Trust is central to the therapeutic relationship, but the epistemic asymmetries between the expert healthcare provider and the patient make the patient, the trustor, vulnerable to the provider, the trustee. The narratives of pain sufferers provide helpful insights into the experience of pain at the juncture of trust, expert knowledge, and the therapeutic relationship. While stories of pain sufferers having their testimonies dismissed are well documented, pain sufferers continue to experience their testimonies as being epistemically downgraded. This kind of epistemic (...) injustice has received limited treatment in bioethics. In this paper, we examine how a climate of distrust in pain management may facilitate what Fricker calls epistemic injustice. We critically interrogate the processes through which pain sufferers are vulnerable to specific kinds of epistemic injustice, such as testimonial injustice. We also examine how healthcare institutions and practices privilege some kinds of evidence and ways of knowing while excluding certain patient testimonies from epistemic consideration. We argue that providers ought to avoid epistemic injustice in pain management by striving toward epistemic humility. Epistemic humility, as a form of epistemic justice, may be the kind disposition required to correct the harmful prejudices that may arise through testimonial exchange in chronic pain management. (shrink)

Objectification is a real problem in medicine that can lead to bad medical practice or, in the worst case, dehumanization of the patient. Nevertheless, objectification also plays a major and necessary role in medicine: the patient’s body should be viewed as a biological organism in order to find diseases and be able to cure them. Listening to the patient’s illness story should not be replaced, but, indeed, developed by the physical examination of his body searching for the causes of his (...) complaints. Whereas phenomenologists have so far mainly been identifying the back sides of objectification in medicine, in this paper the aim is to analyze differences between detrimental objectifications and objectifications that do not deprive the patient of his subjectivity but, rather, at least in some cases, may lead the patient to feel more at home with his body. (shrink)

The theory of technological mediation aims to take technological artifacts seriously, recognizing the constitutive role they play in how we experience the world, act in it, and how we are constituted as (moral) subjects. Its quest for a compatible ethics has led it to Foucault’s “care of the self,” i.e., a transformation of the self by oneself through self-discipline. In this regard, technologies have been interpreted as power structures to which one can relate through Foucaultian “technologies of the self” or (...) ascetic practices. However, this leaves unexplored how concrete technologies can actuallysupportthe process of self-care. This paper explores this possibility by examining one such technology: a gamified To-Do list app. Doing so, it first shows that despite the apparent straightforwardness of gamification, confrontation and shame play an important role in how the app motivates me to do better. Second, inspired by Ihde’s schema of human-technology relations, it presents different ways in which the app may confront me with myself. Subsequently, it accounts for the motivation and shame that this technologically mediated confrontation with myself invokes through a Levinasian account of ethical subjectivity. In so doing, it also shows how Levinas’ phenomenology implies a responsibility for self-care and how nonhuman, technological others may still call me to responsibility. It concludes with a reflection on the role of gamification in technologically mediated subjectivation and some implications for design. (shrink)

A generation ago scientific ideas floated free in the air, as historians gazed up at them in wonder and admiration. From time to time, historians agreed, the ideas that made up the body of scientific truth became incarnate: they were embedded into the fleshly forms of human culture and attached to particular times and places. How this incarnation occurred was a great mystery. How could spirit be made flesh? How did the transcendent and the timeless enter the forms of the (...) mundane and the contingent? Platonist and providentialist perspectives offered ways of speaking about the mystery, but, in general, it remained unresolved at the core of orthodox idealist historiography.1. (shrink)

Mobile health applications (‘health apps’) that promise the user to help her with some aspect of her health are very popular: for-profit apps such as MyFitnessPal, Fitbit, or Headspace have tens of millions of users each. For-profit health apps are designed and run as optimization systems. One would expect that these health apps aim to optimize the health of the user, but in reality they aim to optimize user engagement and, in effect, conversion. This is problematic, I argue, because digital (...) health environments that aim to optimize user engagement risk being manipulative. To develop this argument, I first provide a brief analysis of the underlying business models and the resulting designs of the digital environments provided by popular for-profit health apps. In a second step, I present a concept of manipulation that can help analyze digital environments such as health apps. In the last part of the article, I use my concept of manipulation to analyze the manipulative potential of for-profit health apps. Although for-profit health can certainly empower their users, the conditions for empowerment also largely overlap with the conditions for manipulation. As a result, we should be cautious when embracing the empowerment discourse surrounding health apps. An additional aim of this article is to contribute to the rapidly growing literature on digital choice architectures and the ethics of influencing behavior through such choice architectures. I take health apps to be a paradigmatic example of digital choice architectures that give rise to ethical questions, so my analysis of the manipulative potential of health apps can also inform the larger literature on digital choice architectures. (shrink)

Narrative ethics taps into an inherent human need to tell our own stories centred on our own moral values and to have those stories heard and acknowledged. However, not everyone’s words are afforded equal power. The use of narrative ethics in bioethical decision-making is problematized by a disparity in whose stories are told, whose stories are heard, and whose stories are believed. Here, I conduct an analysis of narrative ethics through a critical theory lens to show how entrenched patterns of (...) narrative neglect in medicine are harming not only our capacity to make use of narrative ethics but also our capacity to deliver effective healthcare. To illustrate this point, I use three examples where the patient’s gender affects how their stories unfold: autism, weight, and pain management. From these, I argue that the use of narrative ethics without the application of a critical theory lens risks the exacerbation of what Miranda Fricker refers to as “testimonial injustice,” the prima facie harm experienced by individuals whose credibility is undermined by others’ prejudices. Finally, I suggest that narrative ethics can be a powerful tool for mitigating oppressive practices in medicine if we couple it with critical analysis that enables us to understand the power dynamics at play in storytelling. (shrink)

Several philosophers have recently argued that phenomenology is well-suited to help understand the concepts of health, disease, and illness. The general claim is that by better analysing how illness appears to or is experienced by ill individuals—incorporating the first-person perspective—some limitations of what is seen as the currently dominant third-person or ‘naturalistic’ approaches to understand health and disease can be overcome. In this article, after discussing some of the main insights and benefits of the phenomenological approach, I develop three general (...) critiques of it. First, I show that what is often referred to as naturalism tends to be misunderstood and/or misrepresented, resulting in straw-man arguments. Second, the concept of normality is often problematically employed such that some aspects of naturalism are actually presupposed by many phenomenologists of medicine. Third, several of the key phenomenological insights and concepts, e.g. having vs. being a body, the alienation of illness, the epistemic role of the first-person perspective, and the idea of health within illness, each bring with them new problems that limit their utility. While acknowledging the possible contributions of phenomenology, these criticisms point to some severe limitations of bringing phenomenological insights to bear on the problems facing philosophy of medicine that should be addressed if phenomenology is to add anything substantially new to its debates. (shrink)

The traditional contrast between naturalist and normativist disease concepts fails to capture the most salient features of the health concepts debate. By using health concepts as a window on background notions of medical science and ethics, I show how Christopher Boorse (an influential naturalist) and Lennart Nordenfelt (an influential normativist) actually share deep assumptions about the character of medicine. Their disease concepts attempt, in different ways, to shore up the same medical model. For both, health concepts function like demarcation criteria (...) in the philosophy of science: they mark off the jurisdiction of medical science, and protect it from an inappropriate intrusion of socioeconomic factors, which threaten the integrity of modern medicine. These views are challenged by new developments in healthcare such as managed care and total quality review. To frame the health concepts debate in a way that better captures the issues integral to these new developments, I advance a new way of reading the distinction between weak and strong normativists. Strong normativists are skeptical of the demarcation project, think facts and values cannot be disentangled, and hold that socioeconomic conditions unavoidably influence how pathology is understood. The new health concepts debate should be framed as one between weak and strong normativists, and it concerns how we should respond to the current developments in health care. (shrink)

Rather than focus on effects, the isolatable and measureable outcomes of events and interventions, the papers assembled here offer different perspectives on the affective dimension of the meaning and politics of human/non-human relations. The authors begin by drawing attention to the constructed discontinuity between humans and non-humans, and to the kinds of knowledge and socialities that this discontinuity sustains, including those underpinned by nature-culture, subject-object, body-mind, individual-society polarities. The articles presented track human/non-human relations through different domains, including: humans/non-humans in history (...) and animal welfare science (Fudge and Buller); the relationship between the way we live, the effects on our natural environment and contested knowledges about ‘nature’ (Whatmore); choreographies of everyday life and everyday science practices with non-human animals such as horses, meerkats, mice, and wolves (Latimer, Candea, Davies, Despret). Each paper also goes on to offer different perspectives on the human/non-human not just as division, or even as an asymmetrical relation, but as relations that are mutually affective, however invisible and inexpressible in the domain of science. Thus the collection contributes to new epistemologies/ontologies that undercut the usual ordering of relations and their dichotomies, particularly in that dominant domain of contemporary culture that we call science. Indeed, in their impetus to capture ‘affect’, the collection goes beyond the usual turn towards a more inclusive ontology, and contributes to the radical shift in the epistemology and philosophy of science’s terms of engagement. (shrink)

Some of Michel Foucault’s work focusses on an archeological and genealogical analysis of certain aspects of the medical episteme, such as ‘Madness and Civilization’ (1964/2001), ‘The Birth of the Clinic’ (1973) and ‘The History of Sexuality’ (1978/2020a). These and other Foucauldian works have often been invoked to characterize, but also to normatively interpret mechanisms of the currently existing medical episteme. Writers conclude that processes of patient objectification, power, medicalization, observation and discipline are widespread in various areas where the medical specialty (...) operates and that these aspects have certain normative implications for how our society operates or should operate. The Foucauldian concepts used to describe the medical episteme and the normative statements surrounding these concepts will be critically analyzed in this paper.By using Foucault’s work and several of his interpreters, I will focus on the balance between processes of subjectification and objectification and the normative implications of these processes by relating Foucault’s work and the work of his interpreters to the current medical discipline. Additionally, by focusing on the discussion of death and biopower, the role of physicians in the negation and stigmatization of death is being discussed, mainly through the concept of biopower. Lastly, based on the discussion of panopticism in the medical discipline, this paper treats negative and positive forms power, and a focus will be laid upon forms of resistance against power. The discussed aspects will hopefully shed a different and critical light on the relationship between Foucault’s work and medicine, something that eventually can also be deduced from Foucault’s later work itself. (shrink)

The aim of this article is (1) to investigate the ‘neurosciences’ as an object of study for historical and genealogical approaches and (2) to characterize what we identify as a particular ‘style of thought’ that consolidated with the birth of this new thought community and that we term the ‘neuromolecular gaze’. This article argues that while there is a long history of research on the brain, the neurosciences formed in the 1960s, in a socio-historical context characterized by political change, faith (...) in scientific and technological progress, and the rise of a molecular gaze in the life sciences. They flourished in part because these epistemological and technological developments were accompanied by multiple projects of institution-building. An array of stakeholders was mobilized around the belief that breakthroughs in understanding the brain were not only crucial, they were possible by means of collaborative efforts, cross-disciplinary approaches and the use of a predominantly reductionist neuromolecular method. The first part of the article considers some of the different approaches that have been adopted to writing the history of the brain sciences. After a brief outline of our own approach, the second part of the article uses this in a preliminary exploration of the birth of the neurosciences in three contexts. We conclude by arguing that the 1960s constitute an important ‘break’ in the long path of the history of the brain sciences that needs further analysis. We believe this epistemological shift we term the ‘neuromolecular gaze’ will shape the future intellectual development and social role of the neurosciences. (shrink)

In his later lectures, Foucault analyzes confession as a key exercise of the Christian pastoral power. The pastoral power’s creation of a lifelong obligation to speak the truth of oneself is a ‘prelude’ to modern practices of government, and a key facet of modernity. There has been some confusion regarding the scope of Foucault’s study. Is it medieval Christian confessional practices or Christian obedience itself that is his theme? In this article, I revisit all of the later lectures touching on (...) confession and avowal in order to clarify Foucault’s ambivalence about Christian proto-governmentality. Foucault exposes two regimes of truth, belief and confession, and offer a practice-based, confession-centred history of the pre-modern self. Connecting his lectures to his method of anarchaeology clarifies how the force of truth (the ‘you have to’) is, for Foucault, a fundamental if ambivalent historical-cultural problem of government. (shrink)

Unconsented pelvic exams under anesthesia are assaults cloaked in defense of healthcare education. Preemptive linguistic qualifiers “presumed” or “implied” attempt to justify such violations with flippancy toward their oxymoronic implications: to suggest a priori that consent can be assumed undermines its otherwise standalone social, ethical, and medico-legal reverence. In this paper I conceptualize “medical sexual assault” and argue that presumed consent for intimate exams exemplifies its definition. By bluntly describing pelvic exams as “penetration,” this work aims to reify the intimate (...) reality of the clinical label “pelvic exam” and to call attention to cisheteronormative and androcentric assumptions involved in its practice. Additionally, this scholarship seeks to create a foundation toward broader work in conceptualizing clinical rape culture. Given recent national survey data indicating a surprising frequency of unconsented intimate exams, detailed language as to their problematics is necessary for ongoing legal and ethical efforts. Explicit consent for intimate exams must be the standard of care for conscious and unconscious patients. (shrink)

Recent debate among bioethicists concerns the potential to enhance human beings’ physical or cognitive capacities by means of genetic, pharmacological, cybernetic, or surgical interventions. Between “transhumanists,” who argue for unreserved enhancement of human capabilities, and “bioconservatives,” who warn against any non-therapeutic manipulation of humanity’s natural condition, lie those who support limited forms of enhancement for the sake of individual and collective human flourishing. Many scholars representing these views also share a concern over the status and interests of human beings with (...) various types of cognitive and physical disabilities, some of which may be ameliorable by enhancement interventions. The question addressed in this paper is whether valuing the enhancement of human capabilities may be reconciled with valuing the existence and phenomenological experiences of human beings with various disabilities. Can we value enhanced capabilities without disvaluing those whose capabilities fall below a defined threshold of “normal function”? Furthermore, if certain forms of disability, particularly cognitive disabilities, negatively impact one’s flourishing, could the enhancement of one’s cognitive capacities through biotechnological means enhance one’s flourishing. (shrink)

Suicide has long been the subject of philosophical, literary, theological and cultural–historical inquiry. But despite the diversity of disciplinary and methodological approaches that have been brought to bear in the study of suicide, we argue that the formal study of suicide, that is, suicidology, is characterized by intellectual, organizational and professional values that distinguish it from other ways of thinking and knowing. Further, we suggest that considering suicidology as a “social practice” offers ways to usefully conceptualize its epistemological, philosophical and (...) practical norms. This study develops the idea of suicidology as a social practice and considers the implications for research, practice and public discourse. (shrink)

This article explores Foucault’s two different notions of power: one where the subject is constituted by power–knowledge relations and another that emphasizes how power is a central feature of human action. By drawing out these two conceptualizations of power, Foucault’s work contributes three critical points to the formation of medicalized subjectivities: the issue of medicalization needs to be discussed both in terms of both specific practices and holistically ; we need to think how we as human beings are “disciplined” and (...) “subjectivated” through medicalization, as discourses, practices, and institutions are all crystallizations of power relations; and we need to reflect on how we can “resist” this process of subjectification, since “power comes from below” and patients shape themselves through “technologies of the self.” Ultimately, Foucault’s work does not merely assist us in refining our analysis; rather, it is essential for conceptualizing medicalization in contemporary society. (shrink)

As befits an emerging field of enquiry, there is on-going discussion about the scope, role and future of the medical humanities. One relatively recent contribution to this debate proposes a differentiation of the field into two distinct terrains, ‘medical humanities’ and ‘health humanities,’ and calls for a supersession of the former by the latter. In this paper, we revisit the conceptual underpinnings for a distinction between ‘the medical’ and ‘health’ by looking at the history of an analogous debate between ‘medical (...) geography’ and ‘the geographies of health’ that has, over the last few years, witnessed a re-blurring of the distinction. Highlighting the value of this debate within the social sciences for the future development of the medical humanities, we call for scholars to take seriously the challenges of critical and cultural theory, community-based arts and health, and the counter-cultural creative practices and strategies of activist movements in order to meet the new research challenges and fulfill the radical potential of a critical medical humanities. (shrink)

The clinical encounter begins with presentation of an illness experience; but throughout that encounter, something else is constructed from it – a symptom. The symptom is a particular interpretation of that experience, useful for certain purposes in particular contexts. The hermeneutics of medicine – the study of the interpretation of human experience in medical terms – has largely taken the process of symptom-construction to be transparent, focussing instead on how constellations of symptoms are interpreted as representative of particular conditions. This (...) paper examines the hermeneutical activity of symptom-construction more closely. I propose a fourfold account of the clinical function of symptoms: as theoretical entities; as tools for communication; as guides to palliative intervention; and as candidates for medical explanation or intervention. I also highlight roles they might play in illness experience. I use this framework to discuss four potential failures of symptom-interpretation: failure of symptom-type and symptom-token recognition; loss of the complete picture of illness experience through overwhelming emphasis on its symptomatic interpretation; and intersubjective feedback effects of symptom description altering the ill person’s own perceptions of their phenomenal experience. I conclude with some suggestions of potential remedies for failures in the process of symptom-construction. (shrink)

Poststructuralism and complexity are plural and diverse modes of thought that share a common subscription to the `anteriority of radical relationality'. They nonetheless subscribe to a different ethic of life because they address the anteriority of radical relationality in different ways. Complexity remains strategic in its bid to become a power-knowledge of the laws of becoming. It derives that strategic ethic from its scientific interest in the implicate order of non-linearity that is said to subvert Newtonian science. Poststructuralism is poetic. (...) It derives its poetic ethic from Heidegger and from the reworking of orphic and tragic sensibilities to radical relationality with the radically non-relational. Observing that all poetry is complexity avant la lettre, the article illustrates these points with the Odyssey and concludes that while complexity is ultimately concerned with fitness, poststructuralism is preoccupied with justice. (shrink)

The ArgumentMontaigne'sEssayswere an exercise in self-knowledge carried out for more than twenty years in Montaigne's private library located in his mansion near Bordeaux. The library was a place of solitude as well as a place of knowledge, a kind ofheterotopiain which two sets of spatial relations coexisted and interacted: the social and the epistemic. The spatial demarcation and arrangement of the site – in both the physical and the symbolic sense – were necessary elements of the constitution of Montaigne's self (...) as an object of knowledge and as a subject of discourse. The spatial setting of the library made possible and constrained certain discursive patterns through which words were systematically linked to things, authority was correlated with access and visibility, and the epistemological was coordinated with the social. In this sense, Montaigne's library resembled other places of empirical knowledge of the late sixteenth and seventeenth centuries in which subjects of knowledge were constituted, objects were posited in their proper phenomenal fields and the entire structure of intellectual activity was reproduced through various cultural mechanisms. But the initial similarity is only apparent. The private library never became a culturally recognized place for knowledge of the self; its heterotopic structure could not have been reproduced without the concrete presence of an author and of a self, while Montaigne's skepticism systematically undermined the possibility of the author's position and of the identity of the self. (shrink)

Foucault and Sellars are representatives of conflicting philosophical traditions: whereas Foucault famously insisted that “power is everywhere,” Sellars proposed the well-known scientia mensura dictum. The tension between the two perspectives seems to be so strong that each of them ends up reducing the other to an epiphenomenal illusion. In this article, I shall attempt to show that the works of Sellars and Foucault are not necessarily irreconcilable. The common ground for this dialogue is what I shall define as a historico-practical (...) conception of science. I will build this concept by tracing a connection between the Foucauldian notion of “conditions of possibility” of science and Sellars’s thesis about the “indispensability” of the manifest image. Finally, I will argue that this conception of science problematizes the clash between the scientific and manifest images of the world, paving the way for a different relationship between naturalism and critical theory. (shrink)

Medicalization has been a process articulated primarily by social scientists, historians, and cultural critics. Comparatively little is written about the role of bioethics in appraising medicalization as a social process. The authors consider what medicalization means, its definition, functions, and criteria for assessment. A series of brief case sketches illustrate how bioethics can contribute to the analysis and public policy discussion of medicalization.

It is widely known that by the end of the 1970s, Foucault had begun to refer to ‘experience’ to account for his intellectual trajectory and to redirect the work on The History of Sexuality. However, the interest in experience also decisively shaped Foucault’s analysis of the ‘critical attitude’ that he explicitly started to address at about the same time. The article argues that Foucault’s notion of critique is informed by a specific reading and understanding of ‘experience’. Experience is conceived of (...) as dominant structure and transformative force, as existing background of practices and transcending event, as the object of theoretical inquiry and the objective of moving beyond historical limits. Foucault defines experience as a dynamic interplay between games of truth, forms of power and relations to the self. Accordingly, the Foucauldian account of critique is characterized by three aspects: the activity of problematization, the art of voluntary insubordination, and the audacity to expose one’s own status as a subject. While the first section of the article briefly reconstructs the trajectory of ‘experience’ in Foucault’s work from the 1960s to the 1980s, the main part discusses the dimensions and implications of this ‘experimental’ critique. (shrink)

This paper addresses Foucauldian theory and its usefulness to nursing research. It is written in the form of a discussion between the authors on the merits and liabilities of Foucauldian theory as applied to analyses of nursing. As such, it focuses upon some of the more pertinent critiques of both Foucauldian and postmodern theory. By addressing Foucault from two different positions, the discussion seeks to demonstrate the complexity of Foucauldian theory and warns against oversimplification in its application to nursing research. (...) The authors also argue for an awareness of the strengths and weaknesses of any given theoretical stance. (shrink)

ABSTRACTThis paper compares Margaret Archer’s morphogenetic critical realism and Michel Foucault’s implicit discursive realism. It argues that there is a surprisingly high degree of correspondence between the two social ontologies. Specifically, both ontologies suggest that there are three largely autonomous domains in operation: cultural, structural, and agentive. Yet, while each of these domains have a level of independence, yet they are also partially constituted by the content and form of the others. This paper discusses the potential to integrate the two (...) approaches in such a way as to overcome their respective short-comings, namely the underdevelopment of culture in Archer’s ontology, and the underdevelopment of social agency in Foucault’s ontology. (shrink)

This paper examines five groups of women that were instrumental in the emergence of the category of “feeblemindedness” in the United States. It analyzes the dynamics of oppression and power relations in the following five groups of women: “feebleminded” women, institutional caregivers, mothers, researchers, and reformists. Ultimately, I argue that a feminist analysis of the history of mental retardation is necessary to serve as a guide for future feminist work on cognitive disability.

This article focuses on patients' participation in decision‐making in meetings with healthcare professionals in a healthcare system, based on neoliberal regulations and ideas. Drawing on two constructed empirical cases, primarily from the perspective of patients, this article analyses and discusses the clinical practice around decision‐making meetings within a Foucauldian perspective. Patients' participation in decision‐making can be seen as an offshoot of respect for patient autonomy. A treatment must be chosen, when patients consult physicians. From the perspective of patients, there is (...) a tendency for healthcare professionals to supply the patients with the information that they think are necessary for them to make their own decision. But patients do not always want to be a ‘customer’ in the healthcare system; they want to be a patient, consulting an expert for help and advice, which creates resistance to some parts of the decision‐making process. Both professionals and patients are subject to the structural frame of the medical field, formed of both neoliberal framework and medical logic. The decision‐making competence in relation to the choice of treatment is placed away from the professionals and seen as belonging to the patient. A ‘projectification’ of the patient occurs, whereby the patient becomes responsible for his/her choices in treatment and care and the professionals support him/her with knowledge, preferences, and alternative views, out of which he/she must make his/her own choices, and the responsibility for those choices now and in the future. At the same time, there is a tendency towards de‐professionalization. In that light, participation of patients in decision‐making can be regarded as a tacit governmentality strategy that shapes the location of responsibility between individual and society, and independent patients and healthcare professionals, despite the basically desirable, appropriate, and necessary idea of involving patients in their own situations from a humanistic perspective. (shrink)

Martin Paleček and Mark Risjord have recently put forward a critical evaluation of the ontological turn in anthropological theory. According to this philosophically informed theory of ethnographic practice, certain insights of twentieth-century analytic philosophy should play a part in the methodological debates concerning anthropological fieldwork: most importantly, the denial of representationalism and the acceptance of the extended mind thesis. In this paper, I will attempt to evaluate the advantages and potential drawbacks of ontological anthropology—arguing that to become a true alternative (...) to current social scientific thinking about methodology, it has to meet certain philosophical objections. (shrink)

Foucauldian discourse analysis (FDA) is a methodology that is well suited to inquiring into nursing knowledge and its organization. It is a critical analytic approach derived from Foucault's histories of science, madness, medicine, incarceration and sexuality, all of which serve to exteriorize or make visible the ‘positive unconscious of knowledge’ penetrating bodies and minds. Foucauldian discourse analysis (FDA) holds the potential to reveal who we are today as nurses and as a profession of nursing by facilitating our ability to identify (...) and trace the effects of the discourses that determine the conditions of possibility for nursing practice that are continuously shaping and (re)shaping the knowledge of nursing and the profession of nursing as we know it. In making visible the chain of knowledge that orders the spaces nurses occupy, no less than their subjectivities, FDA is a powerful methodology for inquiring into nursing knowledge based on its provocation of deep critical reflection on the normalizing power of discourse. (shrink)

The aim of this discussion paper is to explore factors and contexts that influence how nurses might conceptualise and assign personhood for people with altered consciousness, cognition and behaviours. While a biomedical framing is founded upon a dichotomy between the body and self, such that the body can be subjected to a medical and objectifying gaze, relational theories of self, multiculturalism and technological advances for life‐sustaining interventions present new dilemmas which necessitate discussion about what constitutes personhood. The concept of personhood (...) is dynamic and evolving: where historical constructs of rationality, agency, autonomy and a conscious mind once formed the basis for personhood, these ideas have been challenged to encompass embodied, relational, social and cultural paradigms of selfhood. Themes in this discussion include: the right to personhood, mind–body dualism versus the embodied self; personhood as consciousness, rationality and narratives of self; social relational contexts of personhood and cultural contexts of personhood. Patricia Benner's and Christine Tanner's clinical judgement model is then applied to consider the implications for nursing care that seeks to reflexively incorporate personhood. Nurse clinicians are able to move between conceptions of personhood and act to support the body, as well as presumed autonomy and relational, social and cultural personhood. In doing so, they use analytical, intuitive and narrative reasoning which prioritises autonomous constructions of self. They also incorporate relational and social contexts of the person receiving care within the possibilities of technological advances and constraints of contextual resources. (shrink)

This paper explores the impact that developments in the field of neuroprosthetics will have on the ethical viability of healthy limb amputation, specifically in cases of Body Integrity Identity Dis...

Medicalization appears to be an issue that is both ubiquitous and unquestionably problematic as it seems to signal at once a social and existential threat. This perception of medicalization, however, is nothing new. Since the first main writings in the 1960s and 1970s, it has consistently been used to describe inappropriate or abusive instances of medical authority. Yet, while this standard approach claims that medicalization is a growing problem, it assumes that there is simply one “medical model” and that the (...) expanding realm of “the medical” can be more or less clearly delineated. Moreover, while intended to establish the reality of this growing threat, this research often requires making arbitrary or unjustified distinctions between different practices. To better clarify the concept of medicalization, I will focus more on capturing the variety of medical practices than on the sociological aspects of medical discourse. In doing so, I will explore the distinction between medicalization and pathologization, a distinction that is often overlooked and that brings with it many conceptual and practical implications. After defining these terms, I will use some examples to show that while pathologizing is closely tied to medicalizing, both can occur independently. I will then further develop this distinction in terms of the different individual and social effects of these practices. (shrink)

Opponents of the provision of therapeutic, healthy limb amputation in Body Integrity Identity Disorder cases argue that such surgeries stand in contrast to the goal of medical practice – that of health restoration and maintenance. This paper refutes such a conclusion via an appeal to the nuanced and reflective model of health proposed by Georges Canguilhem. The paper examines the conceptual entanglement of the statistically common with the normatively desirable, arguing that a healthy body can take multiple forms, including that (...) of an amputee, provided that such a form enables the continuing ability to initiate new norms of existence. It concludes that the practice of healthy limb amputation in cases of Body Integrity Identity Disorder is not only compatible with the goal of medicine but is potentially the only method of achieving this goal in the face of a complex and often mischaracterized disorder. (shrink)

The ability to dominate or exercise will in social encounters is often assumed in social theory to define power, but there is another form of power that is often confused with it and rarely analyzed as distinct: logistics or the ability to mobilize the natural world for political effect. I develop this claim through a case study of seventeenthcentury France, where the power of impersonal rule, exercised through logistics, was fundamental to state formation. Logistical activity circumvented patrimonial networks, disempowering the (...) nobility and supporting a new regime of impersonal rule: the modern, territorial state. (shrink)

Discourse analysis is a relatively recent form of inquiry without a strict step‐by‐step method. The methodology of discourse analysis has a longer history in Continental Europe than in other countries.1 The complex theoretical assumptions, the goals and the target (discourse) have been explicated, but the methodology may be applied in different ways. This paper will describe discourse analysis and give examples of some of the possible variations. It is the claim of this paper that discourse analysis deserves consideration as a (...) methodology for nursing inquiry. (shrink)

Most mainstream attempts to understand the “placebo effect” invoke expectancy theory, arguing that expecting certain outcomes from a treatment or intervention can manifest those outcomes. Expectancy theory is incompatible with the phenomena of placebo responses, more appropriately named “meaning responses.” The expectancy account utilizes reflexive consciousness to connect a world of conceptual representations to mechanical physiology. An alternative account based upon Merleau-Ponty's motor intentionality argues that the body understands and is capable of responding to meanings without the need for any (...) conceptual or linguistic content. A motor intentional framework of meaning poses dramatic implications for the interpretation of clinical trials and in the clinical practice of medicine. Most strongly, it argues that the empathic physician can facilitate the physiologic effects of treatments through skillful participation and manipulation of the meaning response. (shrink)

When Gilles Deleuze, in his book on Michel Foucault, asks, ‘who would think of looking for life among the archives?’, he uncovers something particular to Foucault's philosophy, but also to his own: a commitment to the question of what it means to think, and think politically. Although Foucault and Deleuze, who first met in 1952, immediately felt fondness for each other, a growing animosity had settled into the friendship by the end of the 1970s – a rift deepened by theoretical (...) differences. Notwithstanding these difficulties, Foucault and Deleuze shared a love for Nietzsche, as well as a curious fascination with Kant. Kant's influence, which was met with more opposition, is precisely the tension I tease out in this article, showing how Foucault critiques Kant's a priori through his own concept of the historical a priori, along with regularity and resistance, while Deleuze and Guattari, if more obliquely, critique Kant's a priori by further developing Foucault's notion of the historical a priori through their own method of pragmatics, particularly in three chapters of A Thousand Plateaus, namely ‘The Geology of Morals’, ‘Postulates of Linguistics’ and ‘On Several Regimes of Signs’. What I am interested in, then, is Deleuze and Guattari's treatment of redundancy, a concept mentioned seventy times in A Thousand Plateaus. Although not one of their main or most developed concepts, redundancy is a thread that can be traced back to Deleuze's first book, Empiricism and Subjectivity. Moreover, their more developed concepts, for example the diagram, the abstract machine, becoming, micro-politics and the ritornello, as well as their political philosophy, are grounded in their understanding of redundancy, which moves their philosophy beyond mapping out the conditions of possibility and demonstrating that the historical a priori emerges as a contingent function of its own expression to the genesis of thought. (shrink)

In light of the recent events of terrorism and publicized cases of mass slayings and serial killings, there have been calls from the public and policy-makers alike for neuroscience and neurotechnology (neuroS/T) to be employed to intervene in ways that define and assess, if not prevent, such wanton acts of aggression and violence. Ongoing advancements in assessment neuroS/T have enabled heretofore unparalleled capabilities to evaluate the structure and function of the brain, yet each and all are constrained by certain technical (...) and practical limitations. In this paper, we present an overview of the capabilities and constraints of current assessment neuroS/T, address neuro-ethical and legal issues fostered by the use and potential misuse of these approaches, and discuss how neuroethics may inform science and the law to guide right and sound applications of neuroS/T to “deliver us from evil” while not being led into temptations of ampliative claims and inapt use. (shrink)

In everyday life, we usually go by theone-body-one-person rule: one person has one body. This social belief builds on two assumptions: bodies are individual units and they are the same in different situations. This is also the conceptual resource for social theories that build on the notion of individuals. In this article, we turn it into a sociological topic. We develop a vocabulary for reconstructing bodily one-ness and bodily sameness as practically achieved social order, asbody boundary work: what belongs to (...) a body is a matter of local practices that define its situational contours, limits and margins. Practices of identification and personification draw on social memories and enact bodies as trans-situational entities. Persons and bodies, we argue, evolve in co-individuation. Personal corporality, then, can be conceptualized as abody of workthat encompasses these practical efforts of boundary-making. (shrink)

The case history in the colonial context was a hybrid form, caught between bureaucratic pressures toward racialization, aggregation, and generalization, on the one hand, and the individualistic bias of the genre, on the other. This tension posed a problem for colonial rulers. In their drive to harvest neat, ideologically reliable knowledge about the minds of colonial subjects, officials and researchers in the 20th-century British Empire read case histories in selective ways, pared them down to simplistic fables, and ultimately bypassed them (...) whenever they could. In other words, although they worked mightily to bend the case history to their purposes, they never fully succeeded. The authority granted to personal testimony and the capaciousness of the detail in case histories always contained a subversive potential. As a result, the politics of the colonial case history were underdetermined, overflowing the categories and resisting the generalizations that colonial rulers sought to impose. (shrink)

The concept of ecosystem health is problematic. Do ecosystems as such exist? Is health an objective condition of organisms or is it socially constructed? Can 'health' be unequivocally predicated of ecosystems? Is ecosystem health both objective and valuative? Are ecosystem health and biological integrity identical? How do these concepts interface with the concept of biodiversity? Ecosystems exist, although they are turning out to be nested sets of linked process-functions with temporal boundaries, not tangible superorganisms with spatial boundaries. Ecosystem health – (...) or normal occurrence of ecological processes and functions – is an objective condition of ecosystems, although the concept of ecosystem health allows some room for personal and social determination or construction. Ecosystem health is prudentially, aesthetically, and intrinsically valuable, although the value of ecosystem health is subjectively conferred. Biodiversity and biological integrity are different from, but not unrelated to, ecosystem health. Together these three normative concepts represent complementary conservation goals. (shrink)

The article examines the patient-doctor relationship, relying on Michel Foucault’s concept of the clinical gaze. We argue that during the last decades, a profound transformation of the social nature of medicine took place, one that Foucault’s understanding of the clinical gaze cannot adequately account for. First, the article offers an elaboration of the three-node network of clinical gaze, the clinic, and nosology to explain the positioning of the doctor and the patient within the specific social ontology generated by the rise (...) of medicine. We then discuss intensive but irresolute developments brought by technological advancements, especially the X-ray tube. Finally, we argue that in the contemporary clinic, equipped with a plethora of sophisticated devices, the position of the doctor endured the most radical transformation in comparison with Foucault’s proponent of the clinical gaze at the dawn of modern medicine. (shrink)

Often a physician’s first introduction to a patient is not a physical encounter but a review of their chart. A glaring “violence risk” flag in an Electronic Medical Record (EMR) is often noticeable...

What clinicians, biomedical scientists, and other health care professionals know as individuals or as groups and how they come to know and use knowledge are central concerns of medical epistemology. Activities associated with knowledge production and use are called epistemic practices. Such practices are considered in biomedical and clinical literatures, social sciences of medicine, philosophy of science and philosophy of medicine, and also in other nonmedical literatures. A host of different kinds of knowledge claims have been identified, each with different (...) uses and logics of justification. A general framework is needed to situate these diverse contributions in medical epistemology, so we can see how they fit together. But developing such a framework turns out to be quite tricky. In this survey, three possible frameworks are considered along with the difficulties associated with each of them. The essay concludes with a fourth framework, which considers any epistemology as part of a practice that is oriented toward overcoming errors that emerge in antecedently given practices where knowledge is developed and used. As medicine indirectly advances health by directly mitigating disease, so epistemology indirectly advances knowledge by directly mitigating error. (shrink)