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Table 1 A summary of some important meanings of “the edge of medicine,” some examples, the corresponding key issues and challenges as well as the role of philosophy and ethics

From: The role of philosophy and ethics at the edges of medicine

Meaning of “on the edge” Example Key issue and
Challenges
Role of Philosophy and/or Ethics
Border
On the border of what belongs to or counts as medicine
Expansion of concepts of disease, illness, or sickness.
Between esthetics and ethics (Cosmetic surgery)
Between healthcare and home care
Between professionals and patients/relatives (roles)
Between covered and non-covered services (dentistry)
Between medical and “non-medical conditions”:
• Sports medicine
• Female genital mutilation
• Male circumcision
Demarcation (of subject matter)
Differentiating between what is disease (illness or sickness) and not, what belongs to the goals and tasks of the health professional and the health care system and what is more appropriately handled by others, and when the health services do more good than harm.
Defining essence or goal
Revealing diagnostic creep, overdiagnosis, overtreatment, medicalization
Clarify concepts (disease, aging, autonomy, coercion)
Clarify the relationship between professionalism and ethics
Margin (of life): Between life and death (non-existence) Neonatology
Palliative care
Physician assisted suicide
Euthanasia
Demarcation (of existence).
Defining the tasks of medicine at the margins of life
Setting limits (to existence)
Defining key concepts, such as life, death, person, pain, moral status
Brink, Verge The application of the knowledge and remedies of advanced medicine in areas of austerity
Global health emergencies
Health services to refugees and asylum seekers
• DNA-testing, ethics and migration
• Age determination in refugee children
• Refugees’ access to health care
• Domestic violence among asylum seekers
Relevance
• Are our approaches in medicine relevant for other contexts?
Jurisdiction
• How far does the jurisdiction of our health care system go?
Reflecting on cultural and social contingency, universality
Demarcation
Reflection on goals
Emergency bioethics
Frontier
Forefront
Forefront of research
New technologies
• Gene editing, gene drives
• DtC genetic testing
Experimental treatments
Validation of personalised medicine
AI-based diagnosis and treatment decisions
Medical enhancement
Conception
Expansion
Demarcation
Cost containment
Resource allocation
Clarifying concepts (human being, natural, therapy, knowledge, information, responsibility)
Clarifying goals
Analysing analogies
Providing methods for knowledge production and assessment (epistemology).
Fringes Conceptual and moral grey zones Vagueness (conceptual) Relevance (moral) Defining and handling:
• Vagueness
• Relevance
Plunge, abyss Situations without moral resolutions • Culpability, blame, shame
• Moral distress
• Residue, remorse
• Tragic choices
Defining and handling:
• Culpability, shame
• Moral distress
• Residue (moral)
• Tragic choices
Conflict Moral dilemmas
Moral failure
Moral disagreement
Catch-22-situations.
Disagreement
Conflicting perspectives
Conceptual clarification
Critique of perspectives and arguments
Brokering
Balancing between unacceptable situations or conditions. Finding optimum, panacea Mammography screening
Reject and retake of medical images
Judgement, balancing,
Quality, optimization
Finding ways to balance interests, perspectives, and concerns
Quality assurance