Perspectives in Biology and Medicine

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ISSN / EISSN : 0031-5982 / 1529-8795
Published by: Johns Hopkins University Press (10.1353)
Total articles ≅ 4,199
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Latest articles in this journal

Scott Y. H. Kim
Perspectives in Biology and Medicine, Volume 64, pp 29-43; https://doi.org/10.1353/pbm.2021.0003

Abstract:
Euthanasia or assisted suicide (EAS) is permitted in a handful of jurisdictions. But its scope (ranging from being restricted to the end of life to no restrictions save those of autonomy) and its legal basis (ranging from a necessary prerogative of physicians to a human right) vary greatly. The debate over psychiatric EAS (pEAS) needs to be understood within this complex context. This essay addresses one specific aspect: can pEAS be grounded on a basic human right? The author argues against pEAS as grounded on a basic human right by showing that such a view has several implications we ought not accept.
Sweetha Saji, Sathyaraj Venkatesan, Brian Callender
Perspectives in Biology and Medicine, Volume 64, pp 136-154; https://doi.org/10.1353/pbm.2021.0010

Abstract:
Comics have always responded to pandemics/catastrophes, documenting the way we deal with such crises. Recently, graphic medicine, an interdisciplinary field of comics and medicine, has been curating comics, editorial cartoons, autobiographical cartoons, and social media posts under the heading "COVID-19 Comics" on their websites. These collected comics express what we propose to call covidity, a neologism that captures both individual and collective philosophical, material, and wide-ranging emotional responses to the COVID-19 pandemic. Treating such comics as the source material and drawing insights from theorists Ian Williams, Alan Bleakley, Susan Sontag, and others, this article examines graphic medicine's representation of the COVID-19 pandemic. The conceptual metaphors of war, anthropomorphism, and superheroism are used to represent and illustrate the lived experience of the pandemic, and the article investigates metaphor types, their utility, and motivational triggers for such representations. In doing so, the essay situates graphic medicine as a productive site that presents the pandemic's multifarious impact.
Emily Waples
Perspectives in Biology and Medicine, Volume 64, pp 119-135; https://doi.org/10.1353/pbm.2021.0009

Abstract:
The coronavirus pandemic has prompted renewed scholarly and popular interest in epidemic fiction, from biomedical thrillers to dystopian tales of disease-desolated worlds. While fiction may cultivate our expectations about the probable paths of the pandemic, it also invites us to participate in the creative process of imagining alternative futures. This essay examines how two recent novels, Ling Ma's Severance (2018) and Karen Thomson Walker's The Dreamers (2019), offer feminist refigurations of the genre Priscilla Wald has termed "the outbreak narrative." Shifting emphasis from the epidemiological quest plot that has tended to dominate this genre, both novels focus on everyday cultures and ethics of care, illustrating how patriarchal systems produce and perpetuate conditions of vulnerability. In particular, pregnancy plots in both novels work to interrogate cultures of paternalism, raising key ethical questions about limitations and violations of the bodily autonomy. Illuminating, in spectacular and speculative fashion, how conditions of inequality and precarity are radically revealed and intensified by a public health crisis, novels like Severance and The Dreamers are essential tools for teaching about—and living through—the crisis of our pandemic present.
Joel T. Braslow, Sarah L. Starks, Enrico G. Castillo, John S. Brekke, Jeremy Levenson
Perspectives in Biology and Medicine, Volume 64, pp 82-102; https://doi.org/10.1353/pbm.2021.0007

Abstract:
Over the past quarter century, Recovery has become the hegemonic model guiding mental health policy. Advocates presented Recovery as a radical departure from the past, with the promise of dramatically improved outcomes for those with serious mental illness. This article looks at the implementation of Recovery-based policies in California from the 1990s to the present and interrogates the ways these policies emerged out of and reinforced many of the problems they were intended to solve. Against the backdrop of welfare reform, managed care, and a growing belief in market forces and individual responsibility, California policymakers pivoted from rigorously studied pilot programs that were intended to provide intensive, long-term treatment to Recovery-oriented programs that, while initially intensive, promised to "flow" increasingly independent and self-sufficient patients to less-intensive services. Moreover, these new programs promised to produce cost savings by reducing homelessness, hospitalization, and incarceration. Reported outcomes from these programs have been overwhelmingly positive but are based on flawed evaluations that lean more heavily on belief than on evidence. While proclaiming a comprehensive, patient-centered approach, Recovery's embrace of independence over long-term care and social supports has justified a system of care that systematically fails the sickest patients by abandoning them to the streets and jails.
Yingcheng (Elaine) Xu, Dominic Sisti
Perspectives in Biology and Medicine, Volume 64, pp 44-55; https://doi.org/10.1353/pbm.2021.0004

Abstract:
Conceptual parity posits that both medical and mental illness are both simply illness, and thus should be considered as fundamentally the same, especially in health services and policy. Recent controversy over medical assistance in dying (MAID) highlights both the unequal treatment of physical and mental illnesses in end-of-life care and the need for more conceptual clarification of terminal mental illness. This article presents an argument for the necessary elements in terminal mental illness, the value of qualitative assessments, and important areas that require further research and clarity in order for terminal mental illness to be appropriately identified. Given current conceptual limitations, palliative psychiatry, and not MAID, is recommended in severely treatment-resistant cases of mental illness.
Stephen J. Morse
Perspectives in Biology and Medicine, Volume 64, pp 56-69; https://doi.org/10.1353/pbm.2021.0005

Abstract:
This essay considers the foundational rationale for why the law treats at least some mentally disordered people specially in a wide array of civil and criminal contexts. It suggests that non-responsible incapacity for rational behavior in specific contexts is the primary principle that warrants special legal treatment. It also considers the major distractions and confusions about why such special treatment is sometimes justifiable. It concludes with the reductionist challenge to conceptions of mental disorder and more broadly to the law that some advocate, usually based on the new neuroscience of brain imaging.
Franklin G. Miller
Perspectives in Biology and Medicine, Volume 64, pp 200-210; https://doi.org/10.1353/pbm.2021.0016

Abstract:
John Stuart Mill’s classic text, On Liberty, maps the scope and limits on individual freedom. His “harm principle”—that liberty can be legitimately restricted by government or society only to prevent harm to others—has had a great influence on contemporary public health ethics. This essay examines Mill’s philosophy of liberty as it pertains to public health interventions in response to the coronavirus pandemic. Particular applications include examination of face masks, lockdowns, and mandatory vaccination.
Olaf Dammann
Perspectives in Biology and Medicine, Volume 64, pp 155-172; https://doi.org/10.1353/pbm.2021.0018

Abstract:
In order to support health interventions, biomedical and population health researchers need to collect solid evidence. This article asks what type of evidence this should be and expands on previous work that focused on etiological explanations, or causal-mechanical explanations of why and how illness occurs. The article proposes adding predictive evidence to the explanatory evidence, in order to form a joint evidence set, or JES = [A,B,C,D], which consists of four different types of evidence: association [A], biology [B], confirmation [C], and difference-making [D]. The article discusses explanatory coherence as a backbone for this proposal, suggests criteria for each type of evidence, and offers a rubric for multi-evidence mapping.
Elizabeth Lanphier
Perspectives in Biology and Medicine, Volume 64, pp 211-234; https://doi.org/10.1353/pbm.2021.0013

Abstract:
Narrative is now a commonly used term in medical education, ethics, and practice. Yet the concept of narrative defies singular definition, and definitional and functional pluralism about narrative in health care remains underappreciated. Diverse conceptualizations of narrative are generically grouped under umbrella terms like “medical humanities” or “narrative medicine.” Such broad grouping risks undermining attention to relevant differences in use, meaning, or theory of narrative, overestimating the scope of certain criticisms of narrative practice or use, while overlooking more insidious concerns. This essay moves toward a conceptual clarification of narrative in medicine through a process of naming and sorting. Narrative conceptualizations are grouped into narrative premises which include descriptive and normative claims about narrative, and narrative practices, which put narrative into action as process, method, or tool. A philosophical pragmatist approach to narrative in medicine reworks narrative anxieties about fact and fiction, truth or falsehood, in terms of the justifiability of belief, the inclusion or exclusion of experience, and the rationality of practices that are never perfect and always up for revision.
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