A study of Kant’s Critique of Judgment (1790). Our topics will include Kant’s motivations for a critique of judgment; principles of ‘reflective’ and ‘determining’ judgment; theory of aesthetic judgment, including epistemology and metaphysics of the beautiful and sublime; theory of genius; teleology in the critical philosophy—including harmony of the cognitive faculties, organisms, scope and limits of mechanical explanation, physicoand ethico-theology; the relation of ethics, aesthetics and teleology. A basic familiarity with Kant’s theoretical philosophy is presupposed.

Critique of Judgment

Empathy, sympathy and compassion are defined and conceptualised in many different ways in the literature and the terms are used interchangeably in research reports and in everyday speech.1 This conceptual and semantic confusion has practical implications for clinical practice, research and medical education. Empathy, sympathy and compassion also share elements with other forms of pro-social behaviour such as generosity, kindness and patient-centredness.2 There is a need for conceptual clarity if doctors are to respond to the calls to provide more ‘compassionate care’.3 This paper argues that there is currently a problem in the balance between scientific–technical and psychosocial elements of patient care. A broad model of empathy is suggested which could replace the vaguer concepts of sympathy and compassion and so enable improvements in patient care, psycho-social research and medical education.

https://journals.sagepub.com/doi/pdf/10.1177/0141076816680120

Empathy, sympathy and compassion in healthcare: Is there a problem? Is there a difference? Does it matter?:

Objective To study how doctors care for their patients, both medically and as fellow humans, through observing their conduct in patient–doctor encounters. Design Qualitative study in which 101 videotaped consultations were observed and analysed using a Grounded Theory approach, generating explanatory categories through a hermeneutical analysis of the taped consultations. Setting A 500-bed general teaching hospital in Norway. Participants 71 doctors working in clinical non-psychiatric departments and their patients. Results The doctors were concerned about their patients9 health and how their medical knowledge could be of service. This medical focus often over-rode other important aspects of the consultations, especially existential elements. The doctors actively directed the focus away from their patients9 existential concerns onto medical facts and rarely addressed the personal aspects of a patient9s condition, treating them in a biomechanical manner. At the same time, however, the doctors attended to their patients with courteousness, displaying a polite and friendly attitude and emphasising the relationship between them. Conclusions The study suggests that the main failing of patient–doctor encounters is not a lack of courteous manners, but the moral offence patients experience when existential concerns are ignored. Improving doctors9 social and communication skills cannot resolve this moral problem, which appears to be intrinsically bound to modern medical practice. Acknowledging this moral offence would, however, be the first step towards minimising the effects thereof.

https://jme.bmj.com/content/medethics/37/11/650.full.pdf

Courteous but not curious: how doctors' politeness masks their existential neglect. A qualitative study of video-recorded patient consultations

The Biopsychosocial Approach: Past, Present, Future

Approximately 15% of patients are perceived by clinicians as "difficult" Early theories about difficult patients focused on patients' and clinicians' characteristics, often underemphasizing the influence of the environment on patients' behavior The Stanford Prison Experiment, a classic experiment in the psychology of human behavior, provides a broader systems approach for understanding the environmental influences on patient behavior A systems approach to the care of the difficult patient takes into consideration not only the patient's characteristics but also the health care environment and the more distal environments (ie, familial, societal, and cultural) Clinicians who are aware of the multilevel impact of these various environments on the behavior of patients are better equipped to understand, address, and hopefully even prevent difficult patient encounters

The Stanford Prison Experiment: Implications for the Care of the "Difficult" Patient.

The principle of respect for autonomy has shaped much of the bioethics' discourse over the last 50 years, and is now most commonly used in the meaning of respecting autonomous choice. This is probably related to the influential concept of informed consent, which originated in research ethics and was soon also applied to the field of clinical medicine. But while available choices in medical research are well defined, this is rarely the case in healthcare. Consideration of ordinary medical practice reveals that the focus on patient choice does not properly grasp the moral aspects involved in healthcare. Medical decisions are often portrayed as if doctors and patients in confidence confront specific decisions about examinations or treatment, yet the reality often involves many different participants, with decisions being made over time and space. Indeed, most of the decisions are never even presented to patients, as it would be unethical to suggest something that is not medically justifiable. The options patients do confront are somewhat arbitrarily constructed within the narrow framework of both what is deemed to be medically appropriate and how the healthcare system is organised practically. While the autonomy discourse has proven valuable, a failure to distinguish between the fields of medical research and clinical medicine has generated a focus on patient choice that does not reflect what is really at stake in healthcare settings. This is alarming, because the current discourse misrepresents medical practice in a way that actually contributes to bioethical self-delusion.

https://jme.bmj.com/content/medethics/37/4/212.full.pdf

Choice is not the issue. The misrepresentation of healthcare in bioethical discourse

In this article, we qualitatively explore the manner and style in which medical encounters between patients and general practitioners (GPs) are mutually conducted, as exhibited in situ in 10 consultations sourced from the One in a Million: Primary Care Consultations Archive in England. Our main objectives are to identify interactional modes, to develop a classification of these modes, and to uncover how modes emerge and shift both within and between consultations. Deploying an interactional perspective and a thematic and narrative analysis of consultation transcripts, we identified five distinctive interactional modes: question and answer (Q&A) mode, lecture mode, probabilistic mode, competition mode, and narrative mode. Most modes are GP-led. Mode shifts within consultations generally map on to the chronology of the medical encounter. Patient-led narrative modes are initiated by patients themselves, which demonstrates agency. Our classification of modes derives from complete naturally occurring consultations, covering a wide range of symptoms, and may have general applicability.

https://journals.sagepub.com/doi/pdf/10.1177/1049732321993790

Modes of Interaction in Naturally Occurring Medical Encounters With General Practitioners: The "One in a Million" Study.

A certain kind of externalism—"the view from nowhere"—lies at the heart of evidence-based medicine (EBM). As a consequence, the individual case glides out of focus. However, to judge to what extent external knowledge is applicable to an individual case, the clinician has to rely on some sort of knowledge of the case at hand. The article focuses on the tension between the externalism of EBM and the "internal evidence" one has to presuppose when making clinical judgments.

External and Internal Evidence in Clinical Judgment: The Evidence-Based Medicine Attitude

Toulmin’s Diagnosis In his classical article with the unforgettable title “How medicine saved the life of ethics” (Toulmin 1982), Stephen Toulmin claims that medicine saved ethics by giving the philosophers a positive reality check through medical challenges: (1) Ethics in medicine is a serious topic, not just something to discuss at seminars. If, for example, both A and B need treatment and there are only enough resources for one , the fundamental interests of these two people compete against each other. (2) In clinical medicine, the individual case might demand a different approach than that suggested by theory. Similarly, an ethicist who is confronted by a diversity of medical cases becomes aware of the fact that solutions drawn from ethical theory can be irrelevant in practice. (3) The moral philosopher has often focused on the individual and his or her universal commitments. The fact that ethical dilemmas can have deep roots in practical challenges and must be understood within a certain context has been “forgotten.” (4) In clinically relevant ethics, it is important to find solutions that all involved parties find reasonable. This revitalizes central Aristotelian schools of thought on, for example, ethical judgment and situational understanding. Today, there is a common understanding that in both the education of doctors and in the implementation of medical knowledge and technology there needs to be ethical guidelines and control. Toulmin wants us to see that the background for this agreement is multifaceted. It was not just the ethicists who saved the doctors. The doctors helped the ethicists to escape their academic isolation.

Medicine-Based Values?

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