incompetent patients: A living will, a substituted judgment by a surrogate, and a best interest judgment. Almost universally, the third mechanism is deemed the worst possible of the three, to be invoked only when the former two are unavailable. In this article, I argue in favor of best interest judgments. The evermore common aversion of best interest judgments entails a risk that health care providers withdraw (...) from the decision-making process, abandoning patients to these most difficult of decisions about life and death. My approach in this article is primarily negative, that is, I criticize the alleged superiority of the living will and substituted judgment. The latter two mechanisms gain their alleged superiority because they are supposedly morally neutral, whereas the best interest judgment entails a value judgment on behalf of the patient. I argue that on closer inspection living wills and substituted judgments are not morally neutral; indeed, they generally rely on best interest judgments, even if those are not made explicit. (shrink)
This is the first book in healthcare ethics addressing the moral issues regarding ownership of the human body. Modern medicine increasingly transforms the body and makes use of body parts for diagnostic, therapeutic and preventive purposes. The book analyzes the concept of body ownership. It also reviews the ownership issues arising in clinical care (for example, donation policies, autopsy) and biomedical research. Societies and legal systems also have to deal with issues of body ownership. A comparison is made between specific (...) legal arrangements in The Netherlands and France, as examples of legal approaches. In the final section of the book, different theoretical perspectives on the human body are analyzed: libertarian, personalist, deontological and utilitarian theories of body ownership. (shrink)
In this paper we discuss the epistemological positions of evolution theories. A sharp distinction is made between the theory that species evolved from common ancestors along specified lines of descent (here called the theory of common descent), and the theories intended as causal explanations of evolution (e.g. Lamarck's and Darwin's theory). The theory of common descent permits a large number of predictions of new results that would be improbable without evolution. For instance, (a) phylogenetic trees have been validated now; (b) (...) the observed order in fossils of new species discovered since Darwin's time could be predicted from the theory of common descent; (c) owing to the theory of common descent, the degrees of similarity and difference in newly discovered properties of more or less related species could be predicted. Such observations can be regarded as attempts to falsify the theory of common descent. We conclude that the theory of common descent is an easily-falsifiable & often-tested & still-not-falsified theory, which is the strongest predicate a theory in an empirical science can obtain. Theories intended as causal explanations of evolution can be falsified essentially, and Lamarck's theory has been falsified actually. Several elements of Darwin's theory have been modified or falsified: new versions of a theory of evolution by natural selection are now the leading scientific theories on evolution. We have argued that the theory of common descent and Darwinism are ordinary, falsifiable scientific theories. (shrink)
BackgroundOver the past decade, the exponential growth of the literature devoted to personalized medicine has been paralleled by an ever louder chorus of epistemic and ethical criticisms. Their differences notwithstanding, both advocates and critics share an outdated philosophical understanding of the concept of personhood and hence tend to assume too simplistic an understanding of personalization in health care.MethodsIn this article, we question this philosophical understanding of personhood and personalization, as these concepts shape the field of personalized medicine. We establish a (...) dialogue with phenomenology and hermeneutics (especially with E. Husserl, M. Merleau-Ponty and P. Ricoeur) in order to achieve a more sophisticated understanding of the meaning of these concepts We particularly focus on the relationship between personal subjectivity and objective data.ResultsWe first explore the gap between the ideal of personalized healthcare and the reality of today’s personalized medicine. We show that the nearly exclusive focus of personalized medicine on the objective part of personhood leads to a flawed ethical debate that needs to be reframed. Second, we seek to contribute to this reframing by drawing on the phenomenological-hermeneutical movement in philosophy. Third, we show that these admittedly theoretical analyses open up new conceptual possibilities to tackle the very practical ethical challenges that personalized medicine faces.ConclusionFinally, we propose a reversal: if personalization is a continuous process by which the person reappropriates all manner of objective data, giving them meaning and thereby shaping his or her own way of being human, then personalized medicine, rather than being personalized itself, can facilitate personalization of those it serves through the data it provides. (shrink)
In reference to historical developments, this article introduces the topic of this special issue of Theoretical Medicine and Bioethics, that is, the relationship(s) between theory and practice. The authors emphasize the need for scientific research in this neglected area for the sake of both clinical practice and medical education.
The present study investigated whether individual differences between psychologists in thinking styles are associated with accuracy in diagnostic classification. We asked novice and experienced clinicians to classify two clinical cases of clients with two co-occurring psychological disorders. No significant difference in diagnostic accuracy was found between the two groups, but when combining the data from novices and experienced psychologists accuracy was found to be negatively associated with certain decision making strategies and with a higher self-assessed ability and preference for a (...) rational thinking style. Our results underscore the idea that it might be fruitful to look for explanations of differences in the accuracy of diagnostic judgments in individual differences between psychologists (such as in thinking styles or decision making strategies used), rather than in experience level. (shrink)
Within the arena of sport, as throughout society, traditional definitions of femininity and masculinity have established and maintained gender differentiation. The authors’research examines this pattern in intercollegiate athletics by analyzing National Collegiate Athletic Association media guide cover photographs. They find gender differentiation in the depiction of women and men athletes. For example, women athletes are less likely to be portrayed as active participants in sport and more likely to be portrayed in passive and traditionally feminine poses. These differences changed little (...) between 1990 and 1997. The findings suggest that while one might expect less gender stereotyping from the teams themselves, the gendered images produced by intercollegiate athletic programs vary little from those produced by the popular press. (shrink)
This book is for those searching for an ethics engine with enough philosophical power to drive healthcare reform toward a balance between medical technology and human compassion. Jos Welie's project is to This is an important goal that has eluded others. Jos Welie has more nearly succeeded in this book than any other author who has come to my attention.
The Random Number Generation task has a long history in neuropsychology as an assessment procedure for executive functioning. In recent years, understanding of human behavior has gradually changed from reflecting a static to a dynamic process and this shift in thinking about behavior gives a new angle to interpret test results. However, this shift also asks for different methods to process random number sequences. The RNG task is suited for applying non-linear methods needed to uncover the underlying dynamics of random (...) number generation. In the current article we present RandseqR: an R-package that combines the calculation of classic randomization measures and Recurrence Quantification Analysis. RandseqR is an easy to use, flexible and fast way to process random number sequences and readies the RNG task for current scientific and clinical use. (shrink)