This paper explores a novel philosophy of ethical care in the face of burgeoning biomedical technologies. I respond to a serious challenge facing traditional bioethics with its roots in analytic philosophy. The hallmarks of these traditional approaches are reason and autonomy, founded on a belief in the liberal humanist subject. In recent years, however, there have been mounting challenges to this view of human subjectivity, emerging from poststructuralist critiques, such as Michel Foucault's, but increasingly also as a result of advances (...) in biotechnology itself. In the face of these developments, I argue that the theoretical relevance and practical application of mainstream bioethics is increasingly under strain. Traditionalists will undoubtedly resist. Together, professional philosopher-bioethicists, public health policymakers, and the global commercial healthcare industry tend to respond conservatively by shoring up the liberal humanist subject as the foundation for medical ethics and consumer decision-making, appealing to the familiar tropes of reason, autonomy, and freedom. (shrink)

Working within the tradition of continental philosophy, this article argues in favour of a phenomenological understanding of language as a crucial component of bioethical inquiry. The authors challenge the ‘commonsense’ view of language, in which thinking appears as prior to speaking, and speech the straightforward vehicle of pre-existing thoughts. Drawing on Maurice Merleau-Ponty's (1908–1961) phenomenology of language, the authors claim that thinking takes place in and through the spoken word, in and through embodied language. This view resituates bioethics as a (...) matter of bodies that speak. It also refigures the meaning of ethical self-reflexion, and in so doing offers an alternative view on reflexivity and critique. Referring to the Kantian critical tradition and its reception by Hannah Arendt and Michel Foucault, we advance a position we call ‘critical ethical reflexivity’. We contend that Merleau-Ponty's phenomenology of language offers valuable insight into ethical reflexivity and subject formation. Moreover, his understanding of language may foster new qualitative empirical research in bioethics, lead to more nuanced methods for interpreting personal narratives, and promote critical self-reflexion as necessary for bioethical inquiry. (shrink)

ABSTRACT Written in late March 2020 in the early days of the U.S. coronavirus outbreak, this essay represents a contingent reflection on the American pandemic response, mourning in anticipation of what would soon surely unfold. I argue that the State's long-standing sacrificial economies have in this moment culminated in a suicidal State. The term is Foucault's, appearing in a controversial lecture on biopolitics, Nazism, and “biological racism.” Despite Foucault's problematic treatment of racism, I suggest that some aspects of this discourse (...) might nevertheless be apropos in our context. The U.S. pandemic response is racism's suicidal State legacy writ large: an extension and retooling of historically racist infrastructures deployed in racialized domains, but in this moment also across biosocial inequities and vulnerabilities marked by differential fungibilities other than race. (shrink)

The global response to managing the spread of HIV has recently undergone a significant shift with the advent of ‘treatment as prevention’, a strategy which presumes that scaling-up testing and treatment for people living with HIV will produce a broader preventative benefit. Treatment as prevention includes an array of diagnostic, technological and policy developments that are creating new understandings of how HIV circulates in bodies and spaces. Drawing on the work of Michel Foucault, we contextualize these developments by linking them (...) to systems of governance and discursive subjectivation. The goal of this article is to problematize the growing importance of viral suppression in the management of HIV and the use of related surveillance technologies. For people living with HIV, we demonstrate how treatment-as-prevention’s emphasis on individual and collective viral load is transforming the performative dimensions of embodied risk, affect, subjectivity and sex. (shrink)

Beginning with a focus on the ethical foundations of caregiving in health and expanding towards problems of ethics and justice implicated in a range of issues, this book develops and expands the notion of care itself and its connection to practice. Organised around the themes of culture as a restraint on caregiving in different social contexts and situations, innovative methods in healthcare, and the way in which culture works to position care as part of a rhetorical approach to dependency, responsibility, (...) and justice, The Ethics of Carepresents case studies examining institutional responses to end-of-life issues, the notion of informed consent, biomedicine, indigenous rights and postcolonialism in care and theoretical approaches to the concept of care. Offering discussions from a variety of disciplinary approaches, including sociology, communication, and social theory, as well as hermeneutics, phenomenology, and deconstruction, this book will appeal to scholars across the social sciences with interests in healthcare, medicine, justice and the question of how we think about care as a notion and social form, and how this is related to practice. (shrink)

Rationale, aims and objectives : Evidence-based medicine (EBM) claims to be based on 'evidence', rather than 'intuition'. However, EBM's fundamental distinction between quantitative 'evidence' and qualitative 'intuition' is not self-evident. The meaning of 'evidence' is unclear and no studies of quality exist to demonstrate the superiority of EBM in health care settings. This paper argues that, despite itself, EBM holds out only the illusion of conclusive scientific rigour for clinical decision making, and that EBM ultimately is unable to fulfil its (...) own structural criteria for 'evidence'. Methods : Our deconstructive analysis of EBM draws on the work of the French philosopher, Jacques Derrida. Deconstruction works in the name of justice to lay bare, to expose what has been hidden from view. In plain language, we deconstruct EBM's paradigm of 'evidence', the randomized controlled trial (RCT), to demonstrate that there cannot be incontrovertible evidence for EBM as such. We argue that EBM therefore 'auto-deconstructs' its own paradigm, and that medical practitioners, policymakers and patients alike ought to be aware of this failure within EBM itself. Results : EBM's strict distinction between admissible evidence (based on RCTs) and other supposedly inadmissible evidence is not itself based on evidence, but rather, on intuition. In other words, according to EBM's own logic, there can be no 'evidentiary' basis for its distinction between admissible and inadmissible evidence. Ultimately, to uphold this fundamental distinction, EBM must seek recourse in (bio)political ideology and an epistemology akin to faith. (shrink)

This essay reads J.M. Coetzee’s novel, Diary of a Bad Year, as an occasion to problematize contemporary bioethical paradigms. Coetzee’s rhetorical strategies are analyzed to better understand the “scene of address” within which ethical claims can be voiced. Drawing on Foucault’s Socratic understanding of ethics as the self’s relation to itself, self-relation is explored through the rhetorical figure of catachresis. The essay ultimately argues that the ethical voice emerges when the terms—terms by which I relate to myself, to others, to (...) my own body, and to the bodies of others—are themselves subject to catachrestic refiguration. (shrink)

The view from inside : gendered embodiment and the medical representation of sex / Shelley Wall -- The politics of medico-legal recognition : the terms of gendered subjectivity in the UK Gender Recognition Act / Sarah Burgess -- Journeys of choice? : abortion, travel, and women's autonomy / Christabelle Sethna and Marion Doull -- The code of ethics in medicine : intertextuality and meaning in Plato's Sophist and Hippocrates' oath / Twyla Gibson -- Sleeping ethics : gene, episteme, and the (...) body politic / Deborah Lynn Steinberg -- The last temptation of Marion Woodman : the anorexic remainder in bone : dying into life / David L. Clark. (shrink)

◆ Writing is per se already violence: the rupture there is in each fragment, the break, the splitting, the tearing of the shred—acute singularity, steely point. And yet this combat is, for patience, debate. The name wears away [s'use], the fragment fragments, erodes.There is much talk today but little speech, or rather, little speech that could be received and responded to absent the vows of the unavowable community of its speakers. There is combat but debate is foreclosed by the absence (...) of asignifying absence. To avow that a community is unavowable—when the name wears away—is not to say that it has been disavowed, subjected, though in many cases this is so, for often the name names sovereignly.... (shrink)

Each is for the other the middle term, through which each mediates itself with itself and unites with itself; and each is for itself, and for the other, an immediate being on its own account, which at the same time is such only through this mediation. They recognize themselves as mutually recognizing one another. Scholars seeking an account of recognition will be familiar with the seminal section on lordship and bondage in Hegel’s Phenomenology of Spirit. In these passages we learn (...) that the dialectic of mutual recognition is the key to actualized self-consciousness, that moment in which the “I” transcends its immanence in the life process to become a self-reflective subject, actively superseding the.. (shrink)

In the introduction to his recent book outlining a "deep rhetoric" that can affirm rhetoric's "philosophical foundations," James Crosswhite celebrates a remark made by the late Henry Johnstone, the founding and long-time editor of Philosophy and Rhetoric. Johnstone, claims Crosswhite, "once suggested that rhetoric was an attempt to be 'philosophy without tears'". The passage to which Crosswhite refers appears in Johnstone's foreword to the book Rhetoric and Philosophy, a collection of essays edited by Richard Cherwitz. There, in a bungled bid (...) to praise rhetoric's "increased interest in philosophy during the past few decades," Johnstone attributes the "belief that [rhetoric] is 'philosophy without tears'"... (shrink)

In this paper, we extend Michel Foucault’s final works on the ‘care of the self’ to an empirical examination of research practice in community-based research (CBR). We use Foucault’s ‘morality of behaviors’ to analyze interview data from a national sample of Canadian CBR practitioners working with communities affected by HIV. Despite claims in the literature that ethics review is overly burdensome for non-traditional forms of research, our findings suggest that many researchers using CBR have an ambivalent but ultimately productive relationship (...) with institutional research ethics review requirements. They understand and use prescribed codes, but adapt them in practice to account for the needs of participating community members, members of their research teams and the larger communities with whom they work. Complying with ethics protocols was seen as only the beginning, a minimum standard; our research suggests that the real ethical work happens in the field, where CBR practitioners encounter community members in diverse public roles and must forge ethical consensus across communities. CBR represents an ethical terrain in which practitioners challenge themselves to work differently, and as a result they care for themselves—and others—in ways that often resist the propensity for domination through public health research.‘…there are different ways to “conduct oneself” morally, different ways for the acting individual to operate, not just as an agent, but as an ethical subject of action.’ (Foucault, 1985: 26). (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:For More than One Voice: Toward a Philosophy of Vocal ExpressionSarah K. Burgess and Stuart J. MurrayFor More than One Voice: Toward a Philosophy of Vocal Expression. Adriana Cavarero. Trans. Paul A. Kottman. Stanford: Stanford University Press, 2005. Pp. 262. $65.00, hardcover; $24.95, paperback.Adriana Cavarero's most recent book, For More than One Voice, offers the reader a critique of Western metaphysics that challenges the hegemony of speech's (...) relation to thought within politics. Revisiting Aristotle's Politics, Cavarero examines the famous definition of man as "zoon logon echon"—usually translated as "rational animal." She is critical of the tradition that renders logos here as "reason" or "rationality," modeled on the abstract and disembodied Platonic idea. Reading the Politics alongside the Poetics, she brings politics into a distinctly rhetorical sphere, and therefore figures logos as "phone semantike." In this light, man is a "speaking animal," an animal who speaks with a voice (phone) that is meaningful (semantike—an adjectival form that qualifies the voice itself). Cavarero's argument is that voice and meaning—phonic and semantic—must be sharply distinguished. The history of Western philosophy, she contends, has effaced this vital difference and focused instead on speech as a unitary phenomenon in which the vocalic and the semantic are always already joined as meaningful signification. In this way, the singularity of the vocalic itself has been elided in favor of speech that strongly privileges meaning. She therefore wishes to deliver us from language, as it were, through a recuperation of the force of the vocalic, the acoustic, the resonant and sonorous auditory quality of phone.Absent in the history of Western philosophy, this sonorous aspect of the vocalic stands as a corrective to our logocentric metaphysical tradition that singularly values the visual over the acoustic, semantic content over vocal utterances, and an abstract, anonymous "what" over a particular, embodied "who." Cavarero claims that the vocalic is an "anti-metaphysical" force that exceeds and challenges signification. In other words, the vocalic immediately communicates the uniqueness of the speaker without recourse to the signifying content of his or her speech. The voice is essentially relational—a relation that is described as "the condition of every communication.... the communicability of the communicable, or the significance of signification" (29). Indeed, for Cavarero the voice is that which "precedes, generates, and exceeds verbal communication" [End Page 166] (29–30). In this way, remarkably, Cavarero refigures the voice as a presymbolic origin that is both temporally and ontologically prior to signification, as that which is a condition of possibility for signification, and as that which is never exhausted by any signifying speech act as such.The voice is the expression of one unique, embodied individual to another. This expression, a "reciprocal invocation" founded in the sonorous, rhythmic, and resonant materiality of the voice, constitutes a "duet," a musical exchange of voices in and through which individuals mutually invoke one another. Cavarero resists inscribing such a relation within the symbolic realm; yet for her this relation is a "wordless language" that takes place in the paradigmatic scene between mother and infant. Here, in this originary scene, there is not yet the movement of language or speech as such, but the rhythm and cadence of demand and response—the voices of mother and infant that invoke one another. Drawing on Hélène Cixous's and Julia Kristeva's well-known work on the maternal chora, Cavarero demonstrates that the cadence of the "la-la melody" exchanged between mother and infant "configure[s] a reciprocal dependence" (170) that takes a structural form in the movement between demand and response.For Cavarero, the "scene of infancy" enjoys a primacy: it is both ontologically and chronologically prior to the institution of language and law. The maternal chora is figured as that which invisibly underwrites what will be understood as the law of the father—a law that is said to mark the inauguration of language. But if the law of the father is rational and semantic, the maternal should not be conceived as simply irrational and pure sound. For Cavarero, the maternal vocalic demonstrates its own reason through its rhythmic and musical resonance... (shrink)

In his six 1983 lectures published under the title, Fearless Speech (2001), Michel Foucault developed the theme of free speech and its relation to frankness, truth-telling, criticism, and duty. Derived from the ancient Greek word parrhesia, Foucault's analysis of free speech is relevant to the mentoring of medical students. This is especially true given the educational and social need to transform future physicians into able citizens who practice a fearless freedom of expression on behalf of their patients, the public, the (...) medical profession, and themselves in the public and political arena. In this paper, we argue that Foucault's understanding of free speech, or parrhesia, should be read as an ethical response to the American Medical Association's recent educational effort, Initiative to Transform Medical Education (ITME): Recommendations for change in the system of medical education (2007). In this document, the American Medical Association identifies gaps in medical education, emphasizing the need to enhance health system safety and quality, to improve education in training institutions, and to address the inadequacy of physician preparedness in new content areas. These gaps, and their relationship to the ITME goal of promoting excellence in patient care by implementing reform in the US system of medical education, call for a serious consideration and use of Foucault's parrhesia in the way that medical students are trained and mentored. (shrink)

In the summer of 2009, we conceived a special issue of MediaTropes on the theme of “bioconvergence.” We sent out an initial circular to measure interest and solicited abstracts from scholars across disciplines. We received so many engaging and excellent contributions that we decided to publish two volumes of this special issue. Volume I appears here, while the publication of Volume II is anticipated in early 2012. The contributions to this volume examine, from a range of angles, the ways in (...) which living bodies, media, and technologies “converge.” The starting proposition of this special issue is that bodies are technologized and conceived increasingly in technical and biotechnological terms, while correspondingly, techniques and technologies have become increasingly “bodied.” Moreover, both tendencies are pointedly and pervasively mediatized as bodies and technologies constitute intercutting currents of spectacle and digitality in public and cultural life... (shrink)

In this paper, we extend Michel Foucault’s final works on the ‘care of the self’ to an empirical examination of research practice in community-based research (CBR). We use Foucault’s ‘morality of behaviors’ to analyze interview data from a national sample of Canadian CBR practitioners working with communities affected by HIV. Despite claims in the literature that ethics review is overly burdensome for non-traditional forms of research, our findings suggest that many researchers using CBR have an ambivalent but ultimately productive relationship (...) with institutional research ethics review requirements. They understand and use prescribed codes, but adapt them in practice to account for the needs of participating community members, members of their research teams and the larger communities with whom they work. Complying with ethics protocols was seen as only the beginning, a minimum standard; our research suggests that the real ethical work happens in the field, where CBR practitioners encounter community members in diverse public roles and must forge ethical consensus across communities. CBR represents an ethical terrain in which practitioners challenge themselves to work differently, and as a result they care for themselves—and others—in ways that often resist the propensity for domination through public health research.‘…there are different ways to “conduct oneself” morally, different ways for the acting individual to operate, not just as an agent, but as an ethical subject of action.’ (Foucault, 1985: 26). (shrink)

This article is a critical methodological reflection on the use of interpretive phenomenological analysis (IPA) initiated in the context of a qualitative research project on the experience of seclusion in a psychiatric setting. It addresses an explicit gap in the IPA literature to explore the ways that Merleau-Ponty’s phenomenology can extend the remit of IPA for noncognitivist qualitative research projects beyond the field of health psychology. In particular, the article develops Merleau-Ponty’s understanding of the lived-body, language, and embodied speech, with (...) specific attention to the ethical implications of body and place. It concludes with a discussion on phenomenological reflexivity and prompts a reconsideration of phenomenological methods across a wide range of qualitative research projects concerned with subjectivity and ethical practice, including critical health studies, critical bioethics, and cultural studies that employ a qualitative empirical research design. (shrink)

Human enhancement technologies raise serious ethical questions about health practices no longer content simply to treat disease, but which now also propose to “optimize” human beings’ physical, cognitive and psychological abilities. These technologies call for a reassessment of our relationship to health, the human body and the body's organic, identity and social functions. In nursing, such considerations are in their infancy. In this paper, we argue for the relevance of critical phenomenology as a way to better understand the ethical issues (...) related to human enhancement technologies (HET). In so doing, we seek to problematize HET and assess their influence on the future development of nursing science and practice. It is difficult to anticipate the concrete effects of HET, we suggest, because these practices reconfigure the meaning of normativity and disorient our conventional ethical landscape. In this context, we argue that the later work of Martin Heidegger and Michel Foucault invites a critical perspective into how techno‐scientific discourses modify our relationship to care, to health and to our own social and corporeal identities. Despite the traditional philosophical opposition between phenomenology and critical theory, we maintain that a hybrid critical phenomenological approach opens new ways to assess the integration of technology and practice. Our analysis understands HET as a process of “hybridization” between technological objects and human subjects. Critical phenomenology thus effectively questions anthropocentric definitions of technology, challenges the dichotomy between curative treatment and enhancement and, finally, prompts valuable reflection on the implications of HET for nursing theory and practice. (shrink)

This paper opens with first‐hand accounts of critical care medical interventions in which detainees, in the custody of U.S. Immigration and Customs Enforcement (ICE), are brought to the emergency department for treatment. This case dramatizes the extent to which the provision of ethical and acceptable nursing care is jeopardized by federal law enforcement paradigms. Drawing on the scholarship of Michel Foucault and Giorgio Agamben, this paper offers a theoretical account of the power dynamics that inform the health care of patients (...) who find themselves caught in the custodial scaffolding of a vast immigration and detention apparatus. It offers an analysis of the display of sovereign and biopolitical power over the lives (and deaths) of detainees (Foucault), as well as the ways these individuals are reduced to “bare life” under the political pretext of an emergency or “state of exception” (Agamben). Our purpose here is both theoretical and practical: to better understand the often hidden agency or impersonal “will” exercised by the immigrant detention system, but also to equip clinicians in these and cognate facilities (e.g., prisons) with the critical tools by which they might better navigate incommensurable paradigms (i.e., care vs. custody) in order to deliver the best care while upholding their ethical duties as a care provider. This is all the more pressing because hospitals are not sanctuaries and given the incursion of federal law enforcement agents, nurses may find themselves conscripted as de facto agents of the state. (shrink)

In critical care medicine, teaching and mentoring practices are extremely important in regard to attracting and retaining young trainees and faculty in this important subspecialty that has a scarcity of needed personnel in the USA. To this end, we argue that Foucault’s Technologies of the Self is critical background reading when endeavoring to effect the positive transformation of faculty into effective teachers and mentors.

Background There has been growing interest in the use of incentives to increase the uptake of health-related behaviours and achieve desired health outcomes at the individual and population level. However, the use of incentives remains controversial for ethical reasons. An area in which incentives have been not only proposed but used is HIV prevention, testing, treatment and care—each one representing an interconnecting step in the "HIV Cascade." Methods The main objective of this qualitative case study was to document the experiences (...) of health care and service providers tasked with administrating incentivized HIV testing, treatment, and care in British Columbia, Canada. A second objective was to explore the ethical and professional tensions that arise from the use of incentives as well as strategies used by providers to mitigate them. We conducted interviews with 25 providers and 6 key informants, which were analyzed using applied thematic analysis. We also collected documents and took field notes. Results Our findings suggest that incentives target populations believed to pose the most risk to public health. As such, incentives are primarily used to close the gaps in the HIV Cascade by getting the "right populations" to test, start treatment, stay on treatment, and, most importantly, achieve viral suppression. Participants considered that incentives work because they "bring people through the door." However, they believed the effectiveness of incentives to be superficial, short-lived and one-dimensional—thus, failing to address underlying structural barriers to care and structural determinants of health. They also raised concerns about the unintended consequences of incentives and the strains they may put on the therapeutic relationship. They had developed strategies to mitigate the ensuing ethical and professional tensions and to make their work feel relational rather than transactional. Conclusions We identify an urgent need to problematize the use of incentives as a part of the "HIV Cascade" agenda and interrogate the ethics of engaging in this practice from the perspective of health care and service providers. More broadly, we question the introduction of market logic into the realm of health care—an area of life previously not subject to monetary exchanges. (shrink)

Since the Harvard Committees bold and highly successful attempt to redefine death in 1968 (Harvard Ad Hoc committee, 1968), multiple controversies have arisen. Stimulated by several factors, including the inherent conceptual weakness of the Harvard Committees proposal, accumulated clinical experience, and the incessant push to expand the pool of potential organ donors, the lively debate about the definition of death has, for the most part, been confined to a relatively small group of academics who have created a large body of (...) literature of which this issue of the Journal of Medicine and Philosophy is an example. Law and public policy, however, have remained essentially unaffected. This paper will briefly review the multiple controversies about defining death in an attempt to explain why they have and will remain unresolved in the academic community and have even less chance of being understood and resolved by politicians, legislators, and the general public. Considering this, we will end by suggesting the probable course of public policy and clinical practice in the decades ahead. (shrink)

This book is the first comprehensive report and analysis of the Dutch euthanasia experience over the last three decades. In contrast to most books about euthanasia, which are written by authors from countries where the practice is illegal and therefore practised only secretly, this book analyzes empirical data and real-life clinical behavior. Its essays were written by the leading Dutch scholars and clinicians who shaped euthanasia policy and who have studied, evaluated and helped regulate it. Some of them have themselves (...) practised euthanasia. The book will contribute to the world literature on physician-assisted death by providing a comprehensive examination of how euthanasia has been practised and how it has evolved in one specific national and cultural context. It will greatly advance the understanding of euthanasia among both advocates and opponents of the practice. (shrink)

One way of increasing the supply of vital organs without violating the dead donor rule is to declare death on cardiopulmonary criteria after withdrawing life support. The question then is how quickly death may be declared.

One way of increasing the supply of vital organs without violating the dead donor rule is to declare death on cardiopulmonary criteria after withdrawing life support. The question then is how quickly death may be declared.

Over the past decade, public discussion has focused on the ethics of issuing Do‐Not‐Resuscitate Orders, and the failure of many hospitals to acknowledge their actions openly. Recent efforts on the part of some hospitals to establish formal DNR guidelines that are prudent, fair, and humane, are a helpful beginning, though they cannot account for all the vagaries of illness and human communication. But concerns about DNR should not divert us from looking closely and rigorously at other, more common treatment/nontreatment decisions (...) in the critical care setting. (shrink)

In Capital as Organic Unity, Mark E. Meaney argues “that the doctrinal content of Marx’s Grundrisse is indebted for its logical form to Hegel’s exposition of logical categories as found in the Wissenschaft der Logik”. Meaney builds upon an important work by Hiroshi Uchida which had already explored Marx’s debt in the Grundrisse to Hegel’s Logic. But beyond Uchida’s claims, Meaney maps the entire structure of the Grundrisse onto the parallel movements of Hegel’s larger Science of Logic. Meany’s text contains (...) seven chapters. Besides the introduction and conclusion, one chapter discusses money as being, two discuss capital as essence or the essence of capital, and two more discuss the concept of capital in its objective, conceptual completeness. Capital is for Marx a concrete manifestation of Hegel’s objectification of the concept. (shrink)

The transplantation and procurement of human organs has become almost routine in American society. Yet, organ transplantation raises difficult ethical and psychosocial issues in the context of “controlled” death, including the blurring of boundaries between life and death, self and other, healing and harming, and killing and letting die. These issues are explored in the context of the actual experiences of organ donors and recipients, brain death, the introduction of non‐heartbeating donor protocols, and the increasing reliance on living donors. The (...) author draws on a thematic analysis of the way that organ transplantation is presented in the media, films, and science fiction and on his clinical experience as a psychiatrist working with transplant patients, their families, and the nurses and physicians who care for them. (shrink)