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.     

Has the sanctity of life law ‘gone too far’?: analysis of the sanctity of life doctrine and English case law shows that the sanctity of life law has not ‘gone too far’

The medical profession consistently strives to uphold patient empowerment, equality and safety. It is ironic that now, at a time where advances in technology and knowledge have given us an increased capacity to preserve and prolong life, we find ourselves increasingly asking questions about the value of the lives we are saving. A recent editorial by Professor Raanan Gillon questions the emphasis that English law places on the sanctity of life doctrine. In what was described by Reverend Nick Donnelly as a “manifesto for killing patients”, Professor Gillon argues that the sanctity of life law has gone too far because of its disregard for distributive justice and an incompetent person’s previously declared autonomy. This review begins by outlining the stance of the sanctity of life doctrine on decisions about administering, withholding and withdrawing life-prolonging treatment. Using this as a foundation for a rebuttal, a proposal is made that Professor Gillon’s assertions do not take the following into account:

1. 1)
   A sanctity of life law does not exist since English Common Law infringes the sanctity doctrine by tolerating quality of life judgements and a doctor’s intention to hasten death when withdrawing life-prolonging treatment.
    
2. 2)
   Even if a true sanctity of life law did exist:

   1. a)
      The sanctity of life doctrine allows for resource considerations in the wider analysis of benefits and burdens.
       
   2. b)
      The sanctity of life doctrine yields to a competent person’s autonomous decision.
       
    

This review attempts to demonstrate that at present, and with the legal precedent that restricts it, a sanctity of life law cannot go too far.     

Working with Research Integrity—Guidance for Research Performing Organisations: The Bonn PRINTEGER Statement

This document presents the Bonn PRINTEGER Consensus Statement: Working with Research Integrity—Guidance for research performing organisations. The aim of the statement is to complement existing instruments by focusing specifically on institutional responsibilities for strengthening integrity. It takes into account the daily challenges and organisational contexts of most researchers. The statement intends to make research integrity challenges recognisable from the work-floor perspective, providing concrete advice on organisational measures to strengthen integrity. The statement, which was concluded February 7th 2018, provides guidance on the following key issues:

1. § 1.
   Providing information about research integrity
    
2. § 2.
   Providing education, training and mentoring
    
3. § 3.
   Strengthening a research integrity culture
    
4. § 4.
   Facilitating open dialogue
    
5. § 5.
   Wise incentive management
    
6. § 6.
   Implementing quality assurance procedures
    
7. § 7.
   Improving the work environment and work satisfaction
    
8. § 8.
   Increasing transparency of misconduct cases
    
9. § 9.
   Opening up research
    
10. § 10.
    Implementing safe and effective whistle-blowing channels
     
11. § 11.
    Protecting the alleged perpetrators
     
12. § 12.
    Establishing a research integrity committee and appointing an ombudsperson
     
13. § 13.
    Making explicit the applicable standards for research integrity
     

     

Marginal Christian Spirituality: An Example from a Dutch Meditation Group

Spirituality is one of the forms of religion that seems to thrive in secularised Western societies. It has become an umbrella term for a variety of experience-oriented religious practices in Western societies. The popularity of spirituality is clearly visible within Christian settings, both inside and outside churches. This paper explores the nature of ‘marginal’ Christian spirituality, i.e. Christian spirituality outside the churches, through a case study of a meditation group in a Dutch spiritual centre founded by Jesuits. It will be shown how meditation as a free experiential space stimulates the diversity of individual meanings, both traditional and alternative. Hence, meditation in this case is a method which affirms religious individuality.

Exercise

I am the stream

And I flow beyond myself

I am the river

And I pour myself into the sea

I am the sea

And I evaporate into nothing

I am the cloud

And I am losing my hold

In rain and snow

My form fragments

Who can love me

When I appear and disappear

Again and again

You are water, says the water

Water, my child, you are me

Whether ice or fog

You are me

Love yourself, then you love me

And everywhere you are safe in me.

(Visser 1)1 1.?Unless stated otherwise, all translations are by the author. View all notes

     

Renewing Medicine’s basic concepts: on ambiguity

Background

Edmund Pellegrino lamented that the cultural climate of the industrialized West had called the fundamental means and ends of medicine into question, leading him to propose a renewed reflection on medicine’s basic concepts, including health, disease, and illness. My aim in this paper is take up Pellegrino’s call. I argue that in order to usher in this renewal, the concept of ambiguity should take on a guiding role in medical practice, both scientific and clinical. After laying out Pellegrino’s vision, I focus on the concept of normality, arguing that it undergirds modern medicine’s other basic concepts. I draw on critiques by scholars in disability studies that show the concept of normality to be instructively ambiguous. Discussing the cases of Deafness and body integrity identity disorder (BIID), I argue that if medicine is to uphold its epistemic authority and fulfill its melioristic goals, ambiguity should become a central medical concept.

Methods

In this theoretical paper, I consider how central concepts in the philosophy of medicine are challenged by research on experiences of disability. In particular, the idea that medical knowledge produces universal truths is challenged and the importance of historical, cultural, and otherwise situated knowledge is highlighed.

Results

I demonstrate how experiences of disability complicate dominant theories in the philosophy of medicine and why medical practice and the philosophy of medicine should make ambiguity a central concept.

Conclusions

If medical practitioners and philosophers of medicine wish to improve their understanding of the meaning and practice of medicine, they should take seriously the importance and centrality of ambiguity.

     

Framing,Reciprocity and the Grounds of Egalitarian Justice

John Rawls famously claims that ‘justice is the first virtue of social institutions’. On one of its readings, this remark seems to suggest that social institutions are essential for obligations of justice to arise. The spirit of this interpretation has recently sparked a new debate about the grounds of justice. What are the conditions that generate principles of distributive justice? I am interested in a specific version of this question. What conditions generate egalitarian principles of distributive justice and give rise to equality as a demand of justice? My paper focuses on relationalist answers to this question. Advocates of relationalism assume that ‘principles of distributive justice have a relational basis’, in the sense that ‘practice mediated relations in which individuals stand condition the content, scope and justification of those principles’. To say that principles of justice are ‘based’ on and ‘conditioned’ by practice mediated relations is ambiguous. I will here be concerned with advocates of what I call the relationalist requirement, viz. positions which assume that ‘practice mediated relations’ constitute a necessary existence condition for principles of egalitarian distributive justice. Relationalists who endorse this view come in different varieties. My focus is on relationalists that view social and political institutions as the relevant ‘practice mediated relation’. The question at stake, then, is this: Are institutionally mediated relations a necessary condition for equality to arise as a demand of justice? Strong relationalists of the institutionalist cast, call them advocates of the institutionalist requirement, differ in important respects. They argue about what set of institutions is foundationally significant, and they disagree on why only that institutional relation gives rise to egalitarian obligations of justice. My paper engages two ways of arguing for the institutionalist requirement: Julius’s framing argument and Andrea Sangiovanni’s reciprocity argument. The issue at stake are the grounds of egalitarian justice and I will argue that the institutionalist requirement is mistaken. It is not the case that egalitarian obligations of distributive justice arise only between and solely in virtue of individuals sharing a common institution.     

When “All the Five Circles” are Four: New Exercises in Domain Restriction

The domain of a quantifier is determined by a variety of factors, which broadly speaking fall into two types. On the one hand, the context of utterance plays a role: if the focus of attention is on a particular collection of kangaroos, for example, then “Q kangaroos” is likely to range over the individuals in that set. On the other hand, the utterance itself will help to establish the quantificational domain, inter alia through presuppositions triggered within the sentence. In this paper, we concentrate our attention on constructions like the following, in which “the square to which ... ” is the critical presupposition trigger:

1. (i)
   Q circles ...
    
2. (ii)
   Q of these circles ...
    
3. (iii)
   Q of these five circles ... ... have the same colour as the square to which they are connected.
    

Many theories predict that all instances of these schemata will give rise to the presupposition that every circle is connected to a square. We present an analysis which predicts that these sentences should generally be accepted in a context in which not all the circles are connected to a square, with one exception only: if a quantified sentence is of type (iii) and Q is non-intersective, then the sentence should be more likely to be rejected. Furthermore, we predict that manipulating the context so as to make the connected circles more or less salient should have an effect on statements with non-intersective quantifiers only. These predictions were tested in a series of experiments.     

Berkeley’s Contingent Necessities

The paper provides an account of necessary truths in Berkeley based upon his divine language model. If the thesis of the paper is correct, not all Berkeleian necessary truths can be known a priori.

A priori truth

Conclusion There are several epistemic distinctions among truths that I have argued for in this paper. First, there are those truths which holdof every rationally accessible conceptual scheme (class A truths). Second, there are those truths which holdin every rationally accessible conceptual scheme (class B truths). And finally, there are those truths whose truthvalue status isindependent of the empirical sciences (class C truths). The last category broadly includes statementsabout systems and the statements they contain, as well as statements true by virtue of the rules of language itself.At the risk of anachronism, I'll describe the positions of Carnap (1956); Quine (1980); Grice et al. (1956); the various Putnam's and myself in terms of the above distinctions: both Carnap and Quine (pretty much) think there are no class A or class B truths. Both Putnam (1975) and Putnam (1983c) think there are class A and class B truths, and that these classes overlap. I deny there are class B truths but affirm the existence of class A truths (although I haven't given explicit examples of the latter here). Finally, everyone here but Quine (1980) thinks there are class C truths (of one sort or another). Putnam (1975) attempts to show that certain class C truths are simultaneously class A and class B truths. Grice et al. (1956) take pains to distinguish the claim that there are class C truths from the claim that there are class A truths, and claim (against Quine, 1980) that no argument showing there are no class A truths shows there are no class C truths.On my interpretation of Quine (1980) he thinks that the nonexistence of class A truths shows there are no class C truths-given the extra bit of argument that a notion of true by convention or true by virtue of meaning without epistemic content, is a distinction without significance. But that issue, which is the one Grice et al. (1956) are concerned with, has not been the focus in this paper-and so in a sense I have shifted the terms of the original debate.Here I have been primarily concerned to distinguish epistemic notions and sort out how and in what ways they relate to each other. A primary tool in this exercise has been the explicit recognition that formal models of truth make universality an unlikely property of our conceptual schemes. If I have not convinced anyone that the epistemic notions sort out the way I think they do, I hope at least that some burden-shifting has occurred: that philosophers do not either take it for granted that certain notionsmust be expressible in any conceptual scheme or treat the fact that conceptual schemes must be (in some sense) limited as of little (philosophical) moment.On the other hand, if I am right about the epistemology, it follows that previous attempts to mark out the necessary structures in rationally accessible conceptual schemes via a priori truths is hopeless. What I think must replace their role, what I call globally incorrigible sets of sentences, is a topic for another time.My thanks to Arnold Koslow and Mark Richard for their helpful suggestions. I also want to thank the City University of New York Graduate Center for inviting me to be a visiting scholar academic year 1989–90, during which time this paper was written. While there I was partially supported by a Mellon fellowship from Tufts University, for which I am grateful.     

Linking Workplace Aggression to Employee Well-Being and Work: The Moderating Role of Family-Supportive Supervisor Behaviors (FSSB)

Purpose

The present study examined the moderating effects of family-supportive supervisor behaviors (FSSB) on the relationship between two types of workplace aggression (i.e., patient-initiated physical aggression and coworker-initiated psychological aggression) and employee well-being and work outcomes.

Methodology

Data were obtained from a field sample of 417 healthcare workers in two psychiatric hospitals. Hypotheses were tested using moderated multiple regression analyses.

Findings

Psychiatric care providers’ perceptions of FSSB moderated the relationship between patient-initiated physical aggression and physical symptoms, exhaustion and cynicism. In addition, FSSB moderated the relationship between coworker-initiated psychological aggression and physical symptoms and turnover intentions.

Implications

Based on our findings, family-supportive supervision is a plausible boundary condition for the relationship between workplace aggression and well-being and work outcomes. This study suggests that, in addition to directly addressing aggression prevention and reduction, family-supportive supervision is a trainable resource that healthcare organizations should facilitate to improve employee work and well-being in settings with high workplace aggression.

Originality

This is the first study to examine the role of FSSB in influencing the relationship between two forms of workplace aggression: patient-initiated physical and coworker-initiated psychological aggression and employee outcomes.

     

Stepping into a Painting

Until The Red Book: Liber Novus was^{Figure 1} published in 2009, we knew of C. G. Jung's personal adventure with the psyche and its influences on his life, as he described them in his chapter “Confrontation with the Unconscious” in Memories, Dreams, Reflections. He called it the “prima materia for a lifetime's work” (1963, pp. 170–199). But without The Red Book, it would have been impossible to imagine how deep and torturous Jung's descent into the world of his inner images really was. The full extent of his interactions with the figures that manifested on this journey he would later call “active imagination.” My initial reading of The Red Book elicited feelings of awed respect for the density, complexity, and daring of the text and paintings. Closer exploration was followed by a sense of new freedom related to my own experiences with active imagination. It was especially Jung's admonitions and warnings to experience one's own inner world as unique and incomparable to any other that gave new breadth and meaning to my personal experiences with active imagination. This feeling of expansion became the inspiration for this article, in which I describe my own encounters with images of the unconscious and their influence on both my inner and outer lives.

Stepping into a Painting

All authors

Bianca Daalder-van Iersel

https://doi.org/10.1080/00332925.2017.1282257

Published online:

10 March 2017

Figure 1. Incubation—Sleeping in the Temple, 2009 (acrylic painting on linen-covered panel, 10″ × 10″) by author.     

15.

Response to Selected Commentaries on the AJOB Target Article “On the Ethics of Facial Transplantation Research”     

Joseph C. Banis  John H. Barker  Michael Cunningham  Cedric G. Francois  Allen Furr  Federico Grossi 《The American journal of bioethics : AJOB》2013,13(3):W23-W31

     

16.

Integrating cognitive behavioral therapy into a psychodynamic framework     

Amy L. Hoch-Espada  Julie Lippmann 《Cognitive and behavioral practice》2000,7(3)

     

17.

The prevention of sexual abuse: Examination of the effectiveness of a program with kindergarten-age children     

Pam Harvey  Rex Forehand  Carvin Brown  Thomas Holmes 《Behavior Therapy》1988,19(3)

     

18.

The role of emotion in the psychological functioning of adult survivors of childhood sexual abuse     

Brian P. Marx  Denise M. Sloan 《Behavior Therapy》2002,33(4):563-577

     

19.

The relationship between blame attribution, age and personality characteristics in inmates admitted to Grendon therapeutic prison     

John Henry Shine 《Personality and individual differences》1997,23(6):943-947

     

20.

Husbands'' marital violence and the adjustment problems of clinic-referred children     

Renee McDonald  Ernest N. Jouriles  William Norwood  Holly Shinn Ware  Elizabeth Ezell 《Behavior Therapy》2000,31(4):649-665