Clinical encounters are shaped by diagnostic reasoning and explicit judgement, and by how patients are affectively received. Empirical studies in psychiatry and related fields indicate that liking and disliking can influence clinical judgement, management, and treatment choice, yet they say little about the experience through which a patient comes to appear likeable or unlikeable. I develop a phenomenological account of likeability as a sedimented interaffective orientation formed between patient and clinician. Embodied interaction and prior experience are themselves socially and institutionally structured, shaping the affective significance of another person’s conduct. Such reception may orient attention and interpretation, though not in the direction commonly assumed: an easy consultation can reduce interpretive effort precisely because little presses the clinician to clarify what remains unresolved, while a strained one can sustain careful inquiry. How smoothly an interaction proceeds is therefore no measure of epistemic participation. I argue for a two-stage assessment. These affective dynamics of the interaction disadvantage a patient when the resulting restriction, credibility deficit, or withdrawal of interpretive effort is not supported by reasons specific to that patient and clinical task; the disadvantage constitutes an affective or epistemic injustice when it is connected to prejudice or to a patterned allocation of attention across patients already devalued through racialisation, psychiatric labels, or other social hierarchies. The account also explains why clinicians must be able to examine these responses and revise them in light of the patient’s experience.
Software as a Medical Device (SaMD) can influence diagnosis, triage, monitoring, and treatment even when technically valid and epistemically reliable. The unresolved ethical question is how a trustworthy output becomes answerable once it gains practical force in care. This conceptual article develops a workflow-signal account that treats the score, label, alert, or classification in use as the unit of review. Reliability concerns the process producing an output; answerability concerns the clinical arrangement through which it acquires authority. Dignity supplies a status constraint against objectification and exclusion from reason-giving care; answerability requires reasons and a consequential route to correction or revision. The account distinguishes SaMD from broader medical AI and non-device clinical decision support and assesses five affordances: visibility, explainability, auditability, contestability, and revisability. A worked case of computer-aided detection for tuberculosis screening shows how ethical stakes arise through threshold selection, confirmatory testing, human review, and monitoring. The account locates where empirical and institutional work must attach if technically valid SaMD is to remain answerable to persons.
Hospital-based clinical ethics support in Latin America encompasses committees, consultations and integrated service models, but the organizational evidence is dispersed. Objective: To map how these services are structured, accessed and delivered, and what contributions are reported in patient-specific ethical dilemmas. This scoping review followed JBI guidance and PRISMA-ScR. Searches in BVS/VHL, Scopus, PubMed/MEDLINE, Web of Science and SciELO were supplemented by backward/forward citation tracking, Google Scholar and targeted grey-literature searching. Studies were charted at report level and overlapping hospital publications were linked. The inventory contains 119 reports: 50 empirical, 27 institutional/descriptive and 42 conceptual/theoretical. Of 67 directly linked reports describing operating services, 47 non-overlapping operational analytic units were mapped. These comprised 41 committee-centred units, three integrated-service, one hybrid, one team-consultation and one individual-consultation unit. End-of-life decisions, treatment proportionality, autonomy and clinical–family disagreements were recurrent themes. Data on access, response times, patient/family participation and evaluated outcomes were inconsistently reported. Regional evidence documents diverse organizational models and reported contributions of clinical ethics support services, although the available studies provide limited evidence on patient-level outcomes and clinical effectiveness.
The concept of transformative experiences (TE) raises fundamental challenges for medical decision-making and autonomy. Transformative experiences alter a person's preferences, values, and self-understanding in ways that are epistemically inaccessible prior to the experience itself – making genuinely informed decision-making difficult to achieve. Yet such choices must be made in high-stakes medical contexts, such as bilateral prophylactic mastectomy (BPM): carriers of high-risk cancer genes are expected to provide informed consent under conditions of profound uncertainty. This has led some authors to conclude that autonomy itself and the standard of informed consent are undermined. This paper argues against that conclusion. We argue that linking the rationality of a choice to taking into account in advance post-decision preferences is not an adequate demand to determine whether TE decisions are meaningful. Rather, an important part of the normative value of these decisions lies in their being self-determined, in accordance with present preferences and tentative and almost necessarily deficient projections into the future of preferences and experiences. Moreover, we argue that it is possible in many cases to build bridges from present preferences to anticipating future preferences. Facilitating this bridge-building and strengthening a sense of self-determination should be at the center of shared decision-making in the case of medical interventions such as BPM. We make a number of suggestions on how this could be achieved.
