The Philosophy and Practice of Medicine and Bioethics

Rationale of the book About the Authors 1. Metaphor in Medicine. The Metaphorical Method 1.1 Introduction 1.2 Types of metaphor 1.2.1 Substitution 1.2.2 Juxtaposition 1.2.3 Analogy, Simile, or Comparison 1.2.4 Symbolism 1.2.5 Metonymy 1.2.6 Synecdoche 1.2.7 Synesthesia 1.2.8 Reversal 1.2.9 Personification 1.2.10 Oxymora or combination of opposites 1.2.11 Deviation 1.2.12 Metaphor-to-myth fallacy 1.3 Metaphorical methods should be considered for analysis of and writing research papers 1.4. Clarification of medical language 1.5 Case example: A healthcare worker (H) ??? patient (P) metaphoric: H/P modeling in medicine 1.6 H/P models 2. Definition 2.1 Where does it come from that we think we need to define? 2.2 Distinction between types of definition 3. Decision Making: fallacies and other mistakes 3.1 Conditions of decision-making 3.2 Frequent causes of irrational medical thinking and decision-making 3.3 Five levels of decision-making in medicine 3.4 Fallacies in decision-making 3.5 Mistakes 3.5.1. What are mistakes? 3.5.2. What are indications of errors? 3.5.3. Indications that mistakes are often preventable ones 3.5.4. What are the reasons for the mistakes? 3.5.4.1 Questionable medical treatments 3.5.4.2 Error is necessary 3.5.4.3 Uncritical thinking (speaking) 3.5.4.4 Medical knowledge is lacking 3.5.4.5. System as a cause of error 3.5.4.6 Some mistakes are not mistakes 3.5.4.7 Guidelines are not followed 3.5.4.8 Self-caused mistakes 3.5.4.9. Patient errors 3.5.4.10 Lack of sufficient attention 3.5.4.11 Misdiagnosis 3.5.4.12 Overwork 3.5.4.13 Limitations of knowledge in medicine 3.5.4.14 Unfair medical threats of malpractice suits threaten physicians 3.5.4.15 Unfair blame 3.5.4.16 Protocols of good management are violated 3.5.4.17 Unfairness of the law 3.5.4.18 Negative emotions 3.5.5 Case example: Misleading diagnosis 3.5.6 Personal experiences: mistakes 4. Analysis of Causation in Medicine 4.1 Decision-making and cause 4.2 Synonyms of cause 4.3 Antonyms for cause 4.4 Metaphorical models for cause 4.5 Substitutions for cause 4.6 Temporal factors in causality 4.7 Types of causality 4.8. Summary 5. Ethics and Non-Ethics 5.1 Introduction 5.2 A naturalistic theory of ethics 5.3 What is ethics in actual usage? 5.4 Ethics and morals: an unethical society 5.5 Value contradictions 5.6 Examples of contradictions 5.7 On being non-ethical and anti-inquiry 5.8 Brief conclusion 5.9 An Ethics Text for British Medical Schools 5.10 Case example: medicine and dysfunctional culture 5.11 Case example: military medical service as contradictory to medical practice 5.12. Insensitivity to killing: the failure to be embarrassed. 5.13 Case example: on sensitivity 5.14 Case example: Tsunami disaster and cultural irresponsibility 5.15 Case example: culture and family as anti-medicine: female circumcision 6. Medicotheology and Biotheology 6.1 Introduction. How many people have religious beliefs? 6.2 The influence of religion on bioethics and medicine 6.3 Church opposition to medicine 6.4 Should medicine be based on supernaturalism? 6.5 Science and metaphysical causes? 6.6 Case example: religion and autonomy 6.7 Religion versus medicine: a common ground? 6.8 Religion as ethics 6.9 Ethics Committees 6.10 Humanism versus religion 6.11 Absolute religious ethics versus consequentialism 6.12 Case example: deprogramming religion in medicine 6.13 Case example: a real woman 6.14 The person as a soul 6.15 Sanctity-of-life (human) 6.16 General observations regarding the Value of human life 6.17 Contradictions regarding the Sanctity-of-Life doctrine 6.18 Selected arguments from the philosophy of religion 6.19 Prayer as medical treatment 7. Emotion in Medicine 7.1 Introduction 7.2 Case example: non-mental associations provide complexity to cognitions 7.3 Emotion is not an internal state 7.4 Emotions can be changed 7.5 The happy Stoics: passionate rational emotion 7.6 Virtually all judgments involve emotion 7.7 Emotion can change with bodily feeling 7.8 Emotion is not passive 7.9 Emotions are unique 7.10 Rejection of the Release Theory of Emotions 7.11 Case example: emotion requires assessment 7.12 Negative emotions are philosophical language fallacies 7.13 Some traditional examples of philosophy of language fallacies 7.14 Pity 7.15 Hope and humor 7.16 Case example: patients' negative emotions 7.17 Can emotions be reduced to physiology? 7.18 How are diseases and emotions classified? 7.19 Case example: legal recognition of emotional harm 7.20 Brief summary of the Cognitive Theory of Emotion 8. Enlightened Versus Normative Management. Ethics Versus Morals. 8.1 Introduction 8.2 Requirements for good management 8.3 Special section on overwork: a failed metaphor of the medical system 8.3.1 Introduction 8.3.2 How many hours do physicians, nurses and healthcare workers work? 8.3.3 Attempts to limit the number of work hours 8.3.4 Do physicians and nurses also cause the problems of overwork? 8.3.5 What is the effect of overwork? 8.3.6 Overwork harms health of staff 8.3.7 Overwork increases sick leave 8.3.8 Overwork causes stress and burnout 8.3.9 Overwork and suicide 8.3.10 Overwork causes loss of quality of life 8.3.11 Overwork is a cause of negative emotions 8.3.12 Overwork causes loss of interest in medical practice 8.3.13 What is the legal result of overwork? 8.3.14 Denial that healthcare workers overwork and/or that it is harmful 8.3.15 Is there evidence for the harm of overwork? 9. Care: A Critique of the Ethics and Emotion of Care 9.1 Introduction 9.2 Care theories 9.3 The word-field meanings of caring 9.3.1 Introduction 9.3.2 The synonyms and word-field of the term "caring" 9.4 Irrational forms of Caring 9.5 The Cognitive-Emotive Theory of Caring 9.5.1 Feeling 9.5.2 Caring is a value cognition causing feeling 9.5.3 Caring is based on positive cognitions 9.5.4 Emotions can be changed 9.5.5 We cause our own emotions. Caring is caused by ourselves. 9.5.6 The passionate stoics: rational emotion, rational caring 9.5.7 Negative emotion changes with feeling 9.5.8 Negative emotion is not passive 9.5.9 Each emotion of caring is unique 9.5.10 Rejection of the release theory of caring 9.5.11 Judgments generally involve emotion 9.5.12 Metaemotion 9.6 Caring and negative emotions 9.7 Mutuality of Caring 9.8 The patient's Hippocratic Oath 9.10 Empathy and caring 9.11 Summary 10. Egoism and Altruism in Medicine 10.1 Introduction 10.2 Common definition of altruism and egoism 10.3 Definitions of altruism 10.4 Definitions of egoism 10.5 An analysis of the word-fields of altruism and egoism 10.5.1 The word-field of altruism 10.5.2 The word-field of egoism 10.6 Altruism versus egoism 10.7 The problem of the Self 10.8 The ethical basis of altruism and egoism 10.8.1 General remarks 10.8.2 Utilitarian altruism 10.8.3 Ayn Rand's Objectivist Egoism 10.8.4 The Ordinary Language basis of altruism and egoism 10.9 Altruism and egoism as emotions 10.9.1 Altruistic and egoistic emotion are not mere bodily feelings 10.9.2 Altruism and egoism are cognitions causing bodily feelings 10.9.3 The emotions of altruism and egoism can be changed 10.9.4 Altruism and egoism are based on value cognitions 10.10 Sympathy 10.11 Selfishness 10.12 Rational altruism and egoism 10.13 Summary 11. Letting Die 11.1 Introduction 11.2 Misuse of ethical terms 11.3 Criteria for preferential treatment: non-contradiction 11.4 Case example: Oregon Healthcare prioritizing 11.5 What about self-caused illness and how to determine? 11.6 The Hippocratic Oath: pacifism in medicine? 11.7. Should we kill X to save Y? The numbers game 11.8 Allowing death = killing = murder 11.9 Letting-die and the Samaritan 11.10 Albert Schweitzer on Reverence for Life 11.11 Negative emotions kill and let die 11.12 Lack of organs as a form of letting die 11.13 Suicide and euthanasia 11.14 Conclusion 12. A Critique of Autonomy and Patient Responsibility 12.1 Introduction 12.2 Criticisms of the principle of autonomy 12.3 Patient responsibility and a patient code of ethics 12.4 Patients duties and patient code of ethics 12.5 Case report: patient and legal irresponsibility 13. Philosophy and Ethics of the Body 13.1 Introduction 13.2 Definition of philosophy and body 13.3 The scientific method: medicine as a science 13.4 A Naturalistic Ethics of the body 13.5 The value of life in terms of the body 13.6 The mind 13.7 The Self as a language construct 13.8 The un-philosophical body 13.9 Outward physical appearances: beauty 13.10 The face 13.11 The body as a whole and body parts: organs and Transplantation Medicine 13.12 Reproduction of bodies? 13.13 Leib: living to the full. 13.14 The philosophical body: the body as an aesthetic whole 13.15 Summary of the ethics of the body 14. Organ Donation: Mandatory Organ Donation Declaration 14.1 How many people need organs? 14.2 Death requirement 14.3 Opposition to organ donation 14.4 Support of organ donation 14.5 Presumed organ donation 14.6 Family approval as an adverse policy 14.7 Recommendations for obtaining organs for transplantation 14.7.1 Lottery 14.7.2 The economic incentive approach 14.7.3 Irresponsible lifestyles and organ preference 14.7.4 Mandatory Organ Donation Declaration 15. Stem Cell Research: A Question of Beliefs? 15.1 Introduction 15.2 Definitions and clarifications of morals and ethics 15.3 Facts and beliefs about stem cells 15.3.1 What we already know about stem cells 15.3.2 The promise of stem cell research in general 15.4 The controversy about what an embryo is 15.4.1 Definitions 15.4.2 Embryonic development in its context 15.4.3 The moral status ascribed to an embryo 15.4.4. Life is not just life: when is a human a human? 15.5 Ethical issues in stem cell research 15.5.1 How to perform an ethical examination? 15.5.2 Inquiry into language 15.5.3 The abortion argument all over again? 15.5.4 Adult stem cell research, an alternative to embryonic stem cell research? Other alternatives? 15.5.5 IVF "left over" embryos versus "created for research" embryos 15.5.6 Public funding? 15.5.7 The ethical challenge of research 15.6 Conclusions: humaine medicine ??? medicine for suffering people 16. Philosophy of Prevention 16.1 Introduction 16.2 An analysis of prevention 16.3 Unethical behavior and irresponsible lifestyles 16.4 Lifestyle as philosophical and critical thinking 16.5 Areas of prevention 16.5.1 Education: the greatest preventative of disorder 16.5.2 Cancer prevention 16.5.3 AIDS 16.5.4 Alzheimer`s disease (AD) 16.5.5 Lack of exercise: the obvious escapes us 16.5.6 Sexually transmitted disease (STD) 16.5.7 Longevity 16.5.8 Death and disease 16.5.9 Hand-washing: the obvious escapes us again 16.5.10 Drugs and toxins 16.6 Hidden prevention possibilities 16.7 Summary 17. Ethics Counseling: Philosophy of Medicine Counseling Instead of Medical Ethics Counseling 17.1 Introduction 17.2 What is Ethics Counseling? 17.2.1 Task Force on standards of Bioethics Consultation (USA) 17.2.2 Basic ethical principles in European Bioethics and Biolaw 17.2.2.1 Autonomy 17.2.2.2 Dignity 17.2.2.3 Integrity and narrative analysis 19.2.2.4 Vulnerability 17.2.2.5 Solidarity and social responsibility 17.3 Criticism of Bioethical Principlism 17.4 Case Method of Clinical Ethics 17.5 Holistic philosophy of medicine 17.6 Brief description of Dewey's Pragmatism and Naturalistic Ethics 17.7 Humanism contains many of the elements of contemporary definitions of philosophical practice 17.8 The present definitions and methods of Philosophical Counseling are too restrictive 17.9 Philosophical Counseling or Philosophical Practice 17.10 A proposal to change the title of Philosophical Practice to Philosophy Education 17.11 The philosophy practitioner and emotion 17.12 Summary 18. Medical Language: The Ordinary Language Approach 18.1 Introduction 18.2 Formal logic as a pseudo-logical failure 18.3 Formal logic is irrelevant to thought, reason and emotion 18.4 Formal logic as irrelevant to ethics or bioethics 18.5 Formal logic as formal fallacy 18.6 Formal logic as a fallacy of abstractionism 18.7 The arrogance of logicians 18.8 Formal logic reduces language to mathematics 18.9 Formal logic as a faulty view of meaning 18.10 ???Propositions???: a pseudo-logical term 18.11 Formal logic as dogmatism and misuse of symbols 18.12 Formal logic misuses the term ???truth??? 18.13 The useless syllogism 18.14 Formal logic is not philosophy 18.15 The primacy of ordinary language and Pragmatism 18.16 Formal logic excludes metaphor and creative language 19. A Critique of Evidence-Based Medicine. Evidence Based Medicine and Philosophy Based Medicine 19.1 Does EBM really meet the challenge of modern medicine? 19.2 What is the view of evidence in EBM ???is it left undefined? 19.3 EBM as statistics 19.4 EBM often investigates the obvious and trivial 19.5 EBM bears the risk of overgeneralization 19.6 EBM is often unintelligibly complex 19.7 EBM is often too abstractionistic 19.8 EBM as appeal to authority fallacy 19.9 EBM and the individual case and context 19.10 Uncritical use of EBM and clinical experience 19.11 EBM often excludes relevant causes and variables 19.12 EBM has limited self-criticism 19.13 EBM and psychiatry 19.14 EBM and human emotions 19.15 EBM and ethics 19.16 EBM depersonalizes 19.17 EBM text reviews 19.17.1 Evidence-based spirituality 19.17.2 EBM and practical medicine 19.17.3 Evidence-based nursing 19.17.4 EBM and logic 19.17.5 EBM and Gender Medicine 19.18 EBM and rational medicine 19.19 EBM, psychosomatics and philosophy 19.20 EBM and the problem of the placebo 19.21 "Philosophy of Medicine"??? based medicine instead of only "Evidence"??? based medicine 20. Lying in Medicine 20.1. Introduction 20.2 Definitions of lying 20.3 A new theory of lying 20.4 Self lie 20.5 Consequences of lying 20.6 Logic of flattery. Beneficial lying 20.7 Hypocrisy 21. Rhetoric of Death and Dying 21.1 Definitions of death 21.1.1 General definitions 21.1.2 Medical-psychological definitions of death 21.1.3 Death and abortion 21.2 Death: the literature 21.2.1 The poet's view 21.2.2 Wittgenstein on death 21.2.2.1 Death as a language-game 21.2.2.2 The question: what is death? 21.2.2.3 Death is not a thought or concept 21.2.2.4 The epistemological primacy of language 21.2.2.5 The death of mentalistic meaning 21.2.2.6 There is no non-linguistic knowledge of death 21.2.2.7 Language-games again and again 21.2.2.8 What death is not 21.2.2.9 Imagery and sensation 21.2.2.10 Can we imagine death? 21.2.2.11 Illustrations 21.3 Dying 21.3.1 The Cognitive-Emotive Theory 21.3.2 The Cognitive-Emotive Theory of grief and bereavement 21.4 Philosophy of religion 21.4.1 Views in theology 21.4.2 Old Testament 21.4.3 New Testament 21.5 Humanism 21.6 The rhetoric of death using the Metaphorical Method 21.6.1 Introduction to the metaphorical method 21.6.2 Rhetorical techniques for the exploration of the concept 21.6.2.1 Abstraction 21.6.2.2 All-statements or none-statements 21.6.2.3 Allegory 21.6.2.4 Ambiguity 21.6.2.5 Analogy and simile 21.6.2.6 Behavioral metaphor 21.6.2.7 Category-mistakes 21.6.2.8 Grammatical term metaphors 21.6.2.9 Circularity 21.6.2.10 Connotation 21.6.2.11 Context deviation 21.6.2.12 Contradiction humor 21.6.2.13 Defense mechanisms 21.6.2.14 Deviation 21.6.2.15 Euphemism 21.6.2.16 Free association 21.6.2.17 Hopelessness 21.6.2.18 Irony 21.6.2.19 Juxtaposition 21.6.2.20 Metaphor and metaphorization 21.6.2.21 Metonymy 21.6.2.22 Personification 21.6.2.23 Poetic metaphor 21.6.2.24 Probability 21.6.2.25 (Faulty) Questions and riddles 21.6.2.26 Reduction to absurdity 21.6.2.27 Rejuvenate metaphors 21.6.2.28 Reversal humor 21.6.2.29 Substitution 21.6.2.30 Tension metaphors 21.6.2.31 Uselessness 21.6.2.32 Therapeutic metaphor 21.7 Death and medical profession 21.8 Final personal remarks Index