The Journal of Medicine and Philosophy — August 2014


The August issue of The Journal of Medicine and Philosophy does not have a specific theme. The nine articles address a number of quite interesting issues, among them:

  • How existential psychotherapy can offer powerful insights to patients recovering from severe mental disorders such as psychosis
  • How a preference in athletics for natural talent over artificial enhancements (such as doping) may reflect “unsavory beliefs about ‘nature’s aristocracy’ ”
  • How rich, educated, white males may be just as, if not more, vulnerable to threats posed by physician-assisted suicide and voluntary active euthanasia than members of marginalized groups
  • When the decision is made not to administer artificial hydration and nutrition, can the responsibility for the patient’s death be attributed to the underlying pathology, even when that is not the cause of death
  • The right to procreate: Is it possible for prospective mothers to wrong prospective fathers by bearing their child

Note that the articles in this journal are not open access and that I have added the emphasis in the following extracts and abstracts.


Breaking New Ground in the Philosophy of Medicine and Bioethics

Graham M. Valenta

This nonthematic issue of The Journal of Medicine and Philosophy brings together nine articles within the philosophy of medicine and bioethics. The wide range of articles in this issue covers topics from diverse fields such as synthetic biology, doping in elite sports, and artificial hydration and nutrition (AHN), to name a few. Although the essays are diverse, they are united in that each seeks to break new ground by incorporating fresh considerations into established positions. The first essay in this issue, for example, examines the philosophical ramifications of recent technological advancements in the field of synthetic biology. Here, new organisms such as oncomice challenge the concept of death in a way that has not yet been explored. Similarly, “May the Blessed Man Win” compares doping to gain a competitive advantage in sport to society’s general respect for natural talent and comes to the novel conclusion that doping to artificially enhance one’s athletic ability may sometimes be appropriate.

This issue is also particularly interesting for the ways in which the essays connect to other disciplines, such as existential phenomenology, metaphysics, and the philosophy of action. For example, Bryan Pilkington’s article, “On Omissions and Artificial Hydration and Nutrition,” utilizes relatively recent work from the philosophy of action to develop a metaphysical and moral account of omissions that can guide individuals faced with the tough decision of whether to withhold AHN. The second essay in this journal, as another example, focuses on expanding the field of recovery-oriented care through incorporating classic considerations from phenomenology, such as Dasein.

As a whole, this collection of essays will expose the reader to many different topics both within and without bioethics and the philosophy of medicine. Throughout the issue, the reader is asked to question his or her assumptions and established positions on long-standing debates. The …


Disease, Dysfunction, and Synthetic Biology

Sune Holm

Theorists analyzing the concept of disease on the basis of the notion of dysfunction consider disease to be dysfunction requiring. More specifically, dysfunction-requiring theories of disease claim that for an individual to be diseased certain biological facts about it must be the case. Disease is not wholly a matter of evaluative attitudes. In this paper, I consider the dysfunction-requiring component of Wakefield’s hybrid account of disease in light of the artifactual organisms envisioned by current research in synthetic biology. In particular, I argue that the possibility of artifactual organisms and the case of oncomice and other bred or genetically modified strains of organism constitute a significant objection to Wakefield’s etiological account of the dysfunction requirement. I then develop a new alternative understanding of the dysfunction requirement that builds on the organizational theory of function. I conclude that my suggestion is superior to Wakefield’s theory because it (a) can accommodate both artifactual and naturally evolved organisms, (b) avoids the possibility of there being a conflict between what an organismic part is supposed to do and the health of the organism, and (c) provides a nonarbitrary and practical way of determining whether dysfunction occurs.

The Contribution of Existential Phenomenology in the Recovery-Oriented Care of Patients with Severe Mental Disorders

Philippe Huguelet

Promoting recovery has become more and more important in the care of patients with severe mental disorders such as psychosis. Recovery is a personal process of growth involving hope, self-identity, meaning in life, and responsibility. Obviously, these components pertain, at least in part, to a psychotherapeutic care perspective. Yet, up to now, recovery has mainly been taken into account in transforming health services and as a general framework for supportive therapy. Existential phenomenology abdicates a theoretical stance and considers issues such as death anxiety, isolation, responsibility, and meaning. Thus, it is likely to provide some insight into the psychotherapeutic aspects of recovery. Furthermore, existential psychotherapy allows powerful insights for adopting a recovery-oriented attitude and to provide useful themes for discussing issues allowing patients to gain meaning and hope. This paper describes these elements to give clinicians insights into this complex topic.

May the Blessed Man Win: A Critique of the Categorical Preference for Natural Talent over Doping as Proper Origins of Athletic Ability

Pieter Bonte, Sigrid Sterckx and Guido Pennings

Doping scandals can reveal unresolved tensions between the meritocratic values of equal opportunity + reward for effort and the “talentocratic” love of hereditary privilege. Whence this special reverence for talent? We analyze the following arguments: (1) talent is a unique indicator of greater potential, whereas doping enables only temporary boosts (the fluke critique); (2) developing a talent is an authentic endeavor of “becoming who you are,” whereas reforming the fundamentals of your birth suit via artifice is an act of alienation (the phony critique); (3) your (lack of) talent informs you of your proper place and purpose in life, whereas doping frustrates such an amor fati self-understanding (the fateless critique). We conclude that these arguments fail to justify a categorical preference for natural talent over integrated artifice. Instead, they illustrate the extent to which unsavory beliefs about “nature’s aristocracy” may still be at play in the moral theatre of sports.

Why the Debate over Minimal Risk Needs to be Reconsidered

Ariella Binik and Charles Weijer

Minimal risk is a central concept in the ethical analysis of research with children. It is defined as the risks “. . . ordinarily encountered in daily life . . . .” But the question arises: who is the referent for minimal risk? Commentators in the research ethics literature often answer this question by endorsing one of two possible interpretations: the uniform interpretation (which is also known as the absolute interpretation) or the relative interpretation of minimal risk. We argue that describing the debate over minimal risk as a disagreement between the uniform and the relative interpretation impedes progress on the identification of a justifiable referent for minimal risk. There are two main problems with this approach: (1) constructing the debate over minimal risk as a disagreement between a uniform and a relative interpretation misconstrues the main difference between competing interpretations and (2) neither the uniform nor the relative interpretation identifies one unique and consistent group of children as the referent for minimal risk. We conclude that progress on the debate over minimal risk requires that we abandon the uniform and relative interpretations and address the main moral problem at stake: whether healthy children or the subjects of the research should be the referent for minimal risk.

Rich, White, and Vulnerable: Rethinking Oppressive Socialization in the Euthanasia Debate

Erik Krag

Anita Silvers (1998) has criticized those who argue that members of marginalized groups are vulnerable to a special threat posed by physician-assisted suicide (PAS) and voluntary active euthanasia (VAE). She argues that paternalistic measures prohibiting PAS/VAE in order to protect these groups only serve to marginalize them further by characterizing them as belonging to a definitively weak class. I offer a new conception of vulnerability, one that demonstrates how rich, educated, white males, who are typically regarded as having their autonomy enhanced by their social status, are just as, if not more, vulnerable to threats posed by PAS/VAE as a result of the harmful social messages at work just below the surface of contemporary Western culture. I use this new conception of vulnerability to reinforce arguments for continued statutory prohibitions on PAS/VAE.

On Omissions and Artificial Hydration and Nutrition

Bryan C. Pilkington

Understanding what sorts of things one might be responsible for is an important component of understanding what one should do in situations where the administration of artificial hydration and nutrition are required to sustain the life of a patient. Relying on work done in the philosophy of action and on moral responsibility, I consider the implications of omitting the administration of artificial hydration and nutrition and instances in which the omitting agent would and would not be responsible for the death of the patient. I am primarily interested in arguing against those who wish to seat responsibility for the death of a patient in an underlying pathology, even when the underlying pathology is not the cause of the patient’s death.

Fathers and Abortion

Ezio Di Nucci

I argue that it is possible for prospective mothers to wrong prospective fathers by bearing their child; and that lifting paternal liability for child support does not correct the wrong inflicted to fathers. It is therefore sometimes wrong for prospective mothers to bear a child, or so I argue here. I show that my argument for considering the legitimate interests of prospective fathers is not a unique exception to an obvious right to procreate. It is, rather, part of a growing consensus that procreation can be morally problematic and that generally talking of rights in this context might not be warranted. Finally, I argue that giving up a right to procreate does not imply nor suggest giving up on women’s absolute right to abort, which I defend.

Why Care for the Severely Disabled? A Critique of MacIntyre’s Account

Gregory S. Poore

In Dependent Rational Animals, Alasdair MacIntyre attempts to ground the virtues in a biological account of humans. Drawing from this attempt, he also tries to answer the question of why we should care for the severely disabled. MacIntyre’s difficulty in answering this question begins with the fact that his communities of practices do not naturally include the severely disabled within their membership and care. In response to this difficulty, he provides four reasons for why we should care for the severely disabled. I argue that three of these reasons are inadequate, and that the fourth is incomplete although it does point in a promising direction. I conclude that a more satisfactory answer requires a further extension of the central development from After Virtue to Dependent Rational Animals, and I draw from Wendell Berry, whose work MacIntyre admires, to provide an illuminating illustration of what such an answer might look like.

Related posts:
The Journal of Medicine & Philosophy – June 2014
Atul Gawande: Modern death and dying
Actions surrounding the moment of death are highly symbolic
Death be not visible

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