The objective of the paper is to implement and validate diagnosis in the medical field via refined neutrosophic fuzzy logic (RNFL). As such, we have proposed a Max-Min composition (MMC) method in RNFL. This method deals with the diagnosis under certain constraints like uncertainty and indeterminacy. Further, we have considered the diagnosis problems to validate the sensitivity analysis of the novel multi attribute decision-making technique. Finally, we gave the graphical representations and compared the obtained results with other existing measures (...) in refined neutrosophic fuzzy sets. (shrink)

Ontology is currently perceived as the solution of first resort for all problems related to biomedical terminology, and the use of description logics is seen as a minimal requirement on adequate ontology-based systems. Contrary to common conceptions, however, description logics alone are not able to prevent incorrect representations; this is because they do not come with a theory indicating what is computed by using them, just as classical arithmetic does not tell us anything about the entities that are added or (...) subtracted. In this paper we shall show that ontology is indeed an essential part of any solution to the problems of medical terminology – but only if it is understood in the right sort of way. Ontological engineering, we shall argue, should in every case go hand in hand with a sound ontological theory. (shrink)

Background Despite decades of anti-racism and equity, diversity, and inclusion (EDI) interventions in academic medicine, medical racism continues to harm patients and healthcare providers. We sought to deeply explore experiences and beliefs about medical racism among academic clinicians to understand the drivers of persistent medical racism and to inform intervention design. Methods We interviewed academically-affiliated clinicians with any racial identity from the Departments of Family Medicine, Cardiac Sciences, Emergency Medicine, and Medicine to understand their experiences and perceptions (...) of medical racism. We performed thematic content analysis of semi-structured interview data to understand the barriers and facilitators of ongoing medical racism. Based on participant narratives, we developed a logic framework that demonstrates the necessary steps in the process of addressing racism using if/then logic. This framework was then applied to all narratives and the barriers to addressing medical racism were aligned with each step in the logic framework. Proposed interventions, as suggested by participants or study team members and/or identified in the literature, were matched to these identified barriers to addressing racism. Results Participant narratives of their experiences of medical racism demonstrated multiple barriers to addressing racism, such as a perceived lack of empathy from white colleagues. Few potential facilitators to addressing racism were also identified, including shared language to understand racism. The logic framework suggested that addressing racism requires individuals to understand, recognize, name, and confront medical racism. Conclusions Organizations can use this logic framework to understand their local context and select targeted anti-racism or EDI interventions. Theory-informed approaches to medical racism may be more effective than interventions that do not address local barriers or facilitators for persistent medical racism. (shrink)

Clinical diagnostic medicine is an experimental science based on observation, hypothesis making, and testing. It is an use dynamic process that involves observation and summary, diagnostic conjectures, testing, review, observation and summary, new or revised conjectures, i.e. it is an iterative process. It can then be said that diagnostic hypotheses are also ‘observation-laden’. My aim is to enlarge on the strategies of medical diagnosis as these are meshed in training and clinical experience—that is, to describe the patterns of reasoning (...) used by experienced clinicians under different diagnostic circumstances and how these patterns of inquiry allow further insight into the evaluation and treatment of patients. I do not aim to present a theory and illustrate it with examples; I wish rather am to let a realistic example, similar to actual clinical scenarios, direct the exposition. To this end, I introduce an account of medical diagnosis—briefly comparing and contrasting it to other accounts—in order to focus on discussing the process of diagnosis through a detailed clinical case. (shrink)

Clinical diagnostic medicine is an experimental science based on observation, hypothesis making, and testing. It is an use dynamic process that involves observation and summary, diagnostic conjectures, testing, review, observation and summary, new or revised conjectures, i.e. it is an iterative process. It can then be said that diagnostic hypotheses are also ‘observation-laden’. My aim is to enlarge on the strategies of medical diagnosis as these are meshed in training and clinical experience—that is, to describe the patterns of reasoning (...) used by experienced clinicians under different diagnostic circumstances and how these patterns of inquiry allow further insight into the evaluation and treatment of patients. I do not aim to present a theory and illustrate it with examples; I wish rather am to let a realistic example, similar to actual clinical scenarios, direct the exposition. To this end, I introduce an account of medical diagnosis—briefly comparing and contrasting it to other accounts—in order to focus on discussing the process of diagnosis through a detailed clinical case. (shrink)

As do all forms of science, medical theories have a factual as well as a logical basis. New information is presented in medical research articles. These papers have three separate arguments: the argument of the hypothesis, the argument of the experimental protocol, and the argument of the hypothesis's judgment. These arguments may be examples of the hypothetico-deductive or confirmational model of scientific inference. The logical form of these arguments are informal and inductive rather than formal and deductive. Understanding (...) the nature of the logic of the medical research article may help avoid erroneous conclusions. (shrink)

The aim of this article was to prepare a basis for further quantitative research concerning the nutritional knowledge of medical professionals (doctors) and dieticians in view of the accuracy of dietary recommendations given to patients. For this purpose, a review of literature data in this area was performed and logical fallacies were proposed as the ‘tool’ that doctors rely on in cases when they lack the proper knowledge required to be able give an informed and beneficial recommendation. In the (...) course of the study, it was found that nutritional education is neglected in medical curricula, while dieticians are underused as professionals in clinical settings. Furthermore, numerous characteristics of the medical profession and the doctor–patient relationship are conducive to committing several types of logical fallacies, prompted mainly by the need for providing advice without delay and the infallibility traditionally expected from doctors. Hence, the gaps in nutritional knowledge and the fallacious character of recommendations, in addition to the re-valuation of the role of the nutritionist, need to be further investigated in order to improve the quality of patient advice in the area of dietary requirements as well as to propose the necessary changes in curricula. (shrink)

Decision making and choices are frequent themes in medical ethics. Game theory is based upon modelled decision making. Game theory, and associated logic traps, may have relevance to the clinical practice of medicine and medical ethics. The “prisoner’s dilemma” is one logic trap from game theory in which “rational” decision making on the part of participating individuals can lead to “suboptimal” situations. An example of such a situation involving brain death is presented and discussed from the perspective of (...) the prisoner’s dilemma. (shrink)

In the present article I have surveyed several approaches to modeling the clinical diagnostic process. I have argued that at this point of the field's development, logics which simulate the reasoning patterns and knowledge base of expert clinicians represent research programs that are most likely to succeed. No logic of diagnosis has yet attained the status of being definitive; in spite of striking progress much more research and testing is required. On the basis of various existing logics, I have attempted (...) to articulate a number of desiderata which an ideal diagnostic logic should satisfy. In spite of these criticisms, I would maintain that programs such as MYCIN and INTERNIST have already matured to the point where they are useful both in consultations and in teaching diagnostic reasoning. (shrink)

Medical decisions, including diagnosis, prognosis, and disease classification, must often be made on the basis of incomplete or unsatisfactory information. Data which are essential to the care of one patient may be unobtainable for technical or ethical reasons in another patient. For this reason the principles of controlled experimentation may be impossible to satisfy in human studies. In this paper, some formal aspects of medical decision making are discussed. Special operators for the intuitive concepts of certainty, demand, and (...) effort, akin to the operators of modal logic, are used to accommodate the technical and ethical limitations on human studies. Theorems are stated and proved which show how this system handles incomplete information. The embryogenesis of the human heart is presented as a sample problem in classification. (shrink)

Considered ahead of its time since the first publication in 1981, Medical Choices, Medical Chances provides a telescope for viewing how developments in the fields of medical research, medical technology, and health care organization are likely to influence the doctor-patient relationship in the 21st Century. The book explores this intricate web of relationships among doctors, patients, and families and offers a new framework for mastering the emotional and intellectual challenges of uncertainty, while at the same time (...) providing tools for all concerned to regain control from managed care. It is a must-read for all those interested in medicine and where it is headed in the new millennium. (shrink)

Undergraduate medical ethics education currently focuses on ethical concepts and reasoning. This paper uses an intern’s story of an ethically challenging situation to argue that this emphasis is problematic in terms of ensuring students’ ethical practice as junior doctors. The story suggests that it is aligning their actions with the values that they reflectively embrace that can present difficulties for junior doctors working in the pressures of the hospital environment, rather than reasoning to an ethically appropriate action. I argue (...) that junior doctors need skills for implementing their ethical decisions and that these ought to form a central component of undergraduate medical ethics education. (shrink)

When first published twenty years ago, The Logic of Medicine presented a new way of thinking about clinical medicine as a scholarly discipline as well as a profession. Since then, advances in research and technology have revolutionized both the practice and theory of medicine. In this new, extensively rewritten edition, Dr. Murphy includes changes to show how these different areas of scholarship may affect details of "the logic of medicine" without compromising its fundamental coherence. New to this edition are discussions (...) of the challenge of the flood of new empirical data, new ideas in genetics, molecular biology, homeostasis, pathogenesis, cancer, aging, and Alzheimer's disease. Murphy also comments on such new theoretical topics as dynamic systems, chaos, and fractals and their impact on the burgeoning fields of philosophy and practice of medicine. Written with medical students in mind, the book includes a glossary, many new examples, and problems for solutions with comments on each. An entirely new chapter deals with modeling. Clinicians and researchers will also find the principles thought-provoking and illuminating. (shrink)

Decision making is the physician's major activity. Every day, in doctors' offices throughout the world, patients describe their symptoms and com plaints while doctors perform examinations, order tests, and, on the basis of these data, decide what is wrong and what should be done. Although the process may appear routine-even to the physicians in volved-each step in the sequence requires skilled clinical judgment. Physicians must decide: which symptoms are important, whether any laboratory tests should be done, how the various items (...) of clinical data should be combined, and, finally, which of several treatments (including doing nothing) is indicated. Although much of the information used in clinical decision making is objective, the physician's values (a belief that pain relief is more important than potential addiction to pain-killing drugs, for example) and subjectivity are as much a part of the clinical process as the objective findings of laboratory tests. In recent years, both physicians and psychologists have come to realize that patient management decisions are not only subjective but also prob abilistic (although this is not always acknowledged overtly). When doc tors argue that an operation is fairly safe because it has a mortality rate of only 1 %, they are at least implicitly admitting that the outcome of their decision is based on probability. (shrink)

The national curricula of the EU member states are structured around learning outcomes, selected according to Bloom’s Taxonomy. The authors of this paper claim that using Bloom’s Taxonomy to phrase learning outcomes in medical education in terms of students’ achievements is difficult and unclear. This paper presents an efficient method of assessing course learning outcomes using Fuzzy Logic.

This paper argues that there exists a collective epistemic state of ‘Broad Medical Uncertainty’ regarding the effectiveness of many medical interventions. We outline the features of BMU, and describe some of the main contributing factors. These include flaws in medical research methodologies, bias in publication practices, financial and other conflicts of interest, and features of how evidence is translated into practice. These result in a significant degree of uncertainty regarding the effectiveness of many medical treatments and (...) unduly optimistic beliefs about the benefit/harm profiles of such treatments. We argue for an ethical presumption in favour of openness regarding BMU as part of a ‘Corrective Response’. We then consider some objections to this position, including concerns that public honesty about flaws in medical research could undermine trust in healthcare institutions. We suggest that, as it stands, the Anti-Corrective Response is unconvincing. (shrink)

Despite medicine's achievements, medical errors and the difficulty of reproducing research prove medicine is far from perfect. This book provides a critical and historical analysis of medical reasoning that recognizes the constant need for certainty despite the enormous variety of disease, illness, symptoms, and behavior in patients. According to Erwin Montgomery, Jr., medicine depends on logic, balancing utility with certainty, and anticipating errors in judgment.

This title is part of UC Press's Voices Revived program, which commemorates University of California Press's mission to seek out and cultivate the brightest minds and give them voice, reach, and impact. Drawing on a backlist dating to 1893, Voices Revived makes high-quality, peer-reviewed scholarship accessible once again using print-on-demand technology. This title was originally published in 1985.

Ethicists in American medical schools feel increasingly discouraged these days. In the 1960s, 1970s, and 1980s, society's enthusiasm for teaching about medical ethics flourished as new medical technologies posed new ethical perplexities. Americans eagerly sought ethics advice and looked to medical schools to provide it. As the sites where many of the new technologies were developed and future physicians were trained, medical schools were the logical place for medical ethicists to work and teach. A (...) few schools recognized society's need and instituted explicit medical ethics teaching—allocating funds, hiring ethicists, creating departments, and trumpeting their accomplishments. But most schools responded to the need with indifference or even hostility. They distrusted outside “experts” and feared a zealous reform movement aimed at the character or practices of modern medicine. Yet even those schools were forced to create ethics programs to meet powerful accreditation requirements adopted around 1990. Complying reluctantly, these schools allocated few personnel and minimal budgets. The resulting programs struggled. (shrink)

We present the details of a methodology for quality assurance in large medical terminologies and describe three algorithms that can help terminology developers and users to identify potential mistakes. The methodology is based in part on linguistic criteria and in part on logical and ontological principles governing sound classifications. We conclude by outlining the results of applying the methodology in the form of a taxonomy different types of errors and potential errors detected in SNOMED-CT.

Description Logics are nowadays widely accepted as formalisms which provide reasoning facilities which allow us to discover inconsistencies in ontologies in an automatic fashion. Where ontologies are developed in modular fashion, they allow changes in one module to propogated through the system of ontologies automatically in a way which helps to maintain consistency and stability. For this feature to be utilized effectively, however, requires that domain ontologies be represented in a normalized form.

Moshe Tati, a sanitation worker in Jerusalem, was among the first of more than a thousand mortally sick Israelis who signed up for illicit and clandestine ‘transplant tour’ packages that included: travel to an undisclosed foreign and exotic setting; five-star hotel accommodation; surgery in a private hospital unit; a ‘fresh’ kidney purchased from a perfect stranger trafficked from a third country. Although Tati’s holiday turned into a nightmare and he had to be emergency air-lifted from a rented transplant unit in (...) a private hospital in Adana, Turkey back to Israel, Moshe became a poster-boy of transplant tourism for the next decade. João Cavalcanti was among the first of 38 residents of the slums of Recife recruited by retired military Captain Ivan da Silva and his sidekick Captain Gadddy Tauber to travel to Durban, South Africa to provide a spare kidney to an Israeli transplant tourist in Durban. This article examines the logics and practices through which kidney buyers and kidney sellers, organs brokers, surgeons and their accessories convince themselves that they are engaged in an illegal but still mutually beneficial ‘medical-recreational’ adventure, an ‘extreme medical sport’ of sorts. While life, health and survival motivate ‘transplant tourism’, a euphemism for human trafficking in spare body parts, the freedom to roam, mobility, is an essential feature of transplant tours for kidney buyers and kidney sellers. (shrink)

Walton offers a comprehensive, flexible model for physician-patient decision making, the first such tool designed to be applied at the level of each particular case. Based on Aristotelian practical reasoning, it develops a method of reasonable dialogue, a question- and-answer process of interaction leading to informed consent on the part of the patient, and to a decision--mutually arrived at--reflecting both high medical standards and the patient's felt needs. After setting forth his model, he applies it to three vital ethical (...) issues: acts of omission, the cessation of treatment, and possible side effects of treatments. In the final chapter, Walton shows how his method functions in light of the real-life complexities of the clinical encounter and how it bears on ethical questions concerning health-care policy, attitudes toward treatment and toward the medical profession, reasonableness of expectations, and the setting of realistic goals of treatment. (shrink)

Adopting a critical thinking methodology in which critical thinking tools are introduced and applied to medical ethics reading, this book explains the dialogue which is formed by the readings in each chapter and clarifies how the various thinkers are responding to one another in a common discussion. The books' unified approach offers a critical thinking pedagogy, which philosophically and logically pulls the many readings and philosophies together. The book examines an introduction to moral theory and critical thinking tools, while (...) readings address the following issues: surrogacy contracts; abortion; ethical issues at the end of life; genetics and morality; ethics and HIV/AIDS; the relationship between medical professionals and patients; research on human and non-human subjects; allocation of medical resources and justice issues in health care systems. For individuals interested in medical ethics and philosophy. (shrink)

Most attempts to trace the roots of current scientific approaches to the mind have ignored the contributions of post-Kantian German idealism. Paul Redding here shows the relevance of this philosophical tradition to an understanding of the mind and its embodiment as well as the relation of feeling to cognition. Redding observes how Fichte, Schelling, and Hegel struggled with the problem of reconciling Kant's normative approach to experience and thought with the naturalistic stance of the emerging medical sciences. A century (...) later William James, Freud, and Jung also addressed the interconnection of thought and feeling, reaching views similar to those of the post-Kantian idealists. In particular, Redding argues, the idealists conceived of a'logic of affect'that reemerged in Freud's concept of the primary process and in modern evolutionary ideas of subcortical processing. This innovative book demonstrates how new insights can be brought to the study of mentality and consciousness by considering previously overlooked interpretations. Redding shows that these early theorists of the unconscious can bring scholars to a better appreciation not only of classical thinkers like James and Freud but also of contemporary debates about the mind and emotions. (shrink)

In this paper we address the objectivist logic of bipolar gender attribution, the entitlement of ideal masculine virtues, and the repression of so-called non-male characteristics in persons who live with chronic disabling conditions. More specifically, we show how the living experience of chronic disability continues to be co-opted by patriarchal strategies designed to keep particular bodies both invisible and silent.

Psychotherapists in mental health institutions as a professional group are part of the medical system, and from this perspective, as representing an occupation that serves the public health interests, as well as those of the individual seeking help. Despite the different existing therapeutic approaches and diverse forms of therapy deriving from these approaches critical theories, however, consider psychotherapy as a profession with a specific jurisdictional claim and own highly specific interests. In contrast to most of the recent discussion around (...) therapy culture, in this article, I argue that sociology and social theory could benefit from an understanding of psychotherapy as a profession with a separate logic and claim for jurisdiction for mental health. Moreover, I present some general trends showing that, regarding psychotherapy, we face a concurrence of a professionalisation, and simultaneously, an already ongoing deprofessionalisation. To develop my argument, I first discuss the perspectives of sociology of the psychotherapy professions. Second, I present the potential lack of professionalism in four dimensions. Third, I discuss possible tendencies of deprofessionalisation. Finally, I conclude by pointing out the importance of theorising the psychotherapy professions for medical sociology. (shrink)

This is a major work by Ian Maclean exploring the foundations of learning in the Renaissance. Logic, Signs and Nature offers a profoundly learned, compelling and original account of the range of what was thinkable and knowable by learned medics of the period c.1530-1630. This is a study of great significance to the history of medicine, as well as the history of European ideas in general.

Medical knowledge as well as clinical practice are characterized by inescapable uncertainty. There are many reasons this is the case, but foremost among them is that almost everything in medicine is inevitably vague, be it something linguistic such as the term “illness”, or something extra-linguistic such as the condition referred to as illness. If we ask ourselves, then, what the term “illness” means exactly, on the one hand; and how we may precisely delimit the condition illness, on the other; (...) we shall realize that to answer these and similar questions requires specific methods that enable us to adequately cope with vagueness. As we shall see below, fuzzy logic provides us with just such methods. (shrink)

Beneficence and respect for autonomy are two of the most fundamental moral duties in general and in bioethics in particular. Beyond the usual questions of how to resolve conflicts between these duties in particular cases, there are more general questions about the possible forms of the interactions between them. Only recognition of the full spectrum of possible interactions will ensure optimal moral deliberation when duties potentially conflict. This paper has two simultaneous objectives. The first is to suggest a typological scheme (...) of all possible modes of interaction; these will be classified under the “discrete,” “semi-discrete,” and “non-discrete” categories, according to whether the meaning and/or forms of expression of each duty are treated as independent from or rather as constrained by the other. The second objective is to show that all logical possibilities of interaction indeed have real expressions in medical ethics, to provide clear illustrations of each, and in particular to stress those that have usually escaped recognition. (shrink)

Suits that claim that a child would be better off never having been born often founder on conceptual and logical dilemmas. However, the correct interpretation of “wrongful life” does not require a comparison between existence and nonexistence. The New Jersey Supreme Court's decision in the Procanik case to limit damages to extraordinary medical expenses, barring recovery for pain and suffering, is a reasonable resolution.

This article focuses on patients' participation in decision‐making in meetings with healthcare professionals in a healthcare system, based on neoliberal regulations and ideas. Drawing on two constructed empirical cases, primarily from the perspective of patients, this article analyses and discusses the clinical practice around decision‐making meetings within a Foucauldian perspective. Patients' participation in decision‐making can be seen as an offshoot of respect for patient autonomy. A treatment must be chosen, when patients consult physicians. From the perspective of patients, there is (...) a tendency for healthcare professionals to supply the patients with the information that they think are necessary for them to make their own decision. But patients do not always want to be a ‘customer’ in the healthcare system; they want to be a patient, consulting an expert for help and advice, which creates resistance to some parts of the decision‐making process. Both professionals and patients are subject to the structural frame of the medical field, formed of both neoliberal framework and medical logic. The decision‐making competence in relation to the choice of treatment is placed away from the professionals and seen as belonging to the patient. A ‘projectification’ of the patient occurs, whereby the patient becomes responsible for his/her choices in treatment and care and the professionals support him/her with knowledge, preferences, and alternative views, out of which he/she must make his/her own choices, and the responsibility for those choices now and in the future. At the same time, there is a tendency towards de‐professionalization. In that light, participation of patients in decision‐making can be regarded as a tacit governmentality strategy that shapes the location of responsibility between individual and society, and independent patients and healthcare professionals, despite the basically desirable, appropriate, and necessary idea of involving patients in their own situations from a humanistic perspective. (shrink)

This paper naturalizes inductive inference by showing how scientific knowledge of real mechanisms provides large benefits to it. I show how knowledge about mechanisms contributes to generalization, inference to the best explanation, causal inference, and reasoning with probabilities. Generalization from some A are B to all A are B is more plausible when a mechanism connects A to B. Inference to the best explanation is strengthened when the explanations are mechanistic and when explanatory hypotheses are themselves mechanistically explained. Causal inference (...) in medical explanation, counterfactual reasoning, and analogy also benefit from mechanistic connections. Mechanisms also help with problems concerning the interpretation, availability, and computation of probabilities. (shrink)

I am grateful to the esteemed commentators for their critiques of my paper, ‘Why Not Common Morality’.1 As I read through their remarks, however, they seemed to be talking past my arguments. Their criticisms nevertheless make it clear that I need to explain myself better. I am therefore grateful to the editor for allowing me this opportunity to clarify my position. My paper presented two arguments for concluding that common morality is untenable as an account of medical ethics. First, (...) I provided a negative argument to show that common morality does not provide an adequate account of medical ethics. Second, I offered a positive argument that demonstrated why the medical professions require a distinct morality. My negative argument relies on counterexamples to show that the duties of medicine are different from the duties of everyday life. It is intended as a refutation of the claim by Tom Beauchamp and James Childress that ‘The common morality is applicable to all persons in all places, and we rightly judge all human conduct by its standards’.2 Logically, if any of the duties of medical ethics are inconsistent with common morality, they are not compatible with common morality standards. My counterexamples demonstrate that standards of conduct judged acceptable by common morality are irreconcilable with duties of medical ethics. Hence, they could not follow from the same principles. If the standards of common morality lead to particular judgments about the morality of a certain conduct, those same standards cannot also be the basis for reaching the opposite judgments about that sort of conduct. Charles Foster,3 Alex John London,4 Ruth Macklin5 and Bryanna Moore6 all suggest that exceptions to my examples refute my negative argument. As far as they go, …. (shrink)

This article offers a logical analysis of Slippery Slope Arguments. Such arguments claim that adopting a certain act or policy would take us down a slippery slope to an undesirable bottom and infer from this that we should refrain from this act or policy. Even though a logical assessment of such arguments has not received much careful attention, it is of vital importance to their overall assessment because if the premises fail to support the conclusion an argument is worthless. I (...) partition slippery slope reasoning by means of two dichotomies (reasoning under certainty vs. uncertainty and one-step vs. multiple-step reasoning) into four general categories and evaluate these in turn. The analysis reveals that slippery slope arguments are logically fallacious. (shrink)

In 1995 the People's Republic of China passed a controversial Eugenics Law, which, after a torrent of international criticism, was euphemistically renamed the Maternal and Infant Health Law. Aimed at "the implementation of premarital medical checkups" to ensure that neither partner has any hereditary, venereal, reproductive, or mental disorders, the ordinance implies that those deemed "unsuitable for reproduction" should undergo sterilization or abortion or remain celibate in order to prevent "inferior births." Using this recent statute as a springboard, Frank (...) Dikötter explores the contexts and history of eugenics in both Communist China and Taiwan. Dikötter shows how beginning in Late Imperial China, Western eugenics was imported and combined with existing fears of cultural, racial, or biological degeneration in Chinese society, leading to government regulation of sexual reproduction. _Imperfect Conceptions_ is a revealing look at the cultural history of medical explanations of birth defects that demonstrates how Chinese assumptions about the relationship of the individual to society form the very core of their attitudes toward procreation. Dikötter explains the patrilineal model of descent, where a person is viewed as the culmination of his or her ancestors and is held responsible for the health of all future generations. By this logic, a pregnant woman's behavior and attitude directly influence the well-being of her baby, and a deformed or retarded child reflects a moral failing on the part of the parents. Dikötter also shows how the holistic medicine practiced in China blurs any distinction between individual and environment so that people are held responsible for illness. Drawing on cultural, social, economic, and political approaches, Dikötter goes beyond a simple authoritarian model to provide a more complex view of eugenic policy, showing how a variety of voices including those of popular journalists, social reformers, medical writers, sex educators, university professors, and politicians all disseminate information that supports rather than questions the state's program. _Imperfect Conceptions_ reveals how Chinese cultural currents--fear and fascination with the deviant and the urge to draw clear boundaries between the normal and the abnormal--have combined with medical discourse to form a program of eugenics that is viewed with alarm by the rest of the world. (shrink)

Over the last century Christian ethics has moved from an attempt to Christianize the social order to a quandary over whether being Christian unduly biases how medical ethics is done. This movement can be viewed as the internal development of protestant liberalism to its logical conclusion, and Paul Ramsey can be taken as one of the last great representatives of that tradition. By reducing the Christian message to the ‘ethical upshot’ of neighbour love, Ramsey did not have the resources (...) to show how Christian practice might make a difference for understanding or forming the practice of medicine. Instead, medicine became the practice that exemplified the moral commitments of Christian civilization, and the goal of the ethicist was to identify the values that were constitutive of medicine. Ramsey thus prepared the way for the Christian ethicist to become a medical ethicist with a difference, and the difference simply involved vague theological presumptions that do no serious intellectual work other than explaining, perhaps, the motivations of the ethicist. (shrink)

In this unique study Fulford combines the disciplines of rigorous philosophy with an intimate knowledge of psychopathology to overturn traditional hegemonies. The patient replaces the doctor at the heart of medicine. Moral theory and the logic of evaluation replace epistemology as the focus of philosophical enquiry. Ever controversial, mental illness is at the interface of philosophy and medicine. Mad or bad? Dissident or diseased? Dr Fulford shows that it is possible to achieve new insights into these traditional dilemmas, insights at (...) once practically relevant and philosophically significant. (shrink)

What clinicians, biomedical scientists, and other health care professionals know as individuals or as groups and how they come to know and use knowledge are central concerns of medical epistemology. Activities associated with knowledge production and use are called epistemic practices. Such practices are considered in biomedical and clinical literatures, social sciences of medicine, philosophy of science and philosophy of medicine, and also in other nonmedical literatures. A host of different kinds of knowledge claims have been identified, each with (...) different uses and logics of justification. A general framework is needed to situate these diverse contributions in medical epistemology, so we can see how they fit together. But developing such a framework turns out to be quite tricky. In this survey, three possible frameworks are considered along with the difficulties associated with each of them. The essay concludes with a fourth framework, which considers any epistemology as part of a practice that is oriented toward overcoming errors that emerge in antecedently given practices where knowledge is developed and used. As medicine indirectly advances health by directly mitigating disease, so epistemology indirectly advances knowledge by directly mitigating error. (shrink)

A search for consensus about the methodology of discovery among physicians and physiologists led the author to identify a crucial anomaly of medical historiography: in general, physicians stress the significance of clinicopathologic method, while physiologists emphasize the experimental. Hence, physicians and bench scientists might be perceived as members of epistemically distinct research traditions. However, analysis of the historical development of discoveries in medicine, exemplified by case studies in physiology, bacteriology, immunology, and therapeutics, reveals that the epistemic dichotomy is illusory. (...) Both physicians and bench scientists discover in the same way: by identifying and explaining clinical anomalies. It is argued that the sociological role of experimentation is to dramatize clinical hypotheses and not test them in a Popperian sense. Keywords: accident, anomaly, continuity, experiment, logic of discovery, psycholinguistic realm CiteULike Connotea Del.icio.us What's this? (shrink)

The first book to be devoted to the logic behind the application of ethical theories, this collection of essays explores the question of how many different moral traditions (utilitarianism, natural rights theory, Marxism, Christian moral theology, and Kantianism among others) view the relation between theory and concrete judgments. By considering many applications of moral theory in medical ethics the authors illustrate their point.