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History, Philosophy and Ethical Perspectives on Healthcare
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History, Philosophy and Ethical Perspectives on Healthcare

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (29 February 2024) | Viewed by 11189

Special Issue Editors

Prof. Dr. Florian Steger

E-Mail Website
Guest Editor
Institute of the History, Philosophy and Ethics of Medicine, Ulm University, 89073 Ulm, Germany
Interests: history of medicine; medical ethics; bioethics; research ethics; social diversity and access to healthcare; ethics of digitalization of healthcare; politicization of medicine
Special Issues, Collections and Topics in MDPI journals
Dr. Marcin Orzechowski

E-Mail Website
Guest Editor
Institute of the History, Philosophy and Ethics of Medicine, Ulm University, 89073 Ulm, Germany
Interests: ethical challenges of diversity in healthcare; ethics of digitalization of healthcare; history of medicine; research ethics
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Modern medicine and modern life sciences have a long tradition. Scientific development in medicine and philosophical reflection on it have always been interconnected. However, nowadays, modern technological progress, cutting-edge methods, and improved techniques put our societies before new challenges on a daily basis. Scientific breakthroughs promise a better quality of healthcare, but at the same time they raise important questions: Should we really put to use everything that is possible? What are the ethical limits of technologies such as, for example, genetic engineering, new reproduction techniques, or artificial intelligence in patients’ care? How should research on such technologies be conducted in order to preserve human dignity and autonomy? These questions are why moral reservations are repeatedly voiced when it comes to implementing new developments into medical practice. This calls for an increased role of ethics in medicine. Progress should be possible; however, it should be reflected on ethically, especially if it is applied to human beings. Medical research, the treatment of diseases, and medical care should be accompanied by ethics. In this way, we can take a critical look at the risks, evaluate the benefits, respect the rights and preferences of patients and test persons, and, last but not least, ensure that scarce resources in the healthcare system are fairly distributed. 

Philosophical arguments play a central role in resolving these challenges, just as philosophical foundations are important for understanding medicine in general. Medicine, perceived as a practical science, must be reflected upon in terms of the philosophy of science, especially if we consider the epistemic record of medicine. Finally, it needs to be acknowledged and appreciated that medicine is part of a long historicocultural heritage. Both medical theory and medical practice have a history that extends far beyond the European tradition and has produced a rich diversity of research. Answers to modern challenges in medicine should be contemplated from different positions, reflecting various philosophical, historical, and cultural standpoints. 

This Special Issue aims to bring together contributions that address historical, philosophical, and ethical issues in medicine, reflected upon from an individual or integrative point of view. The Guest Editor invites contributions from across the globe from a wide range of academic perspectives, including, but not limited to, the history of medicine, the philosophy of medicine, and medical ethics.

You may choose our Joint Special Issue in Healthcare.

Prof. Dr. Florian Steger
Dr. Marcin Orzechowski
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • medical philosophy
  • history of medicine
  • medical ethics
  • biomedical technologies
  • research ethics
  • ethical analysis

Related Special Issue

Published Papers (7 papers)

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Research

12 pages, 416 KiB  
Article
The Language of Nature and Artificial Intelligence in Patient Care
by Teresa Enríquez, Paloma Alonso-Stuyck and Lourdes Martínez-Villaseñor
Int. J. Environ. Res. Public Health 2023, 20(15), 6499; https://doi.org/10.3390/ijerph20156499 - 01 Aug 2023
Viewed by 1346
Abstract
Given the development of artificial intelligence (AI) and the conditions of vulnerability of large sectors of the population, the question emerges: what are the ethical limits of technologies in patient care? This paper examines this question in the light of the “language of [...] Read more.
Given the development of artificial intelligence (AI) and the conditions of vulnerability of large sectors of the population, the question emerges: what are the ethical limits of technologies in patient care? This paper examines this question in the light of the “language of nature” and of Aristotelian causal analysis, in particular the concept of means and ends. Thus, it is possible to point out the root of the distinction between the identity of the person and the entity of any technology. Nature indicates that the person is always an end in itself. Technology, on the contrary, should only be a means to serve the person. The diversity of their respective natures also explains why their respective agencies enjoy diverse scopes. Technological operations (artificial agency, artificial intelligence) find their meaning in the results obtained through them (poiesis). Moreover, the person is capable of actions whose purpose is precisely the action itself (praxis), in which personal agency and, ultimately, the person themselves, is irreplaceable. Forgetting the distinction between what, by nature, is an end and what can only be a means is equivalent to losing sight of the instrumental nature of AI and, therefore, its specific meaning: the greatest good of the patient. It is concluded that the language of nature serves as a filter that supports the effective subordination of the use of AI to its specific purpose, the human good. The greatest contribution of this work is to draw attention to the nature of the person and technology, and about their respective agencies. In other words: listening to the language of nature, and attending to the diverse nature of the person and technology, personal agency, and artificial agency. Full article
(This article belongs to the Special Issue History, Philosophy and Ethical Perspectives on Healthcare)
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12 pages, 1131 KiB  
Article
Ethical Aspects of Personalized Research and Management of Systemic Inflammatory Response Syndrome (SIRS) in Children
by Elisa Groff, Marcin Orzechowski, Catharina Schuetz and Florian Steger
Int. J. Environ. Res. Public Health 2023, 20(1), 470; https://doi.org/10.3390/ijerph20010470 - 28 Dec 2022
Viewed by 1616
Abstract
Systemic inflammatory response syndrome (SIRS) is a life-threatening condition with nonspecific symptoms. Because of that, defining a targeted therapy against SIRS in children and adults remains a challenge. The identification of diagnostic patterns from individualized immuneprofiling can lead to development of a personalized [...] Read more.
Systemic inflammatory response syndrome (SIRS) is a life-threatening condition with nonspecific symptoms. Because of that, defining a targeted therapy against SIRS in children and adults remains a challenge. The identification of diagnostic patterns from individualized immuneprofiling can lead to development of a personalized therapy. The aim of this study was to identify and analyze ethical issues associated with personalized research and therapy for SIRS in pediatric populations. We conducted an ethical analysis based on a principled approach according to Beauchamp and Childress’ four bioethical principles. Relevant information for the research objectives was extracted from a systematic literature review conducted in the scientific databases PubMed, Embase and Web of Science. We searched for pertinent themes dealing with at least one of the four bioethical principles: “autonomy”, “non-maleficence”, “beneficence” and “justice”. 48 publications that met the research objectives were included in the thorough analysis, structured and discussed in a narrative synthesis. From the analysis of the results, it has emerged that traditional paradigms of patient’s autonomy and physician paternalism need to be reexamined in pediatric research. Standard information procedures and models of informed consent should be reconsidered as they do not accommodate the complexities of pediatric omics research. Full article
(This article belongs to the Special Issue History, Philosophy and Ethical Perspectives on Healthcare)
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14 pages, 344 KiB  
Article
The Understanding of Human Death by Polish Early Career Pre-Specialist Physicians
by Krzysztof Leśniewski, Bożena Baczewska and Beata Antoszewska
Int. J. Environ. Res. Public Health 2022, 19(24), 16573; https://doi.org/10.3390/ijerph192416573 - 09 Dec 2022
Cited by 2 | Viewed by 1030
Abstract
Despite the legal classification of cerebral death as the actual death of a human being and the continuous clarification of neurological criteria, the subject of death, particularly, when exactly it occurs, has been the subject of debate not only in the medical environment [...] Read more.
Despite the legal classification of cerebral death as the actual death of a human being and the continuous clarification of neurological criteria, the subject of death, particularly, when exactly it occurs, has been the subject of debate not only in the medical environment but also in other scientific communities for over sixty years. This issue is also present in social discourse. In Poland, as well as in other countries, the concepts of “death” and “cerebral death” have a legal basis. Considerations devoted to death are also important for tanatopedagogics, which focuses primarily on mortality. Indeed, the quality of relationships with other people depends to a large extent on the awareness of death. The study involved 113 pre-specialist physicians employed in various medical centers in Poland. An original questionnaire was used to study the understanding of human death in the light of legal and medical acts that came into force between 2007 and 2019. The study showed that only 7.08% of pre-specialist physicians could fully and correctly identify the basis for declaring a patient dead after diagnosing the irreversible cessation of brain function, and only 33.63% of all respondents understood death in accordance with legal acts currently in force in Poland. Moreover, nearly half of the study participants (47.79%) indicated that irreversible loss of consciousness is not adequate grounds for determining a patient’s death, while 56.64% felt that cerebral death is equal to the biological death of a human being. Women were significantly more likely to understand the concept of death (p = 0.028) as defined by current documents and to perceive the irreversible loss of consciousness as an insufficient basis for determining a patient’s death (p = 0.040) and also to correctly indicate on what basis cerebral death is identified with human death (p = 0.003), as expressed by current legal regulations in Poland. Full article
(This article belongs to the Special Issue History, Philosophy and Ethical Perspectives on Healthcare)
10 pages, 343 KiB  
Article
Are Old Men Impotent? On a Sparse Discourse of Early Modern Medicine and Its Forensic Implications in Paolo Zacchia’s Quaestiones medico-legales
by Daniel Schäfer
Int. J. Environ. Res. Public Health 2022, 19(24), 16513; https://doi.org/10.3390/ijerph192416513 - 08 Dec 2022
Viewed by 730
Abstract
In early modern medical literature, there are increasing references to sterility and impotence in older men. This is especially true of the Quaestiones medico-legales by the Roman physician Paolo Zacchia (1584–1659). In several books of this systematically structured manual, its author discusses medical [...] Read more.
In early modern medical literature, there are increasing references to sterility and impotence in older men. This is especially true of the Quaestiones medico-legales by the Roman physician Paolo Zacchia (1584–1659). In several books of this systematically structured manual, its author discusses medical and legal arguments on the one hand. On the other hand, in the 10th, only posthumously published volume, a total of five cases of impotence in old men are described on the basis of court decisions of the Rota Romana and expert opinions of the author. The paper examines these cases with regard to central statements on male impotence in old age, which are placed in the medical as well as the social and legal-historical context of the time. It becomes clear that old-age impotence and sterility were less a medical than a legal problem in the 17th century. However, the physician Zacchia emphasises the concept of biological age instead of historically transmitted numerical age limits. In this respect, his expert opinions already show the first signs of medical empiricism. Full article
(This article belongs to the Special Issue History, Philosophy and Ethical Perspectives on Healthcare)
14 pages, 3150 KiB  
Article
Fetal Development in Anatomical Preparations of Ruysch and the Meckels in Comparison
by Oxana Kosenko, Claudia Steinicke, Heike Kielstein and Florian Steger
Int. J. Environ. Res. Public Health 2022, 19(22), 14896; https://doi.org/10.3390/ijerph192214896 - 12 Nov 2022
Cited by 1 | Viewed by 2255
Abstract
Anatomical collections have been used for centuries for research and teaching purposes. By the example of selected preparations of fetal development from the Ruysch collection (17th–18th centuries) and the Meckel collections (18th–19th century), this article aims to trace the changing purposes, specifics and [...] Read more.
Anatomical collections have been used for centuries for research and teaching purposes. By the example of selected preparations of fetal development from the Ruysch collection (17th–18th centuries) and the Meckel collections (18th–19th century), this article aims to trace the changing purposes, specifics and methods of creating specimens as well as the development of anatomy during that period. The selected specimens are compared and analyzed implementing the historical-critical method. Regarding the appearance of the preparations, we see a transition from the visually aesthetic specimens (Ruysch) to exact ones (Meckel collections). If Ruysch’s preparations were compared in his time to works of art, specimens created by three anatomists of the Meckel dynasty were primarily created for teaching and research purposes. However, Ruysch’s preparations tracing fetal circulation were scientific discoveries of the time. As for preparations of fetal development from the Meckel collections, we see both specimens of physiological processes already known at that time and experimental ones. Regarding teratology, Ruysch and Meckel the Younger tried to explain malformations, but their anatomical preparations could hardly give answers to the cause of deviations from the norm. The differences between the collections can be explained by the different stages of development of anatomy of the time and by the research interests of the anatomists themselves. Full article
(This article belongs to the Special Issue History, Philosophy and Ethical Perspectives on Healthcare)
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12 pages, 663 KiB  
Article
Sexual Self-Determination of Individuals with Intellectual Disabilities—A Possible Philosophical Conceptualization and Resulting Practical Challenges
by Tobias Skuban-Eiseler
Int. J. Environ. Res. Public Health 2022, 19(19), 12595; https://doi.org/10.3390/ijerph191912595 - 02 Oct 2022
Cited by 2 | Viewed by 1950
Abstract
(1) Background: Self-determination is one of the central values of many societies. Self-determination concerns many areas of life, including sexuality. Unfortunately, the sexuality of individuals with intellectual disabilities (IID) is often discriminated against, and even in their everyday care, sexuality is often given [...] Read more.
(1) Background: Self-determination is one of the central values of many societies. Self-determination concerns many areas of life, including sexuality. Unfortunately, the sexuality of individuals with intellectual disabilities (IID) is often discriminated against, and even in their everyday care, sexuality is often given too little space, not least because of knowledge deficits of parents and staff. A practicable conceptualization of sexual self-determination is a prerequisite for helping IID to achieve self-determined sexuality. The aim of this paper is to formulate such an applicable conceptualization and to discuss related challenges. (2) Method: This paper uses Harry Frankfurt’s hierarchical conception of desires and the WHO definition of sexuality to develop a suitable understanding of sexual self-determination. (3) Results: The mentioned concepts offer promising tools to develop a conceptualization of sexual self-determination with high practical applicability. (4) Discussion: Sexual self-determination involves decision-making processes in relation to the different dimensions of sexuality. IID do need support to come to these decisions. Challenges that might be involved with such decision processes will be discussed. Full article
(This article belongs to the Special Issue History, Philosophy and Ethical Perspectives on Healthcare)
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12 pages, 361 KiB  
Article
From Monastic Benevolence to Medical Beneficence: The Inception of Medical Ethics in Wallachia and Moldavia before the Second Half of the 19th Century
by Sorin Hostiuc, Oana-Maria Isailă, Octavian Buda and Eduard Drima
Int. J. Environ. Res. Public Health 2022, 19(16), 10229; https://doi.org/10.3390/ijerph191610229 - 17 Aug 2022
Cited by 1 | Viewed by 1390
Abstract
In Middle Ages, in Moldavia and Wallachia, the healthcare system was almost non-existent, medical practice being the attribute of old women, midwives, charmers, and later monastic personnel. The first elements of medical ethics are identifiable in written texts from the 17th century, associated [...] Read more.
In Middle Ages, in Moldavia and Wallachia, the healthcare system was almost non-existent, medical practice being the attribute of old women, midwives, charmers, and later monastic personnel. The first elements of medical ethics are identifiable in written texts from the 17th century, associated with a process of laicization of medicine and the appearance of the first combined civil and penal codes (Vasile Lupu’s Law from 1646 and Matei Basarab’s Law from 1652). In the next 150 years, elements of medical ethics were rarely identified, usually in legal regulations, personal letters, or literary works. Starting with the end of the 18th century, associated with the emergence of the position of public physician, detailed regulations regarding the healthcare system associated with an increased number of ethical norms began to emerge. The purpose of this article is to increase awareness to an international audience about the history of Romanian medical deontology and the roots of concepts appertaining to medical ethics in the territories of Moldavia and Wallachia. Full article
(This article belongs to the Special Issue History, Philosophy and Ethical Perspectives on Healthcare)
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