Wounded Body: A Phenomenological Attempt to Define Physical Pain

A major part of philosophy of medicine, although not all of it, is a branch of philosophy of science. This part is not only currently emerging. Many important contributions belong to this field, like Boorse’s ‘Health as a theoretical concept’ [1], which is probably the most cited article in the philosophy of medicine. Some contributions, although relevant for philosophy of science, are entrenched in bioethics, medical humanities, and historical and social studies of science. Other contributions come from fields such as philosophy of biology, general philosophy of science, philosophy of neuroscience and philosophy of cognitive science, and can rightly be considered pieces of philosophy of medicine. This is so either because they thoroughly scrutinize examples of diseases or because they investigate scientific methods not necessarily specific to, but mostly used in, medical science. Certainly, questions about biological functions, causality, evidence, mechanisms and decision making are not only relevant to the study of medicine, but their specificity to this field makes them important for philosophy of medicine as well. The result is institutional dispersion. Despite the existence of a bunch of periodicals, there is no prominent journal in the philosophy of medicine as a branch of philosophy of science. Academic positions in this field often demand competence in bioethics and although no master’s programme in the world is yet dedicated to this specialty alone, some are emerging. Philosophers in this field, in early career or not, do not have many opportunities to gather for international events: the International Philosophy of Medicine Roundtable organizes the only one specific to the field. Yet philosophers of medicine significantly contribute papers and symposia to events such as the European Advanced Seminar in the Philosophy of the Life Science; the International Society for History, Philosophy, and Social Studies of Biology; the Congress of Logic, Methodology and Philosophy of Science; the Philosophy of Science Association; and the Society for Philosophy of Science in Practice meetings. Some sessions in the meetings of the European Society for Philosophy of Medicine and Healthcare have been dedicated to philosophy of medicine as a part of philosophy of science. Recently, a significant introduction to philosophy of medicine has been published: the Philosophy of Medicine: Handbook of Philosophy of Science [2]. Apart from dedicated journals such as Theoretical Medicine and Bioethics, the Journal of Medicine and Philosophy and Medicine, Health Care and Philosophy – which has significantly drifted towards bioethics for some years – some others have contributed special issues dedicated to philosophy of medicine, as the Journal of Evaluation in Clinical Practice, and more accept from time to time a paper very relevant for the philosophy of medicine, such as Biology and Philosophy; Studies in the History and Philosophy of Science, Part C; and History and Philosophy of the Life Sciences. To contribute to a consolidation of the field, the International Advanced Seminar in the Philosophy of Medicine (IASPM) was created. The IASPM is a biannual event, the first session of which has been held in Paris from 20 June to 22 June 2013. It is sponsored by a consortium of five research centres: the Center for the Humanities and Health at King’s College (London, UK); the Institut fur Geschichte, Theorie und Ethik der Medizin at Johannes Gutenberg (Mainz, Germany); the European School of Molecular Medicine (Milan, Italy); the IHPST at Pantheon-Sorbonne (Paris, France); and the Department of History and Philosophy of Science at Pittsburgh (USA). The Paris session gathered 22 advanced students or junior scholars in the philosophy of medicine: 11 were selected from each partner university and 11 others were selected by standard open call for contributions and peer review. Four senior philosophers gave talks and three others coordinated workshop sessions along with three PhD students. Sixty registered participants attended the event. The topic of the conference was ‘Unity and autonomy in the philosophy of medicine’. It was purposely not very specific, so that bs_bs_banner

Dear Editor, Extracurricular activities for the gifted and talented students in Iran derive from the belief that students with high potentials are expected to make great help for the health care of the community. One of these activities is holding medical science Olympiads. In the previous meeting report about medical science Olympiad in year 2011, a unique experience of Islamic Republic of Iran was reported. The Olympiad was held in three areas of basic sciences, clinical reasoning and management by participation of high rank medical students from all over the country in two stages: individual and group (1-4). After performing 8 Olympiads in the country, the ninth Olympiad was held in September 2017 in Tehran, Iran differently with more emphasis on creativity and productivity. While creativity in health care is mostly supposed to be innovations in surgical devices, medications, and procedures, we believed that it also relates to other health care disciplines like basic sciences, medical education, philosophy of medicine and management. Creativity in these fields is a newer concept that may result in finding novel solutions to health care and educational problems and challenges such as improving patient care and coordinating care across multiple disciplines and difficult conditions. Shahid Beheshti University of Medical Sciences was the host of the Ninth National Medical Science Olympiad in September 2017 under direct supervision of Ministry of Health and Medical Education. This Olympiad was held in five areas including basic sciences, clinical medicine, medical education, philosophy of medicine and health care management. All top ranked students in medical sciences (such as medicine, pharmacy, nursing, health management, dentistry, etc.) from all over the country had the chance of participating in this Olympiad. In Iran integration of medical education and health care delivery system has started in 50 universities of medical sciences all over the country (5). 2151 students from these universities participated in the individual Olympiad exam. Then 30 teams in each of the five areas (total 450 teams) were selected 55 experts in five scientific committees constructed the Olympiad questions in individual and team stages. A unique experience in the Ninth Olympiad was using a novel and creative project based assignment for each team in each of the five areas. These projects were Evidence-based decision making, public private partnership, early clinical exposure, medical futility and autonomic modulation on the brain functional connectivity related to depression. 75 percent of the students stated that they were satisfied with these innovative and creative projects in different areas. 84 percent of the faculties reported that this kind of Olympiad increased students’ motivation and led them to compare issues friendly with each other in a scientific environment. 69.25 percent of the students reported that increasing the number of teams in this Olympiad for problem solving activities was a very good experience for them and ascertained that such activities should be included in the formal curriculum of medical schools. The main shortcoming in this Olympiad reported by the students was the competitive nature of the exam and subjectivity in scoring the projects in some areas. Performing such Olympiads is essential in discovering talented students and developing their capabilities to promote health systems. Although academic merit is not the only indicator of success in health science disciplines, designing additional programs for gifted and talented students is warranted to help academically talented students to further their knowledge.

How could philosophy of medicine have any particular relevance for the philosophy of science, one might wonder. Either medical science is like other sciences or it is not. If it is like them, if (or to the extent that) it is not unique in the features it possesses, then attention to it is unnecessary. If (or to the extent that) it is unique in the features it possesses, then it is irrelevant to an account of science in general. Surely what is wrong with this way of putting the matter is that the differences between the medical and other sciences are matters of degree rather than kind.Medical science is distinctive as a theoretical science in prominantly displaying certain features which, while possessed to some degree by all sciences, were much easier to overlook when we took physics, or even just classical mechanics, as our prime example of science.

The Oxford Handbook of Philosophy of Medicine is a guide to areas of current activity and change, not only in philosophy of medicine but also in medical science and practice. This volume reflects a renewed awareness that medical traditions are culturally diverse and of the philosophical opportunities this creates. It presents important new work on the nature of medicine, its demarcation from rivals, and the legitimacy of its claims to superiority. The volume reviews the varied expressions of discontent with biomedicine, and some of the spirited responses. Social justice has emerged in contemporary philosophy of medicine, as it has elsewhere, as a major concern. The complex relationship between medical knowledge and action is approached from multiple angles. And the volume cuts the waiting list in medical metaphysics, with several new topics receiving treatment alongside familiar ones. This handbook demonstrates a small part of what philosophy of medicine can contribute both to medicine and to philosophy.

What medicine can teach operations: What operations can teach medicine

TOWARD A PRACTICABLE METHODOLOGY FOR MEDICINE: THE IMPACT OF CONCEPTUAL ANALYSIS WIMJ. VAN DER STEEN* Introduction Will biology suffice as a base of medical science? Does medicine need a hermeneutical in addition to a scientific approach? Are concepts of health and disease value-neutral? How should medicine deal with the mind-body problem? Questions as broad as these are typically the ones that are addressed in the philosophy of medicine. Indeed the importance of such questions is obvious. Philosophy of medicine has been less concerned with methodological analysis of concrete science that finds its way into medical journals. (I am using the term "methodology" for philosophical, not statistical methodology.) I will argue that the balance needs to be redressed. An analysis of concrete science should precede the elaboration of general views concerning the role of science in medicine . Elsewhere I have surveyed methodological tools which fit this purpose [1—4]. Here I concentrate on tools for the analysis of concepts in medicine. Methodology is not high on the agenda in medical science. Epidemiology is one of the few areas in medicine where methodology plays an explicit, albeit minor, role. Most philosophical efforts of epidemiologists have gone into a discussion of views on testability defended by the philosopher Popper [5, 6]. Specifically, there have been heated debates concerning the form which the principle of testability should take [7-16]. I will not present my own views of testability here. Instead I will concentrate on conceptual analysis since one cannot meaningfully discuss the testability of hypotheses and theories unless the concepts they contain are clear. I will show by examples, from psychiatry and allied *Faculty of Biology, Free University, De Boelelaan 1087, 1081 HV Amsterdam, The Netherlands.© 1993 by The University of Chicago. All rights reserved. 003 1-5982/93/3604-083 1 $0 1 .00 580 Wim J. van der Steen ¦ Methodology for Medicine areas, that a methodological analysis of concepts can have profound implications for medicine. The methodological tools I will use are relatively straightforward. They are meant as a practicable guide for researchers and practitioners in medicine. In addition to this I will show that the analyses have consequences for the philosophy of medicine. Etiology in Psychiatry Hypotheses in sound research are typically tested against alternatives. In the simplest case of statistical testing, a null hypothesis is pitted against an alternative which is its complement. The two hypotheses in that case represent a dichotomous classification which is exclusive and exhaustive. I will not elaborate this since statistical methodology is welldeveloped in medicine. Hypotheses are also formulated at more abstract levels connected with tests in an indirect way. Concerning those levels, methodology gets less attention. To deal with statistics does not suffice. In addition one needs philosophical methodology. This is illustrated by the following example. Schools in psychiatry attribute debilitating mental disorders to quite different causes. The currently dominant view of biological psychiatry emphasizes biological factors internal to the organism. The ultimate cause of the disorders is thought to be genetic. In other schools the emphasis is rather on psychosocial factors. Now even the most staunch defenders of biological psychiatry grant that environmental factors, in the sense of psychosocial factors, modify the influence ofbiological ones, but they relegate them to a subordinate position. Which side should one take in this controversy? My reaction is that it is unwise to take sides at all because the issues are phrased in methodologically inadequate terms [17, 18]. The following concrete example indicates what's wrong with the controversy. Schwartz and Africa, who argue that both biological and psychosocial factors are important, present the following classification of etiological factors for schizophrenia [19]. A Biological factors Al Genetic factors A2 Specific abnormalities A2a Anatomical and physiological factors A2b Biochemical factors B Psychosocial factors B 1 Development of the individual B2 Development within the family B3 Development within society and the larger environment B3a Population density Perspectives in Biology andMedicine, 36, 4 ¦ Summer 1993 | 581 B3b Socioeconomic class B3c Date of birth B3d Other factors Biological factors here obviously represent internal ones. That is, the concern of biology is assumed to be with processes inside the organism. External factors are placed in the domain of the...

This paper discusses the structure of medical science with a special focus on the role of generalizations and universals in medicine, and philosophy of medicine's relation with the philosophy of science. I argue that a usually overlooked aspect of Kuhnian paradigms, namely, their characteristic of being "exemplars", is of considerable significance in the biomedical sciences. This significance rests on certain important differences from the physical sciences in the nature of theories in the basic and the clinical medical sciences. I describe those differences and maintain that they are these differentiating features that require the use of more comparative and analogical reasoning in medicine. I suggest that Kitcher's recent introduction of the notion of a 'practice' may have similar implications if it is construed to contain more analogical elements than he appears to recognize in his initial formulation. Finally I argue that though Gorovitz and MacIntyre's characterization of medicine as a "science of particulars" bears some similarities with my thesis, I maintain that such a position without careful qualification can lead to ignoring both the nature of generalizations in these sciences and their role as positive analogies tying together a family of overlapping models.

Pharmacoepidemiology and Drug SafetyVolume 11, Issue 7 p. 617-620 ISPE Commentary Introducing ethics in hospital drug resource allocation decisions: keep expectations modest and beware of unintended effects Part II: the use of ethics Roel Fijn PhD MS MA RPh RCE, Corresponding Author Roel Fijn PhD MS MA RPh RCE [email protected] Division of Pharmacoepidemiology and Drug Policy, Groningen University Institute for Drug Exploration (GUIDE), Department of Social Pharmacy, Pharmacoepidemiology, and Pharmacotherapy, University of Groningen, The NetherlandsMedical Sciences and Pharmacy, Department of Social Pharmacy and Pharmacoepidemiology, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.Search for more papers by this authorL. Sara van Epenhuysen MA, L. Sara van Epenhuysen MA Department of Metamedica (Philosophy, Ethics, and History of Medicine), Medical Sciences and Pharmacy, University of Groningen and Medical Ethics Committee, Groningen University Hospital, Groningen, The NetherlandsSearch for more papers by this authorA. Jeanne M. Peijnenburg PhD MA, A. Jeanne M. Peijnenburg PhD MA Department of Theoretical Philosophy (Philosophy of Science, Logic and Epistemology), Philosophical Institute, University of Groningen, Groningen, The NetherlandsSearch for more papers by this authorLolkje T. W. de Jong-van den Berg PhD MS RPh RCE, Lolkje T. W. de Jong-van den Berg PhD MS RPh RCE Division of Pharmacoepidemiology and Drug Policy, Groningen University Institute for Drug Exploration (GUIDE), Department of Social Pharmacy, Pharmacoepidemiology, and Pharmacotherapy, University of Groningen, The NetherlandsSearch for more papers by this authorJacobus R. B. J. Brouwers PhD MS RPh RCP, Jacobus R. B. J. Brouwers PhD MS RPh RCP Departments of Clinical Pharmacology and Hospital Pharmacy, Leeuwarden Medical Centre, Leeuwarden and General Hospital de Tjongerschans Heerenveen, The NetherlandsSearch for more papers by this author Roel Fijn PhD MS MA RPh RCE, Corresponding Author Roel Fijn PhD MS MA RPh RCE [email protected] Division of Pharmacoepidemiology and Drug Policy, Groningen University Institute for Drug Exploration (GUIDE), Department of Social Pharmacy, Pharmacoepidemiology, and Pharmacotherapy, University of Groningen, The NetherlandsMedical Sciences and Pharmacy, Department of Social Pharmacy and Pharmacoepidemiology, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.Search for more papers by this authorL. Sara van Epenhuysen MA, L. Sara van Epenhuysen MA Department of Metamedica (Philosophy, Ethics, and History of Medicine), Medical Sciences and Pharmacy, University of Groningen and Medical Ethics Committee, Groningen University Hospital, Groningen, The NetherlandsSearch for more papers by this authorA. Jeanne M. Peijnenburg PhD MA, A. Jeanne M. Peijnenburg PhD MA Department of Theoretical Philosophy (Philosophy of Science, Logic and Epistemology), Philosophical Institute, University of Groningen, Groningen, The NetherlandsSearch for more papers by this authorLolkje T. W. de Jong-van den Berg PhD MS RPh RCE, Lolkje T. W. de Jong-van den Berg PhD MS RPh RCE Division of Pharmacoepidemiology and Drug Policy, Groningen University Institute for Drug Exploration (GUIDE), Department of Social Pharmacy, Pharmacoepidemiology, and Pharmacotherapy, University of Groningen, The NetherlandsSearch for more papers by this authorJacobus R. B. J. Brouwers PhD MS RPh RCP, Jacobus R. B. J. Brouwers PhD MS RPh RCP Departments of Clinical Pharmacology and Hospital Pharmacy, Leeuwarden Medical Centre, Leeuwarden and General Hospital de Tjongerschans Heerenveen, The NetherlandsSearch for more papers by this author First published: 30 October 2002 https://doi.org/10.1002/pds.780Citations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume11, Issue7December 2002Pages 617-620 RelatedInformation

This book contains scholarly contributions to several current debates in the philosophy of medicine and health care regarding the nature of health and health promotion, concepts and measurements of mental illness, phenomenological conceptions of health and illness, allocation of health care resources, criteria for proper medical science, the clinical meeting, and ethical constraints in such a meeting. With one exception, the authors in this book are or have been teachers or graduate students at the interdisciplinary Department of Health and Society (Tema H) at Linkoping University, Sweden. While all the texts have a philosophical focus, many other disciplines have influenced the choice of specific perspectives. The university backgrounds of the authors range from medicine, psychology, sociology, and religion to philosophy. What binds the authors together is their deep interest in the theory of medicine and in the pursuit of a philosophy of humanistic medicine and health care.

This book contains scholarly contributions to several current debates in the philosophy of medicine and health care regarding the nature of health and health promotion, concepts and measurements of mental illness, phenomenological conceptions of health and illness, allocation of health care resources, criteria for proper medical science, the clinical meeting, and ethical constraints in such a meeting.With one exception, the authors in this book are or have been teachers or graduate students at the interdisciplinary Department of Health and Society (Tema H) at Linkoping University, Sweden. While all the texts have a philosophical focus, many other disciplines have influenced the choice of specific perspectives. The university backgrounds of the authors range from medicine, psychology, sociology, and religion to philosophy. What binds the authors together is their deep interest in the theory of medicine and in the pursuit of a philosophy of humanistic medicine and health care.

Reviewed by: The Physical and the Moral: Anthropology, Physiology, and Philosophical Medicine in France, 1750–1850 John Pickstone Elizabeth A. Williams. The Physical and the Moral: Anthropology, Physiology, and Philosophical Medicine in France, 1750–1850. Cambridge History of Medicine. Cambridge: Cambridge University Press, 1994. xiii + 281 pp. Ill. $64.95. The medicine of France in the period 1750–1850 is already well charted, and this book is a major addition to that literature. It provides neat, accurate summaries of several established themes and it introduces a series of lesser-known topics and authors; best of all, it maps these traditions and discourses into a sophisticated, many-layered, but coherent historical pattern. The strong introductory sections on Bordeu and Barthez outline a Science of Man designed to draw on anatomy and physiology, to serve as a guide to practice, but also to elucidate the life of man in his physical and social environments. This positivistic medicine stressed observations (rather than deductive systems), emphasizing variety and variability, the effects of climate and regimen, and the changes in organisms over their life histories. The varied and variable quality was the vital force—which was neither spiritual nor material. This optimistic medical omnibus of small-town Enlightenment (cf. Edinburgh and Göttingen) was variously converted and appropriated in Revolutionary Paris. In Bichat’s (more surgical) hands, it provided an anteroom to the experimental physiology of the nineteenth century. Cabanis and the Ideologists gave it a materialist twist as the dominant medical philosophy of the new medical school. The Conservative doctors contemplated a renewal of spiritualism. The battle lines were clearly drawn during the Restoration, especially after the royalist purge of the medical school in 1822. In Montpellier and in Paris, vitalism was promoted as an antidote to materialism and the dehumanizing emphasis on analytical dissections. The middle ground was held by medical “eclectics,” allied with the philosopical school of Victor Cousin, which made room for the will and found there the basis for differences between men. Materialism was championed by Broussais, whose physiological, anti-ontological account of disease still had much in common with vitalism. Like the vitalists, Broussais was less interested in differences between diseases than in differences between men, which were [End Page 523] evidenced in varied responses to the common causes of disease. Such cognitive similarities tended to be hidden by polemical oppositions; Broussais shocked the bourgeoisie by locating human differences in their physical makeup, and by continuing to champion a determinist phrenology. But as Williams seems to suggest, deeper antipathies to medical vitalism would prove more telling, especially after 1830, when the politicization of medicine was less intense. The new medical (and allied) sciences, developed in the medical school, in the museum of natural history, and in politico-social debate, did not build on the same premises as medical vitalism. They did not start from patients, extrapolating up to humanity and down to body parts; rather, they analyzed complex systems into interactive elements specific to each new science. The anatomo-pathology of the new Paris school tended to bypass the holistic individualism of Montpellier. The analytical experimentalism of Magendie offered a new and prestigious way to think about physiology. For Saint-Simonian physicians and for hygienists concerned with political economy, society was a complex functional system. For W. F. Edwards and other physicians in the new Ethnological Society, human history was not a matter of civilizing influences on character and constitution; it was a question of unraveling the interactions of (more or less) constant races. Phrenology, which even with Gall had an analytical quality at odds with medical vitalism, by the 1830s and 1840s was also concerned with showing how individuals with different sets of potentials could best be placed in the complex machinery of society. Williams sees these new concerns as constitutive of a specialization, professionalization (and industrialization) of medicine, which was bound to undermine medical vitalism. She goes on to explore the posthumous use of its themes—in psychiatry, in criminology, and especially in the anthropology of Paul Broca. The idea of degeneration made environmental influences heritable, as it also elided the characteristics of Man and of France. Williams’s final chapter, linking to the work of her...

The exponential growth in scientific knowledge and technology since the end of World War II has brought about enormous changes in the practice of medicine. These advances could have been made, however, only if a new philosophy of medicine that brought science to the bedside had been developed in the first half of the 20th century. A. McGehee Harvey, one of the major contributors to the advances of 20th-century medicine, describes the trends, the institutions, and the people that laid the groundwork for advancing the United States into its leadership position in medical science in this unusual but rather disappointing book on the history of medicine in America between the turn of the century and the end of World War II. The book consists of four parts, four appendices, and an excellent collection of notes and references. Part 1 deals with formative influences in the 19th century that were largely

A central issue in the philosophy of medicine is to solve the problem of determining the nature of the concepts of health and disease. Some theorists claim that health and disease are purely value-free and descriptive concepts that are discoverable and grounded in the biological and medical sciences. Others claim that health and disease are essentially value-laden concepts, i.e. healthy states are those states we (individuals, groups, societies) desire or value and diseased states are those we want to avoid or disvalue.Considering the longtime disagreement among physicians, theorists of health and philosophers about the essential characteristics of health and disease, the aim in the first part of this paper is to briefly present four different philosophical approaches of health and disease in an attempt to introduce the readers to the debate. This article begins with the Biostatistical theory of Christopher Boorse. It turns to the Malady theory of Danner Clouser, Charles Culver and Bernard Gert, the holistic theory of Lennart Nordenfelt and finally the adaptation theory of József Kovács.In the second part of the paper, some objections will be stated to each theory. In the third and last part, a completely different account of health will be given, which holds that self-knowledge is a criterion of human health. Health, unlike disease, is not a state or a condition of the organism but an endless process. Its essence can be better captured in philosophical rather than medical terms and it should be applied only to human beings.

The first great work on the philosophy of medicine is Claude Bernard’s An Introduction to the Study of Experimental Medicine 1 which was written just over one hundred years ago. Bernard was one of the first proponents of an organismic vision of life — neither crudely mechanistic nor vitalistic — that affirmed both the universal validity of physio-chemical laws in the biological domain and the existence of special non-reducible features, physiological in character, of living matter. For Bernard, the body was a “living machine”2 not exempted from the laws of physics and chemistry, and a “creative idea” which “expresses itself” through physio-chemical means. Physio-chemical means, he continues, “are common to all natural phenomena and remain mingled, pell-mell, like the letters of the alphabet in a box till a force goes to fetch them, to express the most varied thoughts and mechanisms.”3 For Bernard, then, organs were like words, and individual organisms were like sentences. Here Bernard’s — and Toulmin’s — analysis would stop. Wartofsky, however, would go one step further and say that socio-historical communities of organisms are like languages: diseases which for Bernard and Toulmin then are pathologies of “words;” and “sentences” are for Wartofsky principally pathologies of“languages.”

An important insight of Bill Fulford’s work is that there is no such thing as “value-free” diagnosis. To characterise a person as having a particular illness is to make a value-laden claim, whether or not people reflect on what the values are that underlie the diagnosis. We agree with him on this point, but want to ground a view about the role of value-judgments in diagnosis in a broader conceptual framework—one which argues that there is no such thing as an approach to health care (including the science of medicine) that is “philosophy-free”. We explain and justify this claim before bringing out its significance to Fulford’s VBP project and his own underlying assumptions about the relationship between value, philosophy, science and practice. Rather than ‘complement’ EBM with VBP, EBM should, we argue, be sublated. VBP should be dropped, and EBM could morph then into FOM: Flourishing-Oriented Medicine, our own proposed answer. No longer positivistic and scientistic, and more honestly ethical and political. With deliberative fora that, far from being mere tick-box exercises or amalgamations of individuals’ preferences, are actually likely to produce the best and most robust decisions. Decisions that are likelier to be compatible with both medical science and human flourishing.