This article examines the philosophical role of illness. It briefly surveys the philosophical role accorded to illness in the history of philosophy and explains why illness merits such a role. It suggests that illness modifies, and thus sheds light on, normal experience, revealing its ordinary and therefore overlooked structure. Illness also provides an opportunity for reflection by performing a kind of suspension (epoché) of previously held beliefs, including tacit beliefs. The article argues that these characteristics warrant a philosophical role for (...) illness. While the performance of most philosophical procedures is volitional and theoretical, however, illness is uninvited and threatening, throwing the ill person into anxiety and uncertainty. As such it can be viewed as a radical philosophical motivation that can profoundly alter our outlook. The article suggests that illness can change the ways in which we philosophise: it may shape philosophical methods and concerns and change one's sense of salience and conception of philosophy. (shrink)

Phenomenology is a useful methodology for describing and ordering experience. As such, phenomenology can be specifically applied to the first person experience of illness in order to illuminate this experience and enable health care providers to enhance their understanding of it. However, this approach has been underutilized in the philosophy of medicine as well as in medical training and practice. This paper demonstrates the usefulness of phenomenology to clinical medicine. In order to describe the experience of illness, we need a (...) phenomenological approach that gives the body a central role and acknowledges the primacy of perception. I present such a phenomenological method and show how it could usefully illuminate the experience of illness through a set of concepts taken from Merleau-Ponty. His distinction between the biological body and the body as lived, analysis of the habitual body, and the notions of motor intentionality and intentional arc are used to capture the experience of illness. I then discuss the applications this approach could have in medicine. These include narrowing the gap between objective assessments of well-being in illness and subjective experiences which are varied and diverse; developing a more attuned dialogue between physicians and patients based on a thick understanding of illness; developing research methods that are informed by phenomenology and thus go beyond existing qualitative methods; and providing medical staff with a concrete understanding of the impact of illness on the life-world of patients. (shrink)

In this paper I respond to Edward Harcourt’s suggestion that human excellences are structured in a way that allows us to see the multiplicity of life forms that can be instantiated by different groups of excellences. I accept this layered model, but suggest that Harcourt’s proposal is not pluralistic enough, and offer three critical points. First, true pluralism would need to take a life-cycle view, thus taking into account plurality within, as well as between, lives. Second, Harcourt’s pluralism still posits (...) physical health as a requirement for excellence, whereas I claim that the challenges of illness give more, not less, opportunity for excellence. Third, I make a more general claim that in certain salient cases it is precisely the absence of excellence that can facilitate virtue. (shrink)

In this article, I propose that illness is philosophically revealing and can be used to explore human experience. I suggest that illness is a limit case of embodied experience. By pushing embodied experience to its limit, illness sheds light on normal experience, revealing its ordinary and thus overlooked structure. Illness produces a distancing effect, which allows us to observe normal human behavior and cognition via their pathological counterpart. I suggest that these characteristics warrant illness a philosophical role that has not (...) been articulated. Illness can be used as a philosophical tool for the study of normally tacit aspects of human existence. I argue that illness itself can be integral to philosophical method, insofar as it facilitates a distancing from everyday practices. This method relies on pathological or limit cases to illuminate normally overlooked aspects of human perception and action. I offer Merleau-Ponty’s analysis of the case of Schneider as an example of this method. (shrink)

This paper offers a nexus of terms – mortality, limits, contingency and vulnerability – painting a picture of human life as marked by limitation and finitude. I suggest that limitations of possibility, capacity, and resource are deep features of human life, but not only restrict it. Limits are also the conditions of possibility for human life and as such have productive, normative, and creative powers that not only delimit life but also scaffold growth and transformation within it. The paper takes (...) a less known interpretation of the term ‘ephēmeros', to mean ‘of the day', rather than ‘short-lived' and suggests that as ephemeral, human life is contingent and mutable, subject to events beyond our control. However, virtue can still be exercised – indeed, can be exuberantly displayed – when we respond to contingent events marked by adversity. (shrink)

Medical practitioners are duty-bound to tell their patients the truth about their medical conditions, along with the risks and benefits of proposed treatments. Some patients, however, would rather not receive medical information. A recent response to this tension has been to argue that that the disclosure of medical information is not optional. As such, patients do not have permission to refuse medical information. In this paper I argue that, depending on the context, the disclosure of medical information can undermine the (...) patient’s ability to exercise her autonomy or have therapeutically detrimental effects. In the light of these insights I go on to develop a context-sensitive approach to medical disclosure. The advantage of this account is that it addresses concerns on both sides of the debate; whilst it acknowledges that patients do not have an exercisable ‘right not to know,’ it allows that in some cases medical information ought to be withheld. (shrink)

Smartphone apps might offer a low-threshold approach to the detection of mental health conditions, such as depression. Based on the gathering of ‘passive data,’ some apps generate a user’s ‘digital phenotype,’ compare it to those of users with clinically confirmed depression and issue a warning if a depressive episode is likely. These apps can, thus, serve as epistemic tools for affected users. From an ethical perspective, it is crucial to consider epistemic injustice to promote socially responsible innovations within digital mental (...) healthcare. In cases of epistemic injustice, people are wronged specifically as epistemic agents, i.e., agents of the production and distribution of knowledge. We suggest that epistemic agency relies on different resource- and uptake-related preconditions which can be impacted by the functionality of passive self-tracking apps. We consider how this can lead to different forms of epistemic injustice (testimonial, hermeneutical, and contributory injustice) and analyze the influence of the apps’ use on epistemic practices on an individual level, in mental healthcare settings, and on the structural level. (shrink)

The professional application of ethics often lacks the necessary conceptual tools to construct adequate theoretical foundations that can be used for practical enterprise. This book focuses on an anthropological approach to mental illness, describing how schizophrenia can distort one's experience of empathy and of the presence in the world through pathological indifference. It describes factual and phenomenological perspectives on a case of schizophrenia, based on the method of Eugène Minkowski.

What is it like to be a bat? What is it like to be sick? These two questions are much closer to one another than has hitherto been acknowledged. Indeed, both raise a number of related, albeit very complex, philosophical problems. In recent years, the phenomenology of health and disease has become a major topic in bioethics and the philosophy of medicine, owing much to the work of Havi Carel (2007, 2011, 2018). Surprisingly little attention, however, has been given to (...) the phenomenology of animal health and suffering. This omission shall be remedied here, laying the groundwork for the phenomenological evaluation of animal health and suffering. (shrink)

The goal of this programmatic paper is to highlight a close connection between the core problem in the philosophy of medicine, i.e. the concept of health, and the core problem of the philosophy of mind, i.e. the concept of consciousness. I show when we look at these phenomena together, taking the evolutionary perspective of modern state-based behavioural and life-history theory used as the teleonomic tool to Darwinize the agent- and subject-side of organisms, we will be in a better position to (...) make sense of them both as natural phenomena. (shrink)

Since Boorse [Philos Sci 44(4):542–573, 1977] published his paper “Health as a theoretical concept” one of the most lively debates within philosophy of medicine has been on the question of whether health and disease are in some sense ‘objective’ and ‘value-free’ or ‘subjective’ and ‘value-laden’. Due to the apparent ‘failure’ of pure naturalist, constructivist, or normativist accounts, much in the recent literature has appealed to more conciliatory approaches or so-called ‘hybrid accounts’ of health and disease. A recent paper by Matthewson (...) and Griffiths [J Med Philos 42(4):447–466, 2017], however, may bear the seeds for the revival of purely naturalist approach to health and disease. In this paper, I defend their idea of Biological Normativity against recent criticism by Schwartz [J Med Philos Forum Bioethics Philos Med 42(4):485–502, 2017] and hope to help it flower into a revival of naturalist approaches in the philosophy of medicine. (shrink)

In the context of the end of life, many authors point out how the experience of identity is crucial for the well-being of patients with advanced disease. They define this identity in terms of autonomy, control, or dependence, associating these concepts with the sense of personal dignity. From the perspective of the phenomenology of embodiment, Kay Toombs and other authors have investigated the ways disease can impact on the subjective world of patients and have stressed that a consideration of this (...) personal world can promote understanding and recognition of their experience. Based on the findings of qualitative studies of the perception of dignity and autonomy in patients at the end of life, this analysis assesses concepts such as being-in-the-world in illness, embodiment, lived body versus objective body or the gaze of the other from a Toombsian phenomenological perspective. (shrink)

Merleau-Ponty se vale de casos patológicos para elaborar una teoría de la percepción que ubica a la corporalidad como expresión central. El artículo indaga y problematiza la experiencia de enfermedad a partir de la propuesta fenomenológica en torno al cuerpo vivido o fe-nomenal. Repensar esta vivencia, desde las antípodas a un abordaje biomédico que la circunscribe a un cuerpo objetivo, permite considerarla a la luz de una perspectiva filosófica como instancia crítica. La experiencia de enfermedad, inaugura una disrupción en el (...) modo de ser-en-el-mundo e introduce la inhabitualidad, como dimensión que participa de una reconfiguración necesaria del esquema corporal. Este aspecto permite repensar los procesos de salud/enfermedad y discutir con concepciones de índole restitutivas, tan características a la hora de abordar los mismos.Merleau-Ponty uses pathological cases to elaborate a theory of perception that places corporality as the central expression. The article investigates and problematizes the experience of illness from the phenomenological proposal around the lived or phenomenal body. Rethinking this experience, from the antipodes to a biomedical approach that circumscribes it to an objective body, allows us to consider it in the light of a philosophical perspective as a critical instance. The experience of illness inaugurates a dis-ruption in the way of being-in-the-world and introduces the unusual, as a dimension that participates in a necessary reconfiguration of the body scheme. This aspect allows to rethink the health / disease processes and to discuss with concepts of a restorative nature, so characteristic when it comes to addressing them. (shrink)

Placebos are commonly defined as ineffective treatments. They are treatments that lack a known mechanism linking their properties to the properties of the condition on which treatment aims to intervene. Given this, the fact that placebos can have substantial therapeutic effects looks puzzling. The puzzle, we argue, arises from the relationship placebos present between culturally meaningful entities, our intentional relationship to the environment and bodily effects. How can a mere attitude toward a treatment result in appropriate bodily changes? We argue (...) that an ‘enactive’ conception of cognition accommodates and renders intelligible the phenomenon of placebo effects. Enactivism depicts an organism’s adaptive bodily processes, its intentional directedness, and the meaningful properties of its environment as co-emergent aspects of a single dynamic system. In doing so it provides an account of the interrelations between mind, body and world that demystifies placebo effects. (shrink)

This article explores the relation among illness, home, and belonging. Through a feminist phenomenological framework, I describe the disorientations of being diagnosed with borderline personality disorder and living with mental illness. This research anticipates the consequences of illness and serious disorientations for a conception of belonging as seamless body–world compatibility. Instead, this article examines how the stability of bodily dwellings in experiences of disorientation can suggest ways of being in the world that are more attentive to interdependency, unpredictability, and change (...) in human experience. I argue that these types of dwellings function as a more capacious and apposite metaphor to account for variations in belonging. This discussion outlines the ethical importance of building worlds that make room for different ways of being at home in and through our interactions with others. Although my discussion does not supply norms for ethical action, I contend that a feminist phenomenology of illness generates saliences and illuminates sensibilities that can transform our ways of being with others. (shrink)

Phenomenology in medicine’s main contribution is to present a first-person narrative of illness, in an effort to aid medicine in reaching an accurate disease diagnosis and establishing a personal relationship with patients whose lived experience changes dramatically when severe disease and disabling condition is confirmed. Once disease is diagnosed, the lived experience of illness is reconstructed into a living-with-disease narrative that medicine’s biological approach has widely neglected. Key concepts like health, sickness, illness, disease and the clinical encounter are being diversely (...) and ambiguously used, leading to distortions in socio-medical practices such as medicalization, pharmaceuticalization, emphasis on surveillance medicine. Current definitions of these concepts as employed in phenomenology of medicine are revised, concluding that more stringent semantics ought to reinforce an empirical phenomenological or postphenomenological approach. (shrink)

Medical humanities have a unique role to play in combating biopiracy. This argument is offered both as a response to contemporary concerns about the ‘value’ and ‘impact’ of the arts and humanities and as a contribution to ongoing legal, political, and ethical debates regarding the status and protection of medical heritage. Medical humanities can contribute to the documentation and safeguarding of a nation or people’s medical heritage, understood as a form of intangible cultural heritage. In so doing it can fulfill (...) a unique service in protecting indigenous cultural heritage which potentially makes it of enormous economic benefit to national governments. I use the Indian Traditional Knowledge Digital Library as a case study of the value of medical humanities in challenging biopiracy. If my argument holds, then the value of medical humanities to current intellectual property debates can be demonstrated, and its pertinence to legal and economic interests made clear. However, there are some dangers in this strategy, and my paper closes with a discussion of them. (shrink)

Abstract Havi Carel has recently argued that one can be ill and happy. An ill person can ?positively respond? to illness by cultivating ?adaptability? and ?creativity?. I propose that Carel's claim can be augmented by connecting it with virtue ethics. The positive responses which Carel describes are best understood as the cultivation of virtues, and this adds a significant moral aspect to coping with illness. I then defend this claim against two sets of objections and conclude that interpreting Carel's phenomenology (...) of illness within a virtue-ethical framework enriches our understanding of how illness can be edifying. (shrink)

What are the worst conditions under which someone can be virtuous and happy? In this paper, I argue that a minimum threshold of favorable circumstances is necessary for moral virtue and human flourishing or happiness. Stoic and Aristotelian traditions make different and important claims about the role of external circumstances in our moral lives. Retrieving the ancient dispute benefits contemporary ethics. For one, the relevance of external circumstances is an important question for the development of present-day virtue ethics. For another, (...) identifying the minimal ingredients for virtue and happiness is helpful for wider ethical concerns such as discussions of our moral obligations to future generations. After explaining the ancient dispute, I describe categories of circumstances that seem intuitively relevant to virtue and happiness. Then, I investigate which are necessary and examine commonsense examples. I conclude that a minimum threshold of favorable circumstances from the following categories is necessary: the necessities for biological life, cognitive ability, and moral education. (shrink)

Analogies of grief to amputation and phantom limb are common in memoirs and literary accounts of loss.1 Consider, for example, C. S. Lewis's response to the suggestion that he will "get over" the loss of his wife, in A Grief Observed: Getting over it so soon? But the words are ambiguous. To say the patient is getting over it after an operation for appendicitis is one thing; after he's had his leg off it is quite another. … There will be (...) hardly any moment when he forgets it. … His whole way of life will be changed. … At present I am learning to get about on crutches. Perhaps I shall presently be given a wooden leg. But I shall never be a biped again.2 As Matthew Ratcliffe has argued, though such references may... (shrink)

According to a widely accepted belief, we cannot know our own death—death means ‘nothing’ to us. At first sight, the meaning of ‘nothing’ just implies the negation or absence of ‘something’. Death then simply refers to the negation or absence of life. As a consequence, however, death has no meaning of itself. This leads to an ontological paradox in which death is both acknowledged and denied: death is … nothing. In this article, I investigate whether insight into the ontological paradox (...) of the nothingness of death can contribute to a good end-of-life. By analysing Aquinas’, Heidegger’s and Derrida’s understanding of death as nothingness, I explore how giving meaning to death on different ontological levels connects to, and at the same time provides resistance against, the harsh reality of death. By doing so, I intend to demonstrate that insight into the nothingness of death can count as a framework for a meaningful dealing with death. (shrink)

Cuerpo físico y cuerpo vivido no deben interpretarse como dos realidades separadas, sino que representan dos aspectos distintos de la misma experiencia corporal descrita en términos fenomenológicos. La experiencia de la corporalidad puede seguir dos direcciones: a) la primera es una dirección ascendente, que implica el desarrollo de las posibilidades de movimiento, acción y expresión del cuerpo en toda su plenitud; b) el otro camino o dirección, en contraste con el anterior, toma una senda descendente, y se halla estrechamente relacionado (...) con la experiencia del dolor, de la limitación, de la resistencia corporal que es experimentada como oposición a la propia voluntad: es el cuerpo vulnerable. Aquí reaparece un nuevo dualismo: el cuerpo poético de la expresión frente al cuerpo vulnerable de la enfermedad y el dolor. Mi contribución trata de cuestionar la idea de que el cuerpo poético de la expresión artística y el cuerpo vulnerable de la vejez, de la discapacidad o de la enfermedad, pertenezcan a esferas completamente separadas. Con este propósito, se intenta poner de relieve los múltiples puntos de intersección entre ambas perspectivas, al tiempo que se sostiene que tales intersecciones pueden llegar a ser interesantes puntos de partida de la investigación interdisciplinar. (shrink)

In this paper, I will argue that ageing can be construed as disease. First, the concept of disease is discussed, where the distinction is made between two lines of thought, an objectivist and a subjectivist one. After determining the disease conception to be used throughout the argument, it is proposed that senescence could be seen as disease. Three common counterarguments are discussed, none of which appears strong enough to effectively counter the advocated view. In the third section, two potential implications (...) of the view advocated here will be briefly touched upon. These are the quest for a cure or treatment for ageing and the general attitude towards the elderly. It is concluded that, utilizing an objective disease concept, ageing could be seen as a disease. None of the considered counterarguments packs enough of a punch to discard this. The implications are complex and intertwined, but need not be negative. (shrink)

This paper considers phenomenological descriptions of health in Gadamer, Heidegger, Merleau-Ponty, and Svenaeus. In these phenomenologies of health, health is understood as a tacit, background state that permits not only normal functioning but also philosophical reflection. Nietzsche’s model of health as a state of intensity that is intimately connected to illness and suffering is then offered as a rejoinder. Nietzsche’s model includes a more complex view of suffering and pain as integrally tied to health, and its language opens up the (...) possibility of many ‘healths,’ providing important theoretical support to phenomenological accounts of the diversity and complexity of health and illness. (shrink)

Clinically significant delusion is a symptom of a number of mental illnesses. We rely on what a person says and how she behaves in order to identify if she has this symptom and it is clear from the literature that delusions are heterogeneous and extremely difficult to define. People with active delusions were interviewed to explore what it is like to develop and experience delusion. The transcribed interview data was analysed to identify themes and narrative trajectories that help to explain (...) the phenomenon. Results showed that delusions can sometimes provide pragmatic benefits and that the genesis of some delusions can be characterised in terms of the enactivist notion of affective framing. Affective framing is a term that captures the background emotions that enable know-how in terms of goal directed action and cognition. If a person’s affective frame alters the world is no longer understood and know-how is lost. The way in which a person relates to her environment can be highly anomalous thus requiring her to find an extraordinary explanation. I argue that delusions arise as a result of a breakdown in affective framing and offer a conceptualisation of delusion supported by empirical findings. (shrink)

According to the doctrine of informed consent medical procedures are morally permissible when a patient has consented to the treatment. Problematically it is possible for a patient to consent to or refuse treatment which consequently leads to a decline in her best interests. Standardly, such conflicts are resolved by prioritising the doctrine of informed consent above the requirement that the medical practitioner acts in accordance with the duty of care. This means that patient free choice is respected regardless as to (...) whether her choice leads to a decline in her best interests, since to disrespect patient choice would be an instance of ‘unwarranted’ paternalism. This thesis defends the claim that in cases where patient consent comes into conflict with her best interests, paternalistic interference is in fact justified. The ambition of the thesis is thus twofold: in the first place I argue that the doctrine of informed consent cannot be used as an ethical guarantor for medical decision making. Secondly I will conclude that hard paternalism is justified in medical practice, thereby calling for a reversal of the prioritisation of informed consent procedures over the medical practitioner’s duty of care. (shrink)

This thesis is a contribution to the ethical justification for clinical research with children. A research subject’s participation in a trial is usually justified, in part, by informed consent. Informed consent helps to uphold the moral principle of respect for persons. But children’s limited ability to make informed choices gives rise to a problem. It is unclear what, if anything, justifies their participation in research. Some research ethicists propose to resolve this problem by appealing to social utility, proxy consent, arguments (...) explaining why it is permissible to expose children to some harm, and an argument concerning the appropriate balance between research harms and benefits. I argue that each of these is a necessary part of the justification for research with children, but that the argument concerning harms and benefits is under-developed. It relies on the concept of minimal risk, but minimal risk is inadequately justified. I propose an interpretation of minimal risk. I defend the idea that minimal risk should be interpreted according to the risks of daily life. I reject the most prominent defense of daily life, which claims that daily risks are morally relevant because they replace, rather than add to, the risks a child would ordinarily face. Instead, I propose that these risks are part of a reasonable trade-off between personal safety and our ability to pursue meaningful lives. I then examine whose daily life should be captured in the concept of minimal risk. I reject arguments that minimal risk should refer to healthy children or the subjects of the research and propose instead that the referent should be children who are not unduly burdened by their lives. I argue that children are not unduly burdened when they fare well and defend the idea that children fare well when they possess sufficiently high degrees of the substantive goods of childhood. I conclude by analyzing a controversial case study using my interpretation of minimal risk. I draw on this case to argue that my interpretation offers clear guidance for research ethics review and contributes to a determination that is more plausible than its rivals. (shrink)

Orthorexia is a condition in which the subject becomes obsessed with identifying and maintaining the ideal diet, rigidly avoiding foods perceived as unhealthy or harmful. In this paper, I examine widespread cultural factors that provide particularly fertile ground for the development of orthorexia, drawing out social and historical connections between religion and orthorexia (which literally means “righteous eating”), and also addressing how ambiguities in the concept of “health” make it particularly prone to take on quasi-religious significance. I argue that what (...) makes this sort of disordered eating destructive to both men and women is ultimately a common urge to transcend rather than to embrace the realities of embodiment. In sum, I believe that orthorexia is best understood as a manifestation of age-old anxieties about human nitude and mortality—anxieties which current dominant sociocultural forces prime us to experi- ence and express in unhealthy attitudes toward healthy eating. (shrink)