33rd EUROPEAN CONFERENCE ON PHILOSOPHY OF MEDICINE AND HEALTH CARE 7 – 10 August 2019 VENUE: UNIVERSITY OF OSLO GEORG SVERDRUPS HUS – UNIVERSITY LIBRARY MOLTKE MOES VEI 39, OSLO PHILOSOPHY AT THE EDGE OF MEDICINE Organised by: The European Society for Philosophy of Medicine and Healthcare (ESPMH) and the Centre for Medical Ethics, University of Oslo (Norway) ABSTRACTS ThE casE for psychophysical dualism Ahlzén, Rolf [email protected] The scientific revolution of the 17th century resulted in a pressing enigma: If man belongs to nature and nature follows natural laws which work fully deterministically – how may freedom of will exist, and how can there be an inner world of thoughts and emotions? Descartes wanted to solve this challenge by postulating that there is an immaterial substance, res cogitans, the thinking soul, that connects with the physical body, res extensa, in the pineal gland. Descartes has been much ridiculed for this attempt, and almost all evils of our time have been projected onto what is commonly called “dualism”. With the rapidly expanding neurosciences, there has appeared a monistic materialism, declaring that the mind is plainly an epiphenomenon of the workings of the brain and that our subjective experience of an inner world and of some degree of free choices and resulting responsibility is just an illusion. This ontological position has gained strength to the extent that any dualistic position is looked upon as blatantly naïve. In this paper, I want to challenge this position. I will draw inspiration from Karl Popper´s and John Eccle´s by now around thirty years old book The Self and its Brain, as well as Swedish philosopher Helge Malmgren, who defends a moderately dualistic position. It will be shown that dualism in a better way pays respect to the absolutely fundamental sense among most people that they have an inner world and that they have some degree of freedom of choice in their lives. Interactive dualism, however, has to accept that there is a fundamental enigma involved in the mind-body problem: How can mind work on matter (i.e. certain structures in the brain), so that not only the brain creates the mind, but also that the mind changes the state of the brain? The position that will be defended in this paper is that science needs to accept that this is inexplicable with the present state of science, but that it, as many scientific enigmas, may be explained with time. It will also be argued that no religiously or metaphysically based theories need to be involved in this. The workings of evolution and the idea of emergent properties offer promising roads towards this richer understanding of the relation between mind and matter. PErsonal rEsponsibility for hEalth” is a futilE project Ahola-Launonen, Johanna [email protected] Healthcare costs are increasing, and chronic diseases have a significant role in these costs. Furthermore, there seems to be a strong correlation between certain lifestyles and the chronic diseases. Boosted by the political trend of the responsibilization of the individual currently taking place elsewhere in politics, the health discussion has come to debate whether individuals should be held accountable for their lifestyle’s choices. Due to these premises, both the theoretical and applied discussion on health, justice, and prioritization currently navigate in the complex jungle of both holding individuals accountable and taking account the social determinants of health affecting health behaviour. This is mostly done by operating within the family of luck egalitarian theories. In this paper, I argue that this discussion should be taken into another direction. The project of finding accurate models of holding individuals responsible for their health is theoretically interesting. However, the applications end up being moralistic, simplistic or ineffective in the non-ideal real life. The consequences of the proposed applications are doomed to be unfair and ineffective. Even though luck egalitarian theories per se can survive criticisms of unfairness (because they can be formulated in pluralistic and holistic exceptions and nuanced excusing conditions), I argue that taking the theories into applied discussions end up merely contributing to the political trend of the responsibilization of the individual. The finely nuanced accounts of responsibility are too complex for popular understanding and the (usually) preferred end-states of public insurance and strong redistributive institutions are buried deep under layers of theory. “Responsible” behaviour in general is not without problems. The literature discusses certain specific risky behaviours related to health standards. It might be a good thing that people acted, at least remotely, according to those standards. However, this usually requires resources of several kinds, namely, the social determinants of health. Therefore, if the goal is to pursue these certain healthy behaviours, the reasonable (fair and efficient) approach should be to enhance the abilities of persons to act “responsibly”, that is, response-ability. In other words, this means enhancing people’s ability to make their own “best” decisions, not “decisions” made under extensively restricted autonomy under circumstances of scarcity. Digital hEalth: Implications for thE doctor-patiEnt rElationship Amann, Julia; Vayena, Effy; Blasimme, Alessandro [email protected] Patient-centered care has become widely recognized as the golden standard in healthcare. In its essence, patient-centered care refers to care that respects and responds to individual patients’ needs and preferences. It seeks to foster patient autonomy by equalizing knowledge and power asymmetries that have long characterized the doctor-patient relationship. A key component of patient-centered care is shared decision-making, which is deeply rooted in the principles of good clinical practice that emphasize the patient’s right to know. Shared decision-making thus presupposes a collaborative exchange between clinician and patient to ensure that all available and relevant information is taken into consideration and that the potential risks and benefits of a particular course of action are made evident to the patient. This, in turn, implies that information is provided to patients in a transparent and accessible manner. To date, research in the field of precision medicine and digital health has predominantly focused on ethical issues related to the collection, storage, and sharing of different types of data for analytical purposes. Only little is known about the clinical impact of introducing data-driven models into practice. In which cases does it make sense to rely on predictive models generated by data analytics? What effects will these new decision support systems have on the doctor- patient relationship and on the provision of care more generally? How can we ensure that patients retain the right to informed choice and control over medical decision-making rather than being subjected to algorithmic classificatory practices? The present contribution centers around the notion of shared decision-making in digital healthcare to generate a better understanding of how the inherent values of patient-centered care, in general, and shared decision-making, in particular, can be aligned with the emerging opportunities offered by real-time data analytics. It seeks to illustrate some of the key challenges associated with this process and makes recommendations on how to address them. Traditional ChinEsE MEdicinE and thE nEw “PErsonalizEd MEdicinE” / P4 Barilan, Y Michael [email protected] The Human Genome Project heralded a new vision of medicine, according to which, genetic and other “personal” markers would guide treatment as to render it more “precise”. A broader vision, inspired by “system biology” speaks of the mobilization of IT in the processing of large amount of “personal data”, from genomics to life-style as to “predict, prevent and personalize by means of participation”. This new vision embodies a turn to some metaphysical and regulative structures that were common in pre-modern Europe and most prominently in Traditional Chinese Medicine. Attention to these points may help us understand “personalized medicine” and some philosophical and moral problems it involves. In the past (and still today), the poor availed themselves of “one drug fit all”, buying remedies for problems from cheap providers. The rich consulted physicians who would write prescriptions for personalized mixtures of generic medicines. The very complex art of creating personalized concoctions renders it difficult to conduct clinical trials evaluating the effects of traditional Chinese herbology. It took a different paradigm of health and pharmacology to facilitate the development of “drugs that fit diseases” (rather than clinicians treat persons), and then test them in clinical trials. The establishment of the Royal College of Physicians in 1518 England, marked the beginning of separation of physicians from apothecaries. During the centuries, it became illegal for physicians to sell drugs, especially medicine they personally develop and concoct. With the advent of P4, the problem of conflict of interest and of physicians’ economic stakes in “personalized” care rears its head back. Modern medicine relies on “big pharma” to develop drugs for the people. The economy of P4 is more dispersed, where numerous small “startup” companies vie for investment. The “Big Pharma” develop many drugs in parallel, while the new “startup”