Showing papers in "Medicine Health Care and Philosophy in 2014"
TL;DR: It is suggested that a phenomenological toolkit may be part of an effort to ameliorate epistemic injustice and that many aspects of the experience of illness are difficult to understand and communicate and this often owes to gaps in collective hermeneutical resources.
Abstract: In this paper we argue that ill persons are particularly vulnerable to epistemic injustice in the sense articulated by Fricker (Epistemic injustice. Power and the ethics of knowing. Oxford University Press, Oxford, 2007). Ill persons are vulnerable to testimonial injustice through the presumptive attribution of characteristics like cognitive unreliability and emotional instability that downgrade the credibility of their testimonies. Ill persons are also vulnerable to hermeneutical injustice because many aspects of the experience of illness are difficult to understand and communicate and this often owes to gaps in collective hermeneutical resources. We then argue that epistemic injustice arises in part owing to the epistemic privilege enjoyed by the practitioners and institutions of contemporary healthcare services—the former owing to their training, expertise, and third-person psychology, and the latter owing to their implicit privileging of certain styles of articulating and evidencing testimonies in ways that marginalise ill persons. We suggest that a phenomenological toolkit may be part of an effort to ameliorate epistemic injustice.
300 citations
TL;DR: Outside of healthcare settings, people use the term empathy to mean ‘‘feeling with’’ another person or putting yourself in someone else’s shoes, which has been problematic for doctors, who have historically believed that they could understand their patients' feelings while striving for emotional detachment.
Abstract: Outside of healthcare settings, people use the term empathy to mean ‘‘feeling with’’ another person or putting yourself in someone else’s shoes. The assumption is that emotional resonance with another clues you in to how they feel. This has been problematic for doctors, who have historically believed that they could understand their patients’ feelings while striving for emotional detachment: objectivity is seen as crucial for making tough diagnoses, and stoicism is believed to be necessary for providing invasive, sometimes noxious, treatment. Additionally, there is concern with avoiding burnout, or more specifically, compassion fatigue. Thus doctors have aimed for their own idealized version of empathy, one in which they suppress personal emotions yet are motivated by an altruistic yet ‘‘detached’’ concern for patients. The term ‘‘detachment’’ can mean different things, some of which do not involve suppressing emotions but rather accepting them. For example, for Zen Buddhists ‘‘detachment’’ refers to allowing emotions to come and go without attaching to any particular emotion. In contrast, American physicians from the early twentieth century until the late 1960’s used it to mean suppressing emotional responses. Writing in 1906, Sir William Osler, father of ‘‘modern medicine,’’ describes how only if the physician was emotionally ‘‘imperturbable’’ so that his ‘‘blood vessels don’t constrict and his heart rate remains steady when he sees terrible sights’’ will he have the ‘‘equanimity’’ to ‘‘see into’’ the patient’s ‘‘inner life.’’ Once emotions are suppressed, what is the basis of the concern for patients? The ‘‘concern’’ in ‘‘detached concern’’ was not based on untrustworthy feelings, but rather on a duty or commitment to heal. Note that Osler acknowledges that physicians are prone to sympathetic identification with their patients, but hopes that they will avoid feeling sympathy and be moved by a purer professional attitude:
102 citations
TL;DR: In this paper, it is argued that in order to render account for this double body ontology, phenomenology should include empirical sociological analyses as well and be in favor of the idea of a socio-phenomenology.
Abstract: In this paper I explore the various meanings of embodiment from a patient's perspective. Resorting to phenomenology of health and medicine, I take the idea of 'lived experience' as starting point. On the basis of an analysis of phenomenology's call for bracketing the natural attitude and its reduction to the transcendental, I will explain, however, that in medical phenomenological literature 'lived experience' is commonly one-sidedly interpreted. In my paper, I clarify in what way the idea of 'lived experience' should be revisited and, subsequently, what this reconsideration means for phenomenological research on embodiment in health and medicine. The insight that the body is a condition of possibility for world-disclosing yet, at the same time, itself conditioned by this world forces us to not only zoom in on the body's subject-side, but also on its object-side. I argue that in order to render account for this double body ontology, phenomenology should include empirical sociological analyses as well. I thus argue in favor of the idea of a socio-phenomenology. Drawing on material from my own research project on embodied self-experiences after breast surgery, I show how this approach can be fruitful in interpreting the impact of disfigurements on a person's embodied agency, or a person's 'I can'.
58 citations
TL;DR: Diagnosing mental disorders and saving the normal : American Psychiatric Association, 2013.
Abstract: Diagnosing mental disorders and saving the normal : American Psychiatric Association, 2013. Diagnostic and statistical manual of mental disorders, 5th ed. American Psychiatric Publishing: Washington, DC. 991 pp., ISBN: 978-0890425558. Price: $122.70
55 citations
TL;DR: For an adequate health care planning in Alzheimer disease the living will can be presented to the patient in the early days of their geriatric care, as soon as the clinical, metabolic or even genetic diagnosis is accomplished.
Abstract: The world population aged significantly over the twentieth century, leading to an increase in the number of individuals presenting progressive, incapacitating, incurable chronic-degenerative diseases. Advances in medicine to prolong life prompted the establishment of instruments to ensure their self-determination, namely the living will, which allows for an informed person to refuse a type of treatment considered unacceptable according to their set of values. From the knowledge on the progression of Alzheimer disease, it is possible to plan the medical care, even though there is still no treatment available. Irreversible cognitive incapacity underlines the unrelenting loss of autonomy of the demented individual. Such a loss requires the provision of specific and permanent care. Major ethical issues are at stake in the physician–patient–family relationship, even when dementia is still at an early stage. The authors suggest that for an adequate health care planning in Alzheimer disease the living will can be presented to the patient in the early days of their geriatric care, as soon as the clinical, metabolic or even genetic diagnosis is accomplished. They also suggest that the appointment of a health care proxy should be done when the person is still in full enjoyment of his cognitive ability, and that the existence and scope of advance directives should be conveyed to any patient in the early stages of the disease. It follows that ethical guidelines should exist so that neurologists as well as other physicians that deal with these patients should discuss these issues as soon as possible after a diagnosis is reached.
48 citations
TL;DR: It is concluded that, through the examination of the controversy about cognitive enhancement, methodological guideposts can be employed to enhance the value of contributions from bioethics and minimize potential epistemic and practical pitfalls in this case and perhaps in other areas of bioethical debate.
Abstract: In the debate on the ethics of the non-medical use of pharmaceuticals for cognitive performance enhancement in healthy individuals there is a clear division between those who view "cognitive enhancement" as ethically unproblematic and those who see such practices as fraught with ethical problems. Yet another, more subtle issue, relates to the relevance and quality of the contribution of scholarly bioethics to this debate. More specifically, how have various forms of speculation, anticipatory ethics, and methods to predict scientific trends and societal responses augmented or diminished this contribution? In this paper, we use the discussion of the ethics of cognitive enhancement to explore the positive and negative contribution of speculation in bioethics scholarship. First, we review and discuss how speculation has relied on different sets of assumptions regarding the non-medical use of stimulants, namely: (1) terminology and framing; (2) scientific aspects such as efficacy and safety; (3) estimates of prevalence and consequent normalization; and (4) the need for normative reflection and regulatory guidelines. Second, three methodological guideposts are proposed to alleviate some of the pitfalls of speculation: (1) acknowledge assumptions more explicitly and identify the value attributed to assumptions; (2) validate assumptions with interdisciplinary literature; and (3) adopt a broad perspective to promote more comprehensive reflection. We conclude that, through the examination of the controversy about cognitive enhancement, we can employ these methodological guideposts to enhance the value of contributions from bioethics and minimize potential epistemic and practical pitfalls in this case and perhaps in other areas of bioethical debate.
44 citations
TL;DR: The article presents a phenomenological analysis of joint musical activity in dementia care and outlines an intercorporeal conception of personhood based on this analysis, and provides a philosophical basis for the idea that others can hold us in personhood.
Abstract: Since John Locke, regnant conceptions of personhood in Western philosophy have focused on individual capabilities for complex forms of consciousness that involve cognition such as the capability to remember past events and one's own past actions, to think about and identify oneself as oneself, and/or to reason. Conceptions of personhood such as Locke's qualify as cognition-oriented, and they often fail to acknowledge the role of embodiment for personhood. This article offers an alternative conception of personhood from within the tradition of phenomenology of the body. The article presents a phenomenological analysis of joint musical activity in dementia care and outlines an intercorporeal conception of personhood based on this analysis. It also provides a philosophical basis for the idea that others can hold us in personhood, and it questions a strict one-body-one-person logic that has pertained in much personhood debate.
38 citations
TL;DR: It is argued that empathy is not principally a matter of ‘simulating’ another person’s experience and is better conceived of as a perception-like exploration of others’ experiences that develops progressively through certain styles of interpersonal interaction.
Abstract: This paper seeks to illuminate the nature of empathy by reflecting upon the phenomenology of depression. I propose that depression involves alteration of an aspect of experience that is seldom reflected upon or discussed, thus making it hard to understand. This alteration involves impairment or loss of a capacity for interpersonal relatedness that mutual empathy depends upon. The sufferer thus feels cut off from other people, and may remark on their indifference, hostility or inability to understand. Drawing upon the example of depression, I argue that empathy is not principally a matter of 'simulating' another person's experience. It is better conceived of as a perception-like exploration of others' experiences that develops progressively through certain styles of interpersonal interaction.
35 citations
TL;DR: It is argued on one hand how unexplained conditions invite us to reconsider and re-think the concept of a “symptom” and on the other hand how the concept is no longer an adequate and necessary fulcrum and must be enriched by socio-cultural, phenomenological and existential dimensions.
Abstract: There is one concept in medicine which is prominent, the symptom. The omnipresence of the symptom seems, however, not to be reflected by an equally prominent curiosity aimed at investigating this concept as a phenomenon. In classic, traditional or conventional medical diagnostics and treatment, the lack of distinction with respect to the symptom represents a minor problem. Faced with enigmatic conditions and their accompanying labels such as chronic fatigue syndrome, fibromyalgia, medically unexplained symptoms, and functional somatic syndromes, the contestation of the symptom and its origin is immediate and obvious and calls for further exploration. Based on a description of the diagnostic framework encompassing medically unexplained conditions and a brief introduction to how such symptoms are managed both within and outside of the medical clinic, we argue on one hand how unexplained conditions invite us to reconsider and re-think the concept we call a “symptom” and on the other hand how the concept “symptom” is no longer an adequate and necessary fulcrum and must be enriched by socio-cultural, phenomenological and existential dimensions. Consequently, our main aim is to expand both our interpretative horizon and the linguistic repertoire in the face of those appearances we label medically unexplained symptoms.
33 citations
TL;DR: It is argued that empathy is a basic condition and source of moral knowledge by being the feeling component of phronesis, and, by the same power, it is also a motivation for acting in a good way.
Abstract: Empathy is a thing constantly asked for and stressed as a central skill and character trait of the good physician and nurse. To be a good doctor or a good nurse one needs to be empathic-one needs to be able to feel and understand the needs and wishes of patients in order to help them in the best possible way, in a medical, as well as in an ethical sense. The problem with most studies of empathy in medicine is that empathy is poorly defined and tends to overlap with other related things, such as emotional contagion, sympathy, or a caring personality in general. It is far from clear how empathy fits into the general picture of medical ethics and the framework of norms that are most often stressed there, such as respect for autonomy and beneficience. How are we to look upon the role and importance of empathy in medical ethics? Is empathy an affective and/or cognitive phenomenon only, or does it carry moral significance in itself as a skill and/or virtue? How does empathy attain moral importance for medicine? In this paper I will attempt to show that a comparison with the Aristotelian concept of phronesis makes it easier to see what empathy is and how it fits into the general picture of medical ethics. I will argue that empathy is a basic condition and source of moral knowledge by being the feeling component of phronesis, and, by the same power, it is also a motivation for acting in a good way.
32 citations
TL;DR: Empirical data is presented to support the view that the ontological state of permanently vegetative patients is unclear: such patients are neither straightforwardly alive nor simply dead.
Abstract: Some brain injured patients are left in a permanent vegetative state, i.e., they have irreversibly lost their capacity for consciousness but retained some autonomic physiological functions, such as breathing unaided. Having discussed the controversial nature of the permanent vegetative state as a diagnostic category, we turn to the question of the patients’ ontological status. Are the permanently vegetative alive, dead, or in some other state? We present empirical data from interviews with relatives of patients, and with experts, to support the view that the ontological state of permanently vegetative patients is unclear: such patients are neither straightforwardly alive nor simply dead. Having defended this view from counter-arguments we turn to the practical question as to how these patients ought to be treated. Some relatives and experts believe it is right for patients to be shifted from their currently unclear ontological state to that of being straightforwardly dead, but many are concerned or even horrified by the only legally sanctioned method guaranteed to achieve this, namely withdrawal of clinically assisted nutrition and hydration. A way of addressing this distress would be to allow active euthanasia for these patients. This is highly controversial; but we argue that standard objections to allowing active euthanasia for this particular class of permanently vegetative patients are weakened by these patients’ distinctive ontological status.
TL;DR: It is argued that IVF with ROPA gives rise to fewer ethical questions than does live uterus transplantation with IVF and, in some cases, egg donor IVF, and is really ethically more problematic than these other cases.
Abstract: In vitro fertilization (IVF) with reception of oocytes from partners (ROPA) allows lesbian mothers to share biological motherhood. The gestational mother receives an egg from her partner who becomes the genetic mother. This article examines the ethics of IVF with ROPA with a focus on the welfare of the woman and the resulting child, on whether ROPA qualifies as a “legitimate” medical therapy that falls within the goals of medicine, and on the meaning and value attributed to a biologically shared bond between parents and child. We also contrast IVF with ROPA with egg donor IVF for heterosexual couples and intrafamilial live uterus transplantation with IVF, and show how Swedish legislation makes certain ways of sharing biological bonds out of place. In Sweden, IVF with ROPA is illegal, egg donor IVF for heterosexual couples is allowed and practiced as is sperm donor IVF for lesbians, and live uterus transplantation is performed within a research project (though not allowed in regular health care). But is ROPA really ethically more problematic than these other cases? The article argues that IVF with ROPA gives rise to fewer ethical questions than does live uterus transplantation with IVF and, in some cases, egg donor IVF.
TL;DR: An overview of the state of the art concerning MCD in the Netherlands concludes that MCD is a part of an integrated ethics policy and serves as a (bottom up) catalyst for such an integrated Ethics policy.
Abstract: The attention for Moral case deliberation (MCD) has increased over the past years. Previous research on MCD is often written from the perspective of MCD experts or MCD participants and we lack a more distant view to the role of MCD in Dutch health care institutions in general. The purpose of this paper is to provide an overview of the state of the art concerning MCD in the Netherlands. As part of a larger national study on clinical ethics support in the Netherlands, we will focus on the prevalence and characteristics of MCD in Dutch health. A mixed methods design was used in which we combined two survey questionnaires (sent to all health care institutions), two focus groups and 17 individual interviews with top managers or ethics support staff. The findings demonstrate that the prevalence of MCD is relatively high in Dutch health care (44 % has MCD), especially in mental health care (in which MCD is mentioned as present in the organization by 62 % of the respondents). Institutions with MCD differ from institutions without MCD concerning size, kind of problems and importance of ideological background. Characteristic of MCD is that it often exists for 3 years or more, has a high participation of health professionals and middle managers and is both organized scheduled as unscheduled. As well integration in existing policy as key persons emerge as important issues in relation to the positioning of MCD. We conclude that MCD is a part of an integrated ethics policy and serves as a (bottom up) catalyst for such an integrated ethics policy.
TL;DR: It is argued that choosing between different metaphysical views on the ‘mind–body problem’ may have important implications for the conceptual foundations of psychosomatic medicine, and therefore potentially for its methods, scientific status and relationship with the scientific disciplines it aims to integrate.
Abstract: Psychosomatic medicine, with its prevailing biopsychosocial model, aims to integrate human and exact sciences with their divergent conceptual models. Therefore, its own conceptual foundations, which often remain implicit and unknown, may be critically relevant. We defend the thesis that choosing between different metaphysical views on the 'mind-body problem' may have important implications for the conceptual foundations of psychosomatic medicine, and therefore potentially also for its methods, scientific status and relationship with the scientific disciplines it aims to integrate: biomedical sciences (including neuroscience), psychology and social sciences. To make this point, we introduce three key positions in the philosophical 'mind-body' debate (emergentism, reductionism, and supervenience physicalism) and investigate their consequences for the conceptual basis of the biopsychosocial model in general and its 'psycho-biological' part ('mental causation') in particular. Despite the clinical merits of the biopsychosocial model, we submit that it is conceptually underdeveloped or even flawed, which may hamper its use as a proper scientific model.
TL;DR: The enhancement debate requires a shift in focus and philosophers should address head-on the question of how to strike a balance between liberty, equality, and utility in cases of conflict in the context of genetics.
Abstract: Though the reputation of eugenics has been tarnished by history, eugenics per se is not necessarily a bad thing. Many advocate a liberal new eugenics—where individuals are free to choose whether or not to employ genetic technologies for reproductive purposes. Though genetic interventions aimed at the prevention of severe genetic disorders may be morally and socially acceptable, reproductive liberty in the context of enhancement may conflict with equality. Enhancement could also have adverse effects on utility. The enhancement debate requires a shift in focus. What the equality and/or utility costs of enhancement will be is an empirical question. Rather than philosophical speculation, more social science research is needed to address it. Philosophers, meanwhile, should address head-on the question of how to strike a balance between liberty, equality, and utility in cases of conflict (in the context of genetics).
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TL;DR: Empathetic perspective-shifting is criticized from the standpoint of a philosophy of normatively accountable agency, and agency turns out to be empathy’s blind spot.
Abstract: The aim of this paper is to mount a philosophical challenge to the currently highly visible research and discourse on empathy. The notion of empathetic perspective-shifting—a conceptually demanding, high-level construal of empathy in humans that arguably captures the core meaning of the term—is criticized from the standpoint of a philosophy of normatively accountable agency. Empathy in this demanding sense fails to achieve a true understanding of the other and instead risks to impose the empathizer’s self-constitutive agency upon the person empathized with. Attempts to ‘simulate’ human agency, or attempts to emulate its cognitive or emotional basis, will likely distort their target phenomena in profound ways. Thus, agency turns out to be empathy’s blind spot. Elements of an alternative understanding of interpersonal relatedness are also discussed, focusing on aspects of ‘interaction theory’. These might do some of the work that high-level constructs of empathy had been supposed to do without running into similar conceptual difficulties.
TL;DR: It is argued that the two suggested versions of the harm argument survive the current criticism against the standard harm argument, and directs attention to the fact that surrogacy involves great incentives to keep the gestational mother’s level of maternal-fetal attachment low, which tend to increase the risk of harm to the child.
Abstract: It has been a common claim that surrogacy is morally problematic since it involves harm to the child or the surrogate—the harm argument. Due to a growing body of empirical research, the harm argument has seen a decrease in popularity, as there seems to be little evidence of harmful consequences of surrogacy. In this article, two revised versions of the harm argument are developed. It is argued that the two suggested versions of the harm argument survive the current criticism against the standard harm argument. The first version argues that the child is harmed by being separated from the gestational mother. The second version directs attention to the fact that surrogacy involves great incentives to keep the gestational mother’s level of maternal-fetal attachment low, which tend to increase the risk of harm to the child. While neither of the two arguments is conclusive regarding the moral status of surrogacy, both constitute important considerations that are often ignored.
TL;DR: This article presents and argues in favour of an alternative intercorporeal framework of giving-through-sharing that more thoroughly explicates the gift metaphor in the context of donation, and offers tools for making sense of relational dimensions of live and post mortem donations.
Abstract: Two ethical frameworks have dominated the discussion of organ donation for long: that of property rights and that of gift-giving. However, recent years have seen a drastic rise in the number of philosophical analyses of the meaning of giving and generosity, which has been mirrored in ethical debates on organ donation and in critical sociological, anthropological and ethnological work on the gift metaphor in this context. In order to capture the flourishing of this field, this article distinguishes between four frameworks for thinking about bodily exchanges in medicine: those of property rights, heroic gift-giving, sacrifice, and gift-giving as aporia. These frameworks represent four different ways of making sense of donation of organs as well as tissue, gametes and blood, draw on different conceptions of the relations between the self and the other, and bring out different ethical issues as core ones. The article presents these frameworks, argues that all of them run into difficulties when trying to make sense of reciprocity and relational interdependence in donation, and shows how the three gift-giving frameworks (of heroism, sacrifice and aporia) hang together in a critical discussion about what is at stake in organ donation. It also presents and argues in favour of an alternative intercorporeal framework of giving-through-sharing that more thoroughly explicates the gift metaphor in the context of donation, and offers tools for making sense of relational dimensions of live and post mortem donations.
TL;DR: The analysis reveals differences in the way patient preferences are taken into consideration and shows how these differences influence the reasons physicians in each country invoke to justify their reluctance to adhering to ADs.
Abstract: This paper presents the results of a qualitative interview study exploring English and French physicians’ moral perspectives and attitudes towards end-of-life decisions when patients lack capacity to make decisions for themselves. The paper aims to examine the importance physicians from different contexts accord to patient preferences and to explore the (potential) role of advance directives (ADs) in each context. The interviews focus on (1) problems that emerge when deciding to withdraw/-hold life-sustaining treatment from both conscious and unconscious patients; (2) decision-making procedures and the participation of proxies/relatives; (3) previous experience with ADs and views on their usefulness; and (4) perspectives on ways in which the decision-making processes in question might be improved. The analysis reveals differences in the way patient preferences are taken into consideration and shows how these differences influence the reasons physicians in each country invoke to justify their reluctance to adhering to ADs. Identifying cultural differences that complicate efforts to develop the practical implementation of ADs can help to inform national policies governing ADs and to better adapt them to practice.
TL;DR: The authors respond to Tronto's framing of ‘practices all the way up’ by arguing that this approach need not be at odds with one inspired by Ricoeur’s conceptual thinking, and can be seen as different movements that both contribute constructively to the shaping of the important intermediary zone between the practices and the abstract ideals.
Abstract: This introduction to the special issue on ‘Ricoeur and the ethics of care’ is not a standard editorial. It provides not only an explanation of the central questions and a first impression of the articles, but also a critical discussion of them by an expert in the field of care ethics, Joan Tronto. After explaining the reasons to bring Ricoeur into dialogue with the ethics of care (I), and analyzing how the four articles of this special issue shape this dialogue (II), the authors give the floor to Tronto (III). She focuses on the central issue at stake: what may be the value of a more abstract, conceptual approach for the ethics of care as a radically practice-oriented way of thinking? She argues that the four contributions too easily frame this value in terms of Ricoeur’s relational anthropology. Instead she points out that if the ethics of care is a kind of practice, it makes sense to think of such practices as necessarily building upon one another, expanding constantly the context and relationships upon which practices are built. In the final section (IV) the authors respond to Tronto’s framing of ‘practices all the way up’ by arguing that this approach need not be at odds with one inspired by Ricoeur’s conceptual thinking. Rather the two can be seen as different movements—upwards and downwards—that both contribute constructively to the shaping of the important intermediary zone between the practices and the abstract ideals.
TL;DR: How genres of the imagination (such as movies and novels) may play a significant role in assessing the societal implications of emerging technological developments such as neuro-enhancement, especially during the preparatory or anticipatory stage is indicated.
Abstract: Limitless is a movie (released in 2011) as well as a novel (published in 2001) about a tormented author who (plagued by a writer’s block) becomes an early user of an experimental designer drug. The wonder drug makes him highly productive overnight and even allows him to make a fortune on the stock market. At the height of his career, however, the detrimental side-effects become increasingly noticeable. In this article, Limitless is analysed from two perspectives. First of all, building on the views of the French novelist Emile Zola, the novel is seen as the report of a closely monitored experiment. Subsequently, building on the phenomenology of Ludwig Binswanger, I will show how the cognitive enhancement drug not only boosts the protagonist’s information processing capacities, but also modifies his experience of space and time, his sense of spatiality, his way of being-in-the-world. On the basis of these (complementary) analyses I will indicate how genres of the imagination (such as movies and novels) may play a significant role in assessing the societal implications of emerging technological developments such as neuro-enhancement, especially during the preparatory or anticipatory stage.
TL;DR: It is argued that LP can be better implemented if there is a preliminary deliberative debate among the stakeholders that elicits their preferences, and makes it possible to rationally defend them.
Abstract: Cass Sunstein and Richard Thaler have been arguing for what they named libertarian paternalism (henceforth LP). Their proposal generated extensive debate as to how and whether LP might lead down a full-blown paternalistic slippery slope. LP has the indubitable merit of having hardwired the best of the empirical psychological and sociological evidence into public and private policy making. It is unclear, though, to what extent the implementation of policies so constructed could enhance the capability for the exercise of an autonomous citizenship. Sunstein and Thaler submit it that in most of the cases in which one is confronted with a set of choices, some default option must be picked out. In those cases whoever devises the features of the set of options ought to rank them according to the moral principle of non-maleficence and possibly to that of beneficence. In this paper we argue that LP can be better implemented if there is a preliminary deliberative debate among the stakeholders that elicits their preferences, and makes it possible to rationally defend them.
TL;DR: The paper examines different interpretations of authenticity relevant for autonomy and concludes that the concept, as it has been elaborated in recent debate, is highly problematic to use as a criterion for autonomous decision-making in healthcare.
Abstract: In healthcare ethics there is a discussion regarding whether autonomy of personal preferences, what sometimes is referred to as authenticity, is necessary for autonomous decision-making. It has been argued that patients’ decisions that lack sufficient authenticity could be deemed as non-autonomous and be justifiably overruled by healthcare staff. The present paper discusses this issue in relation certain psychiatric disorders. It takes its starting point in recent qualitative studies of the experiences and thoughts of patients’ with anorexia nervosa where issues related to authenticity seem particularly relevant. The paper examines different interpretations of authenticity relevant for autonomy and concludes that the concept, as it has been elaborated in recent debate, is highly problematic to use as a criterion for autonomous decision-making in healthcare.
TL;DR: This article is an introduction to a thematic section on the phenomenology of empathy in medicine, attempting to provide an expose of the field.
Abstract: This article is an introduction to a thematic section on the phenomenology of empathy in medicine, attempting to provide an expose of the field. It also provides introductions to the individual articles of the thematic section.
TL;DR: In some situations, having higher functioning levels of focus and concentration is conducive to providing the best possible care to a patient, and in these circumstances medical professionals should use pharmaceutical cognitive enhancements.
Abstract: Emerging data indicates the prevalence and increased use of pharmaceutical enhancements by young medical professionals. As pharmaceutical enhancements advance and become more readily available, it is imperative to consider their impact on medical professionals. If pharmaceutical enhancements augment a person’s neurological capacities to higher functioning levels, and in some situations having higher functioning levels of focus and concentration could improve patient care, then might medical professionals have a responsibility
to enhance? In this paper, I suggest medical professionals may have a responsibility to use pharmaceutical enhancements. In some situations, having higher functioning levels of focus and concentration is conducive to providing the best possible care to a patient. In these circumstances medical professionals should use pharmaceutical cognitive enhancements. I conclude by examining the limitations and implications of this responsibility in the practice of medicine and areas for future research.
TL;DR: It is argued that Ricoeur’s reflection lines up with some essential intentions of care ethics and his contribution to care ethics is given in a delicate balance of autonomy and its vulnerability.
Abstract: We examine an article of Paul Ricoeur on autonomy and vulnerability. Ricoeur presents the two notions in the field of justice as intricately woven into each other. He analyzes their interdependence on three levels of human agency. Ricoeur’s exposition has a focus on judicial judgment. After presenting Ricoeur’s argument and an analysis of his main points, the author argues that Ricoeur’s reflection lines up with some essential intentions of care ethics. Ricoeur’s contribution to care ethics is given in a delicate balance of autonomy and its vulnerability.
TL;DR: A Lacanian analysis allows us to address the question what organ transplantation has in common with other bodily practices involving bodily parts procured from others, such as cannibalism, and reveals the basic difference between the two.
Abstract: Bioethical discourse on organ donation covers a wide range of topics, from informed consent procedures and scarcity issues up to ‘transplant tourism’ and ‘organ trade’. This paper presents a ‘depth ethics’ approach, notably focussing on the tensions, conflicts and ambiguities concerning the status of the human body (as something which constitutes a whole, while at the same time being a set of replaceable elements or parts). These will be addressed from a psychoanalytical (Lacanian) angle. First, I will outline Lacan’s view on embodiment as such. Subsequently, I will argue that, for organ recipients, the donor organ becomes what Lacan refers to as an object a, the ‘partial object’ of desire, the elusive thing we are deprived of, apparently beyond our grasp. Within the recipient’s body an empty space emerges, a kind of ‘vacuole’, once occupied by a faltering organ (now removed). This space can only be filled by a ‘gift’ from the other, by an object a. Once implanted, however, this implant becomes an ‘extimate’ object: something both ‘external’ and ‘intimate’, both ‘embedded’ and ‘foreign’, and which is bound to remain an object of concern for quite some time, if not for life. A Lacanian analysis allows us, first of all, to address the question what organ transplantation has in common with other bodily practices involving bodily parts procured from others, such as cannibalism. But it also reveals the basic difference between the two, as well as the distance between the ‘fragmented body’ of Frankenstein’s ‘monster’—as an aggregate of replaceable parts—and the multiple organ recipients (the ‘puzzle people’) of today.
TL;DR: The author argues that the analysis of the fetus highlights the distinction between knowing that another person is having experiences, and knowing the specific content of the other person’s experiences.
Abstract: In phenomenology, theories of empathy are intimately connected with the question of how it is possible to have insight into the mind of the other person. In this article, the author wants to show why it is self-evident for us that the other person is having experiences. In order to do so, it is not enough to discuss the phenomenon of empathy with a starting point in the already constituted adult person; instead the article presents a genetic approach to human development. The author thus contrasts Edith Stein's discussion of Einfuhlung (empathy), which takes its starting point in the experience of the grown-up, with Max Scheler's discussion of Einsfuhlung (feeling of oneness), where the relation between mother and infant is taken as one example. Maurice Merleau-Ponty's discussion of the world of the infant is read as one way of developing Scheler's theory of intersubjectivity and of Einsfuhlung. This genetic approach is developed further into a phenomenological analysis of the experience of the fetus and of birth. The author argues that the analysis of the fetus highlights the distinction between knowing that another person is having experiences, and knowing the specific content of the other person's experiences. The fetus does not experience different persons, but has a pre-subjective experience of life that includes what is later experienced as belonging to "another." Later in life, the experience of empathy, as an experience of a specific content, can be developed from this experience. In this way empathy and Einsfuhlung can be understood as complementary rather than as competing phenomena.
TL;DR: This article, combining clinical experience and an ethical stance, offers an original, innovating approach to the existence of distrust in care relationships in the area of addiction by identifying the clinical and ethical issues raised by mistrust.
Abstract: Social representations of addiction and the resulting stigmatization have been widely described and studied in the literature, but their effects are no less problematic. These representations, which also occur in care settings, generate a climate of distrust which damages the therapeutic relationship, and its ethical quality. This article, combining clinical experience and an ethical stance, offers an original, innovating approach to the existence of distrust in care relationships in the area of addiction. Pragmatic approaches deriving from the human sciences and analytical philosophy provide an invitation to escape from the demanding climate of mistrust, and to take the gamble on trust so as to improve the quality of interactions between protagonists in care. In complementary fashion, a sociology of action can combat the disquiet generated by distrust through a new commitment to innovating forms of action. This “poetic” mode of action is legitimized by the reflection that backs it up, and by its presentation to peers qualified to approve it. Finally, continental moral philosophy underlines the importance of a carefully weighed commitment on the part of caregivers and addicted patients towards promises aiming to support a sincere care relationship, without damaging the therapeutic dynamic or the ethical quality by providing too many safety nets. This reflection is intended to achieve better identification of the clinical and ethical issues raised by mistrust, and inclusion of these aspects in the training of personnel and in care provision planning.
TL;DR: The study findings suggest that the development and implementation of an ethics policy on euthanasia as an organizational-ethical instrument should be considered as a dynamic process.
Abstract: As euthanasia has become a widely debated issue in many Western countries, hospitals and nursing homes especially are increasingly being confronted with this ethically sensitive societal issue. The focus of this paper is how healthcare institutions can deal with euthanasia requests on an organizational level by means of a written institutional ethics policy. The general aim is to make a critical analysis whether these policies can be considered as organizational-ethical instruments that support healthcare institutions to take their institutional responsibility for dealing with euthanasia requests. By means of an interpretative analysis, we conducted a process of reinterpretation of results of former Belgian empirical studies on written institutional ethics policies on euthanasia in dialogue with the existing international literature. The study findings revealed that legal regulations, ethical and care-oriented aspects strongly affected the development, the content, and the impact of written institutional ethics policies on euthanasia. Hence, these three cornerstones—law, care and ethics—constituted the basis for the empirical-based organizational-ethical framework for written institutional ethics policies on euthanasia that is presented in this paper. However, having a euthanasia policy does not automatically lead to more legal transparency, or to a more professional and ethical care practice. The study findings suggest that the development and implementation of an ethics policy on euthanasia as an organizational-ethical instrument should be considered as a dynamic process. Administrators and ethics committees must take responsibility to actively create an ethical climate supporting care providers who have to deal with ethical dilemmas in their practice.