Jeremy R. Simon

Virtue in Emergency Medicine

At a time in which the integrity of the medical profession is perceptibly challenged, emergency physicians (EPs) have an opportunity to reaffirm their commitment to both their patients and their practice through acceptance of a virtue-based ethic. The virtue-based ethic transcends legalistic rule following and the blind application of principles. Instead, virtue honors the humanity of patients and the high standards of the profession. Recognizing historical roots that are relevant to the modern context, this article describes 10 core virtues important for EPs. In addition to the long-recognized virtues of prudence, courage, temperance, and justice, 6 additional virtues are offered unconditional positive regard, charity, compassion, trustworthiness, vigilance, and agility. These virtues might serve as ideals to which all EPs can strive. Through these, the honor of the profession will be maintained, the trust of patients will be preserved, and the integrity of the specialty will be promoted.

The Ethical Assignment of Authorship in Scientific Publications: Issues and Guidelines

Properly assigning authorship of academic papers is often an ethical challenge. Through a hypothetical case study, the authors examine some of the potential ethical issues involved in determining who should and should not be listed as an author: the problems of honorary authorship, coerced authorship, and ghost authorship, as well as the question of how to order authors. Guidelines for avoiding and negotiating these issues are also discussed.

Beyond Naturalism and Normativism: Reconceiving the ‘Disease’ Debate

Abstract In considering the debate about the meaning of ‘disease’, the positions are generally presented as falling into two categories: naturalist, e.g., Boorse, and normativist, e.g., Engelhardt and many others. This division is too coarse, and obscures much of what is going on in this debate. I therefore propose that accounts of the meaning of ‘disease’ be assessed according to Hares (1997) taxonomy of evaluative terms. Such an analysis will allow us to better understand both individual positions and their interrelationships. Most importantly, it will show that it is unlikely that there is a single unique disease-concept at issue. Rather, different authors are, for the most part, considering different concepts.

Constructive Realism and Medicine: an approach to medical ontology

Metaphysics is an essential part of philosophy of medicine, providing the background for further methodological work. Current accounts of the ontology of particular diseases may be classified as realist or anti-realist. Because strong arguments can be marshaled by both of these positions, an approach to medical ontology that draws support from both sides of this divide would be desirable. Abstract models, as described by Ronald Giere, provide such an approach. After a review of Giere’s account of mechanics, I show how abstract models can provide an account of the ontology of diseases.

Donation After Cardiac Death and the Emergency Department: Ethical Issues

Organ donation after cardiac death (DCD) is increasingly considered as an option to address the shortage of organs available for transplantation, both in the United States and worldwide. The procedures for DCD differ from procedures for donation after brain death and are likely less familiar to emergency physicians (EPs), even as this process is increasingly involving emergency departments (EDs). This article explores the ED operational and ethical issues surrounding this procedure.

Advertisement for the ontology for medicine

The ontology of medicine—the question of whether disease entities are real or not—is an underdeveloped area of philosophical inquiry. This essay explains the primary question at issue in medical ontology, discusses why answering this question is important from both a philosophical and a practical perspective, and argues that the problem of medical ontology is unique, i.e., distinct, from the ontological problems raised by other sciences and therefore requires its own analysis.

The Proper Ends of Science: Philip Kitcher, Science, and the Good*

In Science, Truth, and Democracy, Philip Kitcher challenges the view that science has a single, context‐independent, goal, and that the pursuit of this goal is essentially immune from moral critique. He substitutes a context‐dependent account of science’s goal, and shows that this account subjects science to moral evaluation. I argue that Kitcher’s approach must be modified, as his account of science ultimately must be explicated in terms of moral concepts. I attempt, therefore, to give an account of science’s goal that is free of direct moral entanglements but still makes this goal context‐dependent and leaves the choice of which projects to pursue subject to moral scrutiny.

How to make real, constructive, progress in medicine.

RATIONALE Ones understanding of medical progress - what it is, how it is pursued and how it is assessed - may be deeply dependent on ones understanding of the metaphysics of medicine, and of diseases in particular. AIMS AND OBJECTIVES In this paper I present a new account of the nature of diseases, neither realist nor constructivist, and describe what progress in medicine looks like if we understand diseases in this way. CONCLUSIONS This new account, Constructive Realism, may provide a better account of medicine than either realism or constructivism.

Understanding disease and illness

We are pleased and greatly honored to present to the readers of Theoretical Medicine and Bioethics a selection of the wonderful papers presented at the 6th Philosophy of Medicine Roundtable, held in Bristol in August 2015. As at the prior Roundtables, held in Birmingham (Alabama), Rotterdam, San Sebastian, and New York, a wide variety of papers from around the world were presented, including a keynote presentation by Rachel Cooper of Lancaster University. As always, in keeping with the Roundtable name and mission, the conference focused on philosophical aspects of medicine beyond bioethics, thus providing the only regular gathering devoted to this large and growing field of philosophy. And it is indeed growing. In the two years since papers from the last Roundtable appeared in this journal, there have been no fewer than nine books published in the field, with volumes written by Havi Carel [1], Benjamin Smart [2], and Mark Sullivan [3], collections edited by Robyn Bluhm [4], Giovanni Boniolo and Virginia Sanchini [5], Boniolo and Marco Nathan [6], and Elodie Giroux [7], and textbooks edited by Miriam Solomon, Jeremy Simon, and Harold Kincaid [8], James Marcum [9], and Thomas Schramme and Steven Edwards [10]. The recent release of three textbooks almost simultaneously (all parts of larger series) following on only one previously [11] is especially significant. It speaks to a growing recognition of philosophy of medicine as an essential part of philosophy more generally as well as, one hopes, to a growing demand for texts at the student level. The papers presented at the conference included, not for the first time, several focused on psychiatric conditions and practice, including Prof. Cooper’s keynote. This is notable because the Roundtable was originally conceived, at least in part, as a complement to already existing forums for philosophy of psychiatry. However, these

“Futile Care”—An Emergency Medicine Approach: Ethical and Legal Considerations

&NA; Futility often serves as a proposed reason for withholding or withdrawing medical treatment, even in the face of patient and family requests. Although there is substantial literature describing the meaning and use of futility, little of it is specific to emergency medicine. Furthermore, the literature does not provide a widely accepted definition of futility, and thus is difficult if not impossible to apply. Some argue that even a clear concept of futility would be inappropriate to use. This article will review the origins of and meanings suggested for futility, specific challenges such cases create in the emergency department (ED), and the relevant legal background. It will then propose an approach to cases of perceived futility that is applicable in the ED and does not rely on unilateral decisions to withhold treatment, but rather on avoiding and resolving the conflicts that lead to physicians’ believing that patients are asking them to provide “futile” care.