Obstetric violence has been analyzed from various perspectives. Its psychological effects have been evaluated, and there have been several recent sociological and anthropological studies on the subject. But what I offer in this paper is a philosophical analysis of obstetric violence, particularly focused on how this violence is lived and experienced by women and why it is frequently described not only in terms of violence in general but specifically in terms of gender violence: as violence directed at women because they (...) are women. For this purpose, I find feminist phenomenology most useful as a way to explain and account for the feelings that many victims of this violence experience and report, including feelings of embodied oppression, of the diminishment of self, of physical and emotional infantilization. I believe that the insights to be found in feminist phenomenology are crucial for explaining how and why this phenomenon is different in kind from other types of medical violence, objectification, and reification. Iris Marion Young’s description of feminine existence under patriarchy, as conformed by a perpetual oppressive “I cannot,” is at the center of my analysis. I argue that laboring bodies are at least potentially perceived as antithetical to the myth of femininity, undermining the feminine mode of bodily comportment under patriarchy and thereby seriously threatening the hegemonic powers. Violence, then, appears to be necessary in order to domesticate these bodies, to make them “feminine” again. (shrink)

This paper demonstrates how the problematic kinds of epistemic power that physicians have can diminish the epistemic privilege that pregnant women have over their bodies and can put them in a state of epistemic powerlessness. This result, I argue, constitutes an epistemic injustice for many pregnant women. A reconsideration of how we understand and care for pregnant women and of the physician–patient relationship can provide us with a valuable context and starting point for helping to alleviate the knowledge/power problems that (...) are symptomatic of the current system and structure of medicine. I suggest that we can begin to confront this kind of injustice if medicine adopts a more phenomenological understanding of bodies and if physicians and patients—in this case, pregnant women—become what I call “epistemic peers.”. (shrink)

Recent years have seen a rise in the number of sociological, anthropological, and ethnological works on the gift metaphor in organ donation contexts, as well as in the number of philosophical and theological analyses of giving and generosity, which has been mirrored in the ethical debate on organ donation. In order to capture the breadth of this field, four frameworks for thinking about bodily exchanges in medicine have been distinguished: property rights, heroic gift-giving, sacrifice, and gift-giving as aporia. Unfortunately, they (...) all run into difficulties in terms of both making sense of the relational dimensions of postmortem and live organ donations and being normatively adequate in the sense of shedding light and providing guidance on ethical concerns when body parts are donated. For this reason, this article presents a phenomenological framework of giving-through-sharing, based on Maurice Merleau-Ponty’s philosophy. This framework makes sense of relational dimensions of postmortem and live organ donation. It also sheds light on three highly debated concerns in organ donation ethics: indebtedness on the part of recipients, the fact that some live donors do not experience donation as a matter of choice, and the potentially painful experience of donors’ relatives, who need to make decisions about postmortem organ donation at a time of bereavement. It can indirectly support what may be called a normalization of bodily exchanges in medicine. (shrink)

While there has been a vast amount of research on breast cancer in recent years, areas within this domain remain unexplored. For instance, there have been few attempts to marry an understanding of the social context in which breast cancer occurs with an understanding of subjective experiences of this condition. The purpose of this study was to explore women's experiences of embodiment after breast cancer, utilizing a phenomenological approach rooted in a feminist perspective. The focus of this article is upon (...) the changes to embodiment that are long‐term. Twelve women were interviewed on two occasions each and were asked to talk about changes to their bodies that occurred as a result of breast cancer. Three key themes were identified: (1) how it feels (e.g. sensation and breast loss); (2) managing appearances (e.g. wearing prostheses); and (3) treatments without end (e.g. menopause). The findings of this study show that women with breast cancer are a diverse group and that survivorship is a dynamic, life‐long process, which suggests that health professionals can play an important role in establishing interdisciplinary approaches to caring, beyond the conclusion of acute treatment. (shrink)

The ‘body’ has remained the pivotal and essential mechanism for analysis within disability scholarship. Yet while historically conceptualized as an individual’s fundamental feature, the ‘disabled identity’ has been more recently explained as a function of ‘normalcy’ through social, cultural political, and legal discriminations against difference and deviancy. Disability studies’ established tradition of consultation with philosophical endeavour remains apparently unwilling to exploit or utilize Martin Heidegger’s understanding of ‘Being’ and interpretation of Dasein as a possible framework for unravelling the complexities of (...) contemporary discrimination and oppression of those others. This paper in tracing Heidegger’s explanation of humankind, inspired by arguments proposed by Cerbone (Int J Philos Stud 2:209–230, 2000) and in consultation with Levin (The body: classic and contemporary readings, Blackwell, Malden, 1999), Aho (2009), Malpas (Heidegger’s topology: being place, world, MIT Press, Cambridge, 2008), and Rae (Hum Stud 33:23–39, 2010) among others, will interpret the ‘embodied’ reality of ‘Being,’ of being-disabled-in-the-world as primarily involved within the practical context and structured according to impersonal, normative social norms, rather than detached, theoretical contemplation or observance. (shrink)

This paper considers how the experience of illness fits within Sartre’s account of embodiment in Being and Nothingness. Sartre makes some remarks about illness, but does not develop a full account. I show that the anti‐naturalistic ontological framework in which Sartre’s discussion of the body is placed, which opposes my ‘being‐for‐Others’ to my ‘being‐for‐myself’, imposes a revisionary account of illness, and how Sartre’s model of interpersonal relations affects his view of doctors, and their role in the illness experience. I note (...) and discuss the connection Sartre draws between illness and bad faith. I also point out that recent phenomenologically inspired criticisms of the medical establishment that draw on Sartre’s account of the body are limited by their failure to engage with Sartre’s ontology. (shrink)

This paper is prompted by the charge that the prevailing Western paradigm of medical knowledge is essentially Cartesian. Hence, illness, disease, disability, etc. are said to be conceived of in Cartesian terms. The paper attempts to make use of the critique of Cartesianism in medicine developed by certain commentators, notably Leder (1992), in order to expose Cartesian commitments in conceptions of disability. The paper also attempts to sketch an alternative conception of disability — one partly inspired by the work of (...) Merleau-Ponty. In particular, three key Cartesian claims are identified and subjected to criticism. These are as follows: (a) The claim that the body is an object, (b) what is termed here ‘the modularity thesis’, and (c) the claim that the body cannot be constitutive of the self (i.e. since the soul/mind/brain is). In opposition to these claims, it is argued that the body is properly viewed as a subject; that there are neither purely mental, nor purely physical disabilities; and that selves are constituted, at least in part, by their bodies. (shrink)

The nonreductionistic theory of the multiple aspects of reality offered by the Dutch philosopher Herman Dooyeweerd is employed to illuminate the status of bodies and biological entities in relation to attached and incorporated technological devices. I first present a review of the interpretations of the mechanization of biology and then argue from a Dooyeweerdian viewpoint that this mechanization also amounts to a reduction of the biotic aspect to previous aspects, such as the physical and the regulatory or cybernetic aspect. Next, (...) the irreducible meaning of the biotic aspect is defined as the vital life cycle and generational continuity that delineate the form of a species. Finally, I show how this definition helps us identify a normativity and a respect for living things, and I discuss its implications for bioengineering practices. (shrink)

Starting from a phenomenological understanding of the body, this article discusses the understanding of body awareness in health and illness. I question the common way to understand our relationship to our bodies in terms of subjective and objective perspectives on it, and furthermore, how this opposition has been used in the phenomenological literature to outline an understanding of health and illness as states where the body stays unnoticed versus resurfaces to our attention as dysfunctional. Using examples from an ongoing interview (...) study, I argue for an understanding of the dialectical interplay between body and world in our awareness, and how it can be understood as an approaching or distancing movement to body and world. I furthermore describe how the interplay between body and world effects and is effected by our existence in health and illness. Finally, I suggest what implications this new way of understanding the lived body has for health care practice in general, and for the development of a person‐centred care in particular. I suggest that we leave the dichotomous understanding of subjective and objective perspectives behind, and start to investigate how we move between different kinds of body awareness in health and illness. Illness, as a situation where that which has been taken for granted becomes questioned, can be said to be characterized by mistrust, and by a distancing from world and body. It is thus of importance for caregivers to provide the time, space and trusting atmosphere needed in order to make the approaching movement possible. (shrink)

The once animated efforts in medical phenomenology to integrate the art and science of medicine (or to humanize scientific medicine) have fallen out of philosophical fashion. Yet the current competing medical discourses of evidencebased medicine and patient-centered care suggest that this theoretical endeavor requires renewed attention. In this paper, I attempt to enliven the debate by discussing theoretical weaknesses in the way the “lived body” has operated in the medical phenomenology literature—the problem of the absent body—and highlight how evidence-based medicine (...) has refigured medical phenomenology’s historical nemesis, “biomedicine.” What we now need is a phenomenology of the embodied subject in the age of evidence-based medicine. (shrink)

The move to patient-centered medical practice is important for providing relevant and sustainable health care. Narrative medicine, for example, suggests that patients should be involved significantly in diagnosis and treatment. In order to understand the meaning of symptoms and interventions, therefore, physicians must enter the life worlds of patients. But physicians face high patient loads and limited time for extended consultations. In current medical practice, then, is narrative medicine possible? We argue that engaging patient perspectives in the medical visit does (...) not necessarily require a lengthy interview. Instead, a new orientation to this process that emphasizes dialogue between practitioners and patients should be considered. In this new model, the purpose of the visit is to communicate successfully and develop a mutual understanding of illness and care. (shrink)

Many patients experience aspects of treatment and care as dehumanizing because the body is considered separate from the self and its life context. An attempt to transcend viewing persons in dualistic terms is posed by phenomenologists who focus not on “the body” as such but on what it means to be “embodied.” In this paper, we review the relevance of the phenomenology of the body for health care and report the results of comparing Sally Gadow’s phenomenological insights about body-self unity (...) with a qualitative analysis of patients’ accounts of satisfaction with the outcome of hand surgery. We illustrate the ways in which our findings were and were not congruent with Gadow’s conceptualization of embodiment and highlight aspects that are ambiguous. We conclude that the body-self dialectical relationship should be recast as a body-self-society trialectic and discuss the implications of this new conceptualization for clinical practices. (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)

Evaluation of quality of life, psychic and bodily well-being is becoming increasingly important in oncology aftercare. This type of assessment is mainly carried out by medical psychologists. In this paper I will seek to show that body experience valuation has, besides its psychological usefulness, a normative and practical dimension. Body experience evaluation aims at establishing the way a person experiences and appreciates his or her physical appearance, intactness and competence. This valuation constitutes one’s ‘body image’. While, first, interpreting the meaning (...) of body image and, second, indicating the limitations of current psychological body image assessment, I argue that the normative aspect of body image is related to the experience of bodily wholeness or bodily integrity. Since this experience is contextualized by a person’s life story, evaluation should also focus on narrative aspects. I finally suggest that the interpretation of body experience is not only valuable to assess a person’s quality of life after treatment, but that it can also be useful in counseling prior to interventions, since it can support patients in making decisions about interventions that will change their bodies. To apply this type of evaluation to oncology practice, a rich and tailored vocabulary of body experiences has to be developed. (shrink)

This article argues that a phenomenological notion of “lived body” emerges in the Zhuangzi’s 莊子 critique of the Confucian body of ritual and morality. It also argues that a philosophical account of body cannot be reduced to a Sinological account. This article draws on the phenomenological distinction between “object body” and “lived body,” especially the “three ontological dimensions” of Jean-Paul Sartre to argue that the Zhuangzi criticizes the Confucian body of ritual and morality as being a “body-for-others” and that it (...) maintains a concept of “lived body.” Finally, it argues that through such methods of cultivation as “sitting and forgetting” a liberation of the body is achieved where one is connected to dao 道 and achieves a state of heightened experience. (shrink)

Although by no means mainstream, phenomenological approaches to bioethics and philosophy of medicine are no longer novel. Such approaches take the lived body —as opposed to the body understood as a material, biological object —as their point of departure to offer a more robust understanding of a plurality of experiences that go far beyond those surrounding disease...

Public conversation about biological contributors to mental disorder often centers on whether the problem is “biological or not.” In this paper, we propose moving beyond this bifurcation to a very different question:how exactlyare these problems understood to be biological? Specifically, we consider four issues around which different interpretations of the body’s relationship to mental disorder exist:1. The body’s relationship to day-to-day action; 2. The extent to which the body is changeable; 3. The body’s relationship to context; 4. The degree to (...) which states of the body directly cause mental disorder.Drawing on the work of Merleau-Ponty and other phenomenologists, we examine different responses to these questions and associated implications for how mental health treatment and recovery come to be experienced. Finally, we consider broader questions these patterns raise, including why certain portrayals of the brain dominate public attention and how to foster more deliberation in this regard. (shrink)

A growing body of literature in the field of embodied situated cognition is drawing attention to the hostile ways in which our environments can be constructed, with detrimental effects on people’s ability to flourish as environmentally situated beings. This paper contributes to this body of research, focusing on a specific area of concern. Specifically, I argue that a very particular problematic quasi-Cartesian picture of the human body, the human mind, what it means for these to function well, and the role (...) of technology in promoting such functioning, animate our Western sociotechnical imagination. This picture, I show, shapes the sociotechnical niches we inhabit in an _ableist_ manner, perniciously legislating which body-minds have access to a rich world of affordances and are seen as agential and valuable. Because the ableist quasi-Cartesian commitments animating our Western sociotechnical imagination are problematic and pervasive, I argue that exposing and reimagining these commitments should be a prime focal point of those working at the intersection of science, technology, and human values. I present insights from enactive 4E cognition and critical disability studies as fruitful resources for such much-needed reimagining. I also make the case, more provocatively but also more tentatively, that the ableist view of bodily and minded well- functioning animating our Cartesian Western sociotechnical imagination is not only damaging to embodied minds who deviate from the presumed norm, creating inaccessible worlds for some of us; it is in fact a threat to human and planetary flourishing at large. (shrink)

Today the phenomenological concept of the lived body figures centrally in several philosophical and special scientific debates. In these wide and widening fields, the concept is used with multiple different meanings. In order to clarify and delineate the debates, this paper provides an explication of the phenomenological-transcendental methods. It argues that these methods help us remove the most fundamental ambiguities of the concept of embodiment by distinguishing between the main constituents of the lived body and by illuminating their mutual relations.

Whether in the growing awareness of the origins of supermarket meat or the emergence of meat art, carnality appears to be something increasingly under question. Yet, despite meat carrying connotations that offer provocative connection with feminist concerns regarding the body, consumption and the cultural representation of women, meat consciousness has been only sporadically explored in existing feminist theory. Struck, however, by the comparisons between the dissected Body Worlds corpse and the filleted flesh of meat that are levelled most particularly at (...) female bodies on display, I examine in my article the bodily relations constructed in the Body Worlds exhibition by positioning the Body Worlds cadaver as a grotesque ‘meaty’ body under the broader rubric of the Bakhtinian carnivalesque. Within such webs of alimentary exchange, pleats of meaty matter may bring about localised eruptions of traditional and bodily engagements – including that of the gendered gaze – that entwine the possibility of pleasure, wonder and fascination into each act of inter-bodily engagement. Through this entrance into the very bowels of Body Worlds, my article ultimately asks what, as a feminist, it means to become meat conscious. (shrink)

After describing the disorder of psychopathy, I examine the theories and the evidence concerning the psychopaths’ deficient moral capacities. I first examine whether or not psychopaths can pass tests of moral knowledge. Most of the evidence suggests that they can. If there is a lack of moral understanding, then it has to be due to an incapacity that affects not their declarative knowledge of moral norms, but their deeper understanding of them. I then examine two suggestions: it is their deficient (...) practical reason or their stunted emotions that are at fault. The evidence supports both explanations. I conclude with an overview of the debate concerning whether they are morally or legally responsible for their actions. (shrink)

In this paper I explore the various meanings of embodiment from a patient’s perspective. Resorting to phenomenology of health and medicine, I take the idea of ‘lived experience’ as starting point. On the basis of an analysis of phenomenology’s call for bracketing the natural attitude and its reduction to the transcendental, I will explain, however, that in medical phenomenological literature ‘lived experience’ is commonly one-sidedly interpreted. In my paper, I clarify in what way the idea of ‘lived experience’ should be (...) revisited and, subsequently, what this reconsideration means for phenomenological research on embodiment in health and medicine. The insight that the body is a condition of possibility for world-disclosing yet, at the same time, itself conditioned by this world forces us to not only zoom in on the body’s subject-side, but also on its object-side. I argue that in order to render account for this double body ontology, phenomenology should include empirical sociological analyses as well. I thus argue in favor of the idea of a socio-phenomenology. Drawing on material from my own research project on embodied self-experiences after breast surgery, I show how this approach can be fruitful in interpreting the impact of disfigurements on a person’s embodied agency, or a person’s ‘I can’. (shrink)

A number of art projects are currently tackling the medical domain. This activity stems from a perceived need to increase the transparency and democracy of the medical domain, and it often questions the power relations and the one-dimensionality in current medical practices. This article sheds light on how artists process medical themes, elaborates on research elements embedded in art making processes, and considers the relevance of artists' projects for researchers from other disciplines. It deliberates on the author's media and performance (...) art practice in exploring the doctor-patient relationship and discusses the artistic methods and techniques employed. The article promotes the personal, imaginative, and figurative characteristics in the discussion and signification of the body in medicine. (shrink)

This article argues for a more rigorous distinction between body extensions on the one hand and incorporation of non-bodily objects into the body on the other hand. Real re-embodiment would be a matter of taking things (most often technologies) into the body, i.e. of incorporation of non-bodily items into the body. This, however, is a difficult process often limited by a number of conditions of possibility that are absent in the case of ‘mere’ body extensions. Three categories are discussed: limb (...) extensions/prostheses, perceptual extensions/prostheses and cognitive extensions/prostheses. For each category, a distinction between extensions and incorporations is proposed, and the conditions of possibility for real incorporation are discussed. These conditions of possibility differ in each category, but in general they ask for radical or fundamental alterations not only in the motor and/or sensory or cognitive constitution of a human subject, but also in his or her subjective experience. (shrink)

Current philosophical and legal bioethical reflection on reprogenetics provides little more than a rationalization of the interests of science. There are two reasons for this. First, bioethicists attempt to address ethical issues in a “language of precision” that characterizes science, and this works against analogical and narratological modes of discourse that have traditionally provided guidance for understanding human nature and purpose. Second, the current ethical and legal debate is framed by a public/private distinction that banishes robust norms to the private (...) realm, and leaves a minimalist public discourse of harm avoidance that is insufficient for regulating the science. In this essay, I argue that Mark Hanson's account of anxiety provides a valuable starting point for addressing deficiencies in the current philosophical and legal debate, and it highlights the need for a theological discourse on genetic enhancements. Through an assessment of Joel Shumann's criticism of the public/private distinction, I show how the needed theological discourse should be situated in the context of robust communities, and how such a communitarian inter-ethic is compatible with a variant of liberalism. Finally, I critically assess James Keenan's account of virtue and perfection, in order to outline what a sufficient discourse on reproductive and genetic enhancements requires. (shrink)

Understanding people's experience of skin ageing as it is lived can enable sensitive approaches to promoting healthy skin and to care in general. By understanding the insider perspective, what it is like for individuals, a way to sensitise practice for more humanly sensitive care is offered. Through interviews with seventeen community‐dwelling older people, the essential meaning of living within ageing skin was illuminated as a state of managed inevitability. The skin is inevitably changing, and ageing skin is a marker of (...) change over time but the person within remains. Constituents of the phenomenon comprise the experience of unfamiliar sights and sensations given by ageing skin; facing and accepting bodily changes and seeing this back and forth in family connections; taking care of the skin “to face” the world; and to present oneself to others and a different place in the world, same person, changed body. Findings point to why and how nurses can treat older people as persons by not over emphasising a view on ageing bodies or bodies with aged skin alone, but in tempering this view with deeper existential insights, meeting the older person with a skin care need as a person and not just as a physical entity. (shrink)

Along with anatomical dissection, attendance at hospital autopsies has historically been seen as an essential part of medical education. While the use of the dead body for teaching purposes is losing favour in Australian medical schools, this shift is preceded by a significant decline in the rate of autopsies nationwide (and internationally). The decline of the autopsy has particular implications for pathology training where the capacity to perform an autopsy is a requirement. Rather than join the debates in medical literature (...) about the merits of these shifts, this article goes behind the scenes of a hospital mortuary to study autopsy training and practice from the perspective of those who undertake it. The article first introduces the discipline of pathology—‘the science of medicine’—which is built upon centuries of post-mortem study and establishes the fact of the disappearing autopsy. The article then draws upon data from anthropological fieldwork in a Department of Anatomical Pathology to discuss some of the ways trainees manage the work of cutting up the dead. Concepts such as detachment, immersion and disciplinary practice are covered in during this unveiling of everyday practice in a hospital mortuary. (shrink)

Within the context of applied bioethical reasoning, various conceptions of the human body are focused upon by the author in relation to normative notions of autonomy.

This article seeks to provide a phenomenological inquiry into schizophrenia through which I propose to bring to the fore the mental violence exercised against the self in the case of a psychotic patient. My main aim is to show that a phenomenological analysis of mental illness, interpreted as a disintegration of the ego, can be very fruitful for understanding violence in general because it raises fundamental questions concerning intersubjectivity, intentionality, and self-awareness. In order to accomplish this objective, I will take (...) as my point of departure a case study of mental illness as presented by the analyst Marguerite Sechehaye, and I will explore, first, the phenomenological implications of the disintegration of the ego, and second, the dynamics of the reconstruction of the ego. Third, I will address the question whether mental illness is a form of violence against the self, sketching an answer by interpreting the transition from the disintegration of the ego to its reconstruction as an elevation from a poor phenomenon to a saturated phenomenon. Finally, I will suggest how opening a dialogue between phenomenology and psychoanalysis can contribute to understanding the phenomenon of mental violence. (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)

The promotion of the self‐managing capacities of people has become a marker of contemporary mental health practice, yet self‐management remains a largely uncontested construct in mental health settings. This discourse analysis based upon the work of Foucault investigates self‐management practices for bipolar disorder and their action upon how a person with bipolar disorder comes to think of who they are and how they should live. Using Foucault's framework for exploring the ethical self and transcripts of interviews with people living with (...) bipolar disorder, this discourse analysis finds that the discursive practices of self‐management for bipolar disorder are prescribing a restricted regime for living based upon the quintessential neo‐liberal subject using practices that are focused upon managing an unreliable and problematic self. The article concludes with the proposition that the problem of bipolar disorder (for which self‐management is an answer) is less about the object itself and more about how we construct the nature of the self. A Māori indigenous ontology is used here as an example of an alternative discursive resource through which people make sense of the self and which allows ways of thinking about self‐management that engage with ambivalence and ambiguity rather than restriction and regulation. (shrink)

Based on the distinction between living body and lived body, we describe the disease-subject as representing the impact of disease on the existential life-project of the subject. Traditionally, an individual's subjectivity experiences disorders of the body and describes ensuing pain, discomfort and unpleasantness. The idea of a disease-subject goes further, representing the lived body suffering existential disruption and the possible limitations that disease most probably will impose. In this limit situation, the disease-subject will have to elaborate a new life-story, a (...) new character or way-of-being-in-the-world, it will become a different subject. (shrink)

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)

The nature and scope of medical humanities are under debate. Some regard this field as consisting of those parts of the humanistic sciences that enhance our understanding of clinical practice and of medicine as historical phenomenon. In this article it is argued that aesthetic experience is as crucial to this project as are humanistic studies. To rightly understand what medicine is about we need to acknowledge the equal importance of two modes of understanding, intertwined and mutually reinforcing: the mode of (...) aesthetic imagination and the mode of analytical reflection. (shrink)

POHLMAN S, CIBULKA NJ, PALMER JL, LORENZ RA and SMITHBATTLE L. Nursing Inquiry 2013; 20: 71–81 The placebo puzzle: examining the discordant space between biomedical science and illness/healingThe placebo response presents an enigma to biomedical science: how can ‘inert’ or ‘sham’ procedures reduce symptoms and produce physiological changes that are comparable to prescribed treatments? In this study, we examine this puzzle by explicating the discordant space between the prevailing biomedical paradigm, which focuses on a technical understanding of diagnosis and treatment, (...) and a broader understanding of illness and healing as relational and embodied. Although biomedical achievements are impressive, the knowledge resulting from this paradigm is limited by its ontological and epistemological assumptions. When the body and world are objectified, illness meanings, therapeutic relationships, and healing practices are dismissed or distorted. In spite of a robust critique of the tenets of biomedicine for guiding practice, the biomedical paradigm retains a tenacious hold on evidence-based medicine and nursing, downplaying our clinical understanding of the sentient body, patients’ life-worlds, and illness and healing. In reality, skilled nurses rely on multiple forms of knowledge in providing high-quality care to particular patients. Clinically wise nurses integrate their experience and knowledge of patients’ priorities, fears, and illness trajectories along with biomedical findings to make astute judgments and promote health and healing. (shrink)

In this article, we present an analysis of bodily integrity in hand transplants from a phenomenological narrative perspective, while drawing on two contrasting case stories. We consider bodily integrity as the subjective bodily experience of wholeness which, instead of referring to actual bodily intactness, involves a positive identification with one’s physical body. Bodily mutilations, such as the loss of a hand, may severely affect one’s bodily integrity. A possible restoration of one’s experience of wholeness requires a process of re-identification. Medical (...) interventions, such as a hand transplant, may improve the possibility of a successful re-identification. However, since the experience of wholeness does not refer simply to physical intactness or impairment, the choice for medical intervention should not be based merely upon the degree of physical mutilation. It should also be based upon the degree to which a person fails in re-identifying with his or her mutilated body. We argue that a normalizing operation is only ethically justifiable if the intervention enables the person to be the body he or she has. (shrink)

Although scars never disappear completely, in time most people will basically get used to them. In this paper I explore what it means to habituate to scars against the background of the phenomenological concept of incorporation. In phenomenology the body as Leib or corps vécu functions as a transcendental condition for world disclosure. Because of this transcendental reasoning, phenomenology prioritizes a form of embodied subjectivity that is virtually dis-embodied. Endowing meaning to one’s world through getting engaged in actions and projects (...) is most successful indeed when one’s body is “absent,” “transparent,” or, at least, if it is not in the center of one’s attention. This taken-for-granted nature can be disturbed by discomfort, disability, and disfigurement. Incorporation, so I explain, aims at maintaining or restoring the body’s taken-for-grantedness. My analysis of the case of a woman who successfully habituated to her mastectomy scar demonstrates, however, that habituation to a perceptible scar can only be understood partly in terms of incorporation. Next to a decrease of explicit attention for the scar and the discomfort it produces, the scar should also stop being a sign that refers to something else than itself. This is only possible, I argue, by taking the body’s materiality seriously, rather than it being wiped out as a result of transcendental reasoning. (shrink)

On the basis of extensive research on the relationship between physical activity, exercise and health, as well as strong support from policymakers and practitioners, the “Exercise is Medicine” initiative has become something of a linchpin in the agenda for modern healthcare reform and reflects a broader acceptance that the philosophy of health politics must shift from social engineering to performativity. However, in spite of the avowed commitment to encouraging individuals to take on a more reflexive relation to their health, it (...) remains unclear as to whether an initiative such as this is, unambiguously, a good thing. In this paper, a number of cautionary remarks are made with respect to “Exercise is Medicine” in principle as well as in practice. Firstly, it is argued that equating exercise with medicine is to equate it with a definition of and relation to the body to which it is not entirely akin. And secondly, it is argued that any proposed alignment of the fitness and healthcare industries needs further critical examination, a realigning of interests, and a thorough reconsideration of their suitability of fit. (shrink)

This paper examines the current use of the terms ‘story’, ‘narrative’ and ‘voice’ within health care. It argues that the focus on narrative forms is related to nursing's professional development of an alternative epistemology to science, and to nursing theorists' mistrust of ‘Enlightenment’ modes. However, in order for this project to be productively developed it is necessary to distinguish story from narrative: the former is an informal activity, the latter is meditative and theoretical. Both have dierapeutic dimensions.

The twentieth-century German philosopher Martin Heidegger distinguished “meditative” and “calculative” modes of thinking as a way of highlighting the problematique of modern technology and the limits of modern science. In doing so he also was prescient to recognize, in 1955, that the most significant danger to the future of humanity are developments in molecular biology and biotechnology, in contrast to the post-World War global threat of thermonuclear weapons. These insights are engaged here in view of recent discussion of the need (...) for international regulation of heritable human genome editing and the announcement in 2018 of the birth of the world’s first gene-edited babies in China. Heidegger’s call for meditative thinking requires modern medicine and the life sciences to appropriate the phenomenological conception of the human “way to be” such that it is not restricted to the “present-at-hand” physiology and pathology of the human body. (shrink)

Elucidating a metaphysics of medicine is vital for framing a coherent medical ethics. In this paper, I examine the historical case of Avicenna, the eleventh century physician-philosopher. Avicenna radicalizes the dissective power of reason using a logicized Aristotelian metaphysics to clarify concepts at the metaphysical level, which I call his anatomy of being. One of the practical consequences of Avicenna’s metaphysics is a dehumanizing eschatology of death. I outline the main elements of Avicenna’s thought that constitute his anatomy of being. (...) Through an examination of his logic, metaphysics, and psychology, I show how Avicenna develops a dissective logic. I conclude that one’s epistemology, as a method of knowing, entails a metaphysics, and, in turn, results in an ethical stance to the object of knowledge. For Avicenna, mental dissective logic applied to humans results in dehumanization, thereby destroying the humanistic impulse of medicine. (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)

El trabajo ofrece un análisis crítico a la noción de cuerpo propio (Leib) en M. Merleau-Ponty, como superación del dualismo cuerpo-mente. Se amplía dicha noción para integrar las experiencias del cuerpo físico (Körper) y posibilitar el diálogo entre fe-nomenología y medicina, al proponer una fenomenología del organismo doliente.