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)

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)

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)

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)

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.

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)

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. 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.’. (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)

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)

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)

Maurice Blanchot once wrote, “The cry tends to exceed all language, even if it lends itself to recuperation as language effect”. For now, it would seem, any effectual recuperation remains uncomposed in the writing of the disaster. “If I say: the disaster keeps watch [veille], it is not in order to give a subject to the vigil [à la veille ]; it is to say: the wake [la veille] does not occur under the sidereal sky”. Less as vigil than as (...) proleptic work of grief, then, this, in spectral solidarity with the dead: with those who will have been destined to die, and whose deaths will have been language-effects... (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)

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)