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J Med Philos 2018 Nov;43(6):650-666

University of Kentucky, Lexington, Kentucky, USA.

Despite its many strengths, Engelhardt's After God displays two surprising features: an affinity for voluntaristic ethics and a tendency to oppose Eastern Orthodoxy (as a purely revealed religion) to philosophy. Neither of these is in keeping with the mainstream of Eastern Orthodox tradition. Here, I offer a modest corrective. Read More

J Med Philos 2018 Nov;43(6):710-723

Università di Torino, Torino, Italy.

>Engelhardt's After God gives a comprehensive perspective on the deepest and hardest issues in both moral philosophy and bioethics of our time. Although the book is an intelligent critique of contemporary moral philosophy in favor of a kind of traditionalism rooted in the perspective of the Orthodox Church, containing numerous forceful arguments, I ultimately disagree with Engelhardt on several main points stemming from his pessimistic view of our current culture and society. I have neither the pretense to open new perspectives, nor to put forward new arguments, and I am aware that I might be wrong. Read More

J Med Philos 2018 Nov;43(6):724-745

Harvard University, Boston, Massachusetts, USA.

This article argues that values that apply to health care allocation entail the possibility of "spectrum arguments," and that it is plausible that they often fail to determine a best alternative. In order to deal with this problem, a two-step process is suggested. First, we should identify the Strongly Uncovered Set that excludes all alternatives that are worse than some alternatives and not better in any relevant dimension from the set of eligible alternatives. Read More

J Med Philos 2018 Nov;43(6):746

J Med Philos 2018 Nov;43(6):631-649

Davidson College, Davidson, North Carolina, USA.

In a spirit of critical appreciation, this essay challenges several core aspects of the critique of secular morality and the defense of Orthodox Christianity offered by H. Tristram Engelhardt in After God. First, I argue that his procedurally driven approach to a binding morality based solely on a principle of permission leaves morality without any substantive definition in general terms, in ways that are both conceptually problematic and also at odds with Engelhardt's long-standing distinction between non-malevolence and beneficence. Read More

J Med Philos 2018 Nov;43(6):667-685

University of South Carolina, Columbia, South Carolina, USA.

J Med Philos 2018 Nov;43(6):686-709

Saint Louis University, St. Louis, Missouri, USA.

J Med Philos 2018 Sep;43(5):506-526

Saint Louis University, St. Louis, Missouri, USA.

Some bioethicists have argued that moral bioenhancement, complementing traditional means of enhancing individuals' moral dispositions, is essential if we are to survive as a species. Traditional means of moral enhancement have historically included civil legislation, socially recognized moral exemplars, religious teachings and disciplines, and familial upbringing. I explore the necessity and feasibility of pursuing methods of moral bioenhancement as a complement to such traditional means, grounding my analysis within a virtue-theoretic framework. Read More

J Med Philos 2018 Sep;43(5):527-546

Northern Kentucky University, Highland Heights, Kentucky, USA.

In this article, I argue that as we learn more about how we might intervene in the brain in ways that impact human behavior, the scope of what counts as "moral behavior" becomes smaller and smaller because things we successfully manipulate using evidence-based science are often things that fall outside the sphere of morality. Consequently, the argument that we are morally obligated to morally enhance our neighbors starts to fall apart, not because humans should be free to make terrible choices, but because morality is not something subject to such manipulation. To illustrate my argument, I shall use the rise of veteran diversion courts in the United States as a putative instance of an intervention designed to change human behavior for the better. Read More

J Med Philos 2018 Sep;43(5):490-505

Tilburg University, Tilburg, The Netherlands.

Suppose, we could take a pill that would turn us into morally better people. Would we have a duty to take such a pill? In recent years, a number of philosophers have discussed this issue. Most prominently, Ingmar Persson and Julian Savulescu have argued that we would have a duty to take such a pill. Read More

J Med Philos 2018 Sep;43(5):585-612

Vanderbilt University, Nashville, Tennessee, USA.

Over the coming century, the accelerating advance of bioenhancement technologies, robotics, and artificial intelligence (AI) may significantly broaden the qualitative range of sentient and intelligent beings. This article proposes a taxonomy of such beings, ranging from modified animals to bioenhanced humans to advanced forms of robots and AI. It divides these diverse beings into three moral and legal categories-animals, persons, and presumed persons-describing the moral attributes and legal rights of each category. Read More

J Med Philos 2018 Sep;43(5):547-567

Monash University, Victoria, Australia.

John Harris recently argued that the moral bioenhancement proposed by Persson and Savulescu can damage moral agency by depriving recipients of their freedom to fall (freedom to make wrongful choices) and therefore should not be pursued. The link Harris makes between moral agency and the freedom to fall, however, implies that all forms of moral enhancement that aim to make the enhancement recipients less likely to "fall," including moral education, are detrimental to moral agency. In this article, I present a new moral agency-based critique against the moral bioenhancement program envisaged by Persson and Savulescu. Read More

J Med Philos 2018 Sep;43(5):568-584

Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA.

There is recent empirical evidence that personal identity is constituted by one's moral traits. If true, this poses a problem for those who advocate for moral enhancement, or the manipulation of a person's moral traits through pharmaceutical or other biological means. Specifically, if moral enhancement manipulates a person's moral traits, and those moral traits constitute personal identity, then it is possible that moral enhancement could alter a person's identity. Read More

J Med Philos 2018 Sep 3. Epub 2018 Sep 3.

Umeå University, Umeå, Sweden.

A scientific paradigm typically embraces research norms and values, such as truth-seeking, critical thinking, disinterestedness, and good scientific practice. These values should prevent a paradigm from introducing defective assumptions. But sometimes, scientists who are also physicians develop clinical norms that are in conflict with the scientific enterprise. Read More

J Med Philos 2018 Aug 18. Epub 2018 Aug 18.

Birkbeck College, University of London, London, United Kingdom.

At a time when different groups in society are achieving notable gains in respect and rights, activists in mental health and proponents of mad positive approaches, such as Mad Pride, are coming up against considerable challenges. A particular issue is the commonly held view that madness is inherently disabling and cannot form the grounds for identity or culture. This paper responds to the challenge by developing two bulwarks against the tendency to assume too readily the view that madness is inherently disabling: the first arises from the normative nature of disability judgments, and the second arises from the implications of political activism in terms of being a social subject. Read More

J Med Philos 2018 Jul;43(4):439-468

De Paul University, Chicago, Illinois, USA.

This article explores Foucault's two different notions of power: one where the subject is constituted by power-knowledge relations and another that emphasizes how power is a central feature of human action. By drawing out these two conceptualizations of power, Foucault's work contributes three critical points to the formation of medicalized subjectivities: (1) the issue of medicalization needs to be discussed both in terms of both specific practices and holistically (within the carceral archipelago); (2) we need to think how we as human beings are "disciplined" and "subjectivated" through medicalization, as discourses, practices, and institutions are all crystallizations of power relations; and (3) we need to reflect on how we can "resist" this process of subjectification, since "power comes from below" and patients shape themselves through "technologies of the self." Ultimately, Foucault's work does not merely assist us in refining our analysis; rather, it is essential for conceptualizing medicalization in contemporary society. Read More

J Med Philos 2018 Jul;43(4):421-438

University of Utah, Salt Lake City, Utah, USA.

There has been much debate about whether the concept of disease articulated in Boorse's biostatistical theory is value-neutral or value-laden. Here, I want to examine whether this debate matters. I suggest that there are two basic respects in which value-ladenness might be important: it could threaten either scientific legitimacy or moral permissibility. Read More

J Med Philos 2018 Jul;43(4):402-420

Maquarie University, Sydney, Australia.

In this paper, we examine recent critiques of the debate about defining disease, which claim that its use of conceptual analysis embeds the problematic assumption that the concept is classically structured. These critiques suggest, instead, developing plural stipulative definitions. Although we substantially agree with these critiques, we resist their implication that no general definition of "disease" is possible. Read More

J Med Philos 2018 Jul;43(4):381-401

Wageningen University, Wageningen, the Netherlands.

Whereas theories on health generally argue in favor of one specific concept, we argue that, given the variety of health practices, we need different concepts of health. We thus approach health concepts as a Wittgensteinian family of thick concepts. By discussing five concepts of health offered by (philosophical) theory, we argue that all capture something that seems relevant when we talk and think about health. Read More

J Med Philos 2018 Jul;43(4):469-484

Dalhousie University, Halifax, Nova Scotia, Canada.

Arguments in favor of greater research-practice integration in medicine have tended to be ethical, political, or pragmatic. There are good epistemic reasons to pursue greater integration, and it is important to think through these reasons in order to avoid inadvertently designing new systems in ways that replicate the epistemic elitism common within current systems. Meaningful transformation within health care is possible with close attention to all reasons in favor of greater research-practice integration, including epistemic reasons. Read More

J Med Philos 2018 May 30. Epub 2018 May 30.

University of Milan, Bicocca, Italy.

The general concept of mental disorder specified in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders is definitional in character: a mental disorder might be identified with a harmful dysfunction. The manual also contains the explicit claim that each individual mental disorder should meet the requirements posed by the definition. The aim of this article is two-fold. Read More

J Med Philos 2018 May;43(3):306-312

University of Johannesburg, Johannesburg, South Africa.

In his article "Prediction, Understanding, and Medicine," Alex Broadbent argues that the nature of medicine is determined by its competences, that is, which things it can do well. He argues that although medicine cannot cure well, it can do a good job of enabling people not only to understand states of the human organism and of what has caused them, but also to predict future states of it. From this, Broadbent concludes that medicine is (at least in part) essentially a practice of understanding and predicting, not curing. Read More

J Med Philos 2018 May;43(3):342-360

Oregon Health & Science University, Portland, Oregon, USA.

There is broad agreement among research ethicists that investigators have a duty to obtain the informed consent of all subjects who participate in their research trials. On a common view, the duty to obtain this informed consent follows from the need to respect persons and their autonomous decisions. However, the nature of informed consent and the demands it places on investigators are open to dispute and recently have been challenged. Read More

J Med Philos 2018 May;43(3):313-324

University of Johannesburg, Auckland Park, South Africa.

In "Prediction, Understanding, and Medicine," Alex Broadbent rejects the curative thesis, the view that the core medical competence is to cure, in favor of his predictive thesis that the main intellectual medical competence is to explain and the main practical medical competence is to predict. Broadbent thinks his account explains the phenomenon of multiple consultation, which is the fact that people persist in consulting alternative medical traditions despite having access to mainstream medicine. I argue that Broadbent's explanation of multiple consultation makes sense only from the perspective of patients who migrate from mainstream to alternative consultation. Read More

J Med Philos 2018 May;43(3):289-305

African Centre for Epistemology and, Philosophy of Science, University of Johannesburg, Johannesburg, South Africa.

What is medicine? One obvious answer in the context of the contemporary clinical tradition is that medicine is the process of curing sick people. However, this "curative thesis" is not satisfactory, even when "cure" is defined generously and even when exceptions such as cosmetic surgery are set aside. Historian of medicine Roy Porter argues that the position of medicine in society has had, and still has, little to do with its ability to make people better. Read More

J Med Philos 2018 May;43(3):325-341

African Centre for Epistemology and Philosophy of Science, University of Johannesburg, Johannesburg, South Africa.

This article is a reply to two critics of my "Prediction, Understanding, and Medicine," published elsewhere in this journal issue. In that essay, I argued that medicine is best understood not as essentially a curative enterprise, but rather as one essentially oriented towards prediction and understanding. Here, I defend this position from several criticisms made of it. Read More

J Med Philos 2018 Mar;43(2):241-260

University of Memphis, Memphis, Tennessee, USA.

Often drawing on the phenomenological tradition, a number of philosophers and cognitive scientists working in the field of "embodied cognition" subscribe to the general view that cognition is grounded in aspects of its sensorimotor embodiment and should be comprehended as the result of a dynamic interaction of nonneural and neural processes. After a brief introduction, the paper critically engages Lakoff and Johnson's "conceptual metaphor theory" (CMT), and provides a review of recent empirical evidence that appears to support it. Subsequently, the paper underscores some of the limitations of CMT, points to some philosophical problems that require further attention, and explores possible implications for understanding and treating of mental disorders. Read More

J Med Philos 2018 Mar;43(2):159-186

Fordham University, New York, New York, USA.

I have argued that substance ontology cannot be used to determine the moral status of embryos. Patrick Lee, Christopher Tollefsen, and Robert George wrote a Reply to those arguments in this Journal. In that Reply, Lee, Tollefsen, and George defended and clarified their position that their substance ontology arguments prove that the zygote and the adult into which it develops are the same entity that share the same essence. Read More

J Med Philos 2018 Mar;43(2):211-240

Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom, and Deputy National Clinical Lead for Organ Donation, NHS Blood and Transplant, Nottingham, United Kingdom.

This article defends the criterion of permanence as a valid criterion for declaring death against some well-known recent objections. We argue that it is reasonable to adopt the criterion of permanence for declaring death, given how difficult it is to know when the point of irreversibility is actually reached. We claim that this point applies in all contexts, including the donation after circulatory determination of death context. Read More

J Med Philos 2018 Mar;43(2):187-210

Leibniz Universität Hannover, Hannover, Germany.

The prospect of creating and using human-animal chimeras and hybrids (HACHs) that are significantly human-like in their composition, phenotype, cognition, or behavior meets with divergent moral judgments: on the one side, it is claimed that such beings might be candidates for human-analogous rights to protection and care; on the other side, it is supposed that their existence might disturb fundamental natural and social orders. This paper tries to show that both positions are paradoxically intertwined: they rely on two kinds of species arguments, "individual species arguments" and "group species arguments," which formulate opposing demands but are conceptually interdependent. As a consequence, the existence of HACHs may challenge exactly those normative standards on which the protection of HACHs may eventually be based. Read More

J Med Philos 2018 Mar;43(2):132-158

University of Wisconsin, Wausau, Wisconsin, USA.

Moral status ascribes equal obligations and rights to individuals on the basis of membership in a protected group. Substance change is an event that results in the origin or cessation of individuals who may be members of groups with equal moral status. In this paper, two substance changes that affect the moral status of human embryos are identified. Read More

J Med Philos 2018 Jan;43(1):22-43

Occidental College, Los Angeles, California, USA.

Advances in DNA sequencing technology open new possibilities for public health genomics, especially in the form of general population preventive genomic sequencing (PGS). Such screening programs would sit at the intersection of public health and preventive health care, and thereby at once invite and resist the use of clinical ethics and public health ethics frameworks. Despite their differences, these ethics frameworks traditionally share a central concern for individual rights. Read More

J Med Philos 2018 Jan;43(1):83-114

University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

Phase 1 healthy volunteer clinical trials-which financially compensate subjects in tests of drug toxicity levels and side effects-appear to place pressure on each joint of the moral framework justifying research. In this article, we review concerns about phase 1 trials as they have been framed in the bioethics literature, including undue inducement and coercion, unjust exploitation, and worries about compromised data validity. We then revisit these concerns in light of the lived experiences of serial participants who are income-dependent on phase 1 trials. Read More

J Med Philos 2018 Jan;43(1):44-63

Rutgers University, New Brunswick, New Jersey, USA.

According to the Standard View, a doctor who withdraws life-sustaining treatment does not kill the patient but rather allows the patient to die-an important distinction, according to some. I argue that killing (and causing death) can be understood in either of two ways, and given the relevant understanding, the Standard View is insulated from typical criticisms. I conclude by noting several problems for the Standard View that remain to be fully addressed. Read More

J Med Philos 2018 Mar;43(2):261-280

Lancaster University, Lancaster, United Kingdom.

Currently in the United Kingdom, anyone donating gametes has the status of an open-identity donor. This means that, at the age of 18, persons conceived with gametes donated since April 1, 2005 have a right to access certain pieces of identifying information about their donor. However, in early 2015, the UK Parliament approved new regulations that make mitochondrial donors anonymous. Read More

J Med Philos 2018 Jan;43(1):8-21

Antwerp University, Antwerp, Leuven, Belgium.

With the new and highly accurate noninvasive prenatal test (NIPT), new options for screening become available. I contend that the current state of the art of NIPT is already in need of a thorough ethical investigation and that there are different points to consider before any chromosomal or subchromosomal condition is added to the screening panel of a publicly funded screening program. Moreover, the application of certain ethical principles makes the inclusion of some conditions unethical in a privately funded scheme, even if such screening would enhance a woman's reproductive autonomy. Read More

J Med Philos 2018 Jan;43(1):64-82

University of Michigan, Ann Arbor, Michigan, USA.

In this essay, we defend the design of the Salk polio vaccine trial and try to put some limits on the role schemata should play in designing clinical research studies. Our presentation is structured as a response to de Freitas and Pietrobon (de Freitas, R. S. Read More

J Med Philos 2017 Nov;42(6):690-719

Xi'an Jiaotong University, Xi'an, China.

This essay contends that individual liberty, understood as the permissibility of making choices about one's own health care in support of one's own good and the good of one's family utilizing private resources, is central to the moral foundations of a health care system. Such individual freedoms are important not only because they often support more efficient and effective health care services, but because they permit individuals to fulfill important moral duties. A comparative study of the health care systems in Hong Kong and mainland China is utilized to illustrate the conceptual and moral concerns at stake. Read More

J Med Philos 2017 Nov;42(6):634-652

Vanderbilt University, Nashville, Tennessee, USA.

Julian Koplin, drawing extensively on empirical data, has argued that vendors, even in well-regulated kidney markets, are likely to be significantly harmed. I contend that his reasoning to this conclusion is dangerously mistaken. I highlight two failures. Read More

J Med Philos 2017 Nov;42(6):720-739

Lancaster University, Lancaster, United Kingdom.

Informed consent requirements for medical research have expanded over the past half-century. The Declaration of Helsinki now includes an explicit positive obligation to inform subjects about funding sources. This is problematic in a number of ways and seems to oblige researchers to disclose information irrelevant to most consent decisions. Read More

J Med Philos 2017 Nov;42(6):653-669

Monash University, Melbourne, Victoria, Australia.

Luke Semrau argues that the documented harms of existing organ markets do not undermine the case for establishing regulated systems of paid kidney donation. He offers two arguments in support of this conclusion. First, Semrau argues that the harms of kidney selling are straightforwardly amenable to regulatory solution. Read More

J Med Philos 2017 Nov;42(6):670-689

University at Albany, State University of New York, Albany, New York, USA.

Organ tourism occurs when individuals in countries with existing organ transplant procedures, such as the United States, are unable to procure an organ by using those transplant procedures in enough time to save their life. In this paper, I am concerned with the following question: When organ tourists return to the United States and need another transplant, do US transplant physicians have an obligation to place them on a transplant list? I argue that transplant physicians have a duty not to relist organ tourists. Specifically, I contend that we should locate physicians' duties in these cases within the new role of "transplant physician. Read More

J Med Philos 2017 Oct;42(5):503-517

St. Edward's University, Austin, Texas, USA.

The essays in this issue of The Journal of Medicine and Philosophy explore an innovative voucher program for encouraging kidney donation. Discussions cluster around a number of central moral and political/theoretical themes: (1) What are the direct and indirect health care costs and benefits of such a voucher system in human organs? (2) Do vouchers lead to more effective and efficient organ procurement and allocation or contribute to greater inequalities and inefficiencies in the transplantation system? (3) Do vouchers contribute to the inappropriate commodification of human body parts? (4) Is there a significant moral difference between such a voucher system and a market in human organs for transplantation? This paper argues that while kidney vouchers constitute a step in the right direction, fuller utilization of market-based incentives, including, but not limited to, barter exchanges (e.g. Read More

J Med Philos 2017 Oct;42(5):518-536

Georgetown University, Washington, DC, USA.

The advanced donation program was proposed in 2014 to allow an individual to donate a kidney in order to provide a voucher for a kidney in the future for a particular loved one. In this article, we explore the logistical and ethical issues that such a program raises. We argue that such a program is ethical in principle but there are many logistical issues that need to be addressed to ensure that the actual program is fair to both those who do and do not participate in this program. Read More

J Med Philos 2017 Oct;42(5):559-574

University of Maryland, College Park, MD, USA.

This article probes the voucher program from an ethical perspective. It focuses mainly on an issue of inequity. A disparity exists in US kidney transplantation. Read More

J Med Philos 2017 Oct;42(5):575-596

Monash University, Melbourne, Australia.

An innovative program recently initiated at the University of California, Los Angeles (UCLA) Medical Center allows people to donate a kidney in exchange for a voucher that a loved one can redeem for a kidney if and when needed. As a relatively new practice, the ethical implications of advanced kidney donation have not yet been widely discussed. This paper reflects on some of the bioethical issues at stake in this new donation program, as well as some broader philosophical issues related to the meaning and moral salience of commodification. Read More

J Med Philos 2017 Oct;42(5):537-558

University of California, Los Angeles, Los Angeles, California, USA.

Public surveys conducted in many countries report widespread willingness of individuals to donate a kidney while alive to a family member or close friend, yet thousands suffer and many die each year while waiting for a kidney transplant. Advocates of financial incentive programs or "regulated markets" in kidneys present the problem of the kidney shortage as one of insufficient public motivation to donate, arguing that incentives will increase the number of donors. Others believe the solutions lie-at least in part-in facilitating so-called "altruistic donation;" harnessing the willingness of relatives and friends to donate by addressing the many barriers which serve as disincentives to living donation. Read More

J Med Philos 2017 Oct;42(5):597-614

The College of New Jersey, Ewing, NJ, USA.

The UCLA Medical Center has initiated a "voucher program" under which a person who donated a kidney would receive a voucher that she could provide to someone of her choosing who could then use it to move to the top of the renal transplantation waiting list. If the use of such vouchers as incentives for donors is morally permissible, then cash payments for kidneys are also morally permissible. But, that argument faces five objections. Read More

J Med Philos 2017 Aug;42(4):485-502

Indiana University School of Medicine, Indianapolis, Indiana, USA.

In a series of recent papers, I have made three arguments about how to define "disease" and evaluate and apply possible definitions. First, I have argued that definitions should not be seen as traditional conceptual analyses, but instead as proposals about how to define and use the term "disease" in the future. Second, I have pointed out and attempted to address a challenge for dysfunction-requiring accounts of disease that I call the "line-drawing" problem: distinguishing between low-normal functioning and dysfunctioning. Read More

J Med Philos 2017 Aug;42(4):424-446

Ghent University, Ghent, Belgium.

In the traditional philosophical debate over different conceptual analyses of "disease," it is often presupposed that "disease" is univocally definable and that there are clear boundaries which distinguish this univocal category "disease" from the category of "nondisease." In this paper, I will argue for a shift in the discussion on the concept of "disease" and propose an alternative, pragmatic approach that is based on the conviction that "disease" is not a theoretical concept but a practical term. I develop a view on which our use of the term "disease" is determined by two interacting factors, namely, value-laden considerations about the (un)desirabilty of certain states and discoveries of cause(s) which is/are explanatorily relevant. Read More