In the face of managed care and market economies infringing on the practice of medicine, reducing its autonomy and determining the moral guidelines for medical practice, many physicians are calling out for a return to what is perceived as a traditional medical ethic. Many religiously motivated critics of certain modern developments in medicine have made similar appeals. These calls are best understood as an attempt to define medicine as a practice that is necessarily ethical in nature, a practice the moral (...) basis of which is internal to that practice. This article examines and assesses this definition of medicine in reference to Aristotle's division of human undertakings into three distinct categories: theory, poieisis (i.e., production), and praxis. It is concluded that medicine can be understood as a praxis (as opposed to a theory or production, both of which are morally neutral), because the practice of medicine, and all of its constitutive acts, can only be explained and assessed in reference to health, which is itself a final good and hence of moral value. Such an understanding would immunize medicine against usurpation by the free market. However, by the same token it would also dissociate medicine from all other moralities external to it, including those grounded in faith and religion. (shrink)

This paper seeks to define and delimit the scope of the social responsibilities of health professionals in reference to the concept of a social contract. While drawing on both historical data and current empirical information, this paper will primarily proceed analytically and examine the theoretical feasibility of deriving social responsibilities from the phenomenon of professionalism via the concept of a social contract.

This article examines whether cosmetic interventions by dentists and plastic surgeons are medically indicated and, hence, qualify as medical interventions proper. Cosmetic interventions (and the business strategies used to market them) are often frowned upon by dentists and physicians. However, if those interventions do not qualify as medical interventions proper, they should not be evaluated using medical-ethical norms. On the other hand, if they are to be considered medical practice proper, the medical-ethical principles of nonmaleficence, beneficence, justice and others hold (...) true for cosmetic interventions as much as they do for other medical and dental interventions. It is concluded that most cosmetic interventions do not qualify as medical interventions proper because they do not restore or maintain the patient's health (defined as the patient's integrity) by any objective standards. Rather, cosmetic interventions are intended to enhance a person's physical appearance; more specifically, they intend to fulfill the client's subjective perception of an enhanced appearance. (shrink)

Intuition is frequently used in medicine. Along with the use of existing medical rules, there is a separate channel that physicians rely on when making decisions: their intuition. To cope with the epistemic problem of using intuition, I use some clues from Wittgenstein's philosophy to illuminate the decision-making process in medicine. First, I point to a connection between intuition as functioning in medicine and Wittgenstein's notions of "seeing as" or noticing "aspects". Secondly, I use Wittgenstein notion of empirical regularities hardened (...) into rules to suggest that there are two stages that should be addressed in the analysis of medical practice: the first concerns the accumulation of cases and the second pertains to the setting a rule based on these cases. I argue further that the medical context is exceptional in that the two stages are intertwined and, and explain the consequences of this fact for the physician's work. Finally, inspired by Wittgenstein's rule-following conundrum, I argue that medicine is particularly prone to difficulties in applying a general rule to a specific case represented by an individual patient. Recourse to intuition is reflects the physicians' efforts to bridge this gap. (shrink)

The article identifies a problem in socio-cultural-historical activity theory (SCHAT) with ignoring how hope and power constitute the theory itself, and suggests that this is why the tradition faces a bad choice between functionalist or utopianist reductions of its own social relevance. Currently, remedies for this kind of (perhaps shammed) innocence can be found in Foucauldian and Latourian approaches to knowledge. However, since these appear to presuppose the (often feigned) cynicism of a purely negative standpoint that fits all too smoothly (...) into the neoliberal management it describes, this presents us with an impossible choice or oscillation at another level. To get beyond it, we need the frankly self-reflected standpoint of ideology critique and the articulation of ‘concrete utopia’, i.e. real possibilities for social transformation. The approach is then realized and exemplified as part of an emergent practice research in the field of drug treatment. The field is broadly described as moving toward certain kinds of recognition of users’ standards, but also as filled with paradoxes that allow us to intervene with theory. One of these (sets of) paradoxes concerns the relations between state and civil (bourgeois) society that are played out in drug treatment. Contrary to the doxa of New Public Management, the (welfare) state’s normative power has not dissolved, only hides from itself. An immanent critique of practices and ideas in the field leads to the suggestion that its forms of recognition imply both submission of users, and the creation of positive standards and collectives. To intervene in this set of issues, we must expand the SCHAT reading of its own Hegelian-Marxist legacy, against the dominant liberal and scientistic trend, to engage with theories of recognition. A contemporary, participatory concept of recognition is sketched, which seeks to sublate (include and supersede) submission into the building of the generalizing ethics of a collective. (shrink)

The essay attempts to contextualize the German-Scandinavian tradition of Critical Psychology (GSCP) that bases on Cultural-Historical Activity Theory in today's critical psychologies. It is argued that adding to a psychology and ideology critique the positive dimension of ”foundational” theory is important to counteract the currently prevailing “negative” ideology of liberalism. It is also claimed that an ”instrumental” version of critical psychology, which takes up elements from psychology for tactical purposes will remain dependent on the given discipline of psychology and unable (...) to reflect on its own subject position. GSCP is then rendered as developing the Marxist ontology of social practice (rather than its utopianism) toward a concept of a subjectivity constituted in social practice but with the criteria of action potency and productive needs on the part of the individual. It is suggested that this approach solves important problems in contemporary critical psychology. Finally, it is described how GSCP, too, might grow from the encounter, by developing a theory of collective subjectivity to include – us. (shrink)