A new path for humanistic medicine

According to recent approaches in the philosophy of medicine, biomedicine should be replaced or complemented by a humanistic medical model. Two humanistic approaches, narrative medicine and the phenomenology of medicine, have grown particularly popular in recent decades. This paper first suggests that these humanistic criticisms of biomedicine are insufficient. A central problem is that both approaches seem to offer a straw man definition of biomedicine. It then argues that the subsequent definition of humanism found in these approaches is problematically reduced to a compassionate or psychological understanding. My main claims are that humanism cannot be sought in the patient–physician relationship alone and that a broad definition of medicine should help to revisit humanism. With this end in view, I defend what I call an outcomes-oriented approach to humanistic medicine, where humanism is set upon the capacity for a health system to produce good health outcomes.     

How (not) to think of the ‘dead-donor’ rule

Although much has been written on the dead-donor rule (DDR) in the last twenty-five years, scant attention has been paid to how it should be formulated, what its rationale is, and why it was accepted. The DDR can be formulated in terms of either a Don’t Kill rule or a Death Requirement, the former being historically rooted in absolutist ethics and the latter in a prudential policy aimed at securing trust in the transplant enterprise. I contend that the moral core of the rule is the Don’t Kill rule, not the Death Requirement. This, I show, is how the DDR was understood by the transplanters of the 1960s, who sought to conform their practices to their ethics—unlike today’s critics of the DDR, who rethink their ethics in a question-begging fashion to accommodate their practices. A better discussion of the ethics of killing is needed to move the debate forward.     

Ongoing: On grief’s open-ended rehearsal

Peter Goldie’s account of grief as a narrative process that unfolds over time allow us to address the structure of self-understanding in the experience of loss. Taking up the Goldie’s idea that narrativity plays a crucial role in grief, I will argue that the experience of desynchronization and an altered relation to language disrupt even of our ability to compose narratives and to think narratively. Further, I will argue that Goldie’s account of grief as a narratively structured process focus on the process having come to an end. By contrast, I will propose the idea that grief can be understood as an open-ended rehearsal of our capacity to be alone in the company of an absent other. This makes grief a relational activity that differs from composing narratives about one’s past and about one’s process of grieving. Thus, grief is not primarily a process of recollecting our past narratively; rather, it can be seen as a dedicational activity which involves a future-oriented and open-ended rehearsal of relatedness despite irrevocable absence.     

The real of the rabble: Žižek and the historical truth of the Hegelo-Lacanian dialectic

In this essay I attempt to answer a fundamental question about ?i?ek’s heterodox reading of Hegel’s dialectic: What project sustains this reading in the first place? That is, what is at stake for ?i?ek himself? The purpose of this essay is to develop in this fashion a reading of ?i?ek (since he does not programmatically answer this question), although not one that is necessarily meant to compete against other alternatives. My argument, then, is that ?i?ek’s ontological and hermeneutical project is ultimately political, that when ?i?ek says we need Hegel “now more than ever,” he has a political situation in mind. By finding an element of Hegel’s thought, the political subjectivity of the “rabble,” that resists the traditional picture of dialectical system (especially the critical picture of the post-structuralists), ?i?ek can overturn the distinction between Hegelian method and system by suggesting that there’s no comprehensible distinction at all. And by politicizing Hegel and drawing out the seeds of Lacanian thought that were nonetheless incomplete until Lacan, ?i?ek’s historiographical project takes on the character of ideological critique. As such, Hegel and Lacan reach us anew, as theoretical players in an anti-postmodern political gambit.     

The last low whispers of our dead: when is it ethically justifiable to render a patient unconscious until death?

A number of practices at the end of life can causally contribute to diminished consciousness in dying patients. Despite overlapping meanings and a confusing plethora of names in the published literature, this article distinguishes three types of clinically and ethically distinct practices: (1) double-effect sedation, (2) parsimonious direct sedation, and (3) sedation to unconsciousness and death. After exploring the concept of suffering, the value of consciousness, the philosophy of therapy, the ethical importance of intention, and the rule of double effect, these three practices are defined clearly and evaluated ethically. It is concluded that, if one is opposed to euthanasia and assisted suicide, double-effect sedation can frequently be ethically justified, that parsimonious direct sedation can be ethically justified only in extremely rare circumstances in which symptoms have already completely consumed the patient’s consciousness, and that sedation to unconsciousness and death is never justifiable. The special case of sedation for existential suffering is also considered and rejected.     

Palliative sedation: clinical context and ethical questions

Practitioners of palliative medicine frequently encounter patients suffering distress caused by uncontrolled pain or other symptoms. To relieve such distress, palliative medicine clinicians often use measures that result in sedation of the patient. Often such sedation is experienced as a loss by patients and their family members, but sometimes such sedation is sought as the desired outcome. Peace is wanted. Comfort is needed. Sedation appears to bring both. Yet to be sedated is to be cut off existentially from human experience, to be made incapable of engaging self-consciously in any human action. To that extent, it seems that to lose consciousness is to lose something of real value. In this paper, I describe how sedation and the question of intentionally bringing about sedation arise in the care of patients with advanced illness, and I propose heuristics to guide physicians, including Christian physicians, who seek to relieve suffering without contradicting their profession to heal.     

Attentional bias of students toward negative feedback in bad outcome situations: the mechanism of self-defense

The main goals of the present study were to investigate the effects of outcome valence on attentional bias toward feedback and examine the internal mechanism of self-defense. We systematically manipulated the outcome valence by providing a bogus score in a rational thinking task and recorded the time positive feedback and negative feedback was viewed in experiment 1. We added the intervention of self-affirmation to examine the self-defense mechanism in experiment 2. The results suggest that (1) in good outcome situations, the participants viewed negative feedback longer than positive feedback. There was a tendency to slightly reduce the attention given to negative feedback in bad outcome situations. (2) Self-affirming participants in bad outcome situations increased their viewing time of negative feedback, which supported the activation of defensiveness.     

Manipulation and Degrees of Blameworthiness

We propose an original response to Derk Pereboom’s four-case manipulation argument. This response combines a hard-line and a soft-line. Like hard-liners, we insist that the manipulated agent is blameworthy for his wrongdoing. However, like soft-liners, we maintain that there is a difference in blameworthiness between the manipulated agent and the non-manipulated one. The former is less blameworthy than the latter. This difference is due to the fact that it is more difficult for the manipulated agent to do the right thing. We explain how we can make sense of this notion of difficulty in terms of Fischer and Ravizza’s notion of reasons-responsiveness.