Yael Friedman

Rapid advances in AI for medical applications are accompanied by an increasing demand for vast datasets. Privacy constraints – legal restrictions such as GDPR, as well as more general ethical concerns – pose significant barriers to the acquisition and use of data. Synthetic medical data (SMD) is AI-generated data that mimics real patient information. SMD is being promoted as an ethical solution that preserves privacy while enabling scalable model training. However, as we will show, the use of SMD raises its own set of issues. SMD’s emphasis on privacy and scalability subtly embeds ethical and epistemic trade-offs that undermine the principles commonly regarded as being paramount in medical ethics. These trade-offs lack the kind of ethical justification one would expect in decisions that disrupt commonly accepted values and priorities, such as those captured by Beauchamp and Childress’ four principles. In the discourse on the ethical advantages of SMD, privacy tends to be treated as a value in its own right. We show that this is a problematic assumption. Transparency, privacy, scalability, and fidelity are all linked in complex ways with the principles of medical ethics. We map these relationships and show that when privacy is privileged over other values, it conflicts with autonomy and beneficence. Our aim here is not to establish that this privileging is wrong per se, but to show that it needs careful analysis before we can accept the idea that SMD is indeed ethically advantageous.

One Health medicine aims to improve health by focusing on the relations between the health of humans, animals, and the environment. However, One Health does not provide a clear idea of these relations, which are still represented as conceptually separated and not as one health, as the name implies. Inspired by holobiont research, I suggest a new model and conceptual framework for One Health that expands the notion of the biological patient by providing a gradational and dynamic understanding of environments, patients, and their relations. This new model conceptualizes humans and non-humans, individual organisms, and collectives, as belonging to one system that allows for more or less inclusive understandings of patients. As such, it resolves the conceptual tensions of different One Health approaches and supports the implementation of One Health as an interdisciplinary research field.

This paper consists of two parts. In the first part, I will introduce a philosophical toolbox that I call ‘conceptual scaffolding,’ which helps to reflect holistically on phenomena and concepts. I situate this framework within the landscape of conceptual analysis and conceptual engineering, exemplified by the debate about the concept of disease. Within the framework of conceptual scaffolding, I develop the main idea of the paper, which is ‘the binocular model of plural medicine’, a holistic framework for analyzing medical concepts and phenomena. In the second part, I demonstrate the use and value of the binocular model by analyzing, through the lenses of the model, the phenomenon of health wearable devices and their effects on the concept of diagnosis.

Recovery is a commonly used concept in both professional and everyday contexts. Yet despite its extensive use, it has not drawn much philosophical attention. In this paper, I question the common understanding of recovery, show how the concept is inadequate, and introduce new and much needed terminology. I argue that recovery glosses over important distinctions and even misrepresents the process of moving away from malady as "going back" to a former state of health. It does not invite important nuances needed to distinguish between biomedical, phenomenological, and social perspectives. In addition, I claim that there are many conditions where we are making use of the concept of recovery, although the person recovered from the condition in question, has not regained the same degree of soundness. I show how the concept of recovery leads to conceptual discrepancies that can result in worsening patients' conditions. To gain a fuller understanding, I propose to rethink the direction of the process in question. I define the process of moving away from malady as a move forward towards a new state of soundness. I also suggest three terms, corresponding to different perspectives, to describe this movement forward: 'curing', 'healing', and 'habilitating'. This new terminology provides a more nuanced understanding of the states of both malady and soundness and an attentiveness as to how they differ and relate.