Medicine, Health Care and Philosophy

International association for education in ethics (IAEE)

Evaluating non-disclosure of errors and healthcare organization: a case of bioethics consultation Abstract Sometimes medical errors should not be disclosed. We report a case of semen samples exchange, during a homologous artificial insemination procedure, where a bioethics consultation was required. The bioethics consultation addressed ethical and legal elements in play, supporting non-disclosure to some of the subjects involved. Through a proper methodology, gathering factual and juridical elements, a consultant can show when a moral dilemma between values and rights—privacy versus fatherhood, in our case—is unsubstantial, in a given context, because of the groundlessness of the value or the right itself. However, being the error elicited by organizational factors, a broader ethical pronouncement was needed. Under such circumstances, ethical evaluation should engage in a sort of ‘ethical-based root-cause analysis’, linking ethical principles to quality aims and showing the opportunity to integrate ethical methodology in healthcare management. From this perspective, errors may become an incentive to promote high-quality organizations, attending to the central value of person even through the organizational process.

Communication technologies through an etymological lens: looking for a classification, reflections about health, medicine and care Abstract Information and communication technologies are widely used in healthcare. However, there is not still a unified taxonomy for them. The lack of understanding of this phenomenon implies theoretical and ethical issues. This paper attempts to find out the basis for a classification, starting from a new perspective: the structural elements are obtained from the etymologies of the lexicon commonly used, that is words like telemedicine, telehealth, telecare and telecure. This will promote a better understanding of communication technologies; at the same time, it will allow to draw some reflection about health, medicine and care, and their semantic and relational nature.

The current dialogue between phenomenology and psychiatry: a problematic misunderstanding Abstract A revival of the dialogue between phenomenology and psychiatry currently takes place in the best international journals of psychiatry. In this article, we analyse this revival and the role given to phenomenology in this context. Although this dialogue seems at first sight interesting, we show that it is problematic. It leads indeed to use phenomenology in a special way, transforming it into a discipline dealing with empirical facts, so that what is called “phenomenology” has finally nothing to do with phenomenology. This so-called phenomenology tallies however with what we have always called semiology. We try to explain the reasons why phenomenology is misused in that way. In our view, this transformation of phenomenology into an empirical and objectifying discipline is explained by the role attributed to phenomenology by contemporary authors, which is to solve the problems raised by theDiagnostic and Statistical Manual of Mental Disorders.

Rotten context: the unaffordability of technological advances

Broadening the future of value account of the wrongness of killing Abstract On Don Marquis’s future of value account of the wrongness of killing, ‘what makes it wrong to kill those individuals we all believe it is wrong to kill, is that killing them deprives them of their future of value’. Marquis has recently argued for a narrow interpretation of his future of value account of the wrongness of killing and against the broad interpretation that I had put forward in response to Carson Strong. In this article I argue that the narrow view is problematic because it violates some basic principles of equality and because it allows for some of the very killing that Marquis sets out to condemn; further, I argue that the chief reason why Marquis chooses the narrow view over the broad view—namely that the broad view would take the killing of some non-human animals to be also wrong—should rather be considered a welcome upshot of the broad view.

Bioenhancements and the telos of medicine Abstract Staggering advances in biotechnology within the past decade have given rise to pharmacological, surgical and prosthetic techniques capable of enhancing human functioning rather than merely treating or preventing disease. Bioenhancement technologies range from nootropics capable of enhancing cognitive abilities to distraction osteogenesis, a surgical technique capable of increasing height through limb lengthening. This paper examines whether the use of bioenhancements falls inside or outside the proper boundaries of healthcare, and if so, whether clinicians have professional responsibilities to administer bioenhancements to patients. After explicating two theoretical approaches to the concept of health, one objectivist and the other constructivist, I contend that clinicians' corresponding professional responsibilities hinge on which philosophical account of health is endorsed, and illustrate how the lack of analytic clarity with respect to this concept can lead to defective positions on the place of bioenhancements in healthcare. With this conceptual framework in place, an account of health as a cluster concept that incorporates both constructivist and objectivist components is developed and defended.

A frame of mind from psychiatry Abstract A distinctive characteristic of psychiatry is that it is a discipline that deals with both the physical and the mental lives of individuals. Largely because of this characteristic, different models are used for different disorders, however, there is still a remnant tendency towards reductionist views in the field. In this paper I argue that the available empirical evidence from psychiatry gives us reasons to question biological reductionism and that, in its place, we should adopt a pluralistic explanatory model that is more suited to the needs of the discipline and to the needs of the patients it is meant to help. This will allow us to retain psychiatry as an autonomous science that can productively co-exist with neuroscience while also giving patients the kind of attention they need. I further argue that this same evidence supports a view of the mind that is anti-reductive and that allows that causation can be both bottom-up and top-down and that such a view is available in emergentism coupled with an interventionist model of causation.

The ethical challenges of the clinical introduction of mitochondrial replacement techniques Abstract Mitochondrial DNA (mtDNA) diseases are a group of neuromuscular diseases that often cause suffering and premature death. New mitochondrial replacement techniques (MRTs) may offer women with mtDNA diseases the opportunity to have healthy offspring to whom they are genetically related. MRTs will likely be ready to license for clinical use in the near future and a discussion of the ethics of the clinical introduction of MRTs is needed. This paper begins by evaluating three concerns about the safety of MRTs for clinical use on humans: (1) Is it ethical to use MRTs if safe alternatives exist? (2) Would persons with three genetic contributors be at risk of suffering? and (3) Can society trust that MRTs will be made available for humans only once adequate safety testing has taken place, and that MRTs will only be licensed for clinical use in a way that minimises risks? It is then argued that the ethics debate about MRTs should be reoriented towards recommending ways to reduce the possible risks of MRT use on humans. Two recommendations are made: (1) licensed clinical access to MRTs should only be granted to prospective parents if they intend to tell their children about their MRT conception by adulthood; and (2) sex selection should be used in conjunction with the clinical use of MRTs, in order to reduce transgenerational health risks.