philosophy of medicine/health care

医学 / 保健哲学
  • 文章类型: Journal Article
    本文将人种学解释与对移情概念史的分析相结合。超越更常见的概念,通常依赖于心理学理论和术语,概念历史分析的根源可以追溯到18世纪和19世纪的“Einfuhlung”概念。由于人种学工作遵循了两名智力深厚和多重残疾的年轻女性的专业工作,这篇文章提出了五倍的论点。首先,我们认为,移情通常被认为是个人认知的问题,但应该被重新思考为一种感觉进入的具体过程。第二,我们认为这个过程的特点是不完整的,因此必须承认移情总是部分的,总是在理解的路上。第三,我们认为,这种不完整性迫使我们思考潜在的“连接力”,概念历史表明,我们应该把这种力量看作是爱的一种形式。第四,我们认为这种“爱”是高度体现的,这表明同理心的理论概念应该与亲属关系的概念有关。第五,我们建议这种爱的组合(感情,欣赏),具体的亲属关系和不完整意味着最后的反思,即移情作为一种渴望的概念。
    This article combines ethnographic interpretations with analyses of the conceptual history of empathy. Moving beyond the more common notions, which often rely in psychological theories and terminologies, the conceptual-historical analyses trace its roots to 18th and 19th century notions of \'Einfühlung\'. As the ethnographic work follows the professional work with two young women with profound intellectual and multiple disabilities, the article makes a fivefold argument. First, we argue that empathy is often considered a matter of individual cognition but should be rethought as an embodied process of feeling-into. Second, we argue that this process is characterised by incompleteness-and hence must acknowledge that empathy is always partial, always on the way to understanding. Third, we argue that this incompleteness forces us to think about the underlying \'connecting force\', and that the conceptual history suggests that we should think about this force as a form of love. Fourth, we suggest that this \'love\' is highly embodied, and that this suggests that theoretical notions of empathy should relate to notions of kinship. Fifth, we suggest that the combination of this love (affection, appreciation), embodied kinship and incompleteness suggests a final rethinking, namely the notion of empathy as a form of longing.
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  • 文章类型: Journal Article
    自2020年以来,医学工作中的反种族主义激增。然而,没有道德准则来指导他们。这种疏忽令人担忧,因为医学界的种族主义和白人至上主义很容易挫败他们。本文通过强调医学反种族主义工作的道德准则来解决这一差距。我们提出了九项核心原则,这些原则来自我们形成反种族主义治疗合作组织(AHC)的经验,医学生主导的倡议致力于开发大胆和破坏性的反种族主义医学教育内容。我们制定和实施这些原则的经验教训可以指导其他反种族主义的医学合作,努力促进解放和康复,而不是重述医学中嵌入的种族主义和白人至上文化。最后,我们反思了这些原则如何稳定了我们最近决定结束AHC的决定。他们让我们尊重我们共同取得的成就,加强构成我们行动主义基础的关系,并加强共同的反种族主义使命,这将指导我们个人的旅程向前迈进。他们中的第一个,我们关于医学反种族主义工作的道德准则可以促进对学术环境中反压迫工作中嵌入的风险的更多认识。
    An explosion of antiracism in medicine efforts have transpired since 2020. However, no ethical guidelines exist to guide them. This oversight is concerning because the racism and white supremacy rife within medicine can easily thwart them. This article addresses this gap by highlighting ethical guidelines for antiracism work in medicine. We present nine core tenets derived from our experience forming the Antiracist Healing Collaborative (AHC), a medical student-led initiative committed to developing bold and disruptive antiracist medical education content. Our lessons developing and implementing these tenets can guide other antiracism in medicine collaborations striving to promote liberation and healing, rather than recapitulating the racism and white supremacy culture embedded within medicine. We close by reflecting on how these tenets have steadied our recent decision to draw AHC to a close. They have allowed us to honour what we achieved together, strengthen the relationship that formed the foundation for our activism and bolster the shared antiracism mission that will guide our individual journeys moving forwards. The first of their kind, our ethical guidelines for antiracism work in medicine can facilitate greater recognition of the risks embedded in anti-oppression work transpiring in academic settings.
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  • 文章类型: Journal Article
    加拿大对辅助死亡的非刑事化引发了在医疗保健环境中使用辅助死亡的重大伦理影响。通过切除重要器官进行安乐死(ERVO)是医学辅助死亡的理论扩展,鉴于加拿大辅助死亡资格法律和标准的迅速扩展,实施的合理性增加。ERVO需要在全身麻醉下从活着的患者中取出器官作为死亡机制。虽然ERVO旨在最大限度地提高从安乐死患者那里获得的器官捐赠给接受者的活力,以这种方式结束患者捐献者的生命,仅是为了使患病或垂死的接受者患者受益,值得进一步的道德考虑。具体来说,本文探讨了个人主义生物伦理学在确定通过辅助死亡获取器官的手段是否证明结束改善那些从接受器官中受益的人的生活是合理的。Further,通过讨论医学,ERVO的社会和伦理含义,我将对辅助死亡合法化对人类尊严和良心的影响进行更广泛的哲学理解。
    Canada\'s decriminalisation of assisted death has elicited significant ethical implications for the use of assisted death in healthcare contexts. Euthanasia by removal of vital organs (ERVO) is a theoretical extension of medically assisted death with an increased plausibility of implementation in light of the rapid expansion of assisted death eligibility laws and criteria in Canada. ERVO entails removing organs from a living patient under general anaesthesia as the mechanism of death. While ERVO is intended to maximise the viability of organs procured from the euthanised patient for donation to recipients, ending the lives of patient donors in this manner solely to benefit ill or dying recipient patients merits further ethical consideration. Specifically, the paper explores the application of personalist bioethics in determining whether the means of procuring organs through assisted death justifies the end of improving the lives of those who would benefit from receiving them. Further, by discussing the medical, social and ethical implications of ERVO, I will explicate a broader philosophical understanding of the influences of legalising assisted death on human dignity and conscience.
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  • 文章类型: Journal Article
    功能-有机区别试图将具有可诊断生物学原因的疾病与没有诊断的疾病区分开来,并且是诊断的中心轴,组织医疗专业和服务。以前的研究报告说,临床医生之间关于术语的含义和它们适用的条件的一致性很差,以及注意到相关诊断的高价值含义。因此,我们的目的是了解在精神病学和神经病学服务部门工作的临床医生如何在他们的工作中驾驭功能-有机的区别.20名临床医生(10名医生,10名心理学家)在精神病学和神经病学服务中工作,参加了半结构化访谈,并采用建构主义的基础理论方法进行了分析。这种区别通常被描述为与临床医生如何概念化患者问题不一致。有机因素被认为是客观的,明确可识别和明确的因果关系,而功能性原因是看不见的,可以通过思考和对话来假设。语境因素-包括文化假设,服务需求,患者的需求和同事的观点是如何在实践中进行区分的关键。这种区别在理论上被认为是不令人满意的,最终被取代,但是临床决策需要战略性地使用它。这些用途包括帮助沟通医疗问题,导航服务,通过使心理学解释更可口来隐藏意义,解决耻辱,给予希望,并提供疾病身份。临床医生将个人和社会层面的道德问题作为功能有机区别的概念基础和部署的组成部分,并将积极引导这些问题作为其工作的一部分。功能有机区别作为可在不同条件下推广的合理理论概念的地位与其在医疗保健结构中作为把关工具的作用之间存在相当大的距离。在实际部署时,歧义和矛盾被认为是障碍和好处,战略考虑在决定依靠哪个方面很重要。
    The functional-organic distinction attempts to differentiate disorders with diagnosable biological causes from those without and is a central axis on which diagnoses, medical specialities and services are organised. Previous studies report poor agreement between clinicians regarding the meanings of the terms and the conditions to which they apply, as well as noting value-laden implications of relevant diagnoses. Consequently, we aimed to understand how clinicians working in psychiatry and neurology services navigate the functional-organic distinction in their work. Twenty clinicians (10 physicians, 10 psychologists) working in psychiatry and neurology services participated in semistructured interviews that were analysed applying a constructivist grounded theory approach. The distinction was described as often incongruent with how clinicians conceptualise patients\' problems. Organic factors were considered to be objective, unambiguously identifiable and clearly causative, whereas functional causes were invisible and to be hypothesised through thinking and conversation. Contextual factors-including cultural assumptions, service demands, patient needs and colleagues\' views-were key in how the distinction was deployed in practice. The distinction was considered theoretically unsatisfactory, eventually to be superseded, but clinical decision making required it to be used strategically. These uses included helping communicate medical problems, navigating services, hiding meaning by making psychological explanations more palatable, tackling stigma, giving hope, and giving access to illness identity. Clinicians cited moral issues at both individual and societal levels as integral to the conceptual basis and deployment of the functional-organic distinction and described actively navigating these as part of their work. There was a considerable distance between the status of the functional-organic distinction as a sound theoretical concept generalisable across conditions and its role as a gatekeeping tool within the structures of healthcare. Ambiguity and contradictions were considered as both obstacles and benefits when deployed in practice and strategic considerations were important in deciding which to lean on.
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  • 文章类型: Journal Article
    由于医疗技术的快速发展,现代医院成功地将人类从许多疾病中拯救出来。然而,现代医学,结合先进技术,已经形成了一种强烈的倾向,认为人类仅仅是恢复和修复的目标,现代医院的特点是以技术为中心的治疗空间。这导致人类被还原成物体并被疏远的情况。这项研究,整合海德格尔的居住和护理概念,就医院的基本空间性而言,“护理”是一个至关重要的概念,需要恢复为影响医院空间的关键指导原则。现代医院发展中关怀精神的丧失,影响着医院的构思,建造和管理,以及如何适当地处理或允许医院内的人类经验。这项研究对如何更好地进行医院空间的未来规划提供了批判性的思考,以确保人类的经验,以及适当评估这些经历所需的护理,充分表达,和人类生存的复杂性是适当的考虑。
    Modern hospitals have succeeded in saving humans from numerous diseases owing to the rapid development of medical technology. However, modern medical science, combined with advanced technology, has developed a strong tendency to view human beings as mere targets of restoration and repair, with modern hospitals characterised as spaces centred on technology-focused treatment. This results in a situation where human beings are reduced to objects and alienated. This study, integrating Heidegger\'s concepts of dwelling and care, contends that \'care\' is a vital concept in terms of the fundamental spatiality of hospitals and needs to be restored as the key guiding principle affecting hospital space. The loss of the caring spirit in the development of modern hospitals affects how hospitals are conceived, built and managed, as well as how human experiences within hospitals are dealt with or allowed for appropriately. This study offers critical reflection on how future planning of hospital spaces can be better conducted to ensure that human experiences, and the care needed to appropriately value such experiences, are adequately expressed, and the complexity of human existence is suitably considered.
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  • 文章类型: Journal Article
    在这项研究中,我们对英国成年人群的定性调查数据进行了详细分析,日本和墨西哥将解决以下问题:COVID-19大流行如何改变了人们对身体的生活体验,其他人的身体和世界?我们确定了五个主题:(i)恐惧和危险,(ii)身体怀疑和高度警惕,(iii)风险与信任,(四)适应和持久;(五)视角的变化。我们使用两个理论框架:第一,玛丽·道格拉斯\'关于纯洁的人类学工作,风险,危险和象征意义被用来理解在大流行期间身体上的社会和文化含义是如何变化的。第二,我们使用HaviCarel开发的身体怀疑的概念来解释人们在大流行期间如何以不同的方式体验他们的身体和其他人的身体。虽然我们认识到人们对大流行的具体经历的巨大差异,我们的研究结果表明,存在跨越不同国家和文化的共同点。具体来说,我们关注对COVID-19保护性对策的反应,如国家封锁和身体疏远,我们认为这些措施降低了人们对自己身体的信心,信任他人,信任政治领导。最后,我们提出,在COVID-19大流行期间,我们的生活经历发生了变化,促使人们重新关注人们认为生活中重要的事情,道德,文化和政治观点。
    In this study, we conduct a detailed analysis of qualitative survey data focusing on adult populations in the UK, Japan and Mexico to address the following question: How has the COVID-19 pandemic changed people\'s lived experience of their bodies, other people\'s bodies and the world? We identify five themes: (i) fear and danger, (ii) bodily doubt and hypervigilance, (iii) risk and trust, (iv) adapting and enduring and (v) changes in perspective. We use two theoretical frameworks: first, Mary Douglas\' anthropological work on purity, risk, danger and symbolism is applied to understand how social and cultural meanings attached to the body have changed during the pandemic. Second, we use the concept of bodily doubt developed by Havi Carel to interpret how people experience their bodies and other people\'s bodies differently during the pandemic. While we recognise the significant variation in people\'s embodied experience of the pandemic, our findings suggest there are commonalities that span different countries and cultures. Specifically, we look at responses to COVID-19 protective countermeasures such as national lockdowns and physical distancing which we suggest have reduced people\'s ability to put faith in their own bodies, trust other people and trust the political leadership. We conclude by proposing that the changes to our lived experience during the COVID-19 pandemic have prompted changes in perspective and a renewed focus on what people consider important in life from a social, moral, cultural and political point of view.
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  • 文章类型: Journal Article
    自从更有效的出现以来,新一代丙型肝炎治疗,巨大的资源已经投入到为尽可能多的携带病毒的人提供治疗。扩大治疗范围旨在预防肝病,肝癌和丙型肝炎的继续传播,但是社会研究表明,人们也会考虑到社会承诺,包括希望它可以减少或消除他们生活中的污名。这种希望反映了关于医疗治疗的更广泛的想法,这被视为疾病及其影响的终点,并且能够将自我恢复到(以前的)健康和幸福状态。但是,对于那些治疗不能消除严重污名化疾病的社会影响的人来说,治愈意味着什么?虽然新的治疗有望消除丙型肝炎,对治愈后生活的描述表明,丙型肝炎可以以各种方式持续存在。本文借鉴了在澳大利亚接受过直接抗病毒药物治疗的人(n=30)的采访,以探讨他们对治愈的含义以及他们的治愈后生活经验。我们认为,生物医学对治愈的主要理解是“结束”和“恢复”,可以排除对药物治愈后持续存在的疾病的社会和其他影响的洞察力,以及个人如何应对这些来世。借鉴医学人类学和残疾研究最近对治疗的概念重塑,我们建议,考虑“治愈性原因”的局限性有助于更好地解决慢性病的来世问题。在丙型肝炎的情况下,重新概念化治疗可以为解决人们的治疗后需求提供改进和减少污名化的方法。在消除丙型肝炎的时代,随着接受治疗和治愈的人群在全球范围内的扩大,这种重新概念化变得越来越重要。
    Since the advent of more effective, new-generation treatment for hepatitis C, immense resources have been devoted to delivering cure to as many people with the virus as possible. The scale-up of treatment aims to prevent liver disease, liver cancer and onward transmission of hepatitis C, but social research shows that people also approach treatment with its social promises in mind, including the hope that it might reduce or eradicate stigma from their lives. Such hopes reflect broader ideas about medical cure, which is seen as an end point to illness and its effects, and capable of restoring the self to a (previous) state of health and well-being. But what does cure mean among people for whom treatment does not produce an end to the social effects of a heavily stigmatised disease? While new treatments promise to eliminate hepatitis C, accounts of post-cure life suggest that hepatitis C can linger in various ways. This article draws on interviews with people who have undergone treatment with direct-acting antivirals (n=30) in Australia to explore the meanings they attach to cure and their experiences of post-cure life. We argue that dominant biomedical understandings of cure as an \'ending\' and a \'restoration\' can foreclose insight into the social and other effects of illness that linger after medical cure, and how individuals grapple with those afterlives. Drawing on recent conceptual re-framings of cure from medical anthropology and disability studies, we suggest that thinking at the limits of \'curative reason\' helps to better address the afterlives of chronic illness. In the case of hepatitis C, reconceptualising cure could inform improved and less stigmatising ways of addressing people\'s post-cure needs. And in the era of hepatitis C elimination, such reconceptualisation is increasingly important as the cohort of people undergoing treatment and cure expands worldwide.
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  • 文章类型: Journal Article
    将某人描述为残疾人意味着评估他们与环境的关系,身体,和自我。这样的描述基于人由于其非典型的体现而感知的局限性。然而,损伤本身不是病理性的,残疾也不一定偏离生物常态,科幻小说中经常通过呈现彻底改变的环境来表达差异。在这样的设置中,没有受损的人可以被证明不适合他们所处的世界。一个典型的例子来自H.G.Wells的“盲人的国家”。“本文通过挑战生物学正常的概念,证明了科幻小说将残疾的规范质量与源于医学启蒙运动的经典医学模型脱钩的能力。在探索医学正常性的概念之前,首先简要介绍了残疾。然后它对生物学上一致的存在提出问题,认为健康只有在环境条件下才能理解。接下来,本文概述了“盲人国家”,然后分析了它如何挑战生物常态的概念,将其视为一种社会产品,而不是一个普遍的常数。最后,本文得出的结论是,科幻小说叙事通过设想(非)理想的替代方案,有效地询问了我们世界看似一致的趋势。
    Describing someone as disabled means evaluating their relationship with their environment, body, and self. Such descriptions pivot on the person\'s perceived limitations due to their atypical embodiment. However, impairments are not inherently pathological, nor are disabilities necessarily deviations from biological normality, a discrepancy often articulated in science fiction via the presentation of radically altered environments. In such settings, non-impaired individuals can be shown to be unsuited to the world they find themselves in. One prime example of this comes courtesy of H. G. Wells\'s \"The Country of the Blind.\" This paper demonstrates science fiction\'s capacity to decouple disability\'s normative quality from classical medical models stemming from the medical Enlightenment movement by challenging the idea of the biologically normal. It first provides a brief account of disability before exploring the concept of medical normality. It then problematizes the biologically consistent being, arguing that health is only understandable when environmentally situated. Next, the paper provides an overview of \"The Country of the Blind\" before analyzing how it challenges the idea of biological normality, framing it as a social product rather than a universal constant. Finally, the paper concludes that science fiction narratives effectively interrogate our world\'s seemingly consistent trends by envisioning (un)desirable alternatives.
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  • 文章类型: Journal Article
    本文从哲学的角度探讨了医师精疲力尽的话题。我们探讨了一个问题,即医生精疲力竭的兴起可能与医学意义的潜在侵蚀有关,以医患之间主体间关系的破裂为特征。我们认为,虽然通常被引用的解决职业倦怠的策略-包括促进工作与生活的融合,培养职场社区,和培养韧性-对提高医生的健康至关重要,连接这些方法的共同点是,每种方法都将医生确定为主要干预场所。我们认为,仅靠以医生为中心的方法可能不足以解决倦怠问题,因为这项工作可能还涉及将我们的注意力转移到医生和患者之间存在的主体间空间。为了进一步阐明主体间性与医学意义创造之间的联系,我们呼吁20世纪哲学家伊曼纽尔·列维纳斯。将列维纳斯的哲学应用于临床环境,我们讨论了“去人格化”的现象,并询问是否,而不仅仅是倦怠的结果,去人格化可能是这种情况的核心原因。有了这些观点,我们揭示了一个相对缺乏的观点:以人为本的方法不仅对病人的健康至关重要,而且对医生的健康也至关重要。作为一个“去个性化”的过程,患者可能会导致医生自己同时去人性化。从列维纳斯那里汲取灵感,我们探索如何重新定位到主体间,医生-病人二元的对话维度可以作为一个重要的成分,不仅是病人,还有医生.
    This paper examines the topic of physician burn-out from a philosophical lens. We explore the question of how the rise of physician burn-out may be related to an underlying erosion of meaning in medicine, characterised by the breakdown of the intersubjective relationship between doctors and patients. We argue that while commonly cited strategies for addressing burnout-including promoting work-life integration, cultivating workplace community, and fostering resilience-are critical for enhancing physician well-being, the common thread linking these approaches is that each identifies the physician as the primary locus of intervention. We propose that physician-centric approaches alone may be insufficient in addressing burnout, as the work might also involve shifting our attention to the intersubjective space that exists between the physician and the patient. To further elucidate the connection between intersubjectivity and the creation of meaning in medicine, we call on twentieth-century philosopher Emmanuel Levinas. Applying Levinas\'s philosophy to the clinical context, we discuss the phenomenon of \'depersonalisation\' and ask whether, rather than a mere consequence of burnout, depersonalisation might be a core cause of this condition. With these points we shed light on an idea that is relatively absent from the burn-out literature: that a person-oriented approach is vital not only for patient well-being but for physician wellness as well, as a process that \'de-personalizes\' patients might result in a simultaneous dehumanisation of physicians themselves. Drawing inspiration from Levinas, we explore how a reorientation towards the intersubjective, dialogical dimension of the doctor-patient dyad could serve as one important ingredient in healing not only the patient, but the physician as well.
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  • 文章类型: Journal Article
    电子健康记录(EHR)是有争议的辩论焦点,对当代临床实践至关重要,因为它正在两极分化。关于EHR的辩论引发了关于医生职业身份的问题,临床工作的性质,患者/医生关系的演变,以及技术乐观和悲观的叙述。临床医生认同我们身份的隐喻——我们是历史学家,警探们,教育工作者,技术人员,或者别的什么?-动画的早期基于计算机的医疗记录在20世纪中后期美国的历史。支持者和批评者对EHR揭示的临床医生身份同样感兴趣,以及它如何从根本上重塑它。本文遵循了从1950年代后期到当今EHR的早期基于计算机的患者记录历史上的关键时刻。在联系医生身份发展时,临床认识论结构,以及20世纪中后期美国基于计算机的医疗记录的兴起,我们问为什么EHR在当代医学中是一个两极分化的实体,并将临床医生/EHR的紧张关系置于有抱负的医生身份和一种技术乐观的较长历史中,这种乐观很快让位于对基于计算机的临床工作的悲观情绪。
    The electronic health record (EHR) is a focus of contentious debate, having become as essential to contemporary clinical practice as it is polarising. Debates about the EHR raise questions about physicians\' professional identity, the nature of clinical work, evolution of the patient/practitioner relationship, and narratives of technological optimism and pessimism. The metaphors by which clinicians stake our identities-are we historians, detectives, educators, technicians, or something else?-animate the history of the early computer-based medical record in the mid-to-late twentieth-century USA. Proponents and detractors were equally interested in what the EHR revealed about clinician identity, and how it might fundamentally reshape it. This paper follows key moments in the history of the early computer-based patient record from the late 1950s to the EHR of the present day. In linking physician identity development, clinical epistemological structures, and the rise of the computer-based medical record in the USA in the mid-to-late twentieth century, we ask why the EHR is such a polarising entity in contemporary medicine, and situate clinician/EHR tensions in a longer history of aspirational physician identity and a kind of technological optimism that soon gave way to pessimism surrounding computer-based clinical work.
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