The call for a narrative medicine has been touted as the cure-all for an increasingly mechanical medicine. It has been claimed that the humanities might create more empathic, reflective, professional and trustworthy doctors. In other words, we can once again humanise medicine through the addition of humanities. In this essay, I explore how the humanities, particularly narrative medicine, appeals to the metaphysical commitments of the medical institution in order to find its justification, and in so doing, perpetuates a dualism of (...) humanity that would have humanism as the counterpoint to the biopsychosociologisms of our day. (shrink)

The medical humanities have been presented as a panacea for medical reductionism; a means for ‘humanizing’ medicine. However, there is a lack of consensus about the appropriate contributing disciplines and how curricula should be taught and assessed. This special issue critically examines the role of the medical humanities in medical education and their potential to serve, inadvertently or otherwise, as a tool of governance. The contributors, who include medical educators and medical practitioners, employ a range of perspectives for analysing the (...) pertinent issues. (shrink)

Foucault's work has had a profound impact on the medical humanities over the last decade or so. However, most work to date has focused on Foucault's earlier writings rather than his later contributions on the self and governmentality. This article assesses the significance of the concept of governmentality for critical scholarship in the medical humanities, particularly in creating ethical awareness in the field of health care. It examines the context for Foucault's later work, and contributions arising from scholarship building on (...) this work. The governmentality literature, it is argued, raises novel questions about the ways we have come to think about health care in late modern societies. However, there are some limitations with this body of work which have not been fully acknowledged by scholars. The article discusses some of these limitations and offers some suggestions for a fruitful way forward. (shrink)

Contemporary accounts of individual self-formation struggle to articulate a mode of subjectivity not determined by relations of power. In response to this dilemma, Foucault's late lectures on the ancient ethical practices of "fearless speech" (parrhesia) offer a model of ethical self-governance that educates individuals to ethical and political engagement. Rooted in the psychological capacities of curiosity and resolve, such self-governance equips individuals with a "disposition to steadiness" that orients individuals in the face of uncertainty. The practices of parrhesia accomplish this (...) task without fabricating a distinction between internal soul and external body; by creating not a "body of knowledge" but a "body of practices"; and without reference to an external order such as nature, custom, tradition, or religion. The result is an "expressive subject" defined through expressive practices sustained by a simultaneous relationship to herself and to others. Individuals develop themselves not through their ability to "dare to know" but as those who "dare to act.". (shrink)

But if, with Jonathan Lear, we scrutinize these thinkers' attempts to explain human behavior in terms of a higher principle--whether happiness or death--the ...

This paper first distinguishes governance (collective, autonomous self-regulatory processes) from government (externally-imposed mandatory regulation); it proposes that the second of these is essentially incompatible with a conception of the medical humanities that involves imagination and vision on the part of medical practitioners. It next develops that conception of the medical humanities, as having three distinguishable aspects (all of them distinct from the separate phenomena popularly known as “arts-in-health”): first, an intellectual enquiry into the nature of clinical medicine; second, an important (...) dimension of medical education; third, a resource for moral and aesthetic influences upon clinical practice, supporting “humane health care” as the moral inspirations behind organised medicine. Medical humanities sustains these three aspects through paying proper attention to the existential and subjective aspects of medicine. By encouraging authentic imagination among health care practitioners, medical humanities aligns well with both humane health care and governance in the sense of self-regulation. However, it can neither be achieved mechanistically nor well-measured through proxies such as patient satisfaction. Above all, it should not be allowed to supply, through inappropriate qualitative “targets,” new forms of management tyranny. (shrink)

The purpose of this paper is to show that the standard notion of informed choice is unacceptable and must be replaced. To do so, I examine Foucault's analysis of people in contemporary society, drawing attention to the ways power relations act upon us, and to the possibility of resistance. I show how feminist moral theory can be enriched by Foucault's analysis. Applying this new understanding of people and moral theory to an analysis of informed choice, I claim that the standard (...) notion of informed choice is unacceptable, in part because it relies on a false conception of people. Its “necessary” features—intention, understanding, and absence of controlling influences—are much more difficult, if not impossible, to obtain than proponents of the standard notion believe. I end by offering direction for creating a new, Foucault-inspired, feminist theory of informed choice. (shrink)