The Philosophy and Practice of Medicine and Bioethics

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November 2010



This book challenges the unchallenged methods in medicine, such as "evidence-based medicine," which claim to be, but often are not, scientific. It completes medical care by adding the comprehensive humanistic perspectives and philosophy of medicine.

No specific or absolute recommendations are given regarding medical treatment, moral approaches, or legal advice. Given rather is discussion about each issue involved and the strongest arguments indicated. Each argument is subject to further critical analysis. This is the same position as with any philosophical, medical or scientific view.

The argument that decision-making in medicine is inadequate unless grounded on a philosophy of medicine is not meant to include all of philosophy and every philosopher. On the contrary, it includes only sound, practical and humanistic philosophy and philosophers who are creative and critical thinkers and who have concerned themselves with the topics relevant to medicine. These would be those philosophers who engage in practical philosophy, such as the pragmatists, humanists, naturalists, and ordinary-language philosophers.

A new definition of our own philosophy of life emerges and it is necessary to have one. Good lifestyle no longer means just abstaining from cigarettes, alcohol and getting exercise. It also means living a holistic life, which includes all of one's thinking, personality and actions.

This book also includes new ways of thinking. In this regard the "Metaphorical Method" is explained, used, and exemplified in depth, for example in the chapters on care, egoism and altruism, letting die, etc.


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? Questionable medical treatments Error is necessary Uncritical thinking (speaking) Medical knowledge is lacking System as a cause of error Some mistakes are not mistakes Guidelines are not followed Self-caused mistakes Patient errors Lack of sufficient attention Misdiagnosis Overwork Limitations of knowledge in medicine Unfair medical threats of malpractice suits threaten physicians Unfair blame Protocols of good management are violated Unfairness of the law 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 Autonomy Dignity Integrity and narrative analysis Vulnerability 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 Death as a language-game The question: what is death? Death is not a thought or concept The epistemological primacy of language The death of mentalistic meaning There is no non-linguistic knowledge of death Language-games again and again What death is not Imagery and sensation Can we imagine death? 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 Abstraction All-statements or none-statements Allegory Ambiguity Analogy and simile Behavioral metaphor Category-mistakes Grammatical term metaphors Circularity Connotation Context deviation Contradiction humor Defense mechanisms Deviation Euphemism Free association Hopelessness Irony Juxtaposition Metaphor and metaphorization Metonymy Personification Poetic metaphor Probability (Faulty) Questions and riddles Reduction to absurdity Rejuvenate metaphors Reversal humor Substitution Tension metaphors Uselessness Therapeutic metaphor
21.7 Death and medical profession
21.8 Final personal remarks


Warren Shibles was a Senior philosophy professor at the University of Wisconsin at Whitewater, Wisconsin and also taught courses at Tübingen, Germany. He has published 27 books, and over 180 professional journal articles.He also was a researcher in phonetics. He died in July 2007. Barbara Maier is a Senior physician, gynaecologist and obstetrician at the Women`s Hospital in Salzburg and head of the Department of Gynaecological Endocrinology and Assisted Reproduction at the University Clinic of Gynaecology and Obstetrics in Salzburg, Austria. She has been teaching ethics in medicine at the Institute for Ethics and Law at the University of Vienna since 1993. She has a Ph.D. in Philosophy, and M.D from the University of Vienna.


From the reviews:

'The Philosophy and Practice of Medicine and Bioethics, it provides an overview of the crucial issues being faced in medical practice, replete with interesting case studies and patient-care narratives ' . The authors repeatedly encourage good, open communication between patients and healthcare workers as well as between healthcare professionals and management staff. They also advocate constructive dialogue and human relationships based on trust, which are surely relevant aspects of what a philosophy of medicine must promote.' (Francesca Marin, Theoretical Medicine and Bioethics, Vol. 34, 2013)

'This book advocates a philosophy of medicine founded on humanism and naturalism. ' a philosophical work providing an honest, detailed, analytical inquiry of prevailing concepts and methods used in medicine. ' The book, a mixture of philosophical argument, opinions, case studies, and patient-care narratives from the authors' experience, is best appreciated ' . I found this book to be an informative read ' . most understood and best appreciated by academics in moral philosophy and ethics ' . the book is surely worth the effort.' (Andrew R. Barnosky, Journal of the American Medical Association, Vol. 306 (8), August, 2011)

'The purpose is to present a `naturalistic, practical, pragmatic, consequentialistic, and humanistic theory of ethics,' to apply this to the philosophy of medicine, and to examine existing bioethical arguments in light of this theory. A systematic approach to this topic is quite welcome. ' the book will be helpful to practitioners, and ' healthcare workers (and everyone else) would benefit greatly from paying greater attention to philosophical ethics. ' Readers sympathetic to naturalistic and humanistic philosophies are the most likely to find this work helpful.' (D. Robert MacDougall, Doody's Review Service, February, 2011)


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EAN: 9789048188673
Untertitel: A Naturalistic-Humanistic Approach. 2011. Auflage. Bibliographie. eBook. Sprache: Englisch. Dateigröße in MByte: 5.
Verlag: Springer Netherlands
Erscheinungsdatum: November 2010
Seitenanzahl: xxiii543
Format: pdf eBook
Kopierschutz: Adobe DRM
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