This article adopts Husserl’s transcendental phenomenology to explore the complex relationship between patients and physicians. It delves into the coexistence of two distinct voices in the realm of medicine and health: the “voice of medicine” and the “voice of life-world.” Divided into three sections, the article emphasizes the importance of shifting from a scientific-medical attitude to a more personalistic approach in physician–patient interactions. This shift aims to prevent depersonalization and desubjectification. Additionally, it highlights the equal and irreducible nature of patients (...) while acknowledging the vital role physicians hold in the realm of illness. The article stresses the need for a balanced and equitable relationship between both parties, rooted in the shared life-world. Moreover, empathy is underscored as a crucial element in fostering meaningful dialogue, wherein understanding diverse perspectives and attitudes towards illness is paramount. The article argues that differences between patients and physicians are necessary for empathy, while shared similarities form its foundation. Ultimately, a harmonious relationship facilitates empathy and enables the constitution of a new sense of life for both patients and physicians. (shrink)

In this paper I put forward an ethical argument for the provision of extensive patient choice by the British National Health Service. I base this argument on traditional liberal rights to freedom of choice, on a welfare right to health care, and on a view of health as values-based. I argue that choice, to be ethically sustainable on this basis, must be values-based and rational. I also consider whether the British taxpayer may be persuadable with regard to the moral acceptability (...) of patient choice, making use of Rawls’ theory of political liberalism in this context. I identify issues that present problems in terms of public acceptance of choice, and also identify a boundary issue with regard to public health choices as against individual choices. (shrink)

The emerging concept of systems medicine (or ‘P4 medicine’—predictive, preventive, personalized and participatory) is at the vanguard of the post-genomic movement towards ‘precision medicine’. It is the medical application of systems biology, the biological study of wholes. Of particular interest, P4 systems medicine is currently promised as a revolutionary new biomedical approach that is holistic rather than reductionist. This article analyzes its concept of holism, both with regard to methods and conceptualization of health and disease. Rather than representing a medical (...) holism associated with basic humanistic ideas, we find a technoscientific holism resulting from altered technological and theoretical circumstances in biology. We argue that this holism, which is aimed at disease prevention and health optimization, points towards an expanded form of medicalization, which we call ‘holistic medicalization’: Each person’s whole life process is defined in biomedical, technoscientific terms as quantifiable and controllable and underlain a regime of medical control that is holistic in that it is all-encompassing. It is directed at all levels of functioning, from the molecular to the social, continual throughout life and aimed at managing the whole continuum from cure of disease to optimization of health. We argue that this medicalization is a very concrete materialization of a broader trend in medicine and society, which we call ‘the medicalization of health and life itself’. We explicate this holistic medicalization, discuss potential harms and conclude by calling for preventive measures aimed at avoiding eventual harmful effects of overmedicalization in systems medicine (quaternary prevention). (shrink)

While medicine is solidly grounded on scientific areas such as biology and chemistry, some argue that it is in its essence not a science at all. With medicine playing a substantial societal role, addressing questions about the scientific nature of medicine is of obvious urgency. This paper takes on such a task and starts by consulting the literature on the “demarcation” problem in the philosophy of science. Learning from failures of earlier approaches, it proposes that we adopt a Deflated Approach, (...) which acknowledges that “science” is a family resemblance concept that admits differences of degrees to nonscientific undertakings. Then, drawing on Paul Hoyningen-Huene’s ; account of systematicity and Alexander Bird’s analysis of examples from the history of medicine, the paper argues that medicine meets the requirement for systematicity on all dimensions and thereby qualifies as a science. The paper then considers and defuses two objections. First, it is shown that nonepistemic differences linked to the distinctive duality of medicine do not warrant thinking that medicine is not science. Second, against some recent criticism, the paper uses homeopathy as an example to show that systematicity can succeed as a demarcation criterion. (shrink)

While medicine is solidly grounded on scientific areas such as biology and chemistry, some argue that it is in its essence not a science at all. With medicine playing a substantial societal role, addressing questions about the scientific nature of medicine is of obvious urgency. This paper takes on such a task and starts by consulting the literature on the “demarcation” problem in the philosophy of science. Learning from failures of earlier approaches, it proposes that we adopt a Deflated Approach, (...) which acknowledges that “science” is a family resemblance concept that admits differences of degrees to nonscientific undertakings. Then, drawing on Paul Hoyningen-Huene’s (Systematicity: The nature of science, Oxford University Press, Oxford, 2013); (Synthese 196: 907–928, 2019) account of systematicity and Alexander Bird’s (Synthese 196: 863–879, 2019) analysis of examples from the history of medicine, the paper argues that medicine meets the requirement for systematicity on all dimensions and thereby qualifies as a science. The paper then considers and defuses two objections. First, it is shown that nonepistemic differences linked to the distinctive duality of medicine do not warrant thinking that medicine is not science. Second, against some recent criticism (Oreskes in Synthese 196: 881–905, 2019), the paper uses homeopathy as an example to show that (synchronic and diachronic) systematicity can succeed as a demarcation criterion. (shrink)

Cardiovascular disease (CVD) and sustained high blood glucose as prediabetes are an established comorbidity. People's experience in reconciling these long‐term conditions requires deeper appreciation if nurses are to more effectively support person‐centred care for people who have them. Our analysis explores the initial experience of people admitted to hospital with CVD who then find they also have sustained high blood glucose. Our methodology is informed by the philosophy of Gadamer and applies interpretive description to develop an interpretation of participant experiences. (...) The major theme emerging from participant interviews was the ‘invisible disequilibrium’ characterised by three subthemes: ‘losing equilibrium’, ‘becoming embattled’ and ‘evolving illness’. This study examines CVD and prediabetes in conjunction with the Gadamerian notion of the ‘whole’, as being in a social and emotional world in which illness is also a component part. We explore how participants lived within an ‘invisible disequilibrium’, with prediabetes frequently remaining unnoticed, while CVD was manifest. To identify multiple conditions and support effective intervention to manage them as part of person‐centric care, nursing practice should explore the ‘whole’ of the person's experience, value people’s knowledge as potential indicators of complex illness, thereby reducing the risk of accelerating complex illness. (shrink)

This paper describes how body regimes are effectuated in the prevailing treatment strategy of physiotherapy. The process of self‐mastering in the context of sports‐related injuries is highlighted. Through a Foucauldian perspective on body regimes the aim is to shed light on the process of individualization and self‐mastery in rehabilitation. The treatment of illness in the physiotherapy clinic does not characterize the patient as sick, and exempt the patient from daily duties and expectations. The empirical data include 17 qualitative illness narratives (...) and several years of fieldwork observing patients with anterior cruciate ligament (ACL) injuries in a physiotherapy clinic. The study demonstrates how the expectation that the patients be active and self‐mastering permeates the total process of treatment. The individual responsibility for personal well‐being is a recurrent phenomenon in public health services in general, and specifically prominent in the rehabilitation of sports injuries. (shrink)

Conserving the vitality of suffering: addressing family constraints to illness conversationsWhen persons are confronted with life‐threatening or chronic illness, there is always a possibility that family members other than the person experiencing the illness also suffer as they attempt to manage their own distress. This paper describes exemplars from a hermeneutic study that explored therapeutic conversations between nurses and families who were living with a member experiencing ischaemic heart disease. These conversations uncovered the complexity of both individual and family suffering (...) following acute cardiac illness events, and called attention to nursing practices that addressed some of the ways that family members were constrained from having conversations about the illness. When spaces were created for these conversations to occur, possibilities for making sense of illness and suffering were revealed as vital. These understandings support the efforts of family members to sustain and conserve family relationships in the face of illness and suffering, and inform both the professional and personal lives of nurses. (shrink)

Much of postmodern philosophy questions the assumptions of Modernity, that period in the history of the Western world since the Enlightment. These assumptions are that truth is discoverable through human reason; that certain knowledge is possible; and furthermore, that such knowledge will provide a basis for the ineluctable progress of Mankind. The Enlightenment project is underwritten by the conviction that knowledge gained through the scientific method is secure. In so far as biomedicine inherits these assumptions it becomes fair game for (...) postmodern deconstruction. Today, perhaps more than ever, plural values compete, and contradictory approaches to health, for instance, garner support and acquire supremacy through consumer choice and media manipulation rather than evidence-based science. Many doctors feel a tension between meeting the needs of the patient face to face, and working towards the broader health needs of the public at large. But if the very foundations of medical science are questioned, by patients, or by doctors themselves, wherein lies the value of their work? This paper examines the issues that the anti-foundationalist thrust of postmodernism raises, in the light of a case of mild hypertension. The strict application of medical protocol, derived from a nomothetic, statistical perspective, seems unlikely to furnish value in the treatment of an individual. The anything goes, consumerist approach, however, fares no better. The author argues that whilst value cannot depend on any rationally predetermined parameters, it can be rescued, and emerges from the process of the meeting with the patient. (shrink)

In recent years, autopoietic enactivism has been used to address persistent conceptual problems in psychiatry, such as the problem of demarcating disorder, that other models thus far have failed to overcome. There appear to be three main enactive accounts of psychopathology with subtle, although not incompatible, differences: Maiesecharacterizes disorder as distinct disruptions in autonomy and agency; Nielsen characterizes disorder as behaviors that relevantly conflict with the functional norms of an individual; De Haan emphasizes patterns of disordered sense-making, that are transformed (...) through the existential dimension. Given that these accounts are intended to provide not only an ontologically richer account of psychopathology but also reduce the stigma experienced by individuals with mental disorders by accounting for lived experience, a critical analysis of these approaches is needed. I will provide a problematization of enactive accounts of mental disorder, showing that this particular framework does not, as it stands, necessarily reduce the harm and suffering experienced by individuals with mental disorder because of its ontological openness; enactivism leaves much to be interpreted and applied by the clinician (or patient) such that practical and ethical problems in its use arise. (shrink)

This article presents Gadamer’s interest in temporality as his strategy for advancing hermeneutics as philosophy of experience, a strategy becoming significantly more salient with the appearance of his 1992 essay, ‘Wort und Bild’. I demonstrate how temporal categories readily demarcate the problem of ontological imbalance so central in Gadamer’s philosophical project, a demarcation that removes any illusion of compatibility between Gadamer and the hermeneutics of Paul Ricoeur. The article also considers some common misunderstandings of Gadamer resulting from a failure to (...) take full account of his interest in temporality, misunderstandings that prohibit recognizing the radical potential of Gadamer’s hermeneutical philosophy for our understanding of human finitude. A full account of this orientation must begin with a grasp of the exemplariness of art in his philosophy, and in this connection, the article raises the question of Gadamer’s late interest in the distinct exemplariness, not of lyric poetry, but of narrative art. (shrink)

The professions of nursing and nurse education are currently experiencing a crisis of confidence, particularly in the UK, where the Francis Report and other recent reviews have highlighted a number of cases of nurses who no longer appear willing or able to ‘care’. The popular press, along with some elements of the nursing profession, has placed the blame for these failures firmly on the academy and particularly on the relatively recent move to all‐graduate status in England for pre‐registration student nurses. (...) This has come to be known in the UK as the ‘too‐posh‐to‐wash’ argument, that there is an incommensurability between being educated to degree level and performing basic nursing tasks. I will argue in this paper that the diagnosis of the problem is substantively correct, but the formulation and the prescription are misguided and dangerous. I will suggest that the growing emphasis on research‐based and evidence‐based practice is the logical conclusion of an inappropriate scientific paradigm for nursing which is underpinned by the social sciences, by technical rationality, and by a focus on people. In contrast, I will suggest that a more fruitful way of thinking about and practising nursing and nurse education is to consider it as a human science with a focus on persons in which evidence for practice derives largely from practice itself. The history of the idea of a human science is traced from its roots in nineteenth century hermeneutics to the work of Gadamer and R.D. Laing in the 1960s, and I attempt to imagine a paradigm for nursing practice, scholarship, and education based on Laing's ‘existential–phenomenological’ approach with a focus on the endeavour to understand and relate to individual persons rather than to make broad prescriptions for practice based on statistical and other generalizations. (shrink)

Communication between medical professionals and patients is an important aspect of therapy and patient satisfaction. Common barriers that get in the way of effective communication in this sphere include: (1) gender, age, and cultural differences; (2) physical or psychological discomfort or pain; (3) medical literacy; and (4) distraction due to technological factors or simply being overworked. The author examines these communicative barriers from a philosophical lens and then utilizes Martin Heidegger’s phenomenology and hermeneutics to provide guidance for medical professional–patient interactions. (...) The phenomenological approach espoused emphasizes the particular, contextual nature of such interactions, and thus is opposed to abstract, theoretical principles. Heidegger’s hermeneutics provides a philosophical approach to communication that may guide the back-and-forth interpretation that should happen between medical professionals and patients to achieve effective communication. (shrink)

Most workers report that they are alienated from their jobs and find their workplaces to be stifling and uninviting. Given this condition, the introduction of computer technology, including AI, will only make matters worse, unless a more humane organizational culture is created. The key point in this article is the need to produce a responsible technology, so that employees are not further overworked and manipulated. To achieve this end, phenomenology is invoked, particularly the life world, to provide technology with a (...) human foundation. In practice, this shift in philosophy means that when AI is introduced into an organization, workers have a central role in the design, implementation, and evaluation of this technology. Computer technology can thus promote human flourishing instead of control and alienation in workplaces. (shrink)

Most workers report that they are alienated from their jobs and find their workplaces to be stifling and uninviting. Given this condition, the introduction of computer technology, including AI, will only make matters worse, unless a more humane organizational culture is created. The key point in this article is the need to produce a responsible technology, so that employees are not further overworked and manipulated. To achieve this end, phenomenology is invoked, particularly the life world, to provide technology with a (...) human foundation. In practice, this shift in philosophy means that when AI is introduced into an organization, workers have a central role in the design, implementation, and evaluation of this technology. Computer technology can thus promote human flourishing instead of control and alienation in workplaces. (shrink)

In this paper, the authors describe an aspect of a program of research around grief and clinical practice. The first phase of the study involves examination of experiences of grief with attention to troublesome or problematic beliefs that fuel the extent of suffering in the bereaved. The data, obtained from a review of videotaped clinical interviews with families seen in the Family Nursing Unit at the University of Calgary, were analyzed according to philosophical hermeneutic tradition. Findings suggest that grief is (...) an experience that is ongoing, that changes in nature over time, but that involves a continuing relationship with the deceased; it is a graceful, periodic, deliberate walk backwards while keeping a sure foot in living forward. (shrink)

An obvious feature of the development of the philosophy of science during the past decades is an increasing specialization and fragmentation that have led to reduced impact of philosophy of science outside the sphere of its own discipline. It seems that philosophy of science and scientific research are moving away from each other. The major question of this article is how can reconnect these two?To answer this question I will try to highlight some events especially in the fields of social (...) sciences that researchers are involved in discussions, generally related to philosophy of science, not in an abstract and isolated way, but in a way that is completely intertwined in their research practices. Unfortunately, this phenomenon has not been properly considered by philosophers of science and has remained more as a subject in the field of social sciences, specifically research methodology. It seems that if philosophy of science enters into dialogue with social sciences, we can expect the revival of the philosophy of general science. In this article, I try to show the signs of this phenomenon in cognitive psychology. I will first turn to one of the most influential theories in the cognitive sciences, expertise theory. After reviewing the important theories of expertise and their differences, in the next step I will discuss the seemingly opposing theories in this field and their efforts to find common ground. Then I will review the current movement in cognitive psychology, which I call the “integration model” stream. After a critical review and categorization of these models, I will show that in a broader view in social science, we can realize the meta-theoretical issues that are a good room for a dialogue between philosophy of science and scientific research. In the end, I will point out the horizons that this view opens to the revival of philosophy of general science. (shrink)

After the middle of the twentieth century, symptoms gradually appeared which were collectively called the “crisis of medicine”. This crisis gave philosophy, which had been abstracted from medicine since the mid-nineteenth century, an opportunity to reflect. Medical philosophers attributed the crisis to the inflation of the scientific and technical aspects and, consequently, to the weakening of the human aspects of medicine. Therefore, reflection on the nature of medicine became one of the central issues of philosophy in medicine.In this article, I (...) will first highlight the need to study the nature of medicine, explain the various concpetions of the nature of modern medicine - based on the dichotomy- science vs. art, and show their inadequacy and inappropriatness. Finally, I will provide a model to the nature of medicine beyond the realm of science / art. In this model, medicine is a scientific practice, based on judgment, dialogue, communication and social order. This model faces teleological, epistemological, scientific, political, and professional challenges that require serious and continuous reflection on the nature of medicine. (shrink)

This paper will discuss Hans‐George Gadamer’s ‘The Enigma of Health’ Chapter 2, ‘Apologia for the Art of Healing’s (1965). In this chapter, Gadamer defends the art of healing as essentially an ability to reproduce and re‐establish the health of an ill person. He considers modern medicine’s progressive reliance on technology as mechanical rather than an art of healing. In support of this concept, I will also refer to Gadamer’s Chapter 6, ‘Between Nature and Art’ and briefly to Beardsworth’s ‘Practices of (...) Procrastination’. First, I will discuss the above works showing how the authors make their arguments and what conclusions they draw, and then I will relate these arguments and conclusions to nursing, gerontological nursing in particular. (shrink)

From 1959 until 1969, Heidegger lectured to psychiatrists and psychiatry students at the University of Zurich Psychiatric Clinic and in Zollikon. The transcriptions of these lectures were published as the Zollikon Seminars. In these seminars Heidegger is highly critical of psychoanalysis, because of its causal and objectifying approach to the human being. In general, Heidegger considers it an objectification or even an elimination of the human being to approach a patient from a causal perspective. In our view Heidegger has overlooked (...) the peculiar nature and complexity of psychotherapy and psychiatry, namely that psychiatry is not just a discipline that combines a hermeneutical approach and a natural science approach on a theoretical level, but it also deals with psychopathology in practice. We argue, also referring to Strawson and Gadamer, that in psychiatric practice causal explanation and hermeneutic understanding are no mutually exclusive approaches. We conclude that the encounter of philosophy and psychiatry in matters of causality and motivation could be particularly fruitful when the practical situation is addressed, recognizing the special character of psychopathology. (shrink)

This paper discusses findings from a research study that investigated the experience of being a breastfeeding woman in New Zealand. The study was motivated by a desire to better understand why the majority of New Zealand women wean their infants before 6 months of age, despite the benefits of prolonged breastfeeding being well accepted. Nineteen women, who were breastfeeding or had recently breastfed, were engaged in unstructured interviews about their experience, and the results were examined using a reflective lifeworld research (...) methodology. The findings presented here demonstrate that women often employ an interpretive framework that is aligned with the philosophical tradition of Descartes’ mind–body split, also know as Cartesian dualism. This leads to a widely held perception of the breast as an object, which emerged in the participants’ narratives and is explored using Heidegger's philosophical interpretation of equipment. We conclude that the objectification of the breast in our society fails to provide women with language that describes the breastfeeding experience in a meaningful way, thus undermining women's ability to articulate and reconcile their embodied breastfeeding experiences. (shrink)

Critics are calling for the decolonization of AI (artificial intelligence). The problem is that this technology is marginalizing other modes of knowledge with dehumanizing applications. What is needed to remedy this situation is the development of human-centric AI. However, there is a serious blind spot in this strategy that is addressed in this paper. The corrective that is usually proposed—participatory design—lacks the philosophical rigor to undercut the autonomy of AI, and thus the colonization spawned by this technology. A more radical (...) or substantial proposal is advanced in this discussion that is known as community-based design. This alternative makes a theoretical maneuver that allows AI design to be directed by human agency, thereby introducing a safeguard that may help to prevent colonization by this technology. (shrink)

Medicalization is frequently defined as a process by which some non-medical aspects of human life become to be considered as medical problems. Overdiagnosis, on the other hand, is most often defined as diagnosing a biomedical condition that in the absence of testing would not cause symptoms or death in the person’s lifetime. Medicalization and overdiagnosis are related concepts as both expand the extension of the concept of disease. They are both often used normatively to critique unwarranted or contested expansion of (...) medicine and to address health services that are considered to be unnecessary, futile, or even harmful. However, there are important differences between the concepts, as not all cases of overdiagnosis are medicalizations and not all cases of medicalizations are overdiagnosis. The objective of this article is to clarify the differences between medicalization and overdiagnosis. It will demonstrate how the subject matter of medicalization traditionally has been non-medical (social or cultural everyday life) phenomena, while the subject matter of overdiagnosis has been biological or biomolecular conditions or processes acknowledged being potentially harmful. They also refer to different types of uncertainty: medicalization is concerned with indeterminacy, while overdiagnosis is concerned with lack of prognostic knowledge. Medicalization is dealing with sickness (sick role) while overdiagnosis with disease. Despite these differences, medicalization and overdiagnosis are becoming more alike. Medicalization is expanding, encompassing the more “technical” aspects of overdiagnosis, while overdiagnosis is becoming more ideologized. Moreover, with new trends in modern medicine, such as P4 (preventive, predictive, personal, and participatory) medicine, medicalization will become all-encompassing, while overdiagnosis more or less may dissolve. In the end they may converge in some total “iatrogenization.” In doing so, the concepts may lose their precision and critical sting. (shrink)

Human enhancement is ontologically, epistemologically, and ethically challenging and has stirred a wide range of scholarly and public debates. This article focuses on some conceptual issues with HE that have important ethical implications. In particular it scrutinizes how the concept of human enhancement relates to and challenges the concept of health. In order to do so, it addresses three specific questions: Q1. What do conceptions of HE say about health? Q2. Does HE challenge traditional conceptions of health? Q3. Do concepts (...) of health set limits to or direct HE? Addressing Q1 reveals that HE tends to frame and form our conception of health. Thereby it challenges traditional conceptions of health. Accordingly, health does not provide strong sources for setting limits to HE. On the contrary HE seems to define and expand the concept of health. Common to the concepts of HE and health is that both depend on vague value concepts, such as happiness, well-being, or goodness. There seems to be a tendency in the HE literature to define the goal of human life in terms of what is bigger, stronger, faster, more intelligent, and more resilient. However, this is confusing “goodness” with “more” and quality with quantity. Until HE more appropriately defines happiness, HE will fail to provide a relevant compass for improving the life of human beings. On the contrary, if we let simplified conceptions of “enhancement” come to define goodness or health, we may do more harm than good. Until doing so, we may well learn from Tithonus, listen to Douglas Adams’ Wowbagger, and pay attention to Virginia Woolf’s Orlando. Enhanced life may not be better. The same goes for health. (shrink)

Whereas theories on health generally argue in favor of one specific concept, we argue that, given the variety of health practices, we need different concepts of health. We thus approach health concepts as a Wittgensteinian family of thick concepts. By discussing five concepts of health offered by theory, we argue that all capture something that seems relevant when we talk and think about health. Classifying these concepts reveals their family resemblances: each of these concepts differs from the others in at (...) least one respect and resembles the others in several respects. Moreover, our classification shows that “health” always both describes a condition and evaluates that condition at the same time. Having both descriptive and evaluative dimensions, we can see health concepts as “thick concepts.” It is because of this evaluative dimension that it is important to reflect on the question of what understanding of health guides specific practices. We show that the distinctions revealed by our classification can serve as a conceptual toolbox for reflection on the assumptions and purposes of particular health practices. Finally, we illustrate how such reflection could work out by briefly exploring three specific health practices. (shrink)

Despite an expansive literature on communication in medicine, the role of language is dealt with mostly indirectly. Recently, narrative medicine has emerged as a strategy to improve doctor-patient communication and integrate patient perspectives. However, even in this field which is predicated on language use, scholars have not specifically reflected on how language functions in medicine. In this theoretical paper, the authors consider how different models of language use, which have been proposed in the philosophical literature, might be applied to communication (...) in medicine. In particular, the authors contrast the traditional, indexical thesis of language with new models that focus on interpretation instead of standardization. The authors demonstrate how paying close attention to the role of language in medicine provides a philosophical foundation for supporting recent changes in doctor-patient communication. In particular, interpretive models are at the foundation of new approaches such as narrative medicine, that emphasize listening to patient stories, rather than merely collecting information. Ultimately, debates regarding the role of language which have largely resided in non-medical literatures, have important implications for describing communication in medicine. In particular, interpretive models of language use provide an important rationale for facilitating a more robust dialogue between doctors and patients. (shrink)

In 2002, the Dutch Euthanasia Act was put in place to regulate the ending of one’s life, permitting a physician to provide assistance in dying to a patient whose suffering the physician assesses as...

This essay argues that Hans-Georg Gadamer's philosophical hermeneutics, Jürgen Habermas's communication theory, and Jacques Derrida's deconstruction all fit together within one philosophical paradigm: metamodernism. Metamodernism, as defined, is opposed to both modernism and radical forms of postmodernism. Within metamodernism, a political conundrum provides the key clue for understanding the relations among Gadamer, Habermas, and Derrida as well as for elaborating the contours of the paradigm. Specifically, the political implications of the three philosophies are intransitive: they seem to shift around rather (...) than being in fixed relations to each other. So, for instance, Gadamer sometimes seems to the political right of both Habermas and Derrida, but then, at different times, he stands between them, and then again, at other times, he seems to be to the left of both. This political paradox suggests that the traditional political categories of liberalism and conservatism do not suitably reflect the critical positions within metamodernism. Gadamer, Habermas, and Derrida are far more concerned with explaining the possibility and techniques of interpretive and social critique, while remaining true to the metamodernist paradigm, rather than fitting themselves into the traditional liberal or conservative political camps. (shrink)

Radical personal and systemic social transformation is urgently needed to address world-wide violence and inequality, pervasive moral confusion and corruption, and the rapid, unprecedented global destruction of our environment. Recent years have seen an embrace of intersubjectivity within discourse on educational transformation within academia and the public sphere. As well, there has been a turn toward contemplative education initiatives within North American schools, colleges and universities. This article contends that these turns might benefit from openness to the ontologies, epistemologies, and (...) ethics of the ‘wisdom traditions’ from which many contemplative practices are drawn. To illustrate this point, we discuss the value of intercultural philosophy of education, and introduce Eastern philosophical ideas, specifically, the Shambhala Buddhist notion of the nondual ground and wisdom of basic goodness and related teachings. We detail how awareness of basic goodness and its holistic expression in the ground, path, and fruition of Shambhala teachings can open vital questions regarding intersubjectivity, challenge and reinvigorate aspects of current engagements with contemplative practices, and provide significant insights and educational paths for transformational endeavours in neoliberal times. Informed by our learning from Shambhala, we conclude with a deepened understanding of intercultural philosophy of education. (shrink)

In current phenomenology of medicine, health is often understood as a state of transparency in which our body refrains from being an object of explicit attention. In this paper, I argue that such an understanding of health unnecessarily presupposes an overly harmonious alignment between subjective and objective body, resulting in the idea that our health remains phenomenologically inaccessible. Alternatively, I suggest that there are many occasions in which one’s body in health does become an object of attention, and that technologies (...) mediate how a relation with one’s body is formed. First, I show prominent accounts in current phenomenology of medicine understand health in terms of a harmonious alignment between objective and subjective body. Second, I argue that there are many occasions in which there is a disharmony between objective and subjective body, and suggest that also in health, we cannot escape being an object that we often relate to. Then, I draw on postphenomenology to show how technologies such as digital self-tracking applications and digital twins can be understood as mediating the relationship with one’s own body in a specific way. In conclusion, I argue that both technologies make present the objective body as a site for hermeneutic inquiry such that it can be interacted with in terms of health parameters. Furthermore, I point to some relevant differences in how different technologies make aspects of our own body phenomenologically present. (shrink)

This paper represents a preliminary investigation relating Bernard Lonergan’s thought to health science and the healing arts. First, I provide background for basic elements of Lonergan’s theoretical terminology that I employ. As inquiry is the engine of Lonergan’s method, next I specify two questions that underlie medical insights and define several terms, including health, disease, and illness, in relation to these questions. Then I expand the frame of reference to include all disciplines involved in the cycle of clinical interaction under (...) the heading health science and the healing arts. Finally, I analyze the cycle of clinical interaction in terms of Lonergan’s cognitive theory. I compare and contrast my analysis, based on Lonergan, with that of Pellegrino, Thomasma and Sulmasy as I proceed. In closing, I comment briefly on the next stage of this project regarding Lonergan’s theory of the human good in relation to the practice of the healing arts. (shrink)

Human science researchers tend to be targeted for critique on the grounds that their approach is too individualistic to take due cognisance of societal and political influences. What is accordingly advocated is that the phenomenological and so-called romantic theories should be abandoned in favour of analytic or continental theories that have as their main focus the system, the group, the society, and the various influences of the social world on the existential reality of the individual.Without trying to invalidate these social (...) science strategies, this paper attempts to show that it is not necessary to surrender phenomenology in order to understand not only the individual, but also the social world in which individuals live. It is argued that the desired goal of a less individualistic human science’s theoretical basis can still be founded in phenomenology, in that Merleau-Ponty’s philosophy, which has its origin in Husserlian phenomenology, provides us with an adequate ontology for understanding human existence more comprehensively. Merleau-Ponty’s ontological philosophy elucidates the in-between world, that structure of existence where the individual cannot be separated from her/his world context. In his exploration of the reversibility of existence, Merleau-Ponty demonstrates that there is no ontological gulf between the individual and the social world. Instead, the world is ‘in’ the individual as much as the individual is ‘in’ the world. With this phenomenological epistemology, it is argued, it is possible to generate research that is capable “of more than a frozen existence”, as Merleau-Ponty puts it. (shrink)

The social democratic state pursued interventionism for positive political freedom, making markets adapt to the needs of a fair democratic society, with the provision of social rights. The Robbins’ Report, which inaugurated the expansion of state-funded higher education in the 1960s, held that access to higher education was a social right and that the ‘cultivation’ produced by higher education was a good in itself and the epistemic basis for a social democratic society. Despite rhetorical appeals to negative political freedom, the (...) neoliberal state is interventionist, but with interventionism to promote the economic freedom of corporations. The state adapts the market to corporate needs and seeks to force individuals to adapt to this market. The current Conservative Government is seeking to re-engineer English higher education to make it adapt more fully to enhancing the economic freedom of corporations, using audit culture and changes to the Research Councils, with the former being presented as neutral-technocratic proxies for market signals. Using Gadamer, and his Humboldtian conception of higher education, which is similar to that argued for in the Robbins Report, it is argued that such changes cause objective harm to our ‘Being’, with this inaugurating an authoritarian technocratic approach to English higher education. (shrink)

As a result of simultaneous developments, including the proliferation of opportunities for online feedback, the application of discourse ethics to journalism, and a greater emphasis on journalistic accountability, the time is ripe for revisiting opportunities that online mechanisms provide for holding journalists accountable to audiences. This paper proposes recommendations to guide hosting online comments in light of the Habermasian framework of discourse ethics developed by Glasser and Ettema (2008). It also explores the limits of such approaches in nations with different (...) press models, such as the development model as practiced in China. (shrink)

Increasing evidence demonstrates that the Aboriginal population experience greater health disparities and receive a lower quality of health care services. The Canadian Nurses Association (CNA) code of ethics states that nurses are required to incorporate culture into all domains of their nursing practice and ethical care. The aim of this article is to examine the concepts of cultural competency and cultural safety by way of relational ethics. To address these disparities in health care, cultural competency training programs are being widely (...) advised. Recent research into cultural safety has not only recognized the importance of culture in nursing practice and organizational structures, but also extended the concepts to the culture of the client. In recognizing this diversity, nurses must pay close attention to their relationships with their clients. It is argued that the answers lie in relational ethics, which honors indigenous people’s connection to self, others, the environment, and the universe. (shrink)

Increasing evidence demonstrates that the Aboriginal population experience greater health disparities and receive a lower quality of health care services. The Canadian Nurses Association (CNA) code of ethics states that nurses are required to incorporate culture into all domains of their nursing practice and ethical care. The aim of this article is to examine the concepts of cultural competency and cultural safety by way of relational ethics. To address these disparities in health care, cultural competency training programs are being widely (...) advised. Recent research into cultural safety has not only recognized the importance of culture in nursing practice and organizational structures, but also extended the concepts to the culture of the client. In recognizing this diversity, nurses must pay close attention to their relationships with their clients. It is argued that the answers lie in relational ethics, which honors indigenous people’s connection to self, others, the environment, and the universe. (shrink)

Since the revolutionary mood of the 1960s, patient-centered mental health care and a research emphasis on service users as experts by experience have emerged hand in hand with a view of service users as consumers. What happens to knowledge derived from firsthand experience when mental health users become experts and actively choose care? What kind of perspective do service users pursue on psychological distress? These are important questions in a field where psychiatric expertise on mental illness is socially structured and (...) constrained as an intra-personal disturbance of the mind. We argue that experience experts have lost a coherent perspective on care and health. We illustrate this by rationally reconstructing how the interpersonal view of mental health first gained and then lost coherence between the conception of mental health, the practice of mental health care, and the user experience. Harry Stack Sullivan’s interpersonal theory was a paradigm case for such coherence. The inclusion of mental health consumers as ‘experts by experience’ in the mental health field took place at the cost of Sullivan’s coherent interpersonal theory. Service users who interact side by side with medical experts as experience experts are constrained by the evidence-based imperative and consumerism. Service users are caught up in a race among experts to gain knowledge about mental problems from a third-person perspective instead of from first-person experience. To make a contribution service users have more to gain from a research approach that appreciates that they are persons among persons rather than experts among experts. (shrink)

This article highlights the distinction between the ‘art of nursing’ and ‘fine art’. While something in the nature of nursing can be described as ‘the art of nursing’, it is not to be misunderstood as ‘fine art’ or craft. Therefore, the term ‘aesthetic’ in relation to nursing should not be linked to the aesthetic of modern art, but instead to a broader and more general meaning of the word. The paper's main focus is the aesthetic experience, which is treated in (...) a hermeneutic way and elucidated from classical sources and the philosophy of nursing and from Art. The paper argues that the pioneers used the term ‘art of nursing’ in a metaphorical way to say something more specific on the nature of nursing. The term illustrates the nurse's ability to practise at the highest possible level of excellence. (shrink)

This article highlights the distinction between the ‘art of nursing’ and ‘fine art’. While something in the nature of nursing can be described as ‘the art of nursing’, it is not to be misunderstood as ‘fine art’ or craft. Therefore, the term ‘aesthetic’ in relation to nursing should not be linked to the aesthetic of modern art, but instead to a broader and more general meaning of the word. The paper's main focus is the aesthetic experience, which is treated in (...) a hermeneutic way and elucidated from classical sources and the philosophy of nursing and from Art. The paper argues that the pioneers used the term ‘art of nursing’ in a metaphorical way to say something more specific on the nature of nursing. The term illustrates the nurse's ability to practise at the highest possible level of excellence. (shrink)

A “no ethics” principle has long been prevalent in science and has demotivated deliberation on scientific ethics. This paper argues the following: An understanding of a scientific “ethos” based on actual “value preferences” and “value repugnances” prevalent in the scientific community permits and demands critical accounts of the “no ethics” principle in science. The roots of this principle may be traced to a repugnance of human dignity, which was instilled at a historical breaking point in the interrelation between science and (...) ethics. This breaking point involved granting science the exclusive mandate to pass judgment on the life worth living. By contrast, respect for human dignity, in its Kantian definition as “the absolute inner worth of being human,” should be adopted as the basis to ground science ethics. The pathway from this foundation to the articulation of an ethical duty specific to scientific practice, i.e., respect for objective truth, is charted by Karl Popper’s discussion of the ethical principles that form the basis of science. This also permits an integrated account of the “external” and “internal” ethical problems in science. Principles of the respect for human dignity and the respect for objective truth are also safeguards of epistemic integrity. Plain defiance of human dignity by genetic determinism has compromised integrity of claims to knowledge in behavioral genetics and other behavioral sciences. Disregard of the ethical principles that form the basis of science threatens epistemic integrity. (shrink)

With the increasingly close relationship between the pharmaceutical industry and the American Psychiatric Association (APA) there has been a growing tendency in the mental health professions to interpret everyday emotional suffering and behavior as a medical condition that can be treated with a particular drug. In this paper, I suggest that hermeneutic phenomenology is uniquely suited to challenge the core assumptions of medicalization by expanding psychiatry's narrow conception of the self as an enclosed, biological individual and recognizing the ways in (...) which our experience of things--including mental illness--is shaped by the socio-historical situation in which we grow. Informed by hermeneutic phenomenology, psychiatry's first priority is to suspend the prejudices that come with being a medical doctor in order to hear what the patient is saying. To this end, psychiatry can begin to understand the patient not as a static, material body with a clearly defined brain dysfunction but as an unfolding, situation existence already involved in an irreducibly complex social world, an involvement that allows the patient to experience, feel, and make sense of their emotional suffering. (shrink)

This paper integrates personal narratives with the methods of phenomenology in order to draw some general conclusions about ‘what it means’ and ‘what it feels like’ to be depressed. The analysis has three parts. First, it explores the ways in which depression disrupts everyday experiences of spatial orientation and motility. This disruption makes it difficult for the person to move and perform basic functional tasks, resulting in a collapse or contraction of the life-world. Second, it illustrates how depression creates a (...) situational atmosphere of emotional indifference that reduces the person’s ability to qualitatively distinguish what matters in his or her life because nothing stands out as significant or important anymore. In this regard, depression is distinct from other feelings because it is not directed towards particular objects or situations but to the world as a whole. Finally, the paper examines how depression diminishes the possibility for ‘self-creation’ or ‘self-making’. Restricted by the illness, depression becomes something of a destiny, preventing the person from being open and free to access a range of alternative self-interpretations, identities, and possible ways of being-in-the-world. (shrink)

In this paper, written for a hermeneutic research course for my master's graduate work, I discuss how pediatric oncology nursing is an interpretive practice. I explore the subject of the relational complexity of pediatric oncology nursing, conceptualized as friendship. I discuss the similarities between understandings of hermeneutics and friendship. In the second part of the paper, I provide a narrative and interpretive account of a personal experience of friendship with a palliative patient and his mother, to offer understanding about the (...) complexities of the work of pediatric oncology palliative care nursing. (shrink)

In this paper, we speak to tenets of Gadamerian hermeneutic philosophy that “guide” our hermeneutic inquiry in research that seeks to understand the complexity of human experiences. In our conduct of hermeneutic research, we grapple with “great problems” and encounter the human difficulty of topics such as childhood cancer, grief, mental illness, education and schools, arts and humanities, and other topics that show up in practice professions of nursing, teaching, social work, or psychology.