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Biomedical subjects

Michael H Kottow

Publications and source records attributed to Michael H Kottow.

6 recordsLinked to original sources
PubMed2004

Vulnerability: what kind of principle is it?

The so-called European principles of bioethics are a welcome enrichment of principlist bioethics. Nevertheless, vulnerability, dignity and integrity can perhaps be more accurately understood as anthropological descriptions of the human condition. They may inspire a normative language, but they do not contain it primarily lest a naturalistic fallacy be committed. These anthropological features strongly suggest the need to develop deontic arguments in support of the protection such essential attributes of humanity require. Protection is to be universalized, since all human beings share vulnerability, integrity and dignity, thus fundamenting a mandate requiring justice and respect for fundamental human rights. Being a feature of all humanity, vulnerability is improperly extended to designate destitute individuals and populations. Rather, they are in a state of fallen vulnerability, for they already are harmed in some way, and have become deprived of their range of capabilities. These individuals are destitute and are no longer in command of their fundamental human rights. They have lost the status of unharmed vulnerability; identifying them as susceptible--vulnerated and no longer only vulnerable--stresses the point that bioethics demands specific social action to palliate or remove their distress. When harm does occur--in the form of disease, for example-, individuals are no longer vulnerable--for they have ceased to be intact -, they become susceptible to additional deprivations and sickness; integrity is demeaned and dignity is offended, leading to states of dysfunction that require specific remedial social practices, aimed at treating and removing injuries. The main point this paper addresses is that vulnerability--as well as dignity and integrity--are descriptive characteristics of human beings qua humans, which are not normative in themselves, but fundamental enough to inspire bioethical requirements of protection and respect for human rights in the wake of social justice. A clear distinction must be made in regard to human beings who are injured by poverty, sickness, discriminating deprivations or suffer other destitutions, having ceased to be only vulnerable for they are no longer intact. These individuals and populations require more than protection, their needs must be met by specific care and remedial measures to be identified and instigated by bioethics qua applied ethics.

Anthropology, Cultural↗
PubMed2003

The vulnerable and the susceptible.

Human beings are essentially vulnerable in the view that their existence qua humans is not given but constructed. This vulnerability received basic protection from the State, expressed in the form of the universal rights all citizens are meant to enjoy. In addition, many individuals fall prey to destitution and deprivation, requiring social action aimed at recognising the specific harms they suffer and providing remedial assistance to palliate or remove their plights. Citizens receive protection against their biologic vulnerability by means of an in rem right to health [care], which is more an attitude of protection than a specific programme. When individuals become susceptible, that is, biologically weak or diseased, they also increase their predisposition to additional harm, and require social actions to treat their demeaned condition. Such assistance takes the form of positive healthcare rights. Research on human beings has been slow to observe that the subjects recruited are susceptible, especially so if research is done in less developed countries. By mislabelling them as vulnerable--a characteristic they share with all humans--sponsors avoid registering the deprivation these people suffer, and the ethical obligation to offer them remedial help. The distinction between vulnerability and susceptibility also marks the difference between being intact but fragile--vulnerable--and being injured and predisposed to compound additional harm--susceptible. Awareness of this difference should give additional force to the rejection of double standards in research ethics.

Bioethics↗
PubMed2002

The rationale of value-laden medicine.

Medicine is becoming increasingly confident that scientific advances, especially in the area of genetics, will allow a major improvement in the control and eradication of disease. This development seems to go hand in hand with health-enhancement strategies, erasing the distinction between the states of health and disease, and blurring the specific goals of medical services. Medicine tends to become an increasingly technocentric practice that relies heavily on expert knowledge and on epidemiological evidence, neglecting the lived-body experience of being ill, and tending to transform costly medical services into commodities only affordable by the affluent. This paper argues that disease is not merely a functional description, but rather a definitely value-laden organismic state that is experienced by the patient, needs to be explored and treated by medical practitioners, and requires the assessment and participation of social institutions concerned with the delivery and support of medical services. Each of these perspectives introduces its own set of values, both in the clinical encounter and in public health programmes. Bioethics seems to be the appropriate discipline to discuss all these values involved, and help assign them properly in order to rescue the caring concern of medicine for the sick, as well as uphold a principle of fairness in publicly funded medical services.

Bioethics↗
PubMed1999

A reply to Professor Seedhouse.

This brief reply gives a few references and clarifies some points in order to emphasize that a number of Professor Seedhouse's assertions are debatable and that his criticism of slovenly scholarship and his unbridled ad hominem argumentation are out of place and easily refuted.

Bioethics↗