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Mary Jean Walker
La Trobe University
  1.  42
    The Line-Drawing Problem in Disease Definition.Wendy A. Rogers & Mary Jean Walker - 2017 - Journal of Medicine and Philosophy 42 (4):405-423.
    Biological dysfunction is regarded, in many accounts, as necessary and perhaps sufficient for disease. But although disease is conceptualized as all-or-nothing, biological functions often differ by degree. A tension is created by attempting to use a continuous variable as the basis for a categorical definition, raising questions about how we are to pinpoint the boundary between health and disease. This is the line-drawing problem. In this paper, we show how the line-drawing problem arises within “dysfunction-requiring” accounts of disease, such as (...)
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  2.  36
    Ethical Justifications for Access to Unapproved Medical Interventions: An Argument for (Limited) Patient Obligations.Mary Jean Walker, Wendy A. Rogers & Vikki Entwistle - 2014 - American Journal of Bioethics 14 (11):3-15.
    Many health care systems include programs that allow patients in exceptional circumstances to access medical interventions of as yet unproven benefit. In this article we consider the ethical justifications for?and demands on?these special access programs (SAPs). SAPs have a compassionate basis: They give patients with limited options the opportunity to try interventions that are not yet approved by standard regulatory processes. But while they signal that health care systems can and will respond to individual suffering, SAPs have several disadvantages, including (...)
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  3.  70
    Neuroscience, Self-Understanding, and Narrative Truth.Mary Jean Walker - 2012 - American Journal of Bioethics Neuroscience 3 (4):63-74.
    Recent evidence from the neurosciences and cognitive sciences provides some support for a narrative theory of self-understanding. However, it also suggests that narrative self-understanding is unlikely to be accurate, and challenges its claims to truth. This article examines a range of this empirical evidence, explaining how it supports a narrative theory of self-understanding while raising questions of these narrative's accuracy and veridicality. I argue that this evidence does not provide sufficient reason to dismiss the possibility of truth in narrative self-understanding. (...)
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  4.  26
    Current Dilemmas in Defining the Boundaries of Disease.Jenny Doust, Mary Jean Walker & Wendy A. Rogers - 2017 - Journal of Medicine and Philosophy 42 (4):350-366.
    Boorse’s biostatistical theory states that diseases should be defined in ways that reflect disturbances of biological function and that are objective and value free. We use three examples from contemporary medicine that demonstrate the complex issues that arise when defining the boundaries of disease: polycystic ovary syndrome, chronic kidney disease, and myocardial infarction. We argue that the biostatistical theory fails to provide sufficient guidance on where the boundaries of disease should be drawn, contains ambiguities relating to choice of reference class, (...)
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  5.  26
    A New Approach to Defining Disease.Mary Jean Walker & Wendy A. Rogers - 2018 - Journal of Medicine and Philosophy 43 (4):402-420.
    In this paper, we examine recent critiques of the debate about defining disease, which claim that its use of conceptual analysis embeds the problematic assumption that the concept is classically structured. These critiques suggest, instead, developing plural stipulative definitions. Although we substantially agree with these critiques, we resist their implication that no general definition of “disease” is possible. We offer an alternative, inductive argument that disease cannot be classically defined and that the best explanation for this is that the concept (...)
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  6. Conscientious Objection to Vaccination.Steve Clarke, Alberto Giubilini & Mary Jean Walker - 2017 - Bioethics 31 (3):155-161.
    Vaccine refusal occurs for a variety of reasons. In this article we examine vaccine refusals that are made on conscientious grounds; that is, for religious, moral, or philosophical reasons. We focus on two questions: first, whether people should be entitled to conscientiously object to vaccination against contagious diseases ; second, if so, to what constraints or requirements should conscientious objection to vaccination be subject. To address these questions, we consider an analogy between CO to vaccination and CO to military service. (...)
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  7.  27
    Evidence for Personalised Medicine: Mechanisms, Correlation, and New Kinds of Black Box.Mary Jean Walker, Justin Bourke & Katrina Hutchison - 2019 - Theoretical Medicine and Bioethics 40 (2):103-121.
    Personalised medicine has been discussed as a medical paradigm shift that will improve health while reducing inefficiency and waste. At the same time, it raises new practical, regulatory, and ethical challenges. In this paper, we examine PM strategies epistemologically in order to develop capacities to address these challenges, focusing on a recently proposed strategy for developing patient-specific models from induced pluripotent stem cells so as to make individualised treatment predictions. We compare this strategy to two main PM strategies—stratified medicine and (...)
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  8.  29
    Defining Disease in the Context of Overdiagnosis.Mary Jean Walker & Wendy Rogers - 2017 - Medicine, Health Care and Philosophy 20 (2):269-280.
    Recently, concerns have been raised about the phenomenon of ‘overdiagnosis’, the diagnosis of a condition that is not causing harm, and will not come to cause harm. Along with practical, ethical, and scientific questions, overdiagnosis raises questions about our concept of disease. In this paper, we analyse overdiagnosis as an epistemic problem and show how it challenges many existing accounts of disease. In particular, it raises ques- tions about conceptual links drawn between disease and dysfunction, harm, and risk. We argue (...)
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  9.  14
    On Replacement Body Parts.Mary Jean Walker - 2019 - Journal of Bioethical Inquiry 16 (1):61-73.
    Technological advances are making devices that functionally replace body parts—artificial organs and limbs—more widely used, and more capable of providing patients with lives that are close to “normal.” Some of the ethical issues this is likely to raise relate to how such prostheses are conceptualized. Prostheses are ambiguous between being inanimate objects and sharing in the status of human bodies—which already have an ambiguous status, as both objects and subjects. At the same time, the possibility of replacing body parts with (...)
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  10. Addiction and Self-Deception: A Method for Self-Control?Mary Jean Walker - 2010 - Journal of Applied Philosophy 27 (3):305-319.
    Neil Levy argues that while addicts who believe they are not addicts are self-deceived, addicts who believe they are addicts are just as self-deceived. Such persons accept a false belief that their addictive behaviour involves a loss of control. This paper examines two implications of Levy's discussion: that accurate self-knowledge may be particularly difficult for addicts; and that an addict's self-deceived belief that they cannot control themselves may aid their attempts at self-control. I argue that the self-deceived beliefs of addicts (...)
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  11.  9
    Neurotechnologies, Relational Autonomy, and Authenticity.Mary Jean Walker & Catriona Mackenzie - 2020 - International Journal of Feminist Approaches to Bioethics 13 (1):98-119.
    The ethical debate about neurotechnologies—including both drugs and implanted devices—has been largely framed around the questions of whether and when these technologies could damage or promote authenticity. Patients can experience changes in mood, behavior, emotion, or preferences—seemingly, changes in character or personality. Some describe such changes by saying they feel like different people; that they have become either more or less themselves; or that they feel as though some of their moods, behaviors, emotions or preferences are not their own. These (...)
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  12.  22
    Introduction: The Boundaries of Disease.Mary Jean Walker & Wendy A. Rogers - 2017 - Journal of Medicine and Philosophy 42 (4):343-349.
    Although health and disease occupy opposite ends of a spectrum, distinguishing between them can be difficult. This is the “line-drawing” problem. The papers in this special issue engage with this challenge of delineating the boundaries of disease. The authors explore different views as to where the boundary between disease and nondisease lies, and related questions, such as how we can identify, or decide, what counts as a disease and what does not; the nature of the boundary between the two categories; (...)
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  13.  9
    Just Enough Health: Theories of Health Justice by Thomas Schramme. [REVIEW]Mary Jean Walker - 2019 - Journal of Evaluation in Clinical Practice 25 (6):1232-1233.
  14.  23
    Two Senses of Narrative Unification.Mary Jean Walker - 2018 - Philosophical Explorations 22 (1):78-93.
    In this paper I seek to clarify the role of narrative in personal unity. Examining the narrative self-constitution view developed by Marya Schechtman, I use a case of radical personal change to identify a tension in the account. The tension arises because a narrative can be regarded either to capture a continuing agent with a loosely coherent, consistent self-conception – or to unify over change and inconsistency. Two possible ways of responding, by distinguishing senses of identity or distinguishing identity and (...)
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  15.  5
    Patient-Specific Devices and Population-Level Evidence: Evaluating Therapeutic Interventions with Inherent Variation.Mary Jean Walker - 2018 - Medicine, Health Care and Philosophy 21 (3):335-345.
    Designing and manufacturing medical devices for specific patients is becoming increasingly feasible with developments in 3D printing and 3D imaging software. This raises the question of how patient-specific devices can be evaluated, since our ‘gold standard’ method for evaluation, the randomised controlled trial, requires that an intervention is standardised across a number of individuals in an experimental group. I distinguish several senses of patient-specific device, and focus the discussion on understanding the problem of variations between instances of an intervention for (...)
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  16.  16
    Diagnosis, Narrative Identity, and Asymptomatic Disease.Mary Jean Walker & Wendy A. Rogers - 2017 - Theoretical Medicine and Bioethics 38 (4):307-321.
    An increasing number of patients receive diagnoses of disease without having any symptoms. These include diseases detected through screening programs, as incidental findings from unrelated investigations, or via routine checks of various biological variables like blood pressure or cholesterol. In this article, we draw on narrative identity theory to examine how the process of making sense of being diagnosed with asymptomatic disease can trigger certain overlooked forms of harm for patients. We show that the experience of asymptomatic disease can involve (...)
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  17.  15
    Reasonableness, Credibility, and Clinical Disagreement.Mary Jean Walker & Wendy A. Rogers - 2017 - AMA Journal of Ethics 19 (2):176-182.
    Evidence in medicine can come from more or less trustworthy sources and be produced by more or less reliable methods, and its interpretation can be disputed. As such, it can be unclear when disagreements in medicine result from different, but reasonable, interpretations of the available evidence and when they result from unreasonable refusals to consider legitimate evidence. In this article, we seek to show how assessments of the relevance and implications of evidence are typically affected by factors beyond that evidence (...)
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  18.  13
    Special Access Programs Warrant Further Critical Attention: Authors' Response to Open Peer Commentaries on “Ethical Justifications for Access to Unapproved Medical Interventions: An Argument for (Limited) Patient Obligations”.Mary Jean Walker, Wendy A. Rogers & Vikki Entwistle - 2014 - American Journal of Bioethics 14 (11):W1 - W2.
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  19. An Argument Against Drug Testing Welfare Recipients.Mary Jean Walker & James Franklin - 2018 - Kennedy Institute of Ethics Journal 28 (3):309-340.
    Programs of drug testing welfare recipients are increasingly common in US states and have been considered elsewhere. Though often intensely debated, such programs are complicated to evaluate because their aims are ambiguous – aims like saving money may be in tension with aims like referring people to treatment. We assess such programs using a proportionality approach, which requires that for ethical acceptability a practice must be: reasonably likely to meet its aims, sufficiently important in purpose as to outweigh harms incurred, (...)
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  20.  3
    A Heart Without Life: Artificial Organs and the Lived Body.Mary Jean Walker - 2021 - Hastings Center Report 51 (1):28-38.
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  21.  4
    Defining Disease in the Context of Overdiagnosis.Mary Jean Walker & Wendy Rogers - 2017 - Medicine, Health Care and Philosophy: A European Journal 20 (2):269-280.
    Recently, concerns have been raised about the phenomenon of 'overdiagnosis', the diagnosis of a condition that is not causing harm, and will not come to cause harm. Along with practical, ethical, and scientific questions, overdiagnosis raises questions about our concept of disease. In this paper, we analyse overdiagnosis as an epistemic problem and show how it challenges many existing accounts of disease. In particular, it raises questions about conceptual links drawn between disease and dysfunction, harm, and risk. We argue that (...)
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  22.  43
    Powerlessness and Responsibility in Twelve Step Narratives.Mary Jean Walker - 2014 - In Jerome Miller & Nicholas Plants (eds.), Sobering Wisdom: Philosophical explorations of twelve step spirituality. Charlottesville, USA: University of Virginia Press. pp. 30-41.
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  23.  5
    The Ethical and Epistemic Roles of Narrative in Person Centred Healthcare.Mary Jean Walker, Wendy A. Rogers & Vikki Entwistle - 2020 - European Journal of Person Centred Healthcare 8 (3):345-354.
    Positive claims about narrative approaches to healthcare suggest they could have many benefits, including supporting person-centred healthcare (PCH). Narrative approaches have also been criticised, however, on both theoretical and practical grounds. In this paper we draw on epistemological work on narrative and knowledge to develop a conception of narrative that responds to these concerns. We make a case for understanding narratives as accounts of events in which the way each event is described as influenced by the ways other events in (...)
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  24.  7
    Towards Including End-Users in the Design of Prosthetic Hands: Ethical Analysis of Survey of Australians with Upper-Limb Difference.Mary Jean Walker, Eliza Goddard, Benjamin Stephens-Fripp & Gursel Alici - 2019 - Science and Engineering Ethics (2):1-27.
    Advances in prosthetic design should benefit people with limb difference. But empirical evidence demonstrates a lack of uptake of prosthetics among those with limb difference, including of advanced designs. Non-use is often framed as a problem of prosthetic design or a user’s response to prosthetics. Few studies investigate user experience and preferences, and those that do tend to address satisfaction or dissatisfaction with functional aspects of particular designs. This results in limited data to improve designs and, we argue, this is (...)
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  25.  29
    What Can Feminist Epistemology Do for Surgery?Mary Jean Walker & Wendy Rogers - 2014 - Hypatia 29 (2):404-421.
    Surgery is an important part of contemporary health care, but currently much of surgery lacks a strong evidence base. Uptake of evidence-based medicine (EBM) methods within surgical research and among practitioners has been slow compared with other areas of medicine. Although this is often viewed as arising from practical and cultural barriers, it also reflects a lack of epistemic fit between EBM research methods and surgical practice. In this paper we discuss some epistemic challenges in surgery relating to this lack (...)
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