Social prescribing to mitigate loneliness has been gaining traction worldwide in the past two decades. Patients found to be lonely by their clinicians are linked with social services and are encouraged to engage in non-clinical, social activities such as painting and music classes, Tai Chi, outdoor excursions etc. The science grounding the cost-effectiveness of these interventions, however, has been scarce. From a justice perspective which prioritizes resource allocation based on desired outcomes, social prescribing may be hard to justify. Care ethics, however, may be more adept at justifying and indeed compelling the investment of limited public resources in social prescription activities aimed at reducing loneliness. The assumption is that individuals have an entitlement to such activities first because they have a right to health, and second because, as inherently social creatures, they have a right to not be lonely.
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a debilitating chronic illness whose sufferers are frequently met with disbelief, stigmatization, and psychologization in both clinical and social contexts. Recent work has used the concept of “epistemic injustice” to illuminate important dimensions of this problem, especially the ways in which ME/CFS patients are discredited as knowers and denied adequate interpretive resources. This paper argues that the harms associated with persistent disbelief in ME/CFS are not exhausted by this epistemic dimension. Drawing on recent philosophical work on affective injustice, I argue that persistent disbelief can also impair patients’ affective lives in distinctive and socially patterned ways. More specifically, I argue that individuals with ME/CFS are burdened by unjust affective expectations, pressured into norm-conforming forms of emotional self-presentation, exposed to pathologizing and gaslighting interpretations of their affective experience, denied uptake for apt emotional responses, and exploited through forms of emotional labor and affective appropriation. Conceptualizing these harms in terms of affective injustice, I argue, helps to capture dimensions of marginalization that a focus on testimony and understanding alone leaves obscure. The paper concludes by considering objections and drawing out implications for healthcare and philosophy of medicine.
Diagnosis is indispensable to medicine, yet diagnostic labels often acquire more authority than their evidence can bear. They come to function as if they named natural entities that explain, authorize, and stabilize clinical action. This article proposes a pragmatic criterion for evaluating that ontological surplus: the Conservativity Test. The test asks which clinical, institutional, explanatory, and self-interpretive consequences follow from treating a diagnostic label as a disease entity, but would not already follow from a label-free base description of symptoms, signs, impairments, risks, mechanisms, values, and lived experience. It does not presuppose that diagnoses are either natural kinds or mere social constructions. Rather, it distinguishes conservative shorthand, justified non-conservativity, and reifying non-conservativity. To avoid circularity, the article develops a minimal-ontological account of base description and connects it with pluralist realism and causal-cluster accounts of kinds. Situating the test within the epistemology of diagnosis, it treats diagnostic labels as revisable causal-explanatory hypotheses and spells out why unjustified ontological surplus carries epistemic, clinical, ethical, and institutional costs. It then identifies four modes of diagnostic reification: explanatory, threshold, nominal-institutional, and looping. Prediabetes, ADHD, and long COVID serve as stress tests for the framework. Phenomenologically, the test protects the lived complexity of illness against both objectifying reduction and epistemic dismissal. Ethically, it offers a participatory audit for clinicians, guideline panels, researchers, and patient communities deciding when diagnostic names should coordinate care, justify intervention, or carry stronger ontological commitments.
Philosophy of medicine has drawn its richest account of suffering from a broadly Christian lineage, in which affliction can be borne with meaning and the sufferer retains an inviolable dignity. That lineage is not the only one, and it was not the first. This paper sets out the conceptions of suffering developed in the Stoic and Epicurean schools, in Buddhist thought, in Schopenhauer and Nietzsche, and in the phenomenological and existential reflection of Scheler, Weil, Levinas, Ricoeur, and Frankl, and asks what each contributes to the goals of medicine. The traditions disagree sharply. The Hellenistic schools locate suffering in judgment and counsel its dissolution through a discipline of the mind. Buddhist thought treats unsatisfactoriness as a structural feature of conditioned existence rather than a contingent defect. Schopenhauer reads suffering as the truth of the will, while Nietzsche makes it a condition of growth and meaning. The phenomenological tradition recovers suffering as the affliction of an embodied person and divides over whether it can be redeemed at all. Read together, these accounts test the assumption, common in clinical ethics, that suffering is either a problem to be solved or a meaning to be found. They suggest a medicine that can relieve what can be relieved, accompany what cannot, and decline to impose any single meaning on the person who suffers. The argument is illustrated through chronic pain, palliative care, and the care of the frail aged, where these traditions have already entered clinical practice through acceptance-based and meaning-centered interventions.
Rehabilitation care concerns not only the restoration of function but also how persons live through disruption. Injury and illness may bring loss, uncertainty, altered dependence, changed self-understanding, and a changed horizon of life. Concepts such as coping and resilience capture important aspects of adaptation but do not fully clarify the inner work involved in bearing and inhabiting such change. This paper argues that inner strength can provide a useful concept for clarifying that work. The paper develops a philosophical framework with a preparatory layer and two related dimensions. Inner base names foundational exercises of attention, breath, and body awareness. Inner balance names the centering work of recollection and steadier judgment, while inner posture names the orienting work of finding a viable relation to limitation, vulnerability, and a wider horizon of meaning. Drawing on Pierre Hadot's account of philosophy as a way of life, the paper interprets inner balance and inner posture through the complementary movements of concentration and expansion. It places this proposal in dialogue with rehabilitation research on inner posture and global meaning, and with literature on meaning-making, resilience, mindfulness, and existential care. The framework is conceptual rather than a validated intervention model. It offers a more differentiated vocabulary for grounding, centering, and orientation in rehabilitation care.
Miranda Fricker's concept of epistemic injustice and Axel Honneth's theory of recognition have each been applied, separately, to chronic pain. The relationship between them is usually construed as sequential: epistemic injustice is thought to produce failures of recognition, or prior misrecognition to ground later epistemic marginalisation. This article rejects that reading. It argues that, in the clinical encounter with a person in pain, the relation between the two is not exhausted by causal succession. They are analytically separable dimensions of a single intersubjective relation, dimensions that cannot, in that encounter, be treated apart without descriptive and practical loss. The act by which a clinician withholds credibility from a patient's testimony is the same act by which recognition is refused to that patient as a suffering subject. The claim is offered as a heuristic rather than an ontological thesis. Pain is presented not as uniquely paradigmatic but as a particularly illuminating case within a broader class of testimonially dependent suffering, since its privacy, its dependence on testimony, and the mediating role of diagnostic language converge in it with unusual clarity. The argument bears on recognition theory; on medical ethics, where remedies addressed to one dimension alone prove insufficient; and on clinical practice, where diagnostic classification operates as a technology of recognition.
Since Andrew Jameton introduced the term “moral distress” (MD) in 1984, the concept has attracted extensive attention in the healthcare literature. Much of this work emphasizes the costs of MD–for instance, psychological pain, work dissatisfaction, and burnout–while some highlights its potential benefits, including motivating self-improvement and institutional reform. We survey these assessments and argue that the bulk of them share a common limitation: they evaluate MD purely instrumentally, in terms of its painfulness and consequences, rather than its character as a moral experience. This instrumental framing, we contend, obscures MD’s core moral significance and invites misguided interventions. In particular, it neglects the question of when MD is a fitting response to one’s situation, and thus justified on intrinsic rather than instrumental grounds. We suggest that MD is fitting when one is genuinely constrained from meeting a moral requirement, and that fitting MD is significant in its own right.
Many nurses fear empathizing too much with patients. They worry that empathy requires letting their guard down, which, when caring for a potentially violent patient, will make them vulnerable to the risk of assault. They worry that as empathy leads the nurse to reckon with who the other is, it will draw out prejudices the nurse might have toward some categories of persons. And nurses worry that empathy will cause them to experience and be burdened too much by the patient's suffering. These fears are perhaps most distilled in nurses' relationships with prisoner/patients, and situating our analysis within such relationships, this paper asks how philosopher Edith Stein's accounts of empathy and community address nurses' fears when caring for patients who may pose danger to them. We argue first that empathy for the prisoner/patient permits nurses to anticipate the patient's future actions, including violent ones. Second, what Stein calls reiterated empathy allows nurses to discern prisoner/patients' appraisal of the nurse's care and to self-correct, as needed, any stigmatizing care. Finally, though the suffering of patients is indeed too much for the nurse to bear alone, following Stein we suggest that through relationships of solidarity the nurse may meaningfully bear that suffering in community, and the community may meaningfully bear that suffering in the nurse. In Edith Stein, who, in addition to studying philosophy, had worked briefly as a nurse, we find resources to address nurses' misconceptions and fears of empathy and to enliven nurses' care.
Urine toxicology testing among birthing people in the United States remains a clinical practice often informed more by personal values and conscious and unconscious biases, than by medical evidence and ethical obligations. As empirical evidence addressing harms and benefits of toxicology testing in pregnancy grows, and national organizations are taking a moral stance around clinical practice, no published structure explicitly positions the evolving data within an ethical framework. We draw on a model of applied ethics to inform a set of concrete recommendations about what clinicians ought to do with regards to the practice of urine toxicology testing of pregnant patients. These methods facilitate a relationship between empirical data regarding toxicology testing in pregnancy and ethical norms. Our findings serve as a practical guide for clinicians and policymakers seeking clinical guidance around urine toxicology testing in pregnancy as well as a model for future translation of theoretical approaches into clinical action.
This article offers a Hohfeldian analysis of the right to die and asks what follows, normatively and institutionally, once the relevant incidents are distinguished. It argues that debates about assisted dying frequently conflate four questions: whether choosing death is morally permitted (licence), whether others must not interfere with that choice (negative claim-right), whether a valid request can alter others' normative situation (normative power), and whether anyone owes assistance (positive claim-right). The paper maps major objections to the incident they primarily target and shows that many familiar objections to assisted dying bear most directly on duties of assistance rather than on the underlying permission or the claim against interference. Substantively, it defends a universal moral licence to die and, where competence, voluntariness, and adequate information are satisfied, a corresponding negative claim-right against unjustified interference. Its institutional conclusion is more limited than a direct duty on any particular physician to provide assisted death: what can be justified more securely is a right to make a request that must be assessed under public criteria and, in jurisdictions authorising assisted dying, routed to willing and licensed providers. Separating public validity review from plural provision models, the paper argues, can reduce coercion and conscience-based conflict while preserving access.
In a recent article Gomez-Virseda and coauthors criticize my previous work on methodology in bioethics and argue that bioethics is a discipline. While I think that Gomez-Virseda and co-authors misconstrue my argument, state the obvious, and fail to address pressing questions to their argument, I am most thankful for the inspiration and opportunity to elaborate on why methodology matters for consolidating bioethics’ professional standing, to improving its quality, ascertaining its academic and educational importance, and to advancing its trustworthiness and social impact.
Drawing on a genealogical analysis of the distinction between zoē (biological life as organic functioning) and bios (a distinctively human way of life shaped by meaning, orientation, and evaluative practice), the article reconceives bioethics as bios ethikos: ethical reflection on the conditions under which forms of life become meaningful and inhabitable. It introduces the notion of the existential remainder to describe the ethically significant dimensions that persist when institutional deliberation leaves aspects of lived existence under-articulated. The article proposes a renewed structural orientation grounded in the heuristic formula T = PEWS + C. Ethical thinking (T) is distributed across four interrelated domains of lived existence: Person, Earth, Work, and Society (PEWS), while the addition of C designates the creative openness that resists full institutional codification. PEWS-oriented evaluation may be operationalised through more integrative assessment tools, while maintaining vigilance toward the irreducible horizon of existential creativity. Bioethics, thus reconceived, becomes not only the regulation of life, but reflection on whether the governance of life sustains the conditions under which life can remain meaningfully lived.
Psychiatric advance directives (PADs) are statements that allow people with mental disorders to express their preferences and wishes in anticipation of future crisis situations in which the patient’s decision-making capacity may be compromised due to their mental disorder. The fundamental value of PADs is the promotion of self-determination and personal autonomy. Although PADs have common elements, they may differ across countries in their content, development process and legal status. Italy does not have a specific regulation regarding PADs; however, we argue that important indications may be drawn from Law No. 219/2017 regulating informed consent, advance directives and shared care planning (SCP). Moving from the international context and empirical evidence regarding barriers and facilitators to the implementation of PADs, the paper provides a key for interpreting SCP in the psychiatric field. The discussion highlights the importance of an interdisciplinary collaboration among bioethics, law, and clinics to improve the quality and consistency of care for people with mental disorders.
Paul Ricoeur's ethics comprises three distinct moments where it is possible to recognize the influences of Aristotle, Kant, Rawls and an original ricoeurian moment of practical wisdom, where the concept of phronesis is rehabilitated. When reflecting on medical practices, Ricoeur distinguishes, in continuity with his triadic ethics, three levels of judgment: the prudential and ethical level concerning the singularity of the clinical encounter that is essential for establishing a pact of trust, the formal and moral level where deontological codes emerge and the reflexive level where the two previous judgments become legitimated. Our aim with this paper is, through Paul Ricoeur´s ethics, to perspective deontology and deontological codes as a broader set of implicit philosophical and anthropological conceptions, rooted in the clinical encounter, that constitute a theoretical and foundational background for medical rules and norms.
Modern healthcare faces a mismatch in terms of supply and demand which makes careful priority setting imperative. The debate on priority setting in healthcare has focussed on pharmaceuticals and other tangible medical interventions. This article instead looks at the time that healthcare professionals have at their disposal. How should healthcare professionals divide their time between tangible medical interventions and communication with patients? What communicative goals should be prioritised? This normative analysis focusses on situations which involve time consuming communication between professionals and patients, which cannot easily be carried out alongside other medical interventions or is itself the main intervention as in psychotherapy. The arguments brought forth are applicable across the healthcare panorama and apply to all healthcare professions. It is argued that there are many different communicative goals which cannot be reduced to one type. Some recommendations are given and defended regarding the priority setting of different communicative goals. For reasons of value coherence and formal equality, all patients should be given a baseline amount of time for communication and time beyond that should be prioritised based on healthcare needs. If accepted, the arguments here highlight that a substantive part of healthcare’s (time) resources should be spent on communicative tasks. Indeed, it is time that we take time for communication seriously.
A central tenet of health equity is that access to healthcare should be responsive to need rather than patients' socioeconomic status. The idea that ability to pay can enable some people to access faster, better, or more healthcare strikes many egalitarians as clearly objectionable. This paper argues that this view is more complicated than may initially appear. While there are egalitarian reasons to oppose private healthcare, these are often less decisive than they may initially appear and prohibiting private healthcare on egalitarian grounds is likely to run afoul of egalitarianism's liberal commitments. There are several important theoretical hurdles to pass through for a successful egalitarian argument against private healthcare, which this paper aims to highlight.
The rise of right-wing political movements supported by key players from big tech is transforming Western societies. This so-called techno-feudalism also implies challenges for bioethics. Racist agendas, intentional misinformation on health topics such as vaccinations, banned words and research topics in public institutions, and the massive funding of questionable biomedical research projects undermine health equity, patient safety, and autonomy. This new sociopolitical situation exacerbates a long-standing issue in healthcare that bioethics hitherto mostly failed to address adequately: societal power asymmetries that shape the roles and relationships of actors in healthcare and biomedical research. Although attempts have been made to reflect upon this issue, e.g. in feminist or postcolonial bioethics, there is no coherent bioethical approach that fundamentally focuses on power asymmetries as a lens of bioethical inquiry. In this article, I therefore introduce critical bioethics, an approach that takes epistemic lenses from critical theory, especially the so-called Frankfurt School. These epistemic lenses-totality and embeddedness, instrumental reason, dialectics and emancipation-allow us to uncover the societal causes for ethical issues in healthcare and biomedical research. Based on this methodological foundation, critical bioethics addresses health inequity as a result of power asymmetries by understanding individuals as fundamentally embedded in a concrete socioeconomic context. Through the lens of instrumental reason, it addresses the connection between disruptive technological innovations and economic interests in terms of commodification and solutionism. By using dialectics as a method to uncover contradictions in the way bioethics understands its principles, it provides an emancipatory perspective for normativity that separates it from affirmative forms of bioethical thinking that simply reproduce the suppressive status quo.
Patient-centered care (PCC) is widely endorsed in contemporary medicine, yet philosophical analyses often approach it through concept-first approaches that define patienthood in advance-typically in terms of autonomy, holistic personhood, or rational agency-and then assess clinical practice by reference to these ideals. This paper argues that such an approach can obscure how patienthood is configured in practice. We develop a tool-first approach that treats cognitive, communicative, and material tools as analytically primary for understanding how patients are individuated in clinical reasoning. The argument is grounded in an ethnographic case study conducted in a specialized cancer hospital, focusing on outpatient clinics in medical oncology, colorectal surgery, and palliative care. Rather than treating ethnography as descriptive background, we use it to identify tools-in-use that structure what becomes salient, actionable, and patient-relevant in situated encounters. Across these settings, distinct configurations of tools generate systematically different modes of patienthood. In oncology, staging systems and expectation management configure patients as therapeutic trajectories oriented toward uncertain futures. In surgery, anatomical diagrams and probabilistic framings individuate patients as operative bodies embedded in structured decision spaces. In palliative care, symptom scales, narrative practices, and informational scaffolding configure patients as experiential subjects and epistemic agents. We analyze these differences as instances of structural plurality: patterned, tool-mediated modes of patient individuation that are internally coherent yet irreducible to a single model. On this account, ethical ideals commonly associated with PCC-such as autonomy, shared decision-making, and informed consent-can be understood less as prior normative standards applied to practice, and more as contingent achievements that depend on how tools structure salience, understanding, and possibilities for agency in clinical contexts.
This article argues that Plato was a pioneer of the philosophy of health. It examines the psychosomatic interrelationship between soul (psychē) and body (sōma) primarily in the Charmides and the Timaeus, with selective references to other dialogues, notably the Republic and Phaedrus. The central claim is that Plato's account of the psychosomatic interrelationship can be adequately understood only when its sociopolitical dimension is taken into account. Although this emphasis is relatively novel in contemporary scholarship, it was commonplace in Plato's milieu to conceive of human beings as members and citizens of the city-state (polis). The article further argues that Plato's approach to psychosomatic phenomena extends beyond states of pain or disease and instead encompasses a holistic vision of health and human flourishing. Accordingly, this study aims to deepen the current understanding of Plato's philosophy of health. Given that the philosophy of health is an emerging interdisciplinary field, the article also seeks to contribute to its conceptual development.
