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 |