In this volume, first published in 1983, Professor Rogers examines the usefulness of a phenomenological approach to sociology. Her broad purpose is to demonstrate the theoretical and methodological advantages phenomenological sociology holds. Thus she offers a selective, introductory exposition of phenomenology, highlighting its relevance for social scientists and undercutting the notion of phenomenology as a non-scientific, subjective, or esoteric method of study.

This article offers both a feminist and an ethnomethodological reanalysis of Harold Garfinkel's report on Agnes, the intersexed person he studied with several colleagues. Both reanalyses yield similar conclusions. Specifically, while it does illuminate the work of accomplishing gender, the report on Agnes simultaneously illustrates how gender operates as a powerful background expectancy among professional as well as “lay” sociologists.

This paper explores how Schutz’s ideas enrich and extend the ethic of care promulgated by feminist theorists such as Carol Gilligan, Nel Noddings,Sara Ruddick, and Eva Feder Kittay. Using Schutz’s ideas about the I-Thou relationship, systems of relevances, and growing old together, the authorlays a foundation for continuing dialogue between feminist theorists of care and Schutzian phenomenologists.

This paper explores how Schutz’s ideas enrich and extend the ethic of care promulgated by feminist theorists such as Carol Gilligan, Nel Noddings,Sara Ruddick, and Eva Feder Kittay. Using Schutz’s ideas about the I-Thou relationship, systems of relevances, and growing old together, the authorlays a foundation for continuing dialogue between feminist theorists of care and Schutzian phenomenologists.

The work of literary structuralists, particularly Roland Barthes, provides sharper insights into ethnomethodology than symbolic interactionism, labeling theory, or phenomenology. Further, it suggests that the metaphor of text may be fruitful for analysts of everyday life. Greater theoretical benefits derive from that metaphor, however, if one applies it using the ideas of literary theorists outside the structuralist tradition.

Although little noticed by practicing theorists, narrative voice influences theoretical work. This essay presents a demonstration of voice as method, concentrating on brief segments of works by Garfinkel and Goffman. We attend to two methodological themes: how theorists use voice to establish intellectual autonomy, and how the use of voice influences credibility with readers. Garfinkel maximizes his autonomy by using narrative techniques that isolate him from his readers, and produce little common context with them as a result. Goffman maintains a (...) context for credibility with his readers by using a personal voice, but he uses this voice to request their indulgence as he follows his autonomous muse. Goffman's narrative self-indulgence prevents him from fashioning a coherent theoretical program for his readers, something Garfinkel's distant voice enables him to achieve. (shrink)

The staying power of creationist objections to evolution needs explanation. It depends on the use of “blood” language. Both William Jennings Bryan and, a century later, Ken Ham connect evolution with the blood of predation and the blood of apes, and both also connect evolution with the blood of atonement. Drawing on Mary Douglas and Bettina Bildhauer, I suggest that blood becomes important to societies that image the social body on the human body. Blood reveals the body as porous (...) and vulnerable and therefore needing social work to be constructed as whole and bounded. Blood is the place where society conducts this work. I conclude that blood language is ineliminable from Christian discourse and indeed from discourses that model the social on the individual body. The solution, I suggest, is not to avoid the language of blood, but to continue to use it in ways that broaden its focus from human sin to human and animal suffering. (shrink)

Many health care systems include programs that allow patients in exceptional circumstances to access medical interventions of as yet unproven benefit. In this article we consider the ethical justifications for—and demands on—these special access programs (SAPs). SAPs have a compassionate basis: They give patients with limited options the opportunity to try interventions that are not yet approved by standard regulatory processes. But while they signal that health care systems can and will respond to individual suffering, SAPs have several disadvantages, including (...) the potential to undermine regulatory and knowledge-generation structures that constitute significant public goods. The “balance” between these considerations depends in part on how broadly SAPs are used, but also on whether SAPs can be made to contribute to the generation of knowledge about the effects of health interventions. We argue that patients should usually be required to contribute outcome data while using SAPs. (shrink)

In this paper, we examine recent critiques of the debate about defining disease, which claim that its use of conceptual analysis embeds the problematic assumption that the concept is classically structured. These critiques suggest, instead, developing plural stipulative definitions. Although we substantially agree with these critiques, we resist their implication that no general definition of “disease” is possible. We offer an alternative, inductive argument that disease cannot be classically defined and that the best explanation for this is that the concept (...) is structured as a cluster. We further argue that we do not need to reject the possibility of defining the general concept “disease” to legitimate developing stipulative definitions of disease that are relative to particular purposes. A cluster definition of disease is compatible with contextually motivated definitions, which may be considered précisifications of the more general cluster concept. (shrink)

Boorse’s biostatistical theory states that diseases should be defined in ways that reflect disturbances of biological function and that are objective and value free. We use three examples from contemporary medicine that demonstrate the complex issues that arise when defining the boundaries of disease: polycystic ovary syndrome, chronic kidney disease, and myocardial infarction. We argue that the biostatistical theory fails to provide sufficient guidance on where the boundaries of disease should be drawn, contains ambiguities relating to choice of reference class, (...) and is out of step with medical processes for identifying disease boundaries. Although proponents of the biostatistical theory might regard these practical issues as irrelevant to the aim of providing a theoretical account of disease, we take them to indicate the need for a theoretical account that is adequate for current needs—including limiting new forms of medicalization that are driven by the identification of disease based on dysfunction. Our processes for determining the boundaries for disease need to recognize that there is no value-free method for making these decisions. (shrink)

Recently, concerns have been raised about the phenomenon of ‘overdiagnosis’, the diagnosis of a condition that is not causing harm, and will not come to cause harm. Along with practical, ethical, and scientific questions, overdiagnosis raises questions about our concept of disease. In this paper, we analyse overdiagnosis as an epistemic problem and show how it challenges many existing accounts of disease. In particular, it raises ques- tions about conceptual links drawn between disease and dysfunction, harm, and risk. We argue (...) that ‘disease’ should be considered a vague concept with a non-classical structure. On this view, overdiagnosed cases are ‘borderline’ cases of disease, falling in the zone between cases that are clearly disease, and cases that are clearly not disease. We then develop a pre ́cising definition of disease designed to provide practical help in preventing and limiting overdiagnosis. We argue that for this purpose, we can define disease as dysfunction that has a significant risk of causing severe harm to the patient. (shrink)

Recently, concerns have been raised about the phenomenon of 'overdiagnosis', the diagnosis of a condition that is not causing harm, and will not come to cause harm. Along with practical, ethical, and scientific questions, overdiagnosis raises questions about our concept of disease. In this paper, we analyse overdiagnosis as an epistemic problem and show how it challenges many existing accounts of disease. In particular, it raises questions about conceptual links drawn between disease and dysfunction, harm, and risk. We argue that (...) "disease" should be considered a vague concept with a nonclassical structure. On this view, overdiagnosed cases are 'borderline' cases of disease, falling in the zone between cases that are clearly disease, and cases that are clearly not disease. We then develop a précising definition of disease designed to provide practical help in preventing and limiting overdiagnosis. We argue that for this purpose, we can define disease as dysfunction that has a significant risk of causing severe harm to the patient. (shrink)

An increasing number of patients receive diagnoses of disease without having any symptoms. These include diseases detected through screening programs, as incidental findings from unrelated investigations, or via routine checks of various biological variables like blood pressure or cholesterol. In this article, we draw on narrative identity theory to examine how the process of making sense of being diagnosed with asymptomatic disease can trigger certain overlooked forms of harm for patients. We show that the experience of asymptomatic disease can involve (...) ‘mismatches’ between one’s beliefs about one’s health status on the one hand, and bodily sensations or past experience on the other. Patients’ attempts to integrate these diagnoses into their self-narratives often involve either forming inaccurate beliefs about bodily sensations and/or past experience, or coming to believe that feelings and experience do not necessarily track or predict health status, leading to an ongoing sense of vulnerability to ill health. These resulting alterations in self-understanding can sometimes be considered harmful, in view of their implications for ascriptions of responsibility and ongoing anxiety. (shrink)

Although health and disease occupy opposite ends of a spectrum, distinguishing between them can be difficult. This is the “line-drawing” problem. The papers in this special issue engage with this challenge of delineating the boundaries of disease. The authors explore different views as to where the boundary between disease and nondisease lies, and related questions, such as how we can identify, or decide, what counts as a disease and what does not; the nature of the boundary between the two categories; (...) and what sorts of considerations could justify the location of that boundary. In exploring these questions, the papers draw on detailed clinical examples, provide theoretical critiques of existing approaches to disease definition, and offer new ways to conceptualize key features in debates about disease, including harm and biological dysfunction. (shrink)

Nell restricts cruelty to hominids, although good evidence suggests that secondary aggression in rodents and particularly primates may be considered cruel. A considerable literature shows that glucocorticoid secretion stimulated by stress facilitates learning, memory, arousal, and aggressive behavior. Either secondary aggression (to a conspecific) or increased affiliative behavior reduces stressor-induced activity, suggesting the reward system can be satisfied by other behaviors than cruelty.

This critique of papers by hartshorne, tracy and eslick seeks a possible rapport between process theology and thomistic natural theology. both schools seek a god who is love, intimately involved in daily human life. but a dipolar god is not sufficiently transcendent to be so immanent. hence only love which is purely actual being can satisfy process intentions. tracy's new "tensive analogical language" and eslick's teleological explanation of novelty are thus more feasible on thomistic than on process grounds.

SEARCHING and learning... are altogether recollection". A long and strong tradition in Platonic studies has taken this statement as a literal description of what happens when we come to know something that we had not known before. That literal interpretation is commonly linked to a similarly literal interpretation of Plato's statements about the soul's cycle of rebirths, and to a transcendent rather than a transcendental view of the Ideas, one which gives them an ontological status separate from sensible particulars. Sensibles (...) thus recall to our minds the Ideas which we saw in our earlier life in the other world, the world to which our disembodied souls will return as a reward for having pursued the philosophical life. (shrink)

Positive claims about narrative approaches to healthcare suggest they could have many benefits, including supporting person-centred healthcare (PCH). Narrative approaches have also been criticised, however, on both theoretical and practical grounds. In this paper we draw on epistemological work on narrative and knowledge to develop a conception of narrative that responds to these concerns. We make a case for understanding narratives as accounts of events in which the way each event is described as influenced by the ways other events in (...) the narrative are described. This view of narratives recognises that they can contribute knowledge of different kinds of connections between events: not just causal, and not just of patient’s perspectives. Additionally, narratives can add further epistemic value by suggesting potentially useful lines of inquiry. We take narrative approaches to healthcare to include clinicians considering both patients’ informational offerings and their own professional understandings as narratives. On this understanding, our account is able to overcome the major theoretical and practical criticisms that have been levelled against the use of narrative approaches in healthcare, and can help to explain why and how narrative approaches are consistent with PCH. (shrink)

Surgery is an important part of contemporary health care, but currently much of surgery lacks a strong evidence base. Uptake of evidence-based medicine (EBM) methods within surgical research and among practitioners has been slow compared with other areas of medicine. Although this is often viewed as arising from practical and cultural barriers, it also reflects a lack of epistemic fit between EBM research methods and surgical practice. In this paper we discuss some epistemic challenges in surgery relating to this lack (...) of fit, and investigate how resources from feminist epistemology can help to characterize them. We point to ways in which these epistemic challenges may be addressed by gathering and disseminating evidence about what works in surgery using methods that are contextual, pluralistic, and sensitive to hierarchies. (shrink)

Evidence in medicine can come from more or less trustworthy sources and be produced by more or less reliable methods, and its interpretation can be disputed. As such, it can be unclear when disagreements in medicine result from different, but reasonable, interpretations of the available evidence and when they result from unreasonable refusals to consider legitimate evidence. In this article, we seek to show how assessments of the relevance and implications of evidence are typically affected by factors beyond that evidence (...) itself, such as our beliefs about the credibility of the speaker or source of the evidence. In evaluating evidence, there is thus a need for reflective awareness about why we accept or dismiss particular claims. (shrink)