Cancer patienthood and survivorship are often narrated as stories about hair and wigs. The following article examines cultural representations of cancer in mainstream memoirs, films, and on TV across Western European and American contexts. These representations are both the ideological substrate and a subtly subversive staging of a newly globalized cancer culture that expresses itself as an embodied discourse of individual experience. Wigs have become staples of an alternative story of especially women’s cancer experience, one that contrasts with the (...) advertising slogans of what has been termed ‘Cancer Inc.’ But wigs are also a prop for consumerist self-(re)invention and can be appropriated stereotypically, with regard to stock gendered expectations – despite and alongside their subversive potential. (shrink)

Empirical research on human–robot interaction has demonstrated how humans tend to react to social robots with empathic responses and moral behavior. How should we ethically evaluate such responses to robots? Are people wrong to treat non-sentient artefacts as moral patients since this rests on anthropomorphism and ‘over-identification’ —or correct since spontaneous moral intuition and behavior toward nonhumans is indicative for moral patienthood, such that social robots become our ‘Others’?. In this research paper, I weave extant HRI studies that demonstrate (...) empathic responses toward robots with the recent debate on moral status for robots, on which the ethical evaluation of moral behavior toward them is dependent. Patienthood for robots has standardly been thought to obtain on some intrinsic ground, such as being sentient, conscious, or having interest. But since these attempts neglect moral experience and are curbed by epistemic difficulties, I take inspiration from Coeckelbergh and Gunkel’s ‘relational approach’ to explore an alternative way of accounting for robot patienthood based on extrinsic premises. Based on the ethics of Danish theologian K. E. Løgstrup I argue that empathic responses can be interpreted as sovereign expressions of life and that these expressions benefit human subjects—even if they emerge from social interaction afforded by robots we have anthropomorphized. I ultimately develop an argument in defense of treating robots as moral patients. (shrink)

Maternal–fetal surgery (MFS) encompasses a range of innovative procedures aiming to treat fetal illnesses and anomalies during pregnancy. Their development and gradual introduction into healthcare raise important ethical issues concerning respect for pregnant women’s bodily integrity and autonomy. This paper asks what kind of ethical framework should be employed to best regulate the practice of MFS without eroding the hard-won rights of pregnant women. I examine some existing models conceptualising the relationship between a pregnant woman and the fetus to determine (...) what kind of framework is the most adequate for MFS, and conclude that an ecosystem or maternal–fetal dyad model is best suited for upholding women’s autonomy. However, I suggest that an appropriate framework needs to incorporate some notion of fetal patienthood, albeit a very limited one, in order to be consistent with the views of healthcare providers and their pregnant patients. I argue that such an ethical framework is both theoretically sound and fundamentally respectful of women’s autonomy, and is thus best suited to protect women from coercion or undue paternalism when deciding whether to undergo MFS. (shrink)

This study aims to compare and contrast how specific information health technologies (IHTs) have been debated, how they have proliferated, and what they have enabled in Germany’s and England’s healthcare systems. For this a discourse analysis was undertaken that specifically focussed on future-scenarios articulated in policy documents and strategy papers released by relevant actors from both healthcare systems. The study reveals that the way IHTs have been debated and how they have proliferated depends on country-specific regulatory structures, their respective values, (...) actors’ and institutions’ organized interests, and the status of health professionals. These conditions have enabled IHTs to promote a new and similar concept of patienthood in both countries, although they tend to affect practitioners’ practices more dramatically in England. The conclusion is drawn that with the usage of IHTs, healthcare systems reproduced existing patterns of health provision while also enabling a sort of convergence. Future research should investigate whether the new concept of patienthood emerging in both welfare states actually suits patients’ and professionals’ needs and requirements. (shrink)

Rowlands offers a de-intellectualised account of personhood that is meant to secure the unity of a mental life. I argue that his characterisation also singles out a morally relevant feature of individuals. Along the same lines that the orthodox understanding of personhood reflects a fundamental precondition for moral agency, Rowlands’s notion provides a fundamental precondition for moral patienthood.

How should we understand the relation between corporate agency, corporate moral agency and corporate moral patienthood? For some time, corporations have been treated as increasingly ontologically and morally sophisticated in the literature. To explore the limits of this treatment, I start off by redeveloping and defending a reductio that historically has been aimed at accounts of corporate agency which entail that corporations count as moral patients. More specifically, I argue that standard agents are due a certain type of moral (...) concern, but corporate agents are not due that type of concern, so they are not agents of, at least, the standard type. Diagnosis: because corporations plausibly lack qualia, they are ‘zombie agents’ that mimic real agents. This explains why they are neither standard agents nor standard moral patients: they are not standard agents because they lack mental states, and because they lack experiences, they are, at best, morally notable rather than morally respectable. However, I then argue that we nevertheless have instrumental reasons to include them in our moral responsibility practices, both because that is what notability involves and bluffingly, and both when it comes to treating them as moral agents and as moral patients. Hence, we may treat corporations as part of our moral responsibility practices to a limited extent anyway. (shrink)

In this paper we discuss expected and reported effects on care provider-patient relations of the introduction of electronic patient records (EPRs) in consultation settings by reviewing exemplary studies and literature on the subject from the past decade. We argue that in order for such assessments to be meaningful, talk of effects of “the” EPR needs to be replaced by an “unpacking” of EPR systems into their constituent parts and functionalities, the effects of which need to be assessed individually. Following from (...) this principle, the paper discusses EPR systems ranging from simple data entry and retrieval systems to more sophisticated multi-user and multifunctional on-line systems. On a second level, our analysis of the literature is informed by the question which model of ideal patienthood underlies the assessment of effects of EPRs. To this end, we identify three “models of patienthood” implicit in writing about benefits and drawbacks of EPRs for patients: the autonomy, the consumer, and the holistic models, and argue that assumptions concerning these models need to be reflected upon more critically to improve understanding of what exactly EPR use does to the doctor-patient relationship. (shrink)

The public, mental health consumers, as well as mental health practitioners wonder about what kinds of values mental health professionals hold, and what kinds of values influence psychiatric diagnosis. Are mental disorders socio-political, practical, or scientific concepts? Is psychiatric diagnosis value-neutral? What role does the fundamental philosophical question "How should I live?" play in mental health care? In his carefully nuanced and exhaustively referenced monograph, psychiatrist and philosopher of psychiatry John Z. Sadler describes the manifold kinds of values and value (...) judgements involved in psychiatric diagnosis and classification systems like the DSM. Professor Sadler takes the reader on a fascinating conceptual tour of the inner workings of psychiatric diagnosis, considering the role of science, culture, sexuality, politics, gender, technology, human nature, patienthood, and professions in building his vision of a more humane psychiatric diagnostic process. (shrink)

This thesis examines the practice of haemodialysis and kidney transplantation, the two medical therapies available for persons with kidney failure, from a phenomenological perspective. A basic assumption made in the thesis is that contemporary biomedicine is deeply embedded in the cultural, historical, economic, and political circumstances provided by the particular local, national, and transnational contexts in which it is practiced. The aim of the thesis is twofold. On the one hand, the aim is to examine the forms of person- and (...) patienthood enacted and negotiated in haemodialysis and kidney transplantation care and in the daily lives of persons with kidney failure. On the other hand, the aim is to investigate the ways in which the enacted and negotiated forms of person- and patienthood are culturally embedded and normatively charged. In order to examine and investigate this twofold aim, an empirical material has been gathered that comprises observations and in-depth interviews with patients and caregivers at four haemodialysis units, one in Riga, Latvia, and three in Stockholm, Sweden. The theoretical approach and methodology of the study is cultural and phenomenological in character, drawing on an ethnological and anthropological understanding of culture as processual and relational, and on a phenomenological understanding of personhood as embodied and intertwined with the surrounding world. The thesis shows that patients’ encounters and attempts to deal with the diagnoses and treatments associated with kidney failure are complex and often misalign them with the normatively charged orientations enacted and recommended by medicine. The complex situation that emerges when they undergo transplantation, for example, stands in stark contrast to the widespread official view of organ transplantation as a self-evidently health-bringing and normalising therapy. Through their repeated and extensive experiences of undergoing haemodialysis and living with the disease, patients eventually become able to create a synthesis between their lived experiences of their own body and their body as a medical object – what in the thesis is called a ‘sick body’ – a synthesis that allows them to reorient themselves in life and experience a sense of direction. This process relies, to a large extent, on the temporal structure that haemodialysis affords life; it is by repeatedly undergoing the treatment that patients become able to create a sick body. Even so, many of them find this temporal structure problematic; they experience it as disruptive of their control and future-orientedness and as causing an existentially difficult-to-handle boredom. The thesis also shows that the political developments and the norms prevalent in the two national contexts studied greatly affect the orientations of the treatment practices and the participants’ lives. In both Riga and Stockholm, ideals of freedom, activity, control, and self-actualisation influence what forms of patienthood and personhood are enacted. The study indicates that persons who fall ill with a serious and chronic disease only gradually become able to understand and actively cope with their differently embodied circumstances of life. This suggests that medical professionals should not too hastily enlist their patients as experts on their own bodies, but rather provide them with the time and support necessary for making repeated attempts at creating and maintaining a life with a sick body. (shrink)

Herein we make a plea to machine ethicists for the inclusion of constraints on their theories consistent with empirical data on human moral cognition. As philosophers, we clearly lack widely accepted solutions to issues regarding the existence of free will, the nature of persons and firm conditions on moral agency/patienthood; all of which are indispensable concepts to be deployed by any machine able to make moral judgments. No agreement seems forthcoming on these matters, and we don’t hold out hope (...) for machines that can both always do the right thing (on some general ethic) and produce explanations for its behavior that would be understandable to a human confederate. Our tentative solution involves understanding the folk concepts associated with our moral intuitions regarding these matters, and how they might be dependent upon the nature of human cognitive architecture. It is in this spirit that we begin to explore the complexities inherent in human moral judgment via computational theories of the human cognitive architecture, rather than under the extreme constraints imposed by rational-actor models assumed throughout much of the literature on philosophical ethics. After discussing the various advantages and challenges of taking this particular perspective on the development of artificial moral agents, we computationally explore a case study of human intuitions about the self and causal responsibility. We hypothesize that a significant portion of the variance in reported intuitions for this case might be explained by appeal to an interplay between the human ability to mindread and to the way that knowledge is organized conceptually in the cognitive system. In the present paper, we build on a pre-existing computational model of mindreading (Bello et al. 2007) by adding constraints related to psychological distance (Trope and Liberman 2010), a well-established psychological theory of conceptual organization. Our initial results suggest that studies of folk concepts involved in moral intuitions lead us to an enriched understanding of cognitive architecture and a more systematic method for interpreting the data generated by such studies. (shrink)

In the first part of this article the author explores the implications for justice of the wider range of parties holding moral standing that environmental ethics has recently disclosed. These implications concern the equitable treatment of future generations and nonhuman creatures, and are relevant both to policies, such as approaches to global warming, and procedures, which may need to be revised to give an equitable voice to unrepresented interests. Later the author considers some radical implications of regarding humanity as stewards (...) of the planetary environment, a view defended in his recent book Creation, Evolution and Meaning . If all adult humans have this role, but many are prevented from discharging it by poverty and related constraints, then those who are thus disempowered need to be empowered to exercise this role. This requirement of equity would arise not from their moral patienthood but from what is involved in respecting them as moral agents. Some approaches to tackling global warming are considered in this connection. (shrink)

The paper looks in detail at patients that were treated at one of the most discussed companies operating in the field of untried stem cell treatments, Beike Biotech of Shenzhen, China. Our data show that patients who had been treated at Beike Biotech view themselves as proactively pursuing treatment choices that are not available in their home countries. These patients typically come from a broad variety of countries: China, the United Kingdom, the United States, South Africa and Australia. Among the (...) patients we interviewed there seemed to be both an awareness of the general risks involved in such experimental treatments and a readiness to accept those risks weighed against the possible benefits. We interpret this evidence as possibly reflecting the emergence of risk-taking patients as ‘consumers’ of medical options as well as the drive of patients to seek treatment options in the global arena, rather than being hindered by the ethical and regulatory constraints of their home countries. Further, we found that these patients tend to operate in more or less stable networks and groups in which they interact and cooperate closely and develop opinions and assessments of available treatment options for their ailments. These patients also perform a multiple role as patients, research subjects, and research funders because they are required to pay their way into treatment and research activities. This new social dynamics of patienthood has important implications for the ethical governance of stem cell treatments. (shrink)

The Hospital for Rehabilitation, Stavern, in Norway has treated patients with physical symptoms with no organic cause, so called conversion disorder patients, for over a decade. For four years research on the treatment has been carried out. Patients with conversion disorder seem not to fit in traditional somatic hospitals because their patienthood depends upon psychiatric diagnosis. Ironically, they appear not to belong in psychiatric hospitals because of their physical symptoms. The treatment offered these patients at hospitals for rehabilitation is (...) adapted physical activity consisting of behaviour elements such as positive reinforcement of normal function and lack of positive reinforcement at dysfunction. The pedagogical approach is seen as crucial in the successful rehabilitation of the patients. The disorder and treatment can be understood by using theories about the ecstatic body, radical behaviourism and phenomenology. When patients have problems in behaviour concerning both body and mind, it would be natural to employ both in the road to recovery. This article describes the various treatments and discusses them from phenomenological, ethical and philosophical perspectives. (shrink)

The doctor in a foreign country is a recurring theme in physician writer Richard Selzer’s stories. In his 2009 novel, Knife Song Korea, Selzer returns to this theme, examining it in depth through the lens of gender. Selzer features the American military surgeon Sloane’s multiple border-crossings, namely, from America to Korea, from health to patienthood, and from sex-exploitation to love. Crossing those visible or invisible borders in the gender and race conscious contexts of medical profession and military in wartime (...) Korea, Sloane finds himself liminally located among various masculine stereotypes. The mixed-race situation in the novel further pushes Sloane to realize the unbearability of the baggage of American manhood as represented in his profession. Selzer’s punishment of Sloane’s border-crossings seems to suggest that physicians, together with patients, are equally likely to be victimized by the macho norms in medicine. (shrink)

In this paper we discuss expected and reported effects on care provider-patient relations of the introduction of electronic patient records (EPRs) in consultation settings by reviewing exemplary studies and literature on the subject from the past decade. We argue that in order for such assessments to be meaningful, talk of effects of “the” EPR needs to be replaced by an “unpacking” of EPR systems into their constituent parts and functionalities, the effects of which need to be assessed individually. Following from (...) this principle, the paper discusses EPR systems ranging from simple data entry and retrieval systems to more sophisticated multi-user and multifunctional on-line systems. On a second level, our analysis of the literature is informed by the question which model of ideal patienthood underlies the assessment of effects of EPRs. To this end, we identify three “models of patienthood” implicit in writing about benefits and drawbacks of EPRs for patients: the autonomy, the consumer, and the holistic models, and argue that assumptions concerning these models need to be reflected upon more critically to improve understanding of what exactly EPR use does to the doctor-patient relationship. (shrink)

I would like to thank Scott Waterman for sharing what must have been very challenging personal circumstances. Waterman's reflections touched upon many complex issues. For my part, I would like to explore how Waterman's experience underscores the importance of epistemic humility regarding the limits of scientific knowledge and our sense of the meaning of scientific knowledge while still recognizing the significance and power of scientific knowledge. The first epistemic challenge presented by Scott Waterman's experience of "patienthood" that demonstrates the (...) limits of scientific knowledge is the ability to know pain. Of course, we have all known pain, but such firstperson knowledge would not qualify as scientific... (shrink)

The successful delivery of patient-centered care hinges on clinical affiliation for patients' personal needs and experiences. Narrative competence is a mode of thinking and set of actions that widens the clinical gaze beyond logico-scientific cognition. In this article, we investigate a tool that enables clinicians to rehearse their skills in narrative competence. We apply the narrative competence framework developed by the founding practitioners of narrative medicine to personal accounts of illness and patienthood published on the Internet. We describe our (...) use of the five-point framework in the close reading of 214 accounts by people with the life-threatening skin cancer melanoma. (shrink)

In this engaging, highly instructive, well-written, and carefully constructed work, Bernstein inquires into the qualities that confer moral patienthood on an individual. To be a moral patient is to be an individual deserving of moral consideration ; and to be so deserving requires that the individual have a “welfare” in that it must be capable of being made better or worse off. An individual qualifies as a moral patient if and only if it has a welfare. In the first (...) part of the two-part book, Bernstein discusses three theories of personal welfare—three ways of conceiving how individuals can be made better or worse off—that yield three different conceptions of moral patienthood. (shrink)