Illuminates the influence of 19th-century German philosopher Friedrich Nietzsche on 20th-century French philosopher Michel Foucault, focusing on the notion of genealogy.

The task of aligning the philosophical and clinical perspectives on ethics is a challenging one. Clinical practice informs philosophy, not merely by supplying cases, but through shaping and testing philosophical concepts in the reality of the clinical world. In this paper we explore several aspects of the relationship between the philosophical and the clinical within a framework of palliative care for people living with Alzheimer's disease. We suggest that health professionals have a moral obligation to question previous assumptions concerning the (...) quality of life among people with Alzheimer's, and to address the question: does the concept of palliative care properly embrace people with severe dementia? We propose an ethic of palliative care for people with Alzheimer's that is based, not on the traditionally understood principle of autonomy, but on the need to listen to those living with the disease, acknowledging their profound loss of cognitive abilities, with a focus on preventing and relieving suffering, and improving the individual's quality of life. (shrink)

Children’s linguistic and social skills develop through play with siblings, but there is little research into sibling interaction using naturally occurring data. This conversation analytic case study presents an evidence-based account of how an older sibling responds to verbal challenges from her younger sibling during free play at home. The older sibling employs prosodic, rhetorical and linguistic devices to deflect challenges while avoiding conflict. She does this by acknowledging the grounds of the challenge, before invoking privileged information or epistemic differences (...) to reject it. Structurally, the older sibling inserts extended digressions which obfuscate challenges by engaging the challenger and switching topic. These phenomena blur the traditional accept/reject response dichotomy. The findings provide insight into the complexity of a 5-/6-year-old’s challenge-defence strategies and highlight the importance of face preservation and mitigation of disagreement. We propose that the ability to respond to challenges while maintaining intersubjectivity is a component of communicative competence. (shrink)

The drive for cost-effective use of medical interventions has advantages, but can also be challenging in the context of end-of-life palliative treatments. A quality-adjusted life-year (QALY) provides a common currency to assess the extent of the benefits gained from a variety of interventions in terms of health-related quality of life and survival for the patient. However, since it is in the nature of end-of-life palliative care that the benefits it brings to its patients are of short duration, it fares poorly (...) under a policy of QALY-maximization. Nevertheless, we argue that the goals of palliative care and QALY are not incompatible, and optimal integration of palliative care into the calculation of QALY may reveal a mechanism to modify considerations of how optimal quality of life can be achieved, even in the face of terminal illness. The use of QALYs in resource allocation means that palliative care will always compete with alternative uses of the same money. More research should be conducted to evaluate choices between palliative care and more aggressive therapies for the terminally ill. However, current limited data show that investing in palliative care makes more sense not only ethically, but also financially. (shrink)