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Hofmann B. The role of philosophy and ethics at the edges of medicine. Philos Ethics Humanit Med 2021; 16:14. [PMID: 34742309 PMCID: PMC8572077 DOI: 10.1186/s13010-021-00114-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 10/12/2021] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND The edge metaphor is ubiquitous in describing the present situation in the world, and nowhere is this as clearly visible as in medicine. "The edge of medicine" has become the title of books, scholarly articles, media headlines, and lecture series and seems to be imbued with hype, hope, and aversion. In order better to understand what is at stake at "the edge of medicine" this article addresses three questions: What does "the edge of medicine" mean in contemporary debates on modern medicine? What are the challenges "on the edge of medicine" (in these various meanings of "on the edge")? How can philosophy and ethics contribute with addressing these challenges? METHODS Literature searches in PubMed and Google Scholar are used to identify uses of the phrase "the edge of medicine" while conventional content analysis is used to analyze meanings of and challenges with "the edge of medicine." These results are then investigated with respect to how philosophy and ethics can address the identified challenges. RESULTS The literature reveals that "the edge of medicine" has many meanings, such as: Border; Margin (of life); Frontier; Forefront; Fringes; Plunge (abyss); Brink (verge); Conflict; and Balancing. In general, the various meanings address four basic challenges: setting limits, keeping control, make meaning, and handling conflicts or aporias. The analysis of each of the meanings of "the edge of medicine" identifies a wide range of important and urgent tasks for the humanities in general, and for philosophy and ethics in particular: 1) clarifying concepts; 2) clarifying assumptions and premises of arguments, methods, advice, and decisions; 3) elaborate new concepts and new theories; 4) conceptualize and handle uncertainty, moral regret, and residue; 5) reveal "the emperor's new clothes;" 6) identify trends and reflect on their implications; 7) demarcation; and 8) reflecting on goodness in medicine. CONCLUSION The phrase "the edge of medicine" expresses a wide range of challenges for modern health care. Together with other disciplines philosophy and ethics can and should make crucial contributions at "the edge of medicine," which is where the future of human beings and societies is created and formed.
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Affiliation(s)
- Bjørn Hofmann
- Department of Health Sciences, The Norwegian University Science and Technology, Gjøvik, PO Box 1, N-2802, Gjøvik, Norway.
- Centre for Medical Ethics at the University of Oslo, Oslo, Norway.
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Cho MK, Varsava N, Kraft SA, Ashwal G, Gillespie K, Magnus D, Ormond KE, Thomas A, Wilfond BS, Lee SSJ. Metaphors matter: from biobank to a library of medical information. Genet Med 2017; 20:802-805. [PMID: 29267267 DOI: 10.1038/gim.2017.204] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 10/10/2017] [Indexed: 11/09/2022] Open
Affiliation(s)
- Mildred K Cho
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California, USA.
| | - Nina Varsava
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California, USA
| | - Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, Washington, USA.,Division of Bioethics, Department of Pediatrics, University of Washington School of Medicine, Seattle, USA
| | - Gary Ashwal
- Booster Shot Media, Santa Monica, California, USA
| | - Katie Gillespie
- Palo Alto Medical Foundation Research Institute, Palo Alto, California, USA
| | - David Magnus
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California, USA
| | - Kelly E Ormond
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California, USA.,Department of Genetics, Stanford University School of Medicine, Stanford, California, USA
| | - Alex Thomas
- Booster Shot Media, Santa Monica, California, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, Washington, USA.,Division of Bioethics, Department of Pediatrics, University of Washington School of Medicine, Seattle, USA
| | - Sandra S-J Lee
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California, USA
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Lysdahl KB, Oortwijn W, van der Wilt GJ, Refolo P, Sacchini D, Mozygemba K, Gerhardus A, Brereton L, Hofmann B. Ethical analysis in HTA of complex health interventions. BMC Med Ethics 2016; 17:16. [PMID: 27004792 PMCID: PMC4804607 DOI: 10.1186/s12910-016-0099-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 03/11/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the field of health technology assessment (HTA), there are several approaches that can be used for ethical analysis. However, there is a scarcity of literature that critically evaluates and compares the strength and weaknesses of these approaches when they are applied in practice. In this paper, we analyse the applicability of some selected approaches for addressing ethical issues in HTA in the field of complex health interventions. Complex health interventions have been the focus of methodological attention in HTA. However, the potential methodological challenges for ethical analysis are as yet unknown. METHODS Six of the most frequently described and applied ethical approaches in HTA were critically assessed against a set of five characteristics of complex health interventions: multiple and changing perspectives, indeterminate phenomena, uncertain causality, unpredictable outcomes, and ethical complexity. The assessments are based on literature and the authors' experiences of developing, applying and assessing the approaches. RESULTS The Interactive, participatory HTA approach is by its nature and flexibility, applicable across most complexity characteristics. Wide Reflective Equilibrium is also flexible and its openness to different perspectives makes it better suited for complex health interventions than more rigid conventional approaches, such as Principlism and Casuistry. Approaches developed for HTA purposes are fairly applicable for complex health interventions, which one could expect because they include various ethical perspectives, such as the HTA Core Model® and the Socratic approach. CONCLUSION This study shows how the applicability for addressing ethical issues in HTA of complex health interventions differs between the selected ethical approaches. Knowledge about these differences may be helpful when choosing and applying an approach for ethical analyses in HTA. We believe that the study contributes to increasing awareness and interest of the ethical aspects of complex health interventions in general.
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Affiliation(s)
| | | | - Gert Jan van der Wilt
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, The Netherlands.,Athena Institute for Innovation in the Health and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - Pietro Refolo
- Institute of Bioethics, "A. Gemelli" School of Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Dario Sacchini
- Institute of Bioethics, "A. Gemelli" School of Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Kati Mozygemba
- Department of Health Services Research, Institute of Public Health and Nursing Research, and Health Sciences, University of Bremen, Bremen, Germany.,Health Sciences Bremen, Bremen, Germany
| | - Ansgar Gerhardus
- Department of Health Services Research, Institute of Public Health and Nursing Research, and Health Sciences, University of Bremen, Bremen, Germany.,Health Sciences Bremen, Bremen, Germany
| | | | - Bjørn Hofmann
- Centre for Medical Ethics, University of Oslo, Oslo, Norway.,The Norwegian University for Science and Technology, Gjøvik, Norway
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Cummings L. Argument from Analogy. REASONING AND PUBLIC HEALTH: NEW WAYS OF COPING WITH UNCERTAINTY 2015. [PMCID: PMC7123382 DOI: 10.1007/978-3-319-15013-0_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Similarities between objects, people and places pervade our thinking and influence our interaction with the environment. Many of these similarities serve no logical purpose but have a descriptive or explanatory function in our cognitive affairs. However, for the substantial number of analogies which are used in argument, their logical and other attributes have long been a source of fascination for investigators in a range of disciplines. It is argued in this chapter that cognitive agents use the argument from analogy as a facilitative heuristic to guide their judgements about public health problems when evidence or knowledge is not available in a particular context. To this extent, the argument is one type of adaptation of our rational procedures to the problem of uncertainty in the cognitive domain. Several examples of the use of this argument in a public health context are examined. The dialectical and epistemic features of this argument are addressed within a discussion of the use of analogical argument in systematic and heuristic reasoning. The results of a study of public health reasoning reveal that members of the public are adept at identifying the conditions under which the use of analogical argument is more or less rationally warranted.
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O'Keefe M, Perrault S, Halpern J, Ikemoto L, Yarborough M. "Editing" Genes: A Case Study About How Language Matters in Bioethics. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2015; 15:3-10. [PMID: 26632354 DOI: 10.1080/15265161.2015.1103804] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Metaphors used to describe new technologies mediate public understanding of the innovations. Analyzing the linguistic, rhetorical, and affective aspects of these metaphors opens the range of issues available for bioethical scrutiny and increases public accountability. This article shows how such a multidisciplinary approach can be useful by looking at a set of texts about one issue, the use of a newly developed technique for genetic modification, CRISPRcas9.
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Fisher E, Boenink M, van der Burg S, Woodbury N. Responsible healthcare innovation: anticipatory governance of nanodiagnostics for theranostics medicine. Expert Rev Mol Diagn 2014; 12:857-70. [DOI: 10.1586/erm.12.125] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Rebulla P, Lecchi L, Giovanelli S, Butti B, Salvaterra E. Biobanking in the Year 2007. Transfus Med Hemother 2007. [DOI: 10.1159/000103922] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Johnson S, Burger I. Limitations and justifications for analogical reasoning. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2006; 6:59-61; author reply W13-4. [PMID: 17085413 DOI: 10.1080/15265160600939011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Burns L. Banking on the value of analogies in bioethics. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2006; 6:63-5; author reply W13-4. [PMID: 17085415 DOI: 10.1080/15265160600939060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Holland S. It's not what we say, exactly...or is it? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2006; 6:65-6; author reply W13-4. [PMID: 17085416 DOI: 10.1080/15265160600939110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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White GB. Analogical power and Aristotle's model of persuasion. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2006; 6:67-8; author reply W13-4. [PMID: 17085417 DOI: 10.1080/15265160600939177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Neal KC. Analogical trends in umbilical cord blood legislation in the United States. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2006; 6:68-70; author reply W13-4. [PMID: 17085418 DOI: 10.1080/15265160600939201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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López JJ. Mapping metaphors and analogies. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2006; 6:61-3; author reply W13-4. [PMID: 17085414 DOI: 10.1080/15265160600939037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- José J López
- Department of Sociology and Anthropology, University of Ottawa, Canada
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Samuel GN, Ankeny RA, Kerridge IH. Mixing metaphors in umbilical cord blood transplantation. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2006; 6:58-9; author reply W13-4. [PMID: 17085412 DOI: 10.1080/15265160600938872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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