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1.
Rev Infirm ; 69(258): 27-28, 2020 Feb.
Artigo em Francês | MEDLINE | ID: mdl-32327056

RESUMO

If a patient can refuse care, health professionals may refuse to treat a person, an act often considered discriminatory. Investigations have been carried out to shed light on this practice. This notion calls for a philosophical and ethical point of view.


Assuntos
Preconceito , Relações Profissional-Paciente , Recusa do Médico a Tratar , Ética Médica , Humanos , Filosofia Médica , Recusa do Paciente ao Tratamento
2.
Ambix ; 67(1): 30-46, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118521

RESUMO

The basilisk of the pseudo-Paracelsian De natura rerum is the evil twin of the homunculus. Created from menstrual blood by artificial ectogenesis in an alchemical laboratory, the basilisk embodies the poisonous character traditionally ascribed to catamenial women, but magnified and concentrated by its mode of generation to the degree that it can kill by its glance alone. How does this remarkable thought experiment relate to other instances of the basilisk in the genuine and pseudonymous corpus of Paracelsus? The present paper outlines two primary uses which emerge repeatedly: first, in works other than De natura rerum, the basilisk is used by Paracelsus and his imitators as a means of explaining action at a distance, especially in the case of plague. Relying on a medieval association between the basilisk's deadly gaze and the putative ability of menstruating women to damage mirrors, the genuine Paracelsus links contagious disease to the deleterious action of the female imagination. Second, because the basilisk was traditionally held to be the product of an unnatural birth, being born from an egg laid by a rooster and incubated by a toad, the Paracelsian corpus frequently invokes the monster as a model for unnatural generation in general.


Assuntos
Filosofia Médica/história , Médicos/história , História do Século XVI
4.
BMJ ; 368: m1188, 2020 03 26.
Artigo em Inglês | MEDLINE | ID: mdl-32217521
6.
Ambix ; 67(1): 88-99, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32090708

RESUMO

Paracelsus was not only a reformer of medicine with a preference for medical alchemy, but also emerged as a radical church reformer. However, he only rarely used the imagery of alchemy as a parable for theological salvation. Fire as the driving force for every alchemical process was also suitable as an image for the purification of souls. A central idea of alchemy, to transfer a substance from its still impure original state into the purified final state, was very much in line with Paracelsus's doctrine of the Last Supper, according to which the mortal human who had descended from Adam is to be brought to a new birth through baptism with the Holy Spirit. As an alchemist, Paracelsus was keenly interested in the transfiguration of Christ, which he first explained alchemically, but later magically, probably according to the model of Giovanni Pico della Mirandola.


Assuntos
Alquimia , Filosofia Médica/história , Teologia/história , História do Século XVI , Religião e Medicina
7.
Theor Med Bioeth ; 41(1): 39-52, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32020535

RESUMO

Jerome Wakefield's harmful dysfunction analysis (HDA) of medical disorder is an influential hybrid of naturalist and normative theories. In order to conclude that a condition is a disorder, according to the HDA, one must determine both that it results from a failure of a physical or psychological mechanism to perform its natural function and that it is harmful. In a recent issue of this journal, I argued that the HDA entails implausible judgments about which disorders there are and how they are individuated. The same arguments apply to other views that incorporate a harm criterion. More recently, David G. Limbaugh has modified the HDA by providing a novel account of the way in which a disorder must be harmful. Here, I briefly review the relevant issues and then critically assess Limbaugh's account. I argue in the end that Limbaugh's revisions do not succeed in making accounts like the HDA more attractive.


Assuntos
Doença/classificação , Filosofia Médica , Humanos
8.
Theor Med Bioeth ; 41(1): 23-37, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32034586

RESUMO

This paper revisits Ronald Dworkin's influential position that a person's advance directive for future health care and medical treatment retains its moral authority beyond the onset of dementia, even when respecting this authority involves foreshortening the life of someone who is happy and content and who no longer remembers or identifies with instructions included within the advance directive. The analysis distils a eudaimonist perspective from Dworkin's argument and traces variations of this perspective in further arguments for the moral authority of advance directives by other authors. It then critiques a feature of the eudaimonist perspectives within these arguments-namely, the position that dementia has a retroactive negative impact on what a person has previously valued-and challenges the commonly held assumption underlying them that a person's life and well-being have relatively low value beyond the onset of dementia. Although advance directives have moral authority as a means of guiding one's future health care, accounts that dismiss the value of the lives and well-being of people living with dementia should be questioned to the extent that such accounts are used to support the moral authority of advance directives stipulating measures to foreshorten individuals' lives.


Assuntos
Diretivas Antecipadas/ética , Demência , Obrigações Morais , Humanos , Filosofia Médica
9.
Hist Psychiatry ; 31(2): 131-146, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31969026

RESUMO

Nineteenth-century art historian John Addington Symonds coined the term hæmatomania (blood madness) for the extremely bloodthirsty behaviour of a number of disturbed rulers like Ibrahim II of Ifriqiya (850-902) and Ezzelino da Romano (1194-1259). According to Symonds, this mental pathology was linked to melancholy and caused by an excess of black bile. I explore the historical credibility of this theory of 'wild melancholy', a type of melancholia that crucially deviates from the lethargic main type. I conclude that in its pure form Symonds' black bile theory of hæmatomania was never a broadly supported perspective, but can be traced back to the nosology of the ninth-century physician Ishaq ibn Imran, who practised at the Aghlabid court, to which the sadistic Ibrahim II belonged.


Assuntos
Bile , Transtorno Depressivo/história , Teoria Humoral , Psicologia/história , Mundo Árabe/história , Transtorno Bipolar/história , Transtorno Depressivo/etiologia , Pessoas Famosas , História do Século XV , História do Século XVI , História do Século XVII , História do Século XVIII , História do Século XIX , História Medieval , Humanos , Masculino , Filosofia Médica/história , Teoria Psicológica , Sadismo/história
11.
J Hist Med Allied Sci ; 75(1): 1-23, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31714575

RESUMO

In the classical world, "official" rationalistic medicine made therapeutic use of excrement, urine and other substances that modern humans normally regard as repulsive (this was even true of Galen, the culminating authority); and popular medicine seems to have done so on a large scale. Such practices, which finally lost their professional though not their popular acceptability in the 18th century, have been studied to good purpose by other historians, but they have never been explained in a satisfactory fashion, partly because the relevant evidence is highly diverse. The present paper, by considering the long term (pre-Greek as well as Greek and Roman) and all the relevant contexts, including ancient feelings of disgust and the general state of ancient pharmacology, and by probing people's subconscious motives, attempts to establish a multi-factor explanation. This explanation balances traditions, beliefs about the inherent qualities, physical and magical, of natural substances, and the psychological needs of both healers and the sick.


Assuntos
Assistência à Saúde/história , Fezes , Mundo Grego , Mundo Romano , História Antiga , Higiene/história , Filosofia Médica/história
12.
Georgian Med News ; (295): 159-164, 2019 Oct.
Artigo em Russo | MEDLINE | ID: mdl-31804220

RESUMO

The purpose of the article is to comprehensively disclose the meaning and relevance of the Salerno Health Code as a medieval source of medical and philosophical memo. In the process of writing a scientific article, the authors have used theoretical, empirical, and historical methods of scientific knowledge, in particular, methods of analysis, synthesis, deduction, comparison, the historical method, and the description method. In addition, the analysis of medical legislation, publications in the media and scientific periodicals, allowed us to study the essence and features of the Salerno Health Code. The article gives reason to a correspondence between the treatment methods proposed by the Salerno Health Code and the methods of modern medicine and the reflection of the basic standards of sanitary and epidemic well-being. The individual components of the Salerno Health Code were analyzed, which contributed to the development of bioethical views on sanitation, gerontology, dietetic, pharmaceuticals, disease prevention, medicine philosophy and more. The attention is focused on the author's approach to the formation of a positive worldview by a person and its relationship with the state of his physical health. The author symbolism of the poetic presentation of medical and philosophical ideas is analyzed. The treatise considers the author's approach to the formation of a positive worldview by a person and his relationship with his state of health. The article notes insufficient attention to the work of Arnold de Villanova in the scientific works of modern Ukrainian scientists in medicine and the humanities, which determines the relevance of further scientific research aimed at revealing the importance and potential of this source of medical and philosophical knowledge. Noted the relevance of certain parts of the Salerno Health Code for solving the problems of modern medical science.


Assuntos
Filosofia Médica , História Medieval , Filosofia Médica/história
13.
J Bioeth Inq ; 16(4): 571-586, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31863256

RESUMO

Social justice has been identified as a foundational moral commitment for global health research ethics. Yet what a commitment to social justice means for community engagement in such research has not been critically examined. This paper draws on the rich social justice literature from political philosophy to explore the normative question: What should the ethical goals of community engagement be if it is to help connect global health research to social justice? Five ethical goals for community engagement are proposed that promote well-being, agency, and self-development, particularly for those considered disadvantaged and marginalized. The paper also considers how key terms used in the proposed goals should be defined using existing theories of health and social justice. This analysis is done to give global health researchers and their partners a better idea of what the ethical goals mean. Patterns of convergence amongst different theories are identified that support relying on particular definitions of key terms.


Assuntos
Pesquisa Biomédica/ética , Participação da Comunidade/métodos , Saúde Global , Justiça Social/ética , Nível de Saúde , Humanos , Cooperação Internacional , Objetivos Organizacionais , Filosofia Médica , Política
14.
Dtsch Med Wochenschr ; 144(25): 1784-1788, 2019 12.
Artigo em Alemão | MEDLINE | ID: mdl-31847014

RESUMO

At the turn to the 19th century, medicine in Germany became strongly influenced by the teachings of John Brown, who was a scottish physician. He had advocated a theory which regards and treats disorders as caused by defective or excessive excitation. His teachings were welcomed by natural philosophers like Schelling or Hegel. They modified it and integrated it into their systems of thinking. On the other hand Hufeland, who was one of the foremost physicians at that time, heavily opposed Brunonian System. This becomes evident in a fragmentary text that had been found only recently. In it he criticizes that these teachings were based on pure speculation and not on sound science as executed by Albrecht von Haller. It was meant ironically when he concluded that it thus resembled natural poetry. As viewed from today, evidence based medicine eventually established our modern ways for successfully diagnosing and treating disease. However, Hufelands disapproval appears to be still relevant. There are many people that even now advocate alternative ways and who consult quacks, healers etc.


Assuntos
Medicina Baseada em Evidências/história , Filosofia Médica/história , Médicos/história , Alemanha , História do Século XIX , Humanos , Masculino , Charlatanismo/história , Escócia
15.
BMC Med Ethics ; 20(1): 83, 2019 11 21.
Artigo em Inglês | MEDLINE | ID: mdl-31752935

RESUMO

BACKGROUND: Recent scientific advances in the field of gene editing have led to a renewed discussion on the moral acceptability of human germline modifications. Gene editing methods can be used on human embryos and gametes in order to change DNA sequences that are associated with diseases. Modifying the human germline, however, is currently illegal in many countries but has been suggested as a 'last resort' option in some reports. In contrast, preimplantation genetic (PGD) diagnosis is now a well-established practice within reproductive medicine. Both methods can be used to prevent children from being born with severe genetic diseases. MAIN TEXT: This paper focuses on four moral concerns raised in the debate about germline gene editing (GGE) and applies them to the practice of PGD for comparison: Violation of human dignity, disrespect of the autonomy and the physical integrity of the future child, discrimination of people living with a disability and the fear of slippery slope towards immoral usage of the technology, e.g. designing children for specific third party interests. Our analysis did not reveal any fundamental differences with regard to the four concerns. CONCLUSION: We argue that with regard to the four arguments analyzed in this paper germline gene editing should be considered morally (at least) as acceptable as the selection of genomes on the basis of PGD. However, we also argue that any application of GGE in reproductive medicine should be put on hold until thorough and comprehensive laws have been implemented to prevent the abuse of GGE for non-medical enhancement.


Assuntos
Edição de Genes/ética , Células Germinativas/citologia , Diagnóstico Pré-Implantação/ética , Medicina Reprodutiva/ética , Melhoramento Genético/ética , Humanos , Princípios Morais , Autonomia Pessoal , Pessoalidade , Filosofia Médica , Preconceito
16.
Nephrol Ther ; 15(7): 498-505, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31727511

RESUMO

For more than 10 years, nephrologists in the Grenoble-region have sought advice from the Ethical Concertation Unit in Nephrology with regards to whether to stop or continue dialysis for patients under palliative care. This process deserves a multidisciplinary debate between health professionals and qualified non-health professionals. Thus, we organized a qualitative research protocol in three parts (medical, philosophical, judicial) to explore this issue. Our study aimed to assess the impact of Ethical Concertation Unit in Nephrology's discussions regarding perception, knowledge, and judicial and ethical considerations. The practical repercussions of decision-making within medical practice, its impacts on the patient and his/her family, as well as associated-health professionals, was assessed. To achieve this, two questionnaires and an interview were organized by three Ethical Concertation Unit in Nephrology-leaders to review the viewpoints of the 22 permanent Ethical Concertation Unit in Nephrology members that had participated in 10 Ethical Concertation Unit in Nephrology sessions between 2015 and 2016 to discuss 21 case-reports. Only 13 persons (4 physicians, 6 nurses, 3 non-health professionals) agreed to respond to the questionnaires, and six physicians agreed to participate in an interview. Overall, it was found that most affected patients' physicians agreed with the multidisciplinary discussion, which included judicial and ethical perspectives, and felt reassured with regards to Ethical Concertation Unit in Nephrology's final decision. However, our study showed that Ethical Concertation Unit in Nephrology's functioning could be improved by promoting its existence more widely, by making these decisions earlier within clinical situations, to make Ethical Concertation Unit in Nephrology more accessible to health workers, to make reports easier to understand, to re-examine a posteriori some clinical situations, and to broaden the scope of multidisciplinary skills.


Assuntos
Protocolos Clínicos , Comissão de Ética , Nefrologia/organização & administração , Cuidados Paliativos/ética , Pesquisa Qualitativa , Diálise Renal/ética , Suspensão de Tratamento/ética , Tomada de Decisões/ética , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Comunicação Interdisciplinar , Entrevistas como Assunto , Enfermeiras e Enfermeiros/psicologia , Cuidados Paliativos/legislação & jurisprudência , Filosofia Médica , Médicos/psicologia , Inquéritos e Questionários , Suspensão de Tratamento/legislação & jurisprudência
17.
BMC Med Ethics ; 20(1): 76, 2019 10 26.
Artigo em Inglês | MEDLINE | ID: mdl-31655573

RESUMO

BACKGROUND: Respect for autonomy is a key concept in contemporary bioethics and end-of-life ethics in particular. Despite this status, an individualistic interpretation of autonomy is being challenged from the perspective of different theoretical traditions. Many authors claim that the principle of respect for autonomy needs to be reconceptualised starting from a relational viewpoint. Along these lines, the notion of relational autonomy is attracting increasing attention in medical ethics. Yet, others argue that relational autonomy needs further clarification in order to be adequately operationalised for medical practice. To this end, we examined the meaning, foundations, and uses of relational autonomy in the specific literature of end-of-life care ethics. METHODS: Using PRESS and PRISMA procedures, we conducted a systematic review of argument-based ethics publications in 8 major databases of biomedical, philosophy, and theology literature that focused on relational autonomy in end-of-life care. Full articles were screened. All included articles were critically appraised, and a synthesis was produced. RESULTS: Fifty publications met our inclusion criteria. Twenty-eight articles were published in the last 5 years; publications were originating from 18 different countries. Results are organized according to: (a) an individualistic interpretation of autonomy; (b) critiques of this individualistic interpretation of autonomy; (c) relational autonomy as theoretically conceptualised; (d) relational autonomy as applied to clinical practice and moral judgment in end-of-life situations. CONCLUSIONS: Three main conclusions were reached. First, literature on relational autonomy tends to be more a 'reaction against' an individualistic interpretation of autonomy rather than be a positive concept itself. Dichotomic thinking can be overcome by a deeper development of the philosophical foundations of autonomy. Second, relational autonomy is a rich and complex concept, formulated in complementary ways from different philosophical sources. New dialogue among traditionally divergent standpoints will clarify the meaning. Third, our analysis stresses the need for dialogical developments in decision making in end-of-life situations. Integration of these three elements will likely lead to a clearer conceptualisation of relational autonomy in end-of-life care ethics. This should in turn lead to better decision-making in real-life situations.


Assuntos
Tomada de Decisões , Autonomia Relacional , Assistência Terminal/ética , Dissidências e Disputas , Humanos , Consentimento Livre e Esclarecido/ética , Princípios Morais , Filosofia Médica , Relações Médico-Paciente
18.
Philos Ethics Humanit Med ; 14(1): 15, 2019 10 26.
Artigo em Inglês | MEDLINE | ID: mdl-31655613

RESUMO

BACKGROUND: Despite their shared origins, medicine and dentistry are not always two sides of the same coin. There is a long history in medical philosophy of defining disease and various medical models have come into existence. Hitherto, little philosophical and phenomenological work has been done considering dental caries and periodontitis as examples of disease and illness. METHODS: A philosophical methodology is employed to explore how we might define dental caries and periodontitis using classical medical models of disease - the naturalistic and normativist. We identify shared threads and highlight how the features of these highly prevalent dental diseases prevent them fitting in either definition. The article describes phenomenology and the current thought around the phenomenology of illness, exploring how and why these dental illnesses might integrate into a phenomenological model. RESULTS: We discover that there are some features particular to dental caries and periodontitis: ubiquity, preventability and hyper-monitorablility. Understanding the differences that these dental diseases have compared to many other classically studied diseases leads us to ethical questions concerning how we might manage those who have symptoms and seek treatment. As dental caries and periodontitis are common, preventable and hyper-monitorable, it is suggested that these features affect the phenomenology of these illnesses. For example, if we experience dental illness when we have consciously made decisions that have led to it, do we experience them differently to those rarer illnesses that we cannot expect? Other diseases share these features are discussed. CONCLUSIONS: This paper highlights the central differences between the classical philosophical notion of disease in medicine and the dental examples of caries and periodontitis. It suggests that a philosophical method of conceptualising medical illness - phenomenology - should not be applied to these dental illnesses without thought. A phenomenological analysis of any dental illness is yet to be done and this paper highlights why a separate strand of phenomenology should be explored, instead of employing those that are extant. The article concludes with suggestions for further research into the nascent field of the phenomenology of dental illness and aims to act as a springboard to expose the dental sphere to this philosophical method of analysis.


Assuntos
Cárie Dentária , Periodontite , Filosofia Médica , Cárie Dentária/prevenção & controle , Cárie Dentária/psicologia , Humanos , Estilo de Vida , Periodontite/prevenção & controle , Periodontite/psicologia
19.
Kennedy Inst Ethics J ; 29(3): 205-242, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31656232

RESUMO

This paper argues that epistemic errors rooted in group- or identity-based biases, especially those pertaining to disability, are undertheorized in the literature on medical error. After sketching dominant taxonomies of medical error, we turn to the field of social epistemology to understand the role that epistemic schemas play in contributing to medical errors that disproportionately affect patients from marginalized social groups. We examine the effects of this unequal distribution through a detailed case study of ableism. There are four primary mechanisms through which the epistemic schema of ableism distorts communication between nondisabled physicians and disabled patients: testimonial injustice, epistemic overconfidence, epistemic erasure, and epistemic derailing. Measures against epistemic injustices in general and against schema-based medical errors in particular are ultimately issues of justice that must be better addressed at all levels of health care practice.


Assuntos
Pessoas com Deficiência , Erros Médicos , Preconceito , Competência Clínica , Humanos , Conhecimento , Erros Médicos/prevenção & controle , Erros Médicos/psicologia , Filosofia Médica , Justiça Social
20.
Philos Ethics Humanit Med ; 14(1): 14, 2019 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640739

RESUMO

BACKGROUND: Motivation is a crucial and widespread theme within medicine. From clinical to surgical scenarios, acquiescence in taking a pill or coming to a consultation is imperative for medical treatment to thrive. The "decade of the brain" gave practitioners substantial neuroscientific data on human behavior, helped to explain why people do what they do and created the concept of "motivated brain". Findings from empirical psychology stratified motivation into stages of change, which became more complex over the decades. This research seeks to improve the understanding of how people make decisions about their health, and how to better understand strategies and techniques to help them resolve ambivalence in an effective goal-oriented way. METHODS: We establish a dialogue with Ricoeur's phenomenology of the will in order to understand the meaning of these scientific findings. Starting from Husserlian phenomenology, Paul Ricoeur developed his thoughts away from transcendental idealism, through emancipating the intentional structures of the will from the realm of perception. RESULTS: Through introducing the concepts of the voluntary and the involuntary, Ricoeur deviated from Cartesian dualism, which renders the body as an object body, a target of natural vicissitudes. The new dualism of the voluntary and the involuntary is dealt with by reference to what Ricoeur called the central mystery of incarnate existence, which considers man "double in humanity, simple in vitality". This duality makes it possible to consider the brain to be the natural organ of behavior in the human body, and to use empirical psychology as a path to escape from shallow subjectivations of concepts. CONCLUSIONS: Paul Ricoeur's simplicity (or unity) of existence provides an invitation for medicine to rethink some of its philosophical assumptions, such that patients can be considered to be autonomous subjects with authorial life projects. Ricoeurian anthropology has a deep ethical impact on how medicine should use technology, which arises from empirical psychology findings. The usage of this new knowledge also needs to be thoroughly inspected, since it shifts the social role of medical science.


Assuntos
Assistência à Saúde , Motivação , Controle Comportamental/psicologia , Tomada de Decisões , Humanos , Filosofia Médica , Comportamento de Redução do Risco
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