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  1. Article ; Online: Why Deny ECMO-DT to the Incapacitated?

    Karches, Kyle E

    The American journal of bioethics : AJOB

    2023  Volume 23, Issue 6, Page(s) 70–72

    MeSH term(s) Humans ; Extracorporeal Membrane Oxygenation
    Language English
    Publishing date 2023-06-01
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 2060433-6
    ISSN 1536-0075 ; 1526-5161
    ISSN (online) 1536-0075
    ISSN 1526-5161
    DOI 10.1080/15265161.2023.2201216
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    Zs.A 6814: Show issues Location:
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  2. Article ; Online: The Moral Difference between Faces & FaceTime.

    Karches, Kyle E

    The Hastings Center report

    2023  Volume 53, Issue 4, Page(s) 16–25

    Abstract: Although the technology for telemedicine existed before the Covid-19 pandemic, the need to provide medical services while minimizing the risk of contagion has encouraged its more widespread use. I argue that, although telemedicine can be useful in ... ...

    Abstract Although the technology for telemedicine existed before the Covid-19 pandemic, the need to provide medical services while minimizing the risk of contagion has encouraged its more widespread use. I argue that, although telemedicine can be useful in certain situations, physicians should not consider it an adequate substitute for the office visit. I first provide a narrative account of the experience of telemedicine. I then draw on philosophical critiques of technology to examine how telemedicine has epistemic and ethical effects that make some of the goods of medicine unavailable. Telemedicine rules out an embodied encounter between physician and patient, in which the sense of touch has special importance. The individualized attention facilitated by the in-person visit may better sustain a caring physician-patient relationship. Physicians should criticize attempts by administrators, insurers, or other parties to incentivize the wholesale replacement of traditional office visits with telemedicine.
    MeSH term(s) Humans ; COVID-19 ; Pandemics ; Mobile Applications ; Morals ; Physician-Patient Relations
    Language English
    Publishing date 2023-08-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 194940-8
    ISSN 1552-146X ; 0093-0334
    ISSN (online) 1552-146X
    ISSN 0093-0334
    DOI 10.1002/hast.1497
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    Zs.B 1672: Show issues Location:
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  3. Article ; Online: The Value of a Gut Punch.

    Karches, Kyle E

    JAMA

    2022  Volume 328, Issue 18, Page(s) 1809–1810

    MeSH term(s) Humans ; Physician-Patient Relations ; Students, Medical
    Language English
    Publishing date 2022-11-08
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2958-0
    ISSN 1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
    ISSN (online) 1538-3598
    ISSN 0254-9077 ; 0002-9955 ; 0098-7484
    DOI 10.1001/jama.2022.19627
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  4. Article ; Online: Temperance, Moral Friendship, and Smoking Cessation.

    Karches, Kyle

    The Journal of medicine and philosophy

    2019  Volume 44, Issue 3, Page(s) 299–313

    Abstract: The predominant approach of public health experts to cigarette smoking might be described as behaviorist, for it aims to eliminate this behavior without attending to human agency and intention. The requirement that physicians address smoking cessation at ...

    Abstract The predominant approach of public health experts to cigarette smoking might be described as behaviorist, for it aims to eliminate this behavior without attending to human agency and intention. The requirement that physicians address smoking cessation at every patient visit also constitutes physicians as "managers" who focus narrowly on technical means to achieve predetermined ends. In this paper, I contrast such an approach with the Aristotelian tradition, according to which physician and patient ought to develop the virtue of temperance that would allow the patient to quit smoking. Although this model could potentially mitigate medicine's behaviorist-managerial tendencies, I follow Aristotle to argue that it requires a moral friendship in which participants share a conception of the human good and pursue that good together. Due to the intractable moral pluralism that characterizes contemporary life, physicians and patients are unlikely to achieve this sort of friendship, making Aristotelian medicine impracticable at present.
    MeSH term(s) Friends/psychology ; Humans ; Intention ; Morals ; Philosophy, Medical ; Physician-Patient Relations ; Smoking Cessation/psychology ; Temperance/psychology ; Virtues
    Language English
    Publishing date 2019-05-17
    Publishing country United States
    Document type Journal Article
    ZDB-ID 197282-0
    ISSN 1744-5019 ; 0360-5310
    ISSN (online) 1744-5019
    ISSN 0360-5310
    DOI 10.1093/jmp/jhz003
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    Zs.A 1265: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (1.OG)
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  5. Article ; Online: The ends of medicine and the crisis of chronic pain.

    Karches, Kyle E

    Theoretical medicine and bioethics

    2019  Volume 40, Issue 3, Page(s) 183–196

    Abstract: Pellegrino and Thomasma have proposed a normative medical ethics founded on a conception of the end of medicine detached from any broader notion of the telos of human life. In this essay, I question whether such a narrow teleological account of medicine ... ...

    Abstract Pellegrino and Thomasma have proposed a normative medical ethics founded on a conception of the end of medicine detached from any broader notion of the telos of human life. In this essay, I question whether such a narrow teleological account of medicine can be sustained, taking as a starting point Pellegrino and Thomasma's own contention that the end of medicine projects itself onto the intermediate acts that aim at that end. In order to show how the final end of human life similarly alters intermediate ends, such as the end of medicine, I describe Thomas Aquinas's concept of pain and explain how his remedies for pain derive from his account of the telos of human life. In turn, this account has implications for the way in which physicians who accept such a telos would manage their patients' pain. If a comprehensive telos for human life is necessary to make sense of even such a routine aspect of medical care, then medical ethicists may not be able to sidestep questions about the good life for human beings.
    MeSH term(s) Chronic Pain/therapy ; Ethics, Medical ; Humans ; Philosophy, Medical ; Practice Patterns, Physicians'/ethics
    Language English
    Publishing date 2019-07-27
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 1418481-3
    ISSN 1573-0980 ; 1573-1200 ; 1386-7415
    ISSN (online) 1573-0980 ; 1573-1200
    ISSN 1386-7415
    DOI 10.1007/s11017-019-09489-6
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    Zs.A 1551: Show issues Location:
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  6. Article ; Online: Against the iDoctor: why artificial intelligence should not replace physician judgment.

    Karches, Kyle E

    Theoretical medicine and bioethics

    2018  Volume 39, Issue 2, Page(s) 91–110

    Abstract: Experts in medical informatics have argued for the incorporation of ever more machine-learning algorithms into medical care. As artificial intelligence (AI) research advances, such technologies raise the possibility of an "iDoctor," a machine ... ...

    Abstract Experts in medical informatics have argued for the incorporation of ever more machine-learning algorithms into medical care. As artificial intelligence (AI) research advances, such technologies raise the possibility of an "iDoctor," a machine theoretically capable of replacing the judgment of primary care physicians. In this article, I draw on Martin Heidegger's critique of technology to show how an algorithmic approach to medicine distorts the physician-patient relationship. Among other problems, AI cannot adapt guidelines according to the individual patient's needs. In response to the objection that AI could develop this capacity, I use Hubert Dreyfus's analysis of AI to argue that attention to the needs of each patient requires the physician to attune his or her perception to the patient's history and physical exam, an ability that seems uniquely human. Human physician judgment will remain better suited to the practice of primary care despite anticipated advances in AI technology.
    MeSH term(s) Artificial Intelligence/standards ; Humans ; Judgment ; Physician-Patient Relations ; Physicians/psychology ; Physicians/standards
    Language English
    Publishing date 2018-07-10
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 1418481-3
    ISSN 1573-0980 ; 1573-1200 ; 1386-7415
    ISSN (online) 1573-0980 ; 1573-1200
    ISSN 1386-7415
    DOI 10.1007/s11017-018-9442-3
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    Zs.A 1551: Show issues Location:
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  7. Article ; Online: Dead Enough? NRP-cDCD and Remaining Questions for the Ethics of DCD Protocols.

    Karches, Kyle / Salter, Erica K / Eberl, Jason T / McCruden, Patrick

    The American journal of bioethics : AJOB

    2023  Volume 23, Issue 2, Page(s) 41–43

    MeSH term(s) Humans ; Tissue Donors
    Language English
    Publishing date 2023-01-22
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 2060433-6
    ISSN 1536-0075 ; 1526-5161
    ISSN (online) 1536-0075
    ISSN 1526-5161
    DOI 10.1080/15265161.2022.2159578
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    Zs.A 6814: Show issues Location:
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  8. Article: Brain Death and the Formation of Moral Conscience.

    Ostertag, Christopher / Karches, Kyle

    The Linacre quarterly

    2019  Volume 86, Issue 4, Page(s) 335–346

    Abstract: In this article, we provide an update to Catholic ethicists and clinicians about the current status of Catholic teaching and practice regarding brain death. We aim to challenge the notion that the question has been definitively settled, despite the ... ...

    Abstract In this article, we provide an update to Catholic ethicists and clinicians about the current status of Catholic teaching and practice regarding brain death. We aim to challenge the notion that the question has been definitively settled, despite the widespread application of this concept in medical practice including at Catholic facilities. We first summarize some of the notable arguments for and against brain death in Catholic thought as well as the available magisterial teachings on this topic. Although Catholic bishops, theologians, and ethicists have generally signaled at least tentative approval of the neurological criteria for the determination of death, we contend that no
    Summary: Some prominent Catholic theologians and physicians have argued against the validity of brain death; however, most Catholic ethicists and physicians accept the validity of brain death as true human death. In this paper, we argue that there is no definitive magisterial teaching on brain death, meaning that Catholics are not bound to uphold any position on brain death. Catholics in general, but especially Catholic medical practitioners, should inform their consciences on this intra-Catholic debate on brain death while awaiting more definitive magisterial teaching.
    Language English
    Publishing date 2019-09-09
    Publishing country United States
    Document type Journal Article
    ZDB-ID 604903-5
    ISSN 2050-8549 ; 0024-3639
    ISSN (online) 2050-8549
    ISSN 0024-3639
    DOI 10.1177/0024363919872622
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    Zs.B 2617: Show issues Location:
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  9. Article ; Online: Justice, Courage, and Truthfulness: Virtues That Medical Trainees Can and Must Learn.

    Karches, Kyle E / Sulmasy, Daniel P

    Family medicine

    2016  Volume 48, Issue 7, Page(s) 511–516

    Abstract: Background: Medical educators and powerful physician organizations agree on the importance of professionalism for the formation of good physicians. However, the many definitions of professionalism found in the literature lack content and differ ... ...

    Abstract Background: Medical educators and powerful physician organizations agree on the importance of professionalism for the formation of good physicians. However, the many definitions of professionalism found in the literature lack content and differ significantly, undermining attempts to describe and implement professionalism curricula. The work of the contemporary moral philosopher Alasdair MacIntyre on the virtues may help provide some of the content that the concept of professionalism currently lacks. MacIntyre shows the importance of the virtues, particularly justice, courage, and truthfulness, for the success of any "practice," defined as a form of cooperative human activity. Medicine fits his definition of a practice, and accordingly, medical trainees require these virtues, among others, to succeed. This analysis may provide a foundation for a new form of ethical instruction, in which excellent clinician-educators model the virtues for students and residents, thereby combating the "hidden curriculum" that sometimes corrodes these values. This educational model resembles the way in which masters of other practices, such as music, teach their students and help them become lifelong learners. Such an approach requires leaders at academic medical centers to commit to the establishment of communities in which the virtues flourish. Instruction in the virtues could supplement the emphasis on principles and rule following that predominates in medical education. It would also allow physicians and students to engage with the various cultural and religious traditions in which virtue ethics has flourished, enriching the diversity of medical ethics education and promoting trainees' professional development.
    MeSH term(s) Courage ; Curriculum ; Education, Medical ; Ethics, Medical/education ; Humans ; Internship and Residency ; Learning ; Social Justice/psychology ; Students, Medical ; Virtues
    Language English
    Publishing date 2016-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 639374-3
    ISSN 1938-3800 ; 0742-3225
    ISSN (online) 1938-3800
    ISSN 0742-3225
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  10. Article ; Online: Ethical considerations for turning off pacemakers and defibrillators.

    Karches, Kyle E / Sulmasy, Daniel P

    Cardiac electrophysiology clinics

    2015  Volume 7, Issue 3, Page(s) 547–555

    Abstract: The 2010 guidelines regarding management of cardiovascular implantable electronic devices (CIEDs) conclude that patient requests to deactivate these devices at the end of life should be honored. Nevertheless, many clinicians and patients report feeling ... ...

    Abstract The 2010 guidelines regarding management of cardiovascular implantable electronic devices (CIEDs) conclude that patient requests to deactivate these devices at the end of life should be honored. Nevertheless, many clinicians and patients report feeling uncomfortable discontinuing such therapies, particularly pacemakers. If the principles of clinical ethics are followed, turning off CIEDs at the end of life is morally permissible. Clinicians managing CIEDs should discuss the option of deactivation with the patient at the time of implantation and be prepared to reopen the question as warranted by the patient's clinical course and respect for the patient's authentic values.
    MeSH term(s) Attitude of Health Personnel ; Defibrillators, Implantable/ethics ; Humans ; Pacemaker, Artificial/ethics ; Physician-Patient Relations ; Terminal Care/ethics
    Language English
    Publishing date 2015-09
    Publishing country United States
    Document type Journal Article ; Review
    ISSN 1877-9190
    ISSN (online) 1877-9190
    DOI 10.1016/j.ccep.2015.05.012
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