Journal of evaluation in clinical practice
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Pain has proven to be a refractory problem in US healthcare. This paper argues that starting to address this requires viewing pain-assessment as a form of sense-making that occurs between patients and providers. ⋯ Finally, section four moves beyond Rorty by linking sense-making to philosophical health. Should this prove persuasive, I will have shown an area in biomedicine where philosophy is not an 'optional add on', but a vitally important part of what should be clinical practice.
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The question of how to adaptively cope with chronic illnesses, aging, and other sources of bodily impairment is crucial for patients and clinicians alike, though sometimes overlooked in the focus on biomedical treatment. ⋯ We outline a "chessboard of healing," involving the possibility-spaces for dealing constructively with bodily breakdown. This set of strategies is shown to be nonarbitrary, drawn directly from contemporary work on the phenomenology of the lived body. For example, as we both experience the body as that which 'I am', and as that which 'I have', separable from the self, patients can react to illness by moving towards their bodies in modes of listening and befriending, or away from their body, ignoring or detaching themselves from symptoms. Then too, as the body is ever changing in time, one can seek restoration to a previous state, or transformation to new patterns of bodily usage, including passage into a whole new life-narrative.
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In recent years, a new form of health has emerged, namely philosophical health. This novel concept is part of the philosophical counseling movement and relies on the philosophical method called the SMILE-PH interview, which draws heavily from continental philosophy, including phenomenology. Reflecting on the link between health and philosophy brings us to an ancient healthcare tradition that actively relies on philosophy: Chinese healthcare and its founding wuxing, or five phases ontology. ⋯ We obtained a clear perspective of the place of SMILE-PH in wuxing ontology and added a new layer to philosophical health. The other phases of wuxing ontology remain to be tested and integrated into philosophical health.
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Under conditions of vaccine scarcity, the socially optimal dosing (SOD) strategy administers a lower dose of vaccine to a larger number of people than the individually optimal dosing (IOD) strategy, which administers a higher dose of vaccine to a smaller number of people. In the context of vaccines that generate diminishing returns of effectiveness with each additional dose beyond the first, SOD therefore generates a greater total amount of vaccine-induced protection than IOD and, as such, constitutes the socially optimal strategy. While the clinical and public health arguments in favour of SOD have previously been outlined, this article conducts an ethical analysis of SOD for scarce vaccines through the ethical framework of principlism. ⋯ In conditions of vaccine scarcity, SOD favourably satisfies the ethical framework of principlism.
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Bioethics seems preoccupied with establishing, debating, promoting and sometimes debunking principles. While these tasks trade on the status of the word 'principle' in our ordinary language, scant attention is paid to the way principles operate in language. In this paper, we explore how principles relate to rules and practices so as to better understand their logic. ⋯ While general principles can be, and are, establishable in abstraction from specific practices, as they are in principlist bioethics, such principles are impotent as moral guides to action. We show that the purchase any principle has as a moral guide to action emerges from its indexical properties as a principle which has sense in a specific practice. The meaning of any principle is internal to the practice and context in which it is invoked and, therefore, principles are not kinds of master rule which dictate moral judgement in new contexts but rather chameleon-like rules which change with the contexture in which they are invoked.