What is the place for philosophy within the field of medicine? A review of contemporary issues in medical ethics

This extended essay seeks to unpack some of the key aspects of philosophy which are applicable to medical thought and practice. It proceeds via an analytical discussion of the contemporary debate in three key areas of medical ethics: euthanasia, concepts of health & disease and psychiatry.

The main claims are as follows:

1. 1.
   The case for legalising euthanasia is strong on philosophical grounds but there are numerous practical obstacles.
    
2. 2.
   Elements from the normative and naturalistic definitions of disease are necessary for a thorough definition that dodges common objections to either.
    
3. 3.
   Mental health cannot be subsumed under a purely physicalist model of health rendering it distinctly different from other fields in Medicine.
    

Through a detailed discussion of three salient issues in the philosophy of medicine, it is argued that the application of profound philosophical thought to medicine and its practices reveals a depth that necessitates exploration before simply following the aims of curing all. Philosophical rigour matched with modern medicine has the potential to engage patients and help them make independent, informed decisions and assist physicians to think more clearly, analytically and empathetically.     

Teaching science at the university level: What about the ethics?

Ethics in science is integrated into an interdisciplinary science course called “Science, Technology and Society” (STS). This paper focuses on the section of the course called “Societal Impact on Science and Technology”, which includes the topics Misconduct in Science, Scientific Freedom and Responsibility, and the Use of Human Subjects in Research. Students in the course become aware not only of the science itself, but also of the process of science, some aspects of the history of science, the social responsibilities of scientists, and the ethical issues in science. Teaching techniques include the instructor sharing experiences as a scientist with the students, sharing books and resources with students, utilizing current sources of information like the weekly “Science Times”, inviting guest speakers, and utilizing portfolios to assess student learning. This paper was delivered orally at the National Academy of Sciences’ “Convocation on Scientific Conduct”, 6–7 June 1994.     

Are older adults less efficient in making attributions about the origin of memories for web interaction?

IntroductionAs people age, they may be less likely to recollect where or when an event took place. However, few studies of source monitoring and aging have used tasks that are similar to what people do in everyday life.ObjectivePotential age-related differences in making attributions about the origin of remembered events in Web interaction are examined in the present study.MethodsA Web-based source-monitoring paradigm was modelled to assess both item and source memory, which incorporated typical Web search tasks.ResultsOlder adults exhibited a reduced ability in navigation-oriented search, where both a measure of processing speed and a measure of executive function were significant predictors of performance. They were less able to recognize and recollect items previously encountered in web pages. However, source memory was not more impaired with age than item memory. Interestingly, although the addition of cognitive operations as a cue to source had no impact on source memory, it resulted in increased recognition and recollection in the older adults.ConclusionMore generally, recognition and recollection appeared to be dissociated from source memory as a function of different individual difference measures.     

Are the Descendants of Slaves Owed Compensation for Slavery?

The compensatory-justice justification of affirmative action requires a comparison of the actual world in which the injured person lives with a relevantly similar possible world in which this person lives but where the unjust injuring act never occurred, in order to identify the degree of harm brought about by the unjust injurious act. The problem is that some unjust injuring acts, particularly acts of slavery, led to intercourse and the later creation of the ancestors of many members of minority groups. Hence, there is no possible world in which these individuals exist and in which the injustice, e.g., slavery, did not occur. As a result, the counterfactual test does not allow us to measure or even understand the existence of a compensatable injury to these persons. I provide an inheritance-based account of compensation that escapes this.     

Are infants in the dark about hidden objects?

Infants appear to search for objects hidden by darkness earlier in development than they search for objects hidden by an occluder in the light. However, these two types of search tasks have differed in numerous ways that may have contributed to better performance in the dark (e.g. in whether the hidden objects made sound, in the number of familiarization trials with visible objects). The current studies controlled such incidental differences between search tasks, so that they could be directly compared. Six‐and‐a‐half‐month‐olds received four types of test events, in which either a toy or no toy was presented and then hidden in the dark or under a cloth in the light. Infants searched more often on toy than no‐toy trials in the dark than with a cloth. The advantage in searching for hidden objects in the dark thus appears to be genuine. Theoretical implications are discussed.     

Inhibition of return for the length of a line?

Inhibition of return is most often measured using an exogenous spatial cuing method. The experiments presented here follow up on a small number of studies that have examined whether a similar effect occurs for nonspatial stimulus attributes. In Experiments 1 and 2, the task was to identify a target line as either short or long. In this context, targets on valid trials were of the same length as that of a preceding cue, whereas targets on invalid trials were of a different length than that of a preceding cue. The results were similar to those in spatial orienting studies in that responses were slower for valid than for invalid targets only at stimulus onset asynchronies (SOAs) longer than 300 msec. In Experiment 3, the stimuli were the same but the task was to detect the onset of the target line. This task change resulted in slower responses for valid than for invalid targets at all SOAs. A similar result was observed in Experiment 4, in which validity was defined by color rather than line length, and the task was to identify the target color. The discussion centers on an opponent process approach to interpreting cuing effects, and consequent difficulties in distinguishing spatial and nonspatial cuing effects based on their time course.     

Are the Medical Humanities for Sale? Lessons from a Historical Debate

In November of 1959, William Bean published in the Archives of Internal Medicine a scathing review of Félix Martí-Ibañez’s Centaur: Essays on the History of Medical Ideas. Martí-Ibañez and Bean were two of the leading exponents of the importance of medical humanism during a formative period from the 1950s through the 1970s. But the two physicians differed fundamentally in their views of the ideal relationships among the pharmaceutical industry, the medical profession, and the medical humanities. We situate Bean’s review within its historical context, shedding light on the history and diverging uses of the medical humanities.     

Are the Effects of Height on Well-Being a Tall Tale?

Numerous papers have documented a positive association between height and good physical health and also with good economic outcomes such as earnings. A smaller number have argued for an association with well-being. In this paper, the SHARE survey of over 50 year olds in Europe is used to analyse whether individuals’ height is associated with higher or lower levels of life-satisfaction using ordered probit estimation. In simple models there is a positive, concave relationship between height and life satisfaction. However it is shown that the results are quite sensitive to the inclusion of controls reflecting demographics and, in particular, human capital and health status. Where effects do exist, it is predominantly at low to medium levels of height. That is there is a penalty, in well-being terms, to being short but not necessarily a benefit to being tall. There is also evidence of heterogeneity across countries with the effects being best determined in France.     

Can phronesis save the life of medical ethics?

There has been a growing interest in casuistry since the ground breaking work of Jonsen and Toulmin. Casuistry, in their view, offers the possibility of securing the moral agreement that policy makers desire but which has proved elusive to theory driven approaches to ethics. However, their account of casuistry is dependent upon the exercise of phronesis. As recent discussions of phronesis make clear, this requires attention not only to the particulars of the case, but also to the substantive goods at stake in the case. Without agreement on these goods attention to cases is unlikely to secure the productive consensus that Jonson and Toulmin seek.     

What can we learn by looking for the first code of professional ethics?

The first code of professional ethics must: (1)be a code of ethics; (2) apply to members of a profession; (3) apply to allmembers of that profession; and (4) apply only to members of that profession. The value of these criteria depends on how we define “code”, “ethics”, and “profession”, terms the literature on professions has defined in many ways. This paper applies one set of definitions of “code”, “ethics”, and “profession” to a part of what we now know of the history of professions, there by illustrating how the choice of definition can alter substantially both our answer to the question of which came first and (more importantly) our understanding of professional codes (and the professions that adopt them). Because most who write on codes of professional ethics seem to take for granted that physicians produced the first professional code, whether the Hippocratic Oath, Percival’s Medical Ethics, the 1847 Code of Ethicsof the American Medical Association (AMA), or some other document, I focus my discussion on these codes. This revised version was published online in June 2006 with corrections to the Cover Date.     

Soames on ethics: A new vision for the future of analytic philosophy?

Philosophical Studies -     

Ethics in medicine: Are we blind? In support of teaching medical ethics at the bedside

The ability to recognize and respond to the ethical dimension of medicine is integral to providing health care that is comprehensive and humane. However, this aspect of medical practice is underemphasized in clinical and academic medicine, despite attempts to devise curricula in this field. This paper examines the origins and consequences of this deficiency through a case history of a Jehovah's Witness who reluctantly accepted a blood transfusion. It emphasizes the ubiquity of the ethical context in medicine and argues that blindness to this context stems from the prevailing scientific and technological paradigm in medicine. Innovations in medical education are called for to enhance health care providers' abilities to appreciate and cope with these complex situations.     

Divergent viewpoints about lineups: What policy for the identification of criminals?

IntroductionA fair lineup is needed to maximize the likelihood of correct identification of the criminal and minimize the likelihood of mistaken identification. Fairness depends on distractor plausibility and the lineup method (i.e., simultaneous or sequential).ObjectiveThis paper aims to evaluate the advantages and the limits of distractor plausibility and the presentation of the lineup members, and thus show the best method to ensure correct identification.MethodOur conclusions are based on the major experiments published in the field and on recent debates in the scientific community.Results and conclusionIn addition to distractor plausibility, our conclusions, which are based on previous work by Malpass (2006), suggest that sequential and simultaneous lineups are complementary rather than opposed. The paper argues that two tools specifically designed for and adapted to particular situations are better than one.     

Searching for Shereshevskii: what is superior about the memory of synaesthetes?

Some individuals with superior memory, such as the mnemonist Shereshevskii (Luria, 1968), are known to have synaesthesia. However, the extent to which superior memory is a general characteristic of synaesthesia is unknown, as is the precise cognitive mechanism by which synaesthesia affects memory. This study demonstrates that synaesthetes tend to report subjectively better than average memory and that these reports are borne out with objective testing. Synaesthetes experiencing colours for words show better memory than matched controls for stimuli that induce synaesthesia (word lists) relative to stimuli that do not (an abstract figure). However, memory advantages are not limited to material that elicits synaesthesia because synaesthetes demonstrate enhanced memory for colour per se (which does not induce a synaesthetic response). Our results suggest that the memory enhancement found in synaesthetes is related to an enhanced retention of colour in both synaesthetic and nonsynaesthetic situations. Furthermore, this may account for the fact that synaesthetic associations, once formed, remain highly consistent.     

Are microsaccades responsible for the gap effect?

Extinguishing a fixation point shortly before, or concurrently with, the onset of a peripheral visual target reduces the latency of saccades to that target. Saslow (1967) hypothesized that thisgap effect might occur because fixation point offsets reduce the incidence of corrective microsaccades with an associated saccadic refractory period. In the present study, a robust gap effect was obtained. However, using a Purkinje image eyetracker with 1 arcmin of resolution, we found that fixation point offsets had no effect on the occurrence of microsaccades and that the occurrence of microsaccades had no impact on the magnitude of the gap effect. Microsaccades therefore do not appear to play any part in the production of the gap effect.