https://philmed.pitt.edu/philmed/issue/feed Philosophy of Medicine 2021-12-17T10:36:13-05:00 Editorial Office phil.med@pitt.edu Open Journal Systems <p><em>Philosophy of Medicine</em> publishes original philosophical research and perspectives, as well as content for health professionals, health scientists and the general public.</p> https://philmed.pitt.edu/philmed/article/view/10 On the Brink of Disaster 2021-10-01T08:36:27-04:00 Valentina Petrolini valentina.petrolini@ehu.eus <div> <p class="AbstractParagraphs"><span lang="EN-US">The notions of at-risk and subthreshold conditions are increasingly discussed in psychiatry to describe mild, brief, or otherwise atypical syndromes that fail to meet the criteria for clinical relevance. However, the concept of </span><span lang="EN-US">vulnerability</span> <span lang="EN-US">is still underexplored in philosophy of psychiatry. This article discusses psychiatric vulnerability to clarify some conceptual issues about the various factors contributing to vulnerability, the notions of </span><span lang="EN-US">risk </span><span lang="EN-US">and </span><span lang="EN-US">protection, and </span><span lang="EN-US">the idea that there are multiple ways of crossing the threshold to clinical relevance. My goal is to lay the groundwork for a finer-grained discussion on psychiatric vulnerability that reflects the complex nature of mental conditions and illustrates the kind of thinking needed in clinical practice.</span></p> </div> 2021-10-01T08:19:57-04:00 Copyright (c) 2021 Valentina Petrolini https://philmed.pitt.edu/philmed/article/view/45 Abject Object Relations and Epistemic Engagement in Clinical Practice 2021-11-19T10:36:30-05:00 Helene Scott-Fordsmand helene.scottfordsmand@hotmail.com <p>The article engages with medical practice to develop a philosophically informed understanding of epistemic engagement in medicine, and epistemic object relations more broadly. I take point of departure in the clinal encounter and draw on French psychoanalytical theory to develop and expand a taxonomy already proposed by Karin Knorr-Cetina. Doing so, I argue for the addition of an abject type object relation, that is, the encounter with objects that transgress frameworks and disrupt further investigation, hence preventing dynamic engagement and negatively shaping our epistemic pathways. The article is primarily theoretical although partly grounded in qualitative fieldwork.</p> 2021-11-19T09:25:53-05:00 Copyright (c) 2021 Helene Scott-Fordsmand https://philmed.pitt.edu/philmed/article/view/49 "Doctor Knows Best" 2021-12-17T10:36:13-05:00 Dylan Mirek Popowicz dylan.popowicz@csus.edu <div class="page" title="Page 1"> <div class="layoutArea"> <div class="column"> <p>We often consider medical practitioners to be epistemic authorities: “Doctor knows best,” as the saying goes. The place of expert judgment in evidence-based medicine hierarchies, and the crucial role of patient preferences and values in medical decision-making, however, pose problems for making sense of such authority. I argue that there is an account of such medical epistemic authority that does justice to the complexities of the doctor–patient relationship, while maintaining that medical practitioners hold an epistemically privileged position. Such a view can better inform medical practice by clearly illuminating the distinct roles of patients and doctors in decision-making processes.</p> </div> </div> </div> 2021-12-17T09:19:42-05:00 Copyright (c) 2021 Dylan Mirek Popowicz https://philmed.pitt.edu/philmed/article/view/70 Causal Inference, Moral Intuition, and Modeling in a Pandemic 2021-09-17T10:36:29-04:00 Stephanie Harvard stephanie.harvard@ubc.ca Eric Winsberg winsberg@usf.edu <p><span lang="EN-US">Throughout the Covid-19 pandemic, people have been eager to learn what factors, and especially what public health policies, cause infection rates to wax and wane. But figuring out conclusively what causes what is difficult in complex systems with nonlinear dynamics, such as pandemics. We review some of the challenges that scientists have faced in answering quantitative causal questions during the Covid-19 pandemic, and suggest that these challenges are a reason to augment the moral dimension of conversations about causal inference. We take a lesson from Martha Nussbaum—who cautions us not to think we have just one question on our hands when we have at least two—and apply it to modeling for causal inference in the context of cost-benefit analysis.</span></p> 2021-09-17T10:06:56-04:00 Copyright (c) 2021 Stephanie Harvard, Eric Winsberg https://philmed.pitt.edu/philmed/article/view/66 Interpreting Patient-Reported Outcome Measures 2021-11-19T10:36:15-05:00 Keith Meadows keith@healthoutinsights.com <p><span lang="EN-US">Patient-reported outcome measures (PROMs) are valued in healthcare evaluation for bringing patient perspectives forward, and enabling patient-centered care. The range of evidence permitted by PROMs to measure patients’ quality of life narrowly denies subjective experience. This neglect is rooted in the epistemic assumptions that ground PROMs, and the tension between the standardization (the task of measurement) and the individual and unique circumstances of patients. To counter the resulting methodological shortcomings, this article proposes a hermeutical approach and interpretive phenomenology instead of generic qualitative research methods.</span></p> 2021-11-19T09:26:14-05:00 Copyright (c) 2021 Keith Meadows https://philmed.pitt.edu/philmed/article/view/65 Dementia and the Boundaries of Secular Personhood 2021-11-29T12:36:17-05:00 Nicholas Covaleski ncov@bu.edu <div> <p class="AbstractParagraphs"><span lang="EN-US">For many, dementia disrupts basic ideas about what it means to be human, raising profound philosophical and theological questions on the nature of personhood. In this article I ask what dementia might reveal about personhood in a “secular age.” I suggest that the ill-fitting relationship between Western bioethics, with its emphasis on autonomy, and dementia throws into relief the boundaries of a secular self, and I tease out the ethical implications of the limits of those boundaries by highlighting a biopolitics of secularism. Lastly, I offer a theological account of dementia that situates dependence as a central feature of the human condition, and enriches a secular biomedical understanding of this neurocognitive disorder.</span></p> </div> 2021-11-29T12:06:55-05:00 Copyright (c) 2021 Nicholas Covaleski https://philmed.pitt.edu/philmed/article/view/57 Vaccine Hesitancy by Maya J. Goldenberg 2021-07-27T10:36:31-04:00 Inmaculada de Melo-Martín imd2001@med.cornell.edu 2021-07-27T08:58:24-04:00 Copyright (c) 2021 Inmaculada de Melo-Martín