The article investigates the ethical and philosophical challenges posed by the integration of artificial intelligence in vascular surgery. Based on systematic data analysis and an interdisciplinary approach, the authors evaluate key AI advances, including personalization of treatment, automation of diagnosis, and prediction of complications. Particular attention is paid to the problems of accountability for algorithm decisions, transparency of “black box” systems, dehumanization of medicine, and cyborgization. The contradictions between technological efficiency and preservation of humanitarian values are revealed. The study (...) emphasizes the need for legal, educational and ethical mechanisms for the harmonious implementation of AI, where the doctor remains the central figure in the system “human-algorithm-patient” // Статья посвящена исследованию этических и философских вызовов, возникающих при интеграции искусственного интеллекта в сосудистую хирургию. На основе систематического анализа данных и междисциплинарного подхода авторы оценивают ключевые достижения ИИ, включая персонализацию лечения, автоматизацию диагностики и прогнозирование осложнений. Особое внимание уделено проблемам ответственности за решения алгоритмов, прозрачности «черных ящиков», дегуманизации медицины и киборгизации. Раскрыты противоречия между технологической эффективностью и сохранением гуманитарных ценностей. Исследование подчеркивает необходимость правовых, образовательных и этических механизмов для гармоничного внедрения ИИ, где врач остается центральным звеном в системе «человек-алгоритм-пациент». (shrink)

English law is unambiguous that legal personality, and with it all legal rights and protections, is assigned at birth. This rule is regarded as a bright line that is easily and consistently applied. The time has come, however, for the rule to be revisited. This article demonstrates that advances in fetal surgery and (anticipated) artificial wombs do not marry with traditional conceptions of birth and being alive in law. These technologies introduce the possibility of ex utero gestation, and/or temporary (...) existence ex utero, and consequently developing human beings that are novel to the law. Importantly, therefore, the concepts of birth and born alive no longer distinguish between human beings deserving of legal protection in the way originally intended. Thus, there is a need for reform, for a new approach to determining the legal significance of birth and what being legally alive actually encompasses. Investigating the law of birth is of crucial importance, because of the implications of affording or denying the subjects of new reproductive technologies rights and protections. A determination of the legal status of the subject of fetal surgery or an artificial womb will determine what can and cannot be done to each entity. Moreover, the status afforded to these entities will drastically impact on the freedoms of pregnant women. (shrink)

Qualitative evidence concerning the relationship between QoL and a wide range of disabilities suggests that subjective judgments regarding other people’s QoL are wrong more often than not and that such judgments by medical practitioners in particular can be biased. Guided by their desire to do good and avoid harm, surgeons often rely on "the eyeball test" to decide whether a patient will or will not benefit from surgery. But the eyeball test can easily harbor a range of implicit judgments (...) and biases against patients with disabilities, including erroneous assumptions about QoL. We critique the use of the "eyeball" test and offer suggestions to reduce bias and ensure that patients’ values are more consistently prioritized in surgical decision-making. (shrink)

Transoral laser microsurgery applies to the piecemeal removal of malignant tumours of the upper aerodigestive tract using the CO2 laser under the operating microscope. This method of surgery is being increasingly popularised as a single modality treatment of choice in early laryngeal cancers (T1 and T2) and occasionally in the more advanced forms of the disease (T3 and T4), predomi- nantly within the supraglottis. Thomas Kuhn, the American physicist turned philosopher and historian of science, coined the phrase ‘paradigm shift’ (...) in his groundbreaking book The Structure of Scientific Revolutions. He argued that the arrival of the new and often incompatible idea forms the core of a new paradigm, the birth of an entirely new way of thinking. This article discusses whether Steiner and col- leagues truly brought about a paradigm shift in oncological surgery. By rejecting the principle of en block resection and by replacing it with the belief that not only is it oncologically safe to cut through the substance of the tumour but in doing so one can actually achieve better results, Steiner was able to truly revolutionise the man- agement of laryngeal cancer. Even though within this article the repercussions of his insight are limited to the upper aerodigestive tract oncological surgery, his willingness to question other peoples’ dogma makes his contribution truly a genuine paradigm shift. (shrink)

T.H. Irwin characterizes the reflective equilibrium procedure as one which should not involve ruthless surgery, in a metaphorical sense. I argue that many people will find avoiding this difficult, because they do not conceive or go in for subtle options.

Animal-derived constituents are frequently used in anaesthesia and surgery, and patients are seldom informed of this. This is problematic for a growing minority of patients who may have religious or secular concerns about their use in their care. It is not currently common practice to inform patients about the use of animal-derived constituents, yet what little empirical data does exist indicates that many patients want the opportunity to give their informed consent. First, we review the nature and scale of (...) the problem by looking at the groups who may have concerns about the use of animal-derived constituents in their care. We then summarise some of the products used in anaesthesia and surgery that can contain such constituents, such as anaesthetic drugs, surgical implants and dressings. Finally, we explore the problem of animal-derived constituents and consent using Beauchamp and Childress’ four principles approach, examining issues of autonomy, beneficence, nonmaleficence and justice. Disclosing the use of animal-derived constituents in anaesthesia and surgery is warranted under Beauchamp and Childress’ four principles approach to the problem. Although there exist systemic and practical challenges to implementing this in practice, the ethical case for doing so is strong. The Montgomery ruling presents additional legal reason for disclosure because it entails that patients must be made aware of risks associated with their treatment that they attach significance to. (shrink)

This review aims to identify (1) sources of knowledge and (2) important themes of the ethical debate related to surgical alteration of facial features in East Asians. This article integrates narrative and systematic review methods. In March 2014, we searched databases including PubMed, Philosopher’s Index, Web of Science, Sociological Abstracts, and Communication Abstracts using key terms “cosmetic surgery,” “ethnic*,” “ethics,” “Asia*,” and “Western*.” The study included all types of papers written in English that discuss the debate on rhinoplasty and (...) blepharoplasty in East Asians. No limit was put on date of publication. Combining both narrative and systematic review methods, a total of 31 articles were critically appraised on their contribution to ethical reflection founded on the debates regarding the surgical alteration of Asian features. Sources of knowledge were drawn from four main disciplines, including the humanities, medicine or surgery, communications, and economics. Focusing on cosmetic surgery perceived as a westernising practice, the key debate themes included authenticity of identity, interpersonal relationships and socio-economic utility in the context of Asian culture. The study shows how cosmetic surgery of ethnic features plays an important role in understanding female identity in the Asian context. Based on the debate themes authenticity of identity, interpersonal relationships, and socio-economic utility, this article argues that identity should be understood as less individualistic and more as relational and transformational in the Asian context. In addition, this article also proposes to consider cosmetic surgery of Asian features as an interplay of cultural imperialism and cultural nationalism, which can both be a source of social pressure to modify one’s appearance. (shrink)

This article is concerned with "all-or-nothing" approaches to female genital cosmetic surgeries, those that overemphasize either women's autonomy to defend total accessibility or the oppressive social context affecting women to defend the total banning of the procedures. By contrast, the author takes both phenomena into consideration. The author argues identifying patterns of false consciousness and weighing those against harm done to a patient provides a moral basis for a doctor to possibly deny their consent at face value. This also requires (...) a shift in understanding the doctor–patient relationship as a first step toward a feminist model for women's healthcare. (shrink)

Background: The education of medical students necessitates teaching not only the science of medicine but also the skills needed for ethical reflection and moral reasoning as well as professionalism. At the Université de Montréal, starting in 2004, third-year medical students were initiated to ethics and professionalism during a weekly seminar on clinical skills during their surgery rotation. Students had to recognize an ethical dilemma or a professionalism issue that occurred during the rotation and write a case narrative and reflection (...) on the moral issue. Method: Student narratives describing ethical or professionalism incidents were collected between 2004 and 2020. These were analyzed to identify the moral challenges that students experienced, and how they reacted to ethical dilemmas or professionalism issues. Results: Of the 1145 narratives collected, 396 were coded as an ethical dilemma, subdivided into end-of-life decisions, decision for treatment, dilemmas concerning justice and resource allocation, and student educational dilemmas including relationships with residents. Professional issues were more frequently reported (n=749), subdivided into communication of bad news, professional behaviour and attitude, consent, confidentiality, truthful disclosure of sensitive results, errors, professional responsibility and commitment and relationships with colleagues. In 40% of narratives there was a positive opinion about the issues reported, while in 60% students felt the ethical decision or professional attitude or conduct was less than ideal. Conclusion: This seminar was an effective means for medical students to identify and discuss the ethical and professional issues experienced during their clerkship – issues regarding communication were the primary concern followed by professional behaviour. These narratives provide a good picture of the hidden curriculum; and they show that students can reflect meaningfully on issues concerning ethics and professionalism. (shrink)

The paper identifies the phenomenal rise of increasingly invasive forms of elective cosmetic surgery targeted primarily at women and explores its significance in the context of contemporary biotechnology. A Foucauldian analysis of the significance of the normalization of technologized women's bodies is argued for. Three "Paradoxes of Choice" affecting women who "elect" cosmetic surgery are examined. Finally, two utopian feminist political responses are discussed: a Response of Refusal and a Response of Appropriation.

Objective: During the pandemic, elective cases other than those requiring emergency thoracic surgery were postponed. Depending on the magnitude of the impact the pandemic posed on hospitals and clinics, there have been changes in the number and variety of cases of thoracic surgery. The intention behind conducting this study was to share the experiences gained by a thoracic surgery clinic during the pandemic period. Methods: Altogether, 214 patients were included in the study. Patient data that were recorded (...) included those on age, gender, lung pathology, duration of hospital stay, positivity for COVID-19, survival, and causes of death. Results: Of the 214 patients operated on, 12 died during the postoperative period. Eight of these patients died due to their primary disease and one died due to gastrointestinal bleeding, whereas the remaining three patients died due to COVID-19 infection. Conclusions: If opportunities and facilities favorable for the administration of surgical treatment are made available, surgical treatment services can be offered safely to all patients. (shrink)

When the benefits of surgery do not outweigh the harms or where they do not clearly do so, surgical interventions become morally contested. Cutting to the Core examines a number of such surgeries, including infant male circumcision and cutting the genitals of female children, the separation of conjoined twins, surgical sex assignment of intersex children and the surgical re-assignment of transsexuals, limb and face transplantation, cosmetic surgery, and placebo surgery.

In this article I propose to reframe debates about ideals of emotion in medicine, abandoning the current binary setup of this debate as one between ‘clinical detachment’ and empathy. Inspired by observations from my own field work and drawing on Sky Gross’ anthropological work on rituals of practice as well as Henri Lefebvre’s notion of rhythm, I propose that the normative drive of clinical practice can be better understood through the notion of attunement. In this framework individual types of emotions (...) are not, as such, appropriate or inappropriate, but are evaluated depending on their synchronicity with the specific rhythms of the practice. To set up this proposal, I show how typical arguments about emotions in medicine—what I call emotion-entity focused frameworks—are insufficient. I then draw on ethnographic observations from two orthopaedic departments and interviews with medical practitioners to show (1) how clinical practice is driven by rhythmicity, shaped in the case of orthopaedic surgery by a clinical aim of efficient, controlled intervention, and (2) how clinicians continuously refer to this drive and the flow of rhythms when evaluating inappropriate or problematic emotion. I argue that the use of a rhythm framework rather than ideals of detachment or empathy allows for a sensitivity to the complexity and situation-dependent elements of emotional ideals in clinical practice; and I end by proposing the term ‘attuned concern’—which stresses the importance of regulation and adjustment to circumstances rather than of maintaining a constant distance/involvement—as a more fitting alternative to ‘clinical detachment’. (shrink)

We respond to a Letter to the Editor regarding "Principlism and contemporary ethical considerations for providers of transgender health care." We address criticisms by Castle & Klein (2024) of blatant fatphobia related to the ethical elements concerning BMI restrictions for gender-affirming surgery. Our response corrects several mischaracterizations of the article and clarifies our position. My co-authors and I remain focused on advocating for patient-centered, ethically sound, evidence-based, and equitable healthcare policies.

Objective: microRNAs (miRNAs) have important potential as biomarkers in the diagnosis and prognosis of ischemia/reperfusion (I/R) injury in coronary artery bypass grafting surgery (CABG). This study investigated the relationship between preoperative (preop) and postoperative (post-op) cardiac parameters and miRNA expressions in CABG. -/- Methods: We analyzed a total of 94 individuals (CABG, n= 46 and healthy control, n=48). Quantitative real-time polymerase chain reaction (qRT) was performed to determine plasma miRNA expressions (miR-21, miR-181a, miR-199a, miR-199b, and miR-320a-5p) in triplicates: before (...) surgery, 1 hour after surgery, and 24 hours after surgery. The target genes and pathways of miRNA were determined using bioinformatic analysis. The biomarker potentials of miRNAs were evaluated with receiver operating characteristic (ROC) curve analysis. -/- Results: All miRNAs were significantly downregulated (p < 0.05). Troponin I, LVEF, CPK, and CK-MB were found to be statistically significant for operation groups (p < 0.05). miRNA expressions and cardiac markers were associated with troponin I and/or CK-MB. In ROC analyses, miR-199a was a good diagnostic marker. CREBRF and ZNF704 genes may be a target for these miRNAs. -/- Conclusions: Downregulation of miR-199a has a regulatory role in ischemia/reperfusion. They may contribute to CABG pathology through these two genes involved in signaling cascades to turn on protein response and ion binding. (shrink)

Objective: Acceptable preoperative psychosocial indicators of weight loss after obesity surgery in morbidly obese(MO) patients are still unknown. In this study, the association between personality traits, multidimensional perceived social support, and the percentage of excess weight loss (EWL) following obesity surgery was researched in MO patients. -/- Methods: Participants in this prospective study were recruited from MO patients who applied to the hospital’s obesity unit between July 2021 and June 2022. The study comprised 84 MO individuals. The Temperament (...) and Personality Inventory (TCI) was used to evaluate the personality traits of the MO. Perceived social support was measured using the multidimensional perceived social support scale. The percentage of weight loss after obesity surgery was compared with personality traits and perceived social support scores. Results: The mean age of the patients who were MO was 36.7 ±8.7 years. There were 22 men (25.3%) and 62 women (74.7%). The mean preoperative BMI was 46.2 ±63. The perceived social support score was 68.0±16.4. A univariate analysis found a positive relationship between 6 months and one year’s EWL and Self-Transcendence, a TCI subcategory (p=0.011,p=0.023). -/- Conclusion: Obesity treatment is a complex situation that requires a multidisciplinary approach. Given the potential physiological and psychological consequences of obesity surgery, it is critical to uncover psychological predictive factors such as personality traits that boost the success of obesity surgery and are connected with weight loss. As a result, knowing the individuals who self-transcendence before obesity surgery may be useful in predicting the success of obesity surgery and planning treatment. This requires large-scale research. (shrink)

The laws and principles which predict how perceptual qualities can be extracted from the most elementary visual signals were discovered by the Gestalt psychologists(e.g., Wertheimer,1923; Metzger,1930, translated and re-editedbySpillmann in 2009 and2012, respectively). Their seminal work has inspired visual science ever since, andhas led to exciting discoveries which have confirmed the Gestalt idea that the human brain would have an astonishing capacity for selecting and combining critical visual signals to generate output representations for decision making and action. This capacity of (...) selection and integration enables the perception of form and space, and the correct estimation of relative positions, trajectories, and distances of objects represented in planar images. This paper addresses problems of perceptual organization with critical implications for visual interfaces, and the design of surgical simulator platforms in particular. (shrink)

This work proposes an operational reinterpretation of nucleogenesis as a process of high-frequency scalping (HFT) of Ricci flow at the Planck horizon. Reality is considered not as a volumetric medium, but as a dynamic fixation surface bounded by the light front (axiom 1: space does not yet exist) and the Planck limit (axiom 2: space no longer exists). We introduce a modified Ricci flow equation with a surgical operator , activated upon reaching Planck density. The model demonstrates structural isomorphism between (...) physical processes (particle fixation, neutron decay, inflation) and financial market operations (scalping, stop-orders, candlestick patterns). We formalize the -operator (micro-level scalping surgery) and -operator (macro-level inflationary drift). Testable predictions are made: discreteness of nucleogenesis, correlation of particle lifetimes with structural complexity, and the presence of "inflationary memory" in the large-scale structure of the Universe. The work is conducted within the operational framework of Metamonism. (shrink)

Our present day knowledge in the area of medicine in Ancient Egypt has been severally sourced from medical papyri several of which have been deduced and analyzed by different scholars. For educational purposes it is always imperative to consult different literature or sources in the teaching of ancient Egypt and medicine in particular. To avoid subjectivity the author has found the need to re-engage the efforts made by several scholars in adducing evidences from medical papyri. In the quest to re-engage (...) the efforts of earlier writers and commentaries on the medical papyri, we are afforded the opportunity to be informed about the need to ask further questions to enable us to construct or reconstruct both past and modern views on ancient Egyptian medical knowledge. It is this vocation the author sought to pursue in the interim, through a preliminary review, to highlight, comment and reinvigorate in the reader or researcher the need for a continuous engagement of some pertinent documentary sources on Ancient Egyptian medical knowledge for educational and research purposes. The study is based on qualitative review of published literature. The selection of those articles as sources was based on the focus of the review, in order to purposively select and comment on articles that were published based either on information from a medical papyrus or focused on medical specialization among the ancient Egyptians as well as ancient Egyptian knowledge on diseases and medicine. It was found that the Egyptians developed relatively sophisticated medical practices covering significant medical fields such as herbal medicine, gynecology and obstetrics, anatomy and physiology, mummification and even the preliminary form of surgery. These practices, perhaps, were developed as remedies for the prevailing diseases and the accidents that might have occurred during the construction of their giant pyramids. It must be stated that they were not without flaws. Also, the key issues raised from these literatures are but a few among the Egyptian medical corpus across the academic and publishing world. It should therefore afford researchers, students and readers the opportunity to continue the educational dialogue on the medical practices of the Ancient Egyptians. (shrink)

Important achievements were obtained in the fields of mathematics, medicine, chemistry, astronomy, physics, optics, mechanics, zoology, botanic, mineralogy, geography and etc. in the Turkish-Islamic world between the ninth and thirteenth centuries. According to the leading historians of science, scholars living in different parts of the TurkishIslamic world not only surpassed their Greek and Byzantine predecessors. They also paved the way for development of these fields of science for following centuries. It is possible to mention many physicians that left non-erasable marks (...) in the medicine history among these distinguished scholars. One of these names is an Andalusian surgeon-physician called Abul-Qāsim alZahrāwī. He is known for his solid and unique contributions to the surgical world and regarded as the founder of surgery in the TurkishIslamic world. al-Zahrāwī wrote many books. One of these books, called al-Taṣrīf (The Method of Medicine) regarded as a medical encyclopedia has reached until today. The book attracted more attention in the European countries than in the Turkish-Islamic world and had an impact on Europe. Different chapters from the book were translated into languages such as Hebrew, French, English and especially Latin. al-Zahrāwī’s scientific heritage has also been discussed with all its aspects in Russia where scientists in the Turkish-Islamic world have especially been studied. Even though it was translated at a later period than Avicenna’s al-Qānūn fī al-Ṭibb (The Canon of Medicine), al-Taṣrīf was translated into Russian. The aim of this study is to identify Russian studies on Zahrawi and his main work, al-Taṣrīf -within the framework of available opportunitiesand to present prominent ones among these. In conclusion, this article also aims to contribute to the Turkish literature on al-Zahrāwī and al-Taṣrīf. Therefore, the author wishes to assist the relevant ongoing studies and the ones to be conducted in the future in terms of bibliography and material index. (shrink)

This paper addresses two related topics: 1. The disanalogies between elective cosmetic practices and sex reassignment surgery. Why does it seem necessary for me – an aging professional woman – to ignore the blandishments of hairdressers wielding dyes and dermatologists wielding acids and scalpels? Why does it not seem equally necessary for a transgendered person to repudiate sex reassignment procedures? 2. The role of the body in identity and agency. How do phenomenological insights regarding the constitution of selfhood in (...) relation to the interplay between the body image and corporeal know-how contribute to an account of the agency of transgendered individuals? Studying several paintings by contemporary feminist artist Jenny Saville has advanced my thinking on these topics. Saville’s imagery is an invaluable aid to reflection on these issues because she uses her painterly technique, which critics often dub “virtuoso,” to represent lived human bodies. In her work, viewers encounter representations of subjectivized, agentic corporeity, as distinct from inert, objectified flesh. Moreover, her sympathetic engagement with nonconformist, devalued bodies helps to reconfigure the standard gestalts of the human body that viewers typically carry with them and thus to convert fear and/or disgust into appreciation and understanding. In this paper, I consider three of Saville’s paintings. Plan, Saville’s self-portrait as a nude female whose body has been prepped for liposuction, conveys the pathos of this procedure. Matrix is a nude portrait of self-described “gender variant visual artist” Del LaGrace Volcano. In the words of one critic Saville’s depiction of Volcano’s nude intersexed body “restores beauty to the primitive [female] genital organ.” Passage, another nude portrait of an intersexed individual, is an image of vibrant sexuality despite the presumptively jarring juxtaposition of breasts and a penis. I argue that conceiving the agentic subject as a rational deliberative capability that uses a conjoined body as the instrument of its will makes it impossible to theorize the agency of transgendered people. In contrast, when agentic subjects are understood as embodied subjects and embodiment is understood as a dimension of practical intelligence, the agency of transgendered individuals is intelligible. (shrink)

Recent developments in neuroscience create new opportunities for understanding the human brain. The power to do good, however, is also the power to harm, so scientific advances inevitably foster as many dystopian fears as utopian hopes. For instance, neuroscience lends itself to the fear that people will be forced to reveal thoughts and feelings which they would not have chosen to reveal, and of which they may be unaware. It also lends itself to the worry that people will be encouraged (...) to submit to medication or surgery which, even if otherwise beneficial, alters their brain in ways that undermine their identity and agency. As Kenneth Foster notes, neural implants can have surprising and unintended adverse effects, even when they help to mitigate the loss of bodily control associated with Parkinson’s disease, or help to provide hearing for children who would otherwise be profoundly deaf. While the risk of adverse outcomes are scarcely specific to neuroscience, he thinks that ‘These issues are perhaps more acute’ with the latter than with other medical interventions, ‘because they are intimately and fundamentally related to a person’s communication with the outside world’. [ 2006 196] -/- Neuroscience, like genomic science, then, is likely to create new ways of harming people. Many of these will involve violations of privacy. However, these are unlikely fundamentally to challenge the reasons to value privacy, or our ability to protect it in the foreseeable future. Rather, I would suggest, the major threat to privacy comes from the difficulty of determining its nature and value and when, if ever, efforts to protect it are justified. So I will start by examining some threats to privacy, and their implications for neuroscience, before turning to philosophical problems in understanding the nature and value of privacy, and the practical consequences of those philosophical difficulties. (shrink)

In liberal moral theory, interfering with someone’s deliberate engagement in a self-harming practice in order to promote their own good is often considered wrongfully paternalistic. But what if self-harming decisions are the product of an oppressive social context that imposes harmful norms on certain individuals, such as, arguably, in the case of cosmetic breast surgery? Clare Chambers suggests that such scenarios can mandate state interference in the form of prohibition. I argue that, unlike conventional measures, Chambers’ proposal recognises that (...) harmful, discriminatory norms entail a twofold collective moral obligation: to eliminate the harmful norm in the long run, but also to address unjust harm that is inflicted in the meantime. I show that these two obligations tend to pull in opposite directions, thus generating a serious tension in Chambers’ proposal which eventually leads to an undue compromising of the second obligation in favour of the first. Based on this discussion, I develop an alternative proposal which, instead of prohibiting breast implant surgery, offers compensation for the disadvantages suffered by individuals who decide not to have surgery. (shrink)

The mythical bronze creature Talos (Greek: Τάλως) was worshiped initially as the god of light or the sun in the Hellenic Island of Crete. He is supposed to have lived in the peak Kouloukona of the Tallaia Mountains in the Gerontospelio cave. His relation towards bronze and fire and his continuous voyage circling the island of Crete most probably introduces the concept of the change of the four seasons. The sun was considered in the area of the South-East Mediterranean nations (...) as just judge, a guardian who monitors and judges from above all the actions of the commoners, a controller for the faithful application of laws in Crete [1]. Hesychios in his Lexicon notes that talos means sun and that the name Tallaios was initially attributed to Zeus [2]. The birth of the Olympian gods forged a new Pantheon and nomenclature forcing some of the old gods to fell into lower deities. This happened to Talos who soon became a mythical hero [1]. According to Apollodorus, the bronze creature was forged by the magnificent constructor Hephaestus as a gift to the mythical King Minoa to help him guard the island [3]. Although the verb “peritrohazo” (Greek: περιτροχαζω) was used, meaning a movement in a steady orbit (track), some depictions image him as a winged being. To protect the island, he was throwing rocks into unknown ships or in the case of a foreign landing he was burning with fire or with his flamed bronze body the intruders. He was holding copper plates with the laws of the island and his circle allowed him to pass all island sores three times daily [1,4-6]. Plato, speaks of him as a real person, suggesting he was the brother of King Rhadamanthys, thus a son of Zeus [5]. Talos may be considered as the token of the Cretan power, a symbol of technological development in the field of metalworking in prehistoric and Minoan times. An animated, programmed gigantic android to enforce its will. A primitive robot for basic actions having a power source, fire and ichor (Greek: ιχώρ) the sacred fluid in the vessels of the gods. The first manufactured being with his individual intelligence, a primary concept of artificial intelligence (AI) [7]. Homer was the first to introduce the term automata (Greek: αυτόματα), to describe ingenious machines built by the supreme blacksmith god of invention and technology, God of metal and fire, Hephaestus, manufactured devices “acting of one’s own will” as the Hellenic word indicates [8]. Eons later, the humanoid automaton the “Automa cavaliere” (English: Automaton knight) appeared in the court of the nobleman and Duke of Milan Ludovico Maria Sforza. It was the year 1495, when Leonardo da Vinci presented his robotic knight, an innovative construction operated by a series of pulleys and cables, presenting though no individual mind. Although it was manufactured by a highly intelligent polymath, it could only be operated through an outer intelligence [9]. Advancements made during the Fourth Industrial Revolution allowed modern technology to manufacture intelligent machines to aid the field of invasive surgery. One of those most sophisticated devises is the da Vince Surgical Tower. Launched in the setting of the 21st century, the DaVinci System is one of the most commonly employed tools/systems, which has prevailed in the field of robotic-assisted surgery [10]. One could claim that it practically reshaped the concept of surgery, providing doctors with immense capabilities, aiming towards the optimal post-operative outcome. Through visual augmentation, high resolution 3D video, enhanced precision and reduced complication rates [11] the DaVinci Si and the latest DaVinci Xi system have been implemented in a variety of surgeries, including but not limited to general, urologic, gynecologic, thoracic and even cardiac procedures; valve and coronary artery bypass graft operations [12,13]. Da Vinci is cleared globally for cardiosurgery and came in vogue to fulfill the dream of cardiac surgeons to operate in closet chest. It offers in patients the same benefits as those that open chest incision surgery procedures do [14]. The more recent DaVinci Xi model was introduced to counteract commonly known drawbacks of the Si system, such as the inability to simultaneously manipulate the different abdominal quadrants [10]. It consists of four boom mounted robotic arms along with a mobile platform and a master console. The latter with the adaptable intraocular distance, the cushioned headrest, the modifiable arm bars and the flexible finger loops, is meticulously designed to meet the surgeon´s “demands” [12]. Every robotic arm has three degrees of freedom, which combined with the EndoWrist technology to imitate the delicate motion of the surgeon´s hand, acquires an extra seven degrees of freedom. Evidently, the combination of the user-friendly interface, the high-quality 3D intraoperative images, the multiple joints and sensors, as well as the surgeon himself, who can learn to handle the DaVinci Xi Surgical System in a relatively short period of time, has established the model in the surgical armamentarium, paving the way towards a continuously progressive future of minimally invasive and robotic surgery (Figure 1) [12]. History testifies that the nomination of the AI surgical tower as da Vinci was wrongfully given to commemorate a majestic historical figure. It is clear that the mythical creature Talos which was fabricated by the ingenious god Hephaestus was the first true automaton in the line of AI origins. (shrink)

Orlan is a French performance artist whose work on beauty elicits shock and disgust. Beginning in 1990, she began a series of nine aesthetic surgeries entitled The Reincarnation of St. Orlan that altered her face and body, placed her at risk in the operating room, and centered her within certain controversy in the art world. Undergoing only epidural anaesthesia and controlling the performance to the greatest degree possible, she "choreographs" and documents the events. This enhanced interview I conducted with Orlan (...) cites her own words and offers commentary and explanation on her complex and conceptual works of art. I offer a concept of "virtual beauty" and locate her aesthetic intentionality within the realm of traditional art history (works by the great "masters" of art) and traditional aesthetics, rejecting any possibility of a viewer's disinterested stance toward Orlan's visual representations. (shrink)

A good surgeon knows how to perform a surgery; a good architect knows how to design a house. We value their know-how. We ordinarily look for it. What makes it so valuable? A natural response is that know-how is valuable because it explains success. A surgeon’s know-how explains their success at performing a surgery. And an architect’s know-how explains their success at designing houses that stand up. We value know-how because of its special explanatory link to success. But (...) in virtue of what is know-how explanatorily linked to success? This essay provides a novel argument for the thesis that know-how’s special link to success is to be explained at least in part in terms of its being, or involving, a doxastic attitude that is epistemically alike propositional knowledge. It is argued that the role played by know-how in explaining intentional success shows that the epistemic differences between know-how and knowledge, if any, are less than usually thought; and that "revisionary intellectualism", the view that know-how is true belief that might well fall short of knowledge, is not really a stable position. If its explanatory link to success is what makes know-how valuable, an upshot of my argument is that the value of know-how is due, to a considerable extent, to its being, or involving, a kind of propositional knowledge. (shrink)

In bioethics, the predominant categorization of various types of influence has been a tripartite classification of rational persuasion (meaning influence by reason and argument), coercion (meaning influence by irresistible threats—or on a few accounts, offers), and manipulation (meaning everything in between). The standard ethical analysis in bioethics has been that rational persuasion is always permissible, and coercion is almost always impermissible save a few cases such as imminent threat to self or others. However, many forms of influence fall into the (...) broad middle terrain—and this terrain is in desperate need of conceptual refining and ethical analysis in light of recent interest in using principles from behavioral science to influence health decisions and behaviors. This paper aims to address the neglected space between rational persuasion and coercion in bioethics. First, I argue for conceptual revisions that include removing the “manipulation” label and relabeling this space “nonargumentative]influence,” with two subtypes: “reason-bypassing” and “reason-countering.” Second, I argue that bioethicists have made the mistake of relying heavily on the conceptual categories themselves for normative work and instead should assess the ethical permissibility of a particular instance of influence by asking several key ethical questions, which I elucidate, that relate to (1) the impact of the form of influence on autonomy and (2) the relationship between the influencer and the influenced. Finally, I apply my analysis to two examples of nonargumentative influence in health care and health policy: (1) governmental agencies such as the Food and Drug Administration (FDA) trying to influence the public to be healthier using nonargumentative measures such as vivid images on cigarette packages to make more salient the negative effects of smoking, and (2) a physician framing a surgery in terms of survival rates instead of mortality rates to influence her patient to consent to the surgery. (shrink)

We have basic liberal rights to live and act with integrity; these rights very plausibly ground our rights to freedom of religious belief and expression. In section 1, I argue that many trans people need to be able to change their gender markers on their legal identification documents in order to live and act with integrity, and because of this, trans people have pro tanto rights to change their gender markers on their legal identification documents. In section 2, I then (...) argue that: a) there are no rights, harms, or other considerations that outweigh trans and nonbinary people’s pro tanto rights to freedom of legal gender identification; b) in virtue of a, blanket bans on gender marker change and surgery requirements on gender marker change are unjust and breach trans and nonbinary people’s all-things-considered rights to freedom of legal gender identification; and c) there is a strong presumption in favor of either the legal decertification of gender, gender self-identification, or similar policies that make it relatively easy for trans people to change their gender markers. Finally, in section 3, I argue that this integrity-based approach to rights to freedom of legal gender identification is superior to alternative privacy-, autonomy-, and harm-based approaches. (shrink)

Ellie Anderson had always known that she wanted to have children. Her mother, Louise, was aware of this wish. Ellie was designated male at birth, but according to news sources, identified as a girl from the age of three. She was hoping to undergo gender reassignment surgery at 18, but died unexpectedly at only 16, leaving Louise grappling not only with the grief of losing her daughter, but with a complex legal problem. Ellie had had her sperm frozen before (...) starting hormone treatment, specifically so that she would retain the chance of becoming a parent after her gender reassignment. Ellie had considered what might happen to the sperm if she died and was adamant that her children should be brought into the world. She made her mother promise to ensure that this would happen. But according to UK law, Ellie’s mother has no legal right to retain her sperm, or to use it to fulfil Ellie’s wishes. In this paper, we raise several key ethical questions on this case, namely: does a refusal to bring Ellie’s children into the world wrong her posthumously? Is Ellie’s mother morally entitled to use her daughter’s sperm as Ellie wished? Should the fact that Ellie was a minor at the time of her death or the fact that she was transgendered undermine her wish to have children? Can Ellie become a parent posthumously? We consider how these complex ethical questions could be approached. (shrink)

Suppose that a patient is receiving treatment options from her doctor. In one case, the doctor says, “the surgery has a 90% survival rate.” Now, suppose the doctor instead said, “the procedure has a 10% mortality rate.” Predictably, the patient is more likely to consent on the first description and more likely to dissent on the second. This is an example of a framing effect. A framing effect occurs when “the description of [logically-equivalent] options in terms of gains (positive (...) frame) rather than losses (negative frame) elicits systematically different choices.” Framing effects are ubiquitous, but they are particularly troublesome in medicine. Many worry that there is tension between valuing informed consent and using framing effects in clinical settings. In this paper, I answer this question: if an individual is subject to a framing effect when she gives her consent, does this undermine the validity of her consent? I argue that framing effects do not undermine consent in general. (shrink)

Semaglutide (Wegovy), a glucagon-like peptide-1 receptor agonist (GLP-1 RA), has attracted global attention for its appetite-suppressing and weight-loss effects. Approved by the U.S. FDA in 2022 for adolescents aged 12 and older, it has since been authorized in several other countries. Despite this, its use among youth remains limited, with ongoing concerns about its long-term safety, efficacy, and suitability during periods of growth and development. Advocates see Wegovy as an important tool for addressing pediatric obesity and its psychological burdens, while (...) critics caution against widespread use in such a vulnerable population. -/- This paper examines an underexplored ethical dimension of Wegovy’s use in children: its impact on mental health. We argue that Wegovy may offer mental health benefits for children—such as reducing weight stigma, improving self-esteem, and avoiding invasive interventions such as bariatric surgery. However, these potential benefits are constrained by barriers to access, supply shortages, risks of misuse, and the possibility of reinforcing stigma and class-based discrimination. -/- In light of these considerations, we argue that while Wegovy offers promising health benefits for children, its long-term effects on growth, development, and mental health remain uncertain, warranting further study before definitive policy decisions are made. If future evidence confirms its value, it is our view that access should be equitable and accompanied by reforms to reduce stigma, regulate prescribing, and prevent misuse. Until then, clinicians should prescribe cautiously, ensuring clear medical need and implementing safeguards against risks such as weight regain, treatment interruption, and bias in care. (shrink)

The power of consent enables one person to give another person a moral permission by releasing them from a duty. The examples of consent to sex, surgery, and the sharing of property are familiar. This article considers whether consent requires uptake from the consent-receiver if they are to acquire this moral permission. Most philosophers writing about the ethics of consent suggest that uptake is not necessary. This article argues, by contrast, that we should endorse an uptake condition for consent-based (...) permissions. It does so by locating an uptake condition within a general account of wronging and its interpersonal significance. On the view defended, consent-sensitive duties should be interpreted as requiring a consent-receiver to treat consent as a deliberative constraint on action. On this view, if a consent-receiver acts without recognizing that consent has been given, they violate the consent-sensitive duty they owe to the consent-giver. (shrink)

A common style of argument in the literature on free will and moral responsibility is the Manipulation Argument. These tend to begin with a case of an agent in a deterministic universe who is manipulated, say, via brain surgery, into performing some action. Intuitively, this agent is not responsible for that action. Yet, since there is no relevant difference, with respect to whether an agent is responsible, between the manipulated agent and a typical agent in a deterministic universe, responsibility (...) is not compatible with the truth of determinism. In response, some theorists have argued that there is a relevant difference, and have developed two sorts of accounts of that difference: bypassing views, and manipulator-focused views. Manipulator-focused views suggest that the difference concerns the presence of a manipulator, whereas bypassing views suggest that the relevant difference concerns the fact that the action issues from attitudes that the manipulated agent acquired in a way that bypassed her capacities for control over her mental life. One sort of case used to decide between these sorts of accounts is a case of machine induction, which is just like a manipulation case, yet the change in the agent is the result of some natural force. Against the received view, Xiaofei Liu argues that such cases pose problems for bypassing views, and favor manipulator-focused views instead. This paper addresses Liu’s arguments, as well as a variety of cases, concluding that cases of machine induction do not provide motivation for a bypassing theorist to adopt a manipulator-focused view. (shrink)

In this issue, Ahmadi1 reports on the practice of hymenoplasty—a surgical intervention meant to restore a presumed physical marker of virginity prior to a woman's marriage. As Mehri and Sills2 have stated, these women ‘want to ensure that blood is spilled on their wedding night sheets.’ Although Ahmadi's research was carried out in Iran specifically, this surgery is becoming increasingly popular in a number of Western countries as well, especially among Muslim populations.3 What are the ethics of hymen restoration?Consider (...) the role of the physician. Two of the doctors interviewed by Ahmadi reported being in ‘a perpetual state of guilt because of the surgery's inherent aim at deceiving the groom’ and noted their ‘personal conflict’ at being involved in this deception. Yet: "None of the doctors believed that the surgery was unethical, arguing that the girl could be ‘abused’ and ‘can even die’ if she is discovered not … ". (shrink)

Beauty has captured human interest since before Plato, but how, why, and to whom does beauty matter in today's world? Whose standard of beauty motivates African Americans to straighten their hair? What inspires beauty queens to measure up as flawless objects for the male gaze? Why does a French performance artist use cosmetic surgery to remake her face into a composite of the master painters' version of beauty? How does beauty culture perceive the disabled body? Is the constant effort (...) to remain young and thin, often at considerable economic and emotional expense, ethically justifiable? Provocative essays by an international group of scholars discuss aesthetics in aesthetics, the arts, the tools of fashion, the materials of decoration, and the big business of beautification—beauty matters—to reveal the ways gender, race, and sexual orientation have informed the concept of beauty and driven us to become more beautiful. Here, Kant rubs shoulders with Calvin Klein. Beauty Matters draws from visual art, dance, cultural history, and literary and feminist theory to explore the values and politics of beauty. Various philosophical perspectives on ethics and aesthetics emerge from this penetrating book to determine and reveal that beauty is never disinterested. (shrink)

Florence Ashley has argued that requiring patients with gender dysphoria to undergo an assessment and referral from a mental health professional before undergoing hormone replacement therapy (HRT) is unethical and may represent an unconscious hostility towards transgender people. We respond, first, by showing that Ashley has conflated the self-reporting of symptoms with self-diagnosis, and that this is not consistent with the standard model of informed consent to medical treatment. Second, we note that the model of informed consent involved in cosmetic (...) surgery resembles the model Ashley defends, and that psychological assessment and referral is recognised as an important aspect of such a model. Third, we suggest that the increased prevalence of psychiatric morbidity in the transgender population arguably supports the requirement of assessment and referral from a mental health professional prior to undergoing HRT. (shrink)

Body Integrity Identity Disorder (BIID) is a very rare condition describing those with an intense desire or need to move from a state of ability to relative impairment, typically through the amputation of one or more limbs. In this paper, I draw upon research in critical disability studies and philosophy of disability to critique arguments based upon the principle of nonmaleficence against such surgery. I demonstrate how the action-relative concept of harm in such arguments relies upon suspect notions of (...) biological and statistical normality, and I contend that each fail to provide normative guidance. I then propose a critical theory of harm, one marked by substantive engagement with both empirical and reflective inquiry across the sciences, social sciences, and humanities. I conclude by discussing the implications of this theory and how it might enrich ongoing debates in bioethics, philosophy of disability, and the health humanities. (shrink)

Pascal’s wager uses decision theory to argue that it is rational to attempt to nurture belief in God, based on the expected utility of believing (infinite happiness) compared to not believing (at best, only finite happiness). A belief in an eternal conscious torment in hell (infinite suffering) for non-believers makes the differences in expected utility even more apparent, strengthening the argument. Similar reasoning can also be used to calculate the expected moral value of actions, including procreation. Under theism, if possible (...) future children might suffer eternal conscious torment, the expected moral value of procreation is extremely negative. This implies that theists have a moral obligation not to procreate, which for most theists, entails a moral obligation to be celibate or to undergo sterilisation surgery. (shrink)

Therapy-speak is the imprecise and superficial integration of psychotherapy language into everyday communication, especially by privileged or wealthy people. Despite the advantages of normalizing psychotherapy language, such as resisting epistemic injustice and enhancing awareness of mental health issues, therapy-speak raises important concerns. On the epistemic front, therapy-speak is susceptible to the erosion of the meaning and relevance of psychotherapy terms, pathologizing, and the risk of self-diagnosis. Regarding its ethical concerns, therapy-speak might be used to discredit individuals, evade responsibilities, and even (...) signal social status, by taking an objective stance. Beyond these epistemic and ethical concerns, therapy-speak can also be weaponized to promote and perpetuate some forms of epistemic injustice, and to generate affective injustice. In particular, we argue that the weaponization of therapy-speak exploits the epistemic authority and the credibility excesses of medical evidence, the conflation between the descriptive and the normative, and the linguistic strategy of deniability to impose a specific way to manage emotions in challenging, and unjust, situations. (shrink)

Onychectomy involves the surgical amputation of a cat's claws. Tendonectomy entails surgically cutting tendons to prevent the extension and full use of a cat's claws. Both surgeries practically declaw cats and are not only painful but also associated with high complication rates. While feline declawing surgeries have been banned in various places around the world, they are still elective in many countries and U.S. states. This article provides an ethical analysis of declawing cats. It discusses the harms posed by feline (...) declawing surgeries, like pain and complications, which are not offset by any benefits to cats. Drawing on Martha Nussbaum's capabilities approach, it also offers an additional and broader ethical argument against declawing, namely that removing cats' claws is unjust because it thwarts important capabilities for feline flourishing (e.g., play, bodily integrity, control over one's environment). It concludes that declawing cats for non-medical purposes is unethical and must be opposed. (shrink)

Biomedical technologies can increasingly be used not only to combat disease, but also to augment the capacities or traits of normal, healthy people – a practice commonly referred to as biomedical enhancement. Perhaps the best‐established examples of biomedical enhancement are cosmetic surgery and doping in sports. But most recent scientific attention and ethical debate focuses on extending lifespan, lifting mood, and augmenting cognitive capacities.

In 1993 the Law Lords upheld the original conviction of five men under the 1861 Offences Against the Person Act for participating in sado-masochistic practices. Although the five men were fully consenting adults, the Law Lords held that consent did not constitute a defence to acts of violence within a sado-masochistic context. This paper examines the judgements in this case and argues that sado-masochistic practices are no different from the known exceptions cited by the court to the idea that consent (...) is no defence to violence (sport, parental chastisement and surgery). It also argues that if we can make sense of rape as a non-consensual, violent act, expressed through sex, then we can make sense of sado-masochism as a consensual sexual act, expressed through violence. (shrink)

The ‘man born blind restored to light’ was one of the foundational myths of the Enlightenment, according to Foucault. With ophthalmic surgery in its infancy, the fascination by the sighted with blindness and what the blind might ‘see’ after sight restoration remained largely speculative. Was being blind, as Descartes once remarked, like ‘seeing with the hands’? Did evidence from early cataract operations begin to resolve epistemological debates about the relationship between vision and touch in the newly sighted, such as (...) the famous ‘Molyneux Question’ posed by William Molyneux to John Locke? More recently, how have autobiographical accounts of blind and vision impaired writers and poets advanced the sighted public’s understanding of blind subjectivity? -/- Through an unfolding historical, philosophical and literary narrative that includes Locke, Molyneux and Berkeley in Britain, and Diderot, Voltaire and Buffon in France, this book explores how the Molyneux Question and its aftermath has influenced attitudes towards blindness by the sighted, and sensory substitution technologies for the blind and vision impaired, to this day. (shrink)

Body dysmorphic disorder (BDD) poses a significant challenge to an individual’s mental well-being. The obsessive preoccupation with perceived defects in one’s appearance affects individuals’ daily functioning and can result in serious risks, including suicidal ideation and self-surgery. While treatments such as cognitive behavioural therapy and serotonin reuptake inhibitors can provide relief, they do not achieve complete remission. It has been suggested that therapy should not only interrupt the harmful behaviour, but should also address their sense of self, and that (...) after addressing their internalised values, individuals with BDD will be able to incorporate their perceived defect in a manner similar to how individuals with real deformities often do. Phenomenology of psychopathology analyses subjectivity in cases of pathology, and analyses of BDD show that the perceived defect has become a locus of shame. This implies that individuals with BDD have permanently incorporated the gaze of the Other and constantly experience their body as a body-for-others. This paper further explores the sense of self in individuals with BDD through Jenny Slatman’s interpretation of bodily integrity: bodily integrity as a never-ending process of identification. By comparing the experiences of individuals with BDD to those with real deformities and to those who have undergone cosmetic surgery, I will show that re-identification does not occur in individuals with BDD. This suggests that their bodily integrity is fundamentally disturbed and that addressing their internalised values alone will probably not be sufficient for the disorder to go into remission. (shrink)

Florence Ashley has responded to our response to ‘Gatekeeping hormone replacement therapy for transgender patients is dehumanising.’ Ashley criticises some of our objections to their view that patients seeking hormone replacement therapy (HRT) for gender dysphoria should not have to undergo a prior psychological assessment. Here we clarify our objections, most importantly that concerning the parity between cosmetic surgery and the sort of intervention Ashley has in mind. Firstly, we show Ashley’s criticism of our comparison is insubstantial. We then (...) examine their comments regarding the analogy between abortion and HRT, and the language of informed consent. We also scrutinize the data upon which Ashley relies to defend the claim that informed consent without assessment always yields positive outcomes, finding this conclusion to be overstated. Finally, even if Ashley’s arguments were vindicated, the claim that the gatekeeping of HRT is motivated by hostility towards transgender people remains unsupported. (shrink)

In this paper, we argue that providers who conscientiously refuse to provide legal and professionally accepted medical care are not always morally required to refer their patients to willing providers. Indeed, we will argue that refusing to refer is morally admirable in certain instances. In making the case, we show that belief in a sweeping moral duty to refer depends on an implicit assumption that the procedures sanctioned by legal and professional norms are ethically permissible. Focusing on examples of female (...) genital cutting, clitoridectomy and ‘normalizing’ surgery for children with intersex traits, we argue that this assumption is untenable and that providers are not morally required to refer when refusing to perform genuinely unethical procedures. The fact that acceptance of our thesis would force us to face the challenge of distinguishing between ethical and unethical medical practices is a virtue. This is the central task of medical ethics, and we must confront it rather than evade it. There are no data in this work. (shrink)

Background: Microbiome biomarker discovery for patient diagnosis, prognosis, and risk evaluation is attracting broad interest. Selected groups of microbial features provide signatures that characterize host disease states such as cancer or cardio-metabolic diseases. Yet, the current predictive models stemming from machine learning still behave as black boxes and seldom generalize well. Their interpretation is challenging for physicians and biologists, which makes them difficult to trust and use routinely in the physician-patient decision-making process. Novel methods that provide interpretability and biological insight (...) are needed. Here, we introduce "predomics", an original machine learning approach inspired by microbial ecosystem interactions that is tailored for metagenomics data. It discovers accurate predictive signatures and provides unprecedented interpretability. The decision provided by the predictive model is based on a simple, yet powerful score computed by adding, subtracting, or dividing cumulative abundance of microbiome measurements. -/- Results: Tested on >100 datasets, we demonstrate that predomics models are simple and highly interpretable. Even with such simplicity, they are at least as accurate as state-of-the-art methods. The family of best models, discovered during the learning process, offers the ability to distil biological information and to decipher the predictability signatures of the studied condition. In a proof-of-concept experiment, we successfully predicted body corpulence and metabolic improvement after bariatric surgery using pre-surgery microbiome data. -/- Conclusions: Predomics is a new algorithm that helps in providing reliable and trustworthy diagnostic decisions in the microbiome field. Predomics is in accord with societal and legal requirements that plead for an explainable artificial intelligence approach in the medical field. (shrink)

This paper was written to study the order of medical advances throughout history. It investigates changing human beliefs concerning the causes of diseases, how modern surgery developed and improved methods of diagnosis and the use of medical statistics. Human beliefs about the causes of disease followed a logical progression from supernatural causes, such as the wrath of the Gods, to natural causes, involving imbalances within the human body. The invention of the microscope led to the discovery of microorganisms which (...) were eventually identified as the cause of infectious diseases. Identification of the particular microorganism causing a disease led to immunization against the disease. Modern surgery only developed after the ending of the taboo against human dissection and the discovery of modern anesthesia and the discovery of the need for anti-septic practices. Modern diagnostic practices began with the discovery of x-rays and the invention of medical scanners. Improved mathematics, especially in probability theory, led to statistical studies which led to a much greater ability, to identify the causes of disease, and to evaluate the effectiveness of treatments. These discoveries all occurred in a necessary and inevitable order with the easiest discoveries being made first and the harder discoveries being made later. The order of discovery determined the course of the history of medicine and is an example of how social and cultural history has to follow a particular course determined by the structure of the world around us. (shrink)

Trans healthcare and thus trans people have been severely affected by the COVID-19 pandemic. Trans people’s healthcare situations have turned out to be so vulnerable in this crisis because they have been precarious to begin with. There are multiple ways in which trans healthcare has been affected: Surgeries and other procedures have been cancelled or postponed, and mental health services have been paused or moved online. This raises ethical questions around discrimination against trans people in the healthcare system. This article (...) argues that cancelling trans surgeries and procedures in the COVID-19 crisis is made possible through an understanding of trans healthcare as non-essential. The article explores how trans healthcare in particular has been affected by the pandemic. (shrink)