In Moral Case Deliberation, healthcare professionals discuss ethically difficult patient situations in their daily practice. There is a lack of knowledge regarding the content of MCD and there is a need to shed light on this ethical reflection in the midst of clinical practice. Thus, the aim of the study was to describe the content of healthcare professionals’ moral reasoning during MCD. The design was qualitative and descriptive, and data consisted of 22 audio-recorded inter-professional MCDs, analysed with content analysis. The (...) moral reasoning centred on how to strike the balance between personal convictions about what constitutes good care, and the perceived dissonant care preferences held by the patient. The healthcare professionals deliberated about good care in relation to demands considered to be unrealistic, justifications for influencing the patient, the incapacitated patient’s nebulous interests, and coping with the conflict between using coercion to achieve good while protecting human dignity. Furthermore, as a basis for the reasoning, the healthcare professionals reflected on how to establish a responsible relationship with the vulnerable person. This comprised acknowledging the patient as a susceptible human being, protecting dignity and integrity, defining their own moral responsibility, and having patience to give the patient and family time to come to terms with illness and declining health. The profound struggle to respect the patient’s autonomy in clinical practice can be understood through the concept of relational autonomy, to try to secure both patients’ influence and at the same time take responsibility for their needs as vulnerable humans. (shrink)

BackgroundVascular surgery offers a range of treatments to relieve pain and ulcerations, and to prevent sudden death by rupture of blood vessels. The surgical procedures involve risk of injury and harm, which increases with age and frailty leading to complex decision-making processes that raise ethical questions. However, how vascular surgeons negotiate these questions is scarcely studied. The aim was therefore to explore vascular surgeons’ moral reasoning of what ought to be done for the patient.MethodsQualitative, semi-structured interviews were conducted with 19 (...) vascular surgeons working at three Swedish university hospitals. Data were analysed according to systematic text condensation.ResultsThe surgeons’ moral reasoning about what ought to be done comprised a quest to relieve suffering and avoid harm by exploring what is reasonable to do for the patient. Exploring reasonableness included to shift one´s perspective from the vessels to the whole person, to balance patient’s conflicting needs and to place responsibility for right decision on one´s shoulders. The shift from blood vessels to the whole person implied gaining holistic knowledge in pondering of what is best, struggling with one´s authority for surgery through dialogue, and building relationship for mutual security. To balance patient’s conflicting needs implied weighing the patient’s independence and a sense of being whole against ease of suffering, respecting the patient’s will against protecting life and well-being, and weighing longer life against protecting the present well-being. Finally, to place responsibility on one´s shoulders was conveyed as an urge to remind oneself of the risk of complications, withholding one’s power of proficiency, and managing time during the illness course.ConclusionsThis study contributes to uncovering how moral reasoning is embodied in the vascular surgeons’ everyday clinical discourse as a tangible part of their patient care. The results underpin the significance of moral considerations in the assemblage of medical knowledge and technical skills to further understand vascular surgeons’ clinical practice. The clinical application of these results is the need of forums with sufficient possibilities for articulating these important moral considerations in everyday care. (shrink)

Wissenschaftliche Praxen in das Zentrum der philosophischen Reflexion zu stellen, wird mit dem Anspruch verbunden, problematische Voraussetzungen der klassischen Wissenschaftstheorie zu überwinden. Dass ein solches immanenzphilosophisches Projekt allerdings dann am eigenen Anspruch scheitert, wenn es von einem problematischen faktiven Verständnis wissenschaftlicher Praxen und epistemischer Räume ausgeht, führt Kaja Tulatz in Auseinandersetzung mit Joseph Rouse vor. Demgegenüber macht sie die Argumentationslinie von Gaston Bachelard und Louis Althusser für eine rekonstruktionstheoretische Reflexion fruchtbar und entwickelt ein aktuelleres reflexionsbegriffliches Verständnis epistemischer Räume.

The Threshold of the Visible World advances a revolutionary new political aesthetic--Kaja Silverman explores the possibilities for looking beyond the restrictive mandates of the self, and the normative aspects of the cultural image-repertoire. She provides a detailed account of the social and psychic forces which constrain us to look and identify in normative ways, and the violence which that normativity implies. Accounting for these phenomena on both a conscious and an unconcious level, Silverman analyzes the psychic and textual conditions (...) under which our "field of vision" can be expanded. The title of this book is taken from Lacan's essay on the mirror stage. In that text, Lacan writes that "the mirror-image would seem to be the threshold of the visible world." He thereby suggests that the visible world has no existence as such until the infant subject has access to an image of self. Lacan intimates that the mirror provides the frame through which one relates to others within the domain of vision, stressing the priority of narcissism and the ego over all other libidinal transactions. The Threshold of the Visible World provides a psychic, social and political specification of Lacan's claim, and most particularly of its implications for the subject's relations to the social other. This is accomplished through examination of the ego, as well as two other categories at the center of Lacan's account of the mirror stage: ideality and identification. This book is an ethical-political project which leads to the re-elaboration of a number of crucial theoretical categories--Silverman offers an account of the bodily ego, of identification, of idealization, of the gaze, of the look, and of the "photographic." The Threshold of the Visible World leads as well to the formulation of a fresh model for conceptualizing sexual, racial and class "difference," and the terms under which it might be dismantled. This book thus seeks to apprehend the field of vision through the frame of a different kind of bodily ego, and discover the pleasures to be derived from corporeal transport. (shrink)

Die Publikation untersucht den Umgang mit der kantischen Postulatenlehre in den Diskussionen um 1900 und ordnet diesen ein in die politischen Debatten der Zeit. Die Arbeit weist in diesem Kontext nach, dass diese bis heute zitierten Deutungen der kantischen Morallehre ein Effekt wirkmächtiger spiritistischer und materialistischer Diskurse sind.

In this article, I first problematize the concept of rationality as educational ideal through the use of feminist philosophy. I then offer an alternative concept of rationality as educational ideal based on my reading of Catherine Malabou’s work on plasticity, epigenesis, and rationality. In a last part, I explore the ontological and normative dimensions of this new concept of rationality through Maurice Merleau-Ponty’s concept of “hyper-dialectics.”.

Combining phenomenology and psychoanalysis in highly innovative ways, this book seeks to undo the binary opposition between appearance and Being that has been in place since Plato’s parable of the cave. It is, essentially, an essay on what could be called “world love,” the possibility and necessity for psychic survival of a profound and vital erotic investment by a human being in the cosmic surround. Here, the author takes her cue from Freud’s assertion that the “loss of reality” associated with (...) psychosis is a function of a disturbance not in the capacity to reason or perceive, but rather in the capacity for world love, the libidinal and semiotic circuity by means of which such love actualizes itself. In an implicit challenge to poststructuralist thought, the author claims that this love is always in response to a call issued by the world—that the world has, as it were, a vocation: its beauty ought to be seen. We must think of our own being-in-the world as a response to a primordial calling out to respond to this beauty. We are, the author suggests, at the very core of our being, summoned to what she terms world spectatorship. Drawing on Heidegger’s phenomenological elaboration of care as the being distinctive of human being and the primarily Lacanian conceptualization of the language of desire specific to each human subject, this metapsychology of love attempts to integrate issues in the fields of psychoanalysis, philosophy, visual culture, art history, and literary and film studies. (shrink)

In this article, I offer a critical phenomenological investigation of immigrant indebtedness, with special focus on its temporality. I understand immigrant indebtedness as a relation of debt where what is owed is gratitude, and which takes on a special meaning when the debtor in question is racially construed as immigrant. Understood as such, immigrant indebtedness has the power to function as a social structure that organizes, conditions and impacts people’s lives. By analysing writer and poet Sumaya Jirde Ali's descriptions of (...) immigrant indebtedness in dialogue with Marianne Gullestad, Alia Al-Saji and Maurizio Lazzarato, I argue that the harm of immigrant indebtedness becomes visible once we pay attention to its temporal structure—involving the permanence of the debt-relation, the freezing and distortion of the past, as well as their limiting effects on future and present. (shrink)

With the themed issue “The Critical Phenomenology of Borders and Migration,” we at Puncta wish to highlight the need for a continued systematic reflection on the lived experiences of migrants in relation to the political and social structures that inform these experiences. By claiming that critical phenomenology can be a fruitful approach to this work, we insist that the complex lived experience of migrants should not only be acknowledged and included in the form of examples and anecdotes, but systematically integrated (...) and interrogated in philosophical conversations on migration-related matters. The hope is that critically attuned phenomenological analyses of migrant lived experiences may contribute to offer new knowledges indispensable for understanding what is actually at stake—philosophically, politically, ethically, and existentially—with the particular situations that migrants, border-crossers and border-dwellers continually negotiate. (shrink)

Through a wide-ranging discussion, that extends from Ovid and Leonardo da Vinci to Gerhard Richter, and from philosophy and literature to time-based art, Kaja ...

On the life and works of Maṇḍanamiśra, ancient Hindu philosopher.

Wissenschaftliche Praxen in das Zentrum der philosophischen Reflexion zu stellen, wird mit dem Anspruch verbunden, problematische Voraussetzungen der klassischen Wissenschaftstheorie zu überwinden. Dass ein solches immanenzphilosophisches Projekt allerdings dann am eigenen Anspruch scheitert, wenn es von einem problematischen faktiven Verständnis wissenschaftlicher Praxen und epistemischer Räume ausgeht, führt Kaja Tulatz in Auseinandersetzung mit Joseph Rouse vor. Demgegenüber macht sie die Argumentationslinie von Gaston Bachelard und Louis Althusser für eine rekonstruktionstheoretische Reflexion fruchtbar und entwickelt ein aktuelleres reflexionsbegriffliches Verständnis epistemischer Räume.

Since overweight and obesity have been framed as one of the main contemporary health challenges in industrialized countries, it has become a matter of public health efforts. While the belief that obese individuals are personally responsible for their body weight prevails in public opinion, evidence-based health science widely acknowledges that obesity is significantly influenced by socio-economic factors and thus that prevention requires structural changes. This constellation bears the chance of politicizing an issue formerly conceived of as private which really is (...) dependent on societal contingencies, such as the particular availability of food. Reflecting on the prevention of obesity from an ethical point of view, therefore, requires an elaborate concept of political responsibility. The core thesis of this paper is that existing approaches within the field of obesity ethics fall short in reasonably grasping the political dimensions at play, due to the prevailing individualistic understanding of responsibility. Drawing upon Iris Marion Young’s concept of political responsibility, I propose an alternative approach that emphasizes the structural determinants of obesity. By arguing this way, obesity prevention comes into view as a public endeavor that involves public discourse as well as shared action. Political responsibility then cannot be discharged merely by intrusive governmental action nor by individuals on their own, but should be considered as a task all of us share. As I will sketch in the last part of the paper, this includes contesting discourses on interpretations of need. Thereby, the paper contributes to recognizing obesity as a social instead of an individual problem. (shrink)

Using robots in the military contexts is problematic at many levels. There are social, legal, and ethical issues that should be discussed first before their wider deployment. In this paper, we focus on an additional problem: their human likeness. We claim that military robots should not look like humans. That design choice may bring additional risks that endanger human lives and by that contradicts the very justification for deploying robots at war, which is decreasing human deaths and injuries. We discuss (...) two threats—epistemological and patient. Epistemological one is connected with the risk of mistaking robots for humans due to the limited ways of getting information about the external world, which may be amplified by the rush and need to fight with robots in distance. The patient threat is related to the developing attachment to robots, that in military contexts may cause additional deaths by the hesitance to sacrifice robots in order to save humans in peril or risking human life to save robots. (shrink)