Health and Medicine

The project:

This project addresses conceptual and normative questions relating to health and medicine, broadly construed. These include:

• Consent: Consent is integral to ethical practice in health care and clinical research. By giving valid consent a competent adult can give permission for acts that would otherwise be rights violations. Under what conditions is consent valid?
• Disorders of consciousness in psychiatry. The concept of a disorder of consciousness is central to the medical understanding of post-comatose disorders like coma, the persistent vegetative state and the minimally conscious state. It picks out a family of conditions in which one’s state of wakeful consciousness is severely degraded, dysfunctional or absent. Can we use this and related concepts (such as dreaming, and the psychedelic state) to make sense of the changes to conscious experience reported in depression, schizophrenia and other forms of mental illness?
• Health care allocation: All health care systems are resource-constrained, meaning that not everyone can receive the medical interventions that would benefit them. How can scarce resources for health care be fairly allocated?
• Health research priority setting: The resources available for health research are also limited. Difficult decisions must be made about how to allocate them across different populations, diseases, and types of intervention. How can the different actors involved in health research ethically set priorities?
• Psychiatric categories and mental health. Psychiatric kinds play a key role in modern medical practice. The number of diagnoses of mental disorders is also growing rapidly. What , if anything, does this tell us about the nature of the categories utilized in psychiatry? What are our concepts of mental health and mental illness, and what should they be? Are clinicians ‘over-medicalizing’ mental illness, and what, if anything, ought to be done about it?
• Early diagnosis and public services: public service provision depends on collective ignorance about the timing of each person’s death. For each of us, the possibility that we will survive to old age makes us more willing to contribute into collective resource pots for our future pension and health and social care prevision. But what ought to happen if the technology exists to inform people well ahead of time about the likely timing of their death? Should we seek to retire early? Should we be allowed to do so on grounds of equity?
• Early diagnosis and inequality: Given that advanced diagnostic services rely on new digital technology, e.g., the AI interpretation of medical tests, how should we deal with the potential resulting inequalities in knowledge about one’s own health status and related preventative and curative treatments? How can we cope with this most personal information being known to others, and should employers and professional training programs be specifically barred from discriminating against applicants on this basis? And how can we protect equality when some of that technology draws on sensitive issues of race, sex, gender, genetic inheritance and genetic expression?
• Early diagnosis and culture: How are the various religious and cultural traditions likely to shape responses to advances in early diagnosis capabilities?
• Early diagnosis and pessimism: Can we cultivate gratitude in the face of accurate foreknowledge of our own demise, and can pessimism offer consolation?

Project members:

• Joseph Millum (St Andrews), Project Leader
• Cecily Whiteley (St Andrews)
• Mara van der Lugt (St Andrews)
• Ben Sachs-Cobbe (St Andrews)
• Luca Stroppa (St Andrews)

Teaching:

• PY4666 Bioethics
• PY4670 Ethics and the allocation of health resources
• PY4671 Philosophy of Dreaming
• PY4660: Work, Entitlement, and Welfare

Recent Publications:

Millum, J. “Should health research funding be proportional to the burden of disease?” Politics, Philosophy & Economics 22.1 (2023): 76-99. https://doi.org/10.1177/1470594X221138

Zionts J., Millum J. “How not to count the health benefits of family planning.” Journal of Medical Ethics 49 (2023): 41-44. https://doi.org/10.1136/medethics-2021-107668

Whiteley, C. “Depression as a Disorder of Consciousness” (forthcoming). The British Journal for the Philosophy of Science. https://doi.org/10.1086/716838

Recent Events:

Early Diagnosis: Handling Knowing Public Webinar (12 December 2024) – Online

Early Diagnosis: Handling Knowing Colloquium (27th of November 2024) – University of St Andrews

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