Evidence based or person centered? An ontological debate

Evidence based medicine (EBM) is under critical debate, and person centered healthcare (PCH) has been proposed as an improvement. But is PCH offered as a supplement or as a replacement of EBM? Prima facie PCH only concerns the practice of medicine, while the contended features of EBM also include methods and medical model. I here argue that there are good philosophical reasons to see PCH as a radical alternative to the existing medical paradigm of EBM, since the two seem committed to conflicting ontologies. This paper aims to make explicit some of the most fundamental assumptions that motivate EBM and PCH, respectively, in order to show that the choice between them ultimately comes down to ontological preference. While EBM has a solid foundation in positivism, or what I here call Humeanism, PCH is more consistent with causal dispositionalism. I conclude that if there is a paradigmatic revolution on the way in medicine, it is first of all one of ontology

New Directions in Philosophy of Medicine

The purpose of this chapter is to describe what we see as several important new directions for philosophy of medicine. This recent work (i) takes existing discussions in important and promising new directions, (ii) identifies areas that have not received sufficient and deserved attention to date, and/or (iii) brings together philosophy of medicine with other areas of philosophy (including bioethics, philosophy of psychiatry, and social epistemology). To this end, the next part focuses on what we call the “epistemological turn” in recent work in the philosophy of medicine; the third part addresses new developments in medical research that raise interesting questions for philosophy of medicine; the fourth part is a discussion of philosophical issues within the practice of diagnosis; the fifth part focuses on the recent developments in psychiatric classification and scientific and ethical issues therein, and the final part focuses on the objectivity of medical research

Ethnicity and the Mental Health Act 1983

Background Black and minority ethnic (BME) patients are disproportionately detained under the Mental Health Act 1983. There has been no systematic exploration of differences within and between ethnic groups, nor of the explanations put forward for this excess. Aims To systematically review detention and ethnicity, with meta-analyses of detention rates for BME groups, and to explore the explanations offered for ethnic differences in detention rates. Method Literature search and meta-analysis. Explanations offered were categorised, supporting literature was accessed and the strength of the evidence evaluated. Results In all, 49 studies met inclusion criteria; of these, 19 were included in the meta-analyses. Compared with White patients, Black patients were 3.83 times, BME patients 3.35 times and Asian patients 2.06 times more likely to be detained. The most common explanations related to misdiagnosis and discrimination against BME patients, higher incidence of psychosis and differences in illness expression. Many explanations, including that of racism within mental health services, were not supported by clear evidence. Conclusions Although BME status predicts psychiatric detention in the UK, most explanations offered for the excess detention of BME patients are largely unsupported

The relationship between self-blame for the onset of a chronic physical health condition and emotional distress : a systematic literature review

Objective: Past literature presents contrasting perspectives regarding the potential influence of self-blame on adjustment to illness. This systematic literature review aimed to summarise findings from all investigations to date that have explored the relationship between self-blame for the onset of a chronic physical health condition and emotional distress. Method: Between November 2014 and February 2015 electronic databases were searched for relevant literature. Only those studies which assessed self-blame directly and related specifically to illness onset were included within the review. The methodological and reporting quality of all eligible articles was assessed and themes within the findings were discussed using a narrative synthesis approach. Results: The majority of studies found self-blame to be associated with increased distress. However, several concerns with the quality of the reviewed articles may undermine the validity of their conclusions. Conclusions: It is important for professionals supporting people with chronic physical health conditions to have an understanding of how of self-critical causal attributions might relate to emotional distress. Further research is required to understand the concept of self-blame, the factors that may encourage this belief and to develop reliable and valid measures of this experience

Causal attributions, lifestyle change and coronary heart disease: illness beliefs of patients of South Asian and European origin living in the UK

OBJECTIVE We examined and compared the illness beliefs of South Asian and European patients with coronary heart disease (CHD) about causal attributions and lifestyle change. METHODS This was a qualitative study that used framework analysis to examine in-depth interviews. SAMPLE The study comprised 65 subjects (20 Pakistani-Muslim, 13 Indian-Hindu, 12 Indian-Sikh, and 20 Europeans) admitted to one of three UK sites within the previous year with unstable angina or myocardial infarction, or to undergo coronary artery bypass surgery. RESULTS Beliefs about CHD cause varied considerably. Pakistani-Muslim participants were the least likely to report that they knew what had caused their CHD. Stress and lifestyle factors were the most frequently cited causes for CHD irrespective of ethnic grouping, although family history was frequently cited by older European participants. South Asian patients were more likely to stop smoking than their European counterparts but less likely to use audiotape stress-relaxation techniques. South Asian patients found it particularly difficult to make dietary changes. Some female South Asians developed innovative indoor exercise regimens to overcome obstacles to regular exercise. CONCLUSION Misconceptions about the cause of CHD and a lack of understanding about appropriate lifestyle changes were evident across ethnic groups in this study. The provision of information and advice relating to cardiac rehabilitation must be better tailored to the context of the specific needs, beliefs, and circumstances of patients with CHD, regardless of their ethnicity

The Admissibility of Differential Diagnosis Testimony to Prove Causation in Toxic Tort Cases: The Interplay of Adjective and Substantive Law

This article uses the differential diagnosis opinions to explore a pair of interrelationships. The basic causal framework employed by most courts in toxic tort cases is presented. A key to understanding the developing case law in this area is to appreciate the degree to which the courts have adopted the interpretive conventions of science in assessing admissibility

Some Obstacles to Applying the Principle of Individual Responsibility for Illness in the Rationing of Medical Services

Lately, more and more authors have asserted their belief that one of the criteria which, together with the medical ones, can and should be applied in the policy of selecting and/or prioritizing the patients in need for the allocation of medical resources with limited availability, is the principle of individual responsibility for illness. My intention in this study is to highlight some very serious obstacles looming against the attempt to apply this principle in the distribution of the medical services with limited availability. Although there are numerous such obstacles, I shall only discuss five of them (the most important, in my opinion). These are: 1) the impossibility to establish with certainty whether a patient got ill due to his lifestyle; 2) the lack of a feasible and reliable method of establishing an individual’s responsibility for his lifestyle; 3) a patient’s right to privacy; 4) some moral requirements and principles and, last but not least, 5) the ethics of the medical profession

Pediatric Oncology Nurses’ Perceptions of Prognosis-Related Communication

Background Disclosure of prognosis-related information is an essential aspect of communication with pediatric patients with cancer and their families. The nurse is believed to play an important role in this process, but nurse perceptions and experiences have not been well-described. Purpose Provide an exploration of pediatric oncology nurses’ experiences with prognosis-related communication (PRC). Method Mixed-methods, multiphase design. This paper highlights the qualitative portion of the study. Findings Three themes were identified: Importance of collaboration, impact of PRC, and delivery of prognostic information. Discussion Collaboration is a critical element of PRC. Nurses are often not included in the disclosure process, which limits the ability of nurses to fully function in their roles, compromising patient, family, and nurse outcomes. A paradigm shift is required to empower nurses to be more active participants. More education of physicians and nurses is necessary to consistently engage nurses in PRC and prepare nurses for critical conversations

Attributions, distress and behavioural responses in the significant others of people with Chronic Fatigue Syndrome

To test an attribution-emotion model of reactions to chronic fatigue syndrome (CFS/ME), 30 significant others of 30 adult patients with CFS/ME were administered a semi-structured interview about their beliefs regarding the patient’s illness, and completed questionnaire measures of distress and behavioural responses to the patient. Spontaneous causal explanations (attributions) for illness events, symptom exacerbation and negative patient mood were extracted and coded. Significant other distress and negative behavioural responses towards the CFS/ME patient were associated with attributing illness events to causes personal and internal to the patient. Our findings may inform future family–based interventions for CFS/ME