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)

Nietzsche talks about trust [vertraue*] and mistrust [misstrau*] in all of his published and authorized works, from The Birth of Tragedy to Ecce Homo. He refers to trust in 90 passages and mistrust in 101 – approximately ten times as often as he refers to resentment/ressentiment. Yet the scholarly literature on Nietzsche and trust includes just a handful of publications. Worse still, I have been unable to find a single publication devoted to Nietzsche and mistrust. This chapter aims to fill (...) the gap in the secondary literature by using digital humanities methods to systematically investigate the functions of trust and mistrust in Nietzsche’s writings. I argue that Nietzsche offers three main insights into trust and an additional two into mistrust. When it comes to trust, in his free spirit works, he reflects on the development of interpersonal trust, with an eye to situations in which trust is or is not reciprocated. He also criticizes some of the heuristics people use to identify trustworthy partners, especially the notion that all and only people with stable character are trustworthy. And perhaps Nietzsche’s most interesting thoughts about trust relate to self-trust, which he thinks is often unjustifiably undermined. When it comes to mistrust, although he regards generalized mistrust as a sign of bad character, he also thinks that harnessing mistrust can be valuable in at least two domains. One is morality, where we are disposed to accept traditional pieties and would benefit from turning a suspicious eye towards these pieties. The other is science, which systematizes both trust and mistrust in pursuit of the truth. (shrink)

In the past two decades, epistemologists have significantly expanded the focus of their field. To the traditional question that has dominated the debate — under what conditions does belief amount to knowledge? — they have added questions about testimony, epistemic virtues and vices, epistemic trust, and more. This broadening of the range of epistemic concern has coincided with an expansion in conceptions of epistemic agency beyond the individualism characteristic of most earlier epistemology. We believe that these developments have not gone (...) far enough. While the weak anti-individualism we see in contemporary epistemology may be adequate for the kinds of cases it tends to focus on, a great deal of human knowledge production and transmission does not conform to these models. Furthermore, the dispositions and norms that are knowledge-conducive in the familiar cases may not be knowledge-conducive generally. In fact, dispositions that, at an individual level, count as epistemic vices may be epistemic virtues in common social contexts. We argue that this overlooked feature of human social life means that epistemology must become more deeply and pervasively social. (shrink)

Transhumanism at once embodies our most modern thinking and our biggest longstanding problems. Transhumanism aims to enhance human core capacities: health-span, lifespan, and cognition. The thesis answers the following ethical challenges arising from transhumanist aims. First, whether transhumanism can be an ethical endeavour if it relies on authoritarian intervention by governments and governing bodies to change, generate and enforce behaviour, or to influence and enforce the uptake of medical procedures. Second, the thesis answers the challenge that it is unethical deliberately (...) to encourage the uptake of and pursuit of medical transhumanism given the extent of accessibility and distributive issues that remain unresolved in existing medicine. Finally, the thesis addresses a particular mental health crisis that is often predicted for transhuman beings, namely loss of meaning from loss of death and vulnerability, resulting in widespread loss of social cohesion. The thesis argues that the right solution to the first two problems is a libertarian paternalist approach, viz. nudging, and that this approach will also neutralise the risk of widespread and inevitable boredom or alienation that might otherwise result from the widespread introduction of human enhancement if people are nudged to engage more and more reflectively in their enhancement choices. Additionally, lifestyle issues like obesity, heart disease, cancers, and inaccessibility of vaccines and birth control pose unresolved problems for existing general medicine, killing millions every year worldwide. As a result, another serious challenge for enhancement medicine, which I propose would be addressed by the nudge approach, is to justify its place in the professional domain of medicine. (shrink)

Reasoning is the iterative, path-dependent process of asking questions and answering them. Moral reasoning is a species of such reasoning, so it is a matter of asking and answering moral questions, which requires both creativity and curiosity. As such, interventions and practices that help people ask more and better moral questions promise to improve moral reasoning.