Fulford’s chapter discusses the conceptual challenges facing person-centred care and the role of philosophy in addressing these challenges. He is right that this role - to investigate underlying meanings and reveal assumptions - need not and should not be restricted to the search for definitions of key terminology. The methods of “ordinary language philosophy” enable us to understand the meanings of terms by systematically examining their use in context, with a view to mapping a term's “logical geography”. He makes effective (...) use of this methodology to show that alternative accounts of what it means to be “person-centred” need not be contradictory and can indeed be fully complementary. The approach of mapping the usage of the key terms is necessary if we are to understand the discourse, but it is by no means sufficient in gaining a coherent understanding of the meaning and value of PCC - let alone one that could provide the basis for its effective implementation. While it is true that distinct accounts can reveal different and compatible “aspects” of PCC, the language of PCC - like that of “evidence” and “ethics” - is not simply diverse, it is contested. Fulford argues that “genuine” PCC provides a proper balance between the “extremes” of paternalism and consumerism. This language is clearly normative, going beyond what he characterises as the “empirical” exercise of mapping usage. A broader inquiry, based on the distinction between philosophy as a body of theory and as dialogue, and incorporating a direct engagement with normative questions, is necessary if we are to address the challenges Fulford identifies. The exercise of “mapping logical geography” reminds us that health discourse has no clear borders such that, by following its links to their logical limits, we will find ourselves inevitably in the midst of broader dialogues about the social nature of persons, the nature of value, agency and the basis for our obligations to one another. (shrink)

The field of leadership studies frequently focuses on defining leadership traits in abstraction from the context in which leadership operates. The first aim of this article is to provide a brief overview of reasons why this might be the case. Reasons include: leadership studies being dominated by the perspectives of leaders; the lack of definition and visibility of followership studies; the status and limitations of much qualitative research; and a predominant focus on good leadership. Consequently, many people who experience the (...) effects of leadership, and particularly those of bad leadership, do not recognise their experiences in the literature. However, recognising that followers who experience bad leadership personally increasingly engage in autoethnographic studies, my second aim is to draw out some examples of bad leadership from the autoethnographic literature, as well as their effects. In spite of its negative effects, bad leadership frequently remains unchallenged. My third aim is to explain why this might be the case, where I argue that this stems partly from the pitfalls of autoethnographic studies. I also sketch how these pitfalls might be overcome and how doing so and adopting the principle of ‘accountability for reasonableness’ might help to tackle bad leadership. (shrink)

Moss is right to state that management theory needs to address its epistemological foundations by considering questions in epistemology and the philosophy of science. Whether management theory needs Popper is a more tricky question. It is not clear that all theories should be falsifiable in Popper’s terms. His proposed methodology for social scientific research is inherently conservative and threatens to inhibit intellectual and social progress. But Popper’s philosophical realism and rationalism need to be preserved. Coherentism and associated forms of anti-rationalism (...) (including postmodernism and relativism) threaten to provide a rationale for the worst excesses of management theory. Indeed, the poverty of contemporary management theory is a symptom of a broader intellectual malaise: debate is increasingly characterised by the exchange of persuasive rhetoric, making it difficult to hold those in positions of power accountable for rationally justifying the positions they espouse. (shrink)

Effective person-centred care requires recognition of the personhood not only of patients but of practitioners. This chapter explores the consequences of this recognition for major debates in medical epistemology, regarding clinical reasoning and the relationship between research and practice. For too long these debates have been dominated by false dichotomies - subjectivity versus objectivity, judgement versus evidence, reason versus emotion. Based on flawed understandings of such core concepts as “objectivity” and “engagement”, this distorted dissection of the subject-object relationship has served (...) to depersonalise practice. The costs of this depersonalisation include over-regulation and micromanagement of healthcare processes by administrators and payers at the same time that information from clinical research remains under-utilized and the personhood of patients risks being ignored. Science is a human practice, founded in a broader conception of human reasoning, ontologically dependent on human beings living and engaging with the world in social, emotional and ethical contexts. After looking at different conceptions of epistemic hierarchies and their uses in the analysis and evaluation of reasoning in a range of practice contexts, we propose a “nested hierarchy” that effectively turns upside-down the flawed evidence hierarchies that have helped to depersonalise care. T.S. Eliot’s “wisdom, knowledge, information” scheme (to which we add “data” below “information”) provides a model for a person-centred epistemic hierarchy. This crucial, person-centred inversion represents levels of awareness that characterise more or less developed thinking and judgement on the part of the particular practitioner. (shrink)