This article has two purposes. The first is to show how one can know in a simple way what is an ordinary and obligatory means to care for a person with a serious illness. Using the information at hand, one must be able to answer yes to each of these three questions: “Is this the ordinary, usual, or valid way of treating this illness?” “Is it working?” “Is it within the capacity of the patient to undergo and of the (...) caregivers to administer?” The second purpose of the article is to show the moral validity of these questions, using a historical overview of theological and magisterial teaching and a systematic analysis and moral testing of the three questions. (shrink)

To properly comply with the Health Sector Act of 1992 a functioning competition should be introduced in the interests of the insured of the German Statutory Health Insurance, while still maintaining the principle of solidarity. This is a critical order-political aim, because the principles of solidarity and selfresponsibility as typically understood are functionally in contradiction. This paper analyzes the important measures of the Organizational Reform and concludes, that the principle of self-responsibility ought to obtain priority. Therefore, the German legislature ought (...) to focus on further competitively oriented reform steps. (shrink)

According to the literature, the family is now considered to be the most important resource for the care and support of a sick family member. Families are being increasingly invited and trained to play a utilitarian role, not just as family caregivers, but as healthcare agents. Healthcare institutions, based on neoliberal health policies, are encouraging them to perform increasingly complex and professionalized tasks. The burden associated with this expanded healthcare function, however, is significant (fatigue, emotional distress and exhaustion). (...) The aim of this article was to present French sociologist Jacques Donzelot's theoretical perspective on governing through the family. According to Donzelot, such a government is exercised through various power techniques, including the instrumentalization of the family role and the transfer to families of the responsibility for health care. This author describes how healthcare institutions call on the family to perform hospital and biomedical practices within the home. A spin‐off of neoliberalism, the practices of governing through families specifically target women, who are considered to be the pillar of the family. Donzelot's perspective is very relevant to nursing, but is still rarely mobilized in the discipline. His critical perspective allows for a re‐reading of relations of power and mechanisms of surveillance and control of families, issues that are often overlooked in nursing research. (shrink)

This book offers a long-overdue exploration of care at a pivotal moment in the history of health care.

In the early twenty-first century, we stand on the threshold of welcoming robots into domains of human activity that will expand their presence in our lives dramatically. One provocative new frontier in robotics, motivated by a convergence of demographic, economic, cultural, and institutional pressures, is the development of “carebots”—robots intended to assist or replace human caregivers in the practice of caring for vulnerable persons such as the elderly, young, sick, or disabled. I argue here that existing philosophical reflections on (...) the ethical implications of carebots neglect a critical dimension of the issue: namely, the potential moral value of caregiving practices for caregivers. This value, I argue, gives rise to considerations that must be weighed alongside consideration of the likely impact of carebots on care recipients. Focusing on the goods internal to caring practices, I then examine the potential impact of carebots on caregivers by means of three complementary ethical approaches: virtue ethics, care ethics, and the capabilities approach. Each of these, I argue, sheds new light on the contexts in which carebots might deprive potential caregivers of important moral goods central to caring practices, as well as those contexts in which carebots might help caregivers sustain or even enrich those practices, and their attendant goods. (shrink)

Doctor and patient meet in a circle of feelings determined by suffering. Sensitivity to the suffering is an axis determining the nature of the doctor and patient relationship. The patient's experience of an illness is individual, private, and very often difficult to describe. But the possibility to understand the suffering of another person comes from the fact that suffering is a universal feeling. We propose to enter the world of patient's experience by writing a letter to a doctor, which would (...) reflect their experiences and expectations towards him. This was the task required for 120 students of the second year of medicine and dentistry education. (shrink)

New Natural Law Theory and the Catholic medico-moral tradition often lead to similar conclusions in hard cases regarding end-of-life care. Considering the provision of artificial nutrition and hydration to patients suffering from post-coma unresponsive wakefulness, however, brings to light subtle ways in which NNL differs from the centuries-old natural law tradition. In this essay, I formalize the methodology embedded within the casuistry of the medico-moral tradition and show how it differs from NNL with respect to the role played by (...) double-effect reasoning and the perspective for analyzing cases regarding care for those who cannot speak for themselves. Importantly, the ordinary/extraordinary means distinction has never historically been understood as an application of double effect and logically cannot be so understood. Given the outsized role that double effect plays in NNL, the theory leads to conclusions that deviate from the Catholic medico-moral tradition and creates additional burdens and duties for the sick. (shrink)

Fear, which has always been one of the most powerful of human passions, has grown in importance during modernity. First with Machiavelli and later especially with Hobbes, fear has become one of the foundational ideas of modern political philosophy. If fear, especially fear of death, does indeed occupy a central place in the foundation of modern politics, then it is necessary to study carefully the implications and consequences of the transhumanist attempt to overcome death. Among the main aspirations of transhumanism (...) is the search for almost infinite longevity and, eventually, the total abolition of aging. Therefore, it is necessary to understand the specific role that fear of death has played in modern political philosophy to understand the possible effects that an eventual overcoming of death would have, albeit partial, as wanted by transhumanists. While the possibility of achieving immortality seems unlikely, this doesn’t mean that we shouldn’t study what’s behind this transhumanist aspiration. In this way, transhumanism seems the final consequence of modern development, since it’s in continuity with the modern attempt to respond to the fear of death, but it does so by trying an ultimate solution to it through the elimination of death, at least by sickness and old age. In this paper, we will review the role of fear of death in the founding of modern political philosophy by Machiavelli and Hobbes, and then we will analyse the transhumanist attempt to overcome death as a consequence of this fear and its possible political effects. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.3 (2003) 225-226 [Access article in PDF] Travelers in the Land of Sickness Eric J. Cassell THE PROBLEM OF knowing another person and the world in which that person lives, particularly someone with major mental illness, is addressed in this interesting and rich essay. The number of different metaphors and concepts Potter employs to describe the task of crossing into and then understanding the thoughts, (...) emotions, symptoms, constraints, context, and perspectives of another testifies to the difficulties involved.Yet, as I read the essay, it was not clear what the clinician world traveler, moral tourist, empathizer (and other categories) is supposed to do on the journey to another person. Why do we reach out to the sick person? What is it that we want to know or do that makes this trip necessary? Potter is primarily concerned with mental illness—the examples she cites are patients with schizophrenia—while my experience has in the main been with persons with physical illness, but for the moment, the differences are less important than the central lesson. The illness that the patient presents—the experience of the symptoms, the impairments, disability, and disruptions of the emotional and social existence that happen because of the disease result from an amalgam of the disease process with the specific nature of the sick person. There is no disease in pure form; there is no disease in abstract for clinicians. There is only this sick person. She correctly quotes me, because of all this, as pointing out the importance of integrating knowledge of this particular patient with the abstract knowledge of disease to understand the illness as it is expressed in this person. All to form a basis for the treatment of the patient and especially to help relieve suffering because suffering is always personal, particular, and individual. (It is important in thinking about this topic to remember that most serious diseases, psychiatric and otherwise, are chronic and take place over significant lived time. The acute schizophrenic symptoms or the acute infectious diseases, as dramatic as they are, distract attention from the importance of the place of the sick person.)In physical disease, our long (and continuing) history of separating human beings from nature and the body, and the importance medicine places on objectivity and the objective, have made the inevitable personalization of the disease and symptoms virtually invisible. After ages of explaining psychiatric diseases as the alienation of the person, and a long psychoanalytic period of finding their origins in the person, in the last 30 years these diseases have become increasingly objectified. The place of the person has been diminished as psychiatry has entered the DSM, neurotransmitter, and effective psychotropic drug era. For both physical and mental disease, however, and whatever the current ideology, the nature of person is crucial in determining the onset, diagnosis, course, treatment, and outcome of each illness. It is in order to have an impact on these crucial aspects of sickness that clinicians must come to know their patients to the degree possible. [End Page 225]But there is something more. Nancy Potter quotes a woman with schizophrenia as saying, "All that was my former self has crumbled and fallen together and a creature has emerged of whom I know nothing. She is a stranger to me... She is not real—she is not I... She is I—and because I still have myself on my hands, even if I am a maniac, I must deal with me somehow." (Potter, 2003, p. 215)Must she deal with this crazy self alone? Is that not what her doctors and caregivers are for? But how can they take care of her, protect her, keep what is left intact, and sustain her until she is (hopefully) better without knowing who she is? She makes clear in those few phrases that inside her there is a person with a past, a family, a world, a culture, a role(s) in life, relationships, a body, dreams for the future, things she does, and all the other things that make up a person. It is in... (shrink)

This paper explores the relationship between temporal continuity in nursing and temporal features of sickness. It is based on phenomenological and hermeneutical philosophy, empirical studies of sickness time, and the nursing theories of Nightingale, of Benner and of Benner and Wrubel. In the first part, temporal continuity is defined as distinct from interpersonal continuity. Tensions between temporal continuity and discontinuity are discussed in the contexts of care management, of conceptualisations of disease and of time itself. Temporal limitations to the (...) methodological concept of situation are discussed. The main part of this paper explores nurses' possibilities to relate to their patients' time, and how temporal features of sickness may warrant temporal continuity of nursing. Three temporal characteristics of sickness are discussed: the immediacy of patients' suffering, the basic continuity of life through sickness and health care, and the indeterminism and precariousness of sickness. The timing of nursing acts is discussed. The paper explores how sickness is both part of the continuity of life, and threatens this continuity. It concludes that this tension is implicitly recognised in the temporal continuity of nursing, which allows for discontinuous and continuous aspects of sickness time. Nurses accordingly perceive the sick person's time at several levels of temporality, and distinguish highly complex temporal processes in their patients' trajectory. Temporal continuity provides the time, flexibility, and closeness for nurses to perceive and act into time dimensions of individual sickness. The paper shows that temporal continuity of nursing is grounded in temporal characteristics of severe sickness. It suggests that temporal continuity is an important theoretical concept in nursing. (shrink)

This pastoral-theology-based reflection on hospital chaplaincy, set within the horizon of the pastoral situation of Germany in the post-secular (!) age, introduces the perspective of a consolation-oriented ministry, as this was developed by Ignatius of Loyola. Such a pastoral care for the sick, as integrated into the basic offices of the church, presents a graded model for action: while human accompaniment is offered to all, spiritual ministry is restricted, but realized in an ecumenically encompassing sense. Spiritual and ritual (...) care for members of other religions, while these members are to be addressed according to the principles laid down by Vatican II, is severely limited for reasons of identity and alterity. In all cases, however, Christianity is presented as “therapeutic religion”. (shrink)

Films provide many memorable scenes of care that both shape and reinforce ideas about who deserves care, how carers should behave, and what kinds of people appear ‘naturally’ suited to the labors of caring for children, the sick, the elderly and the disabled (namely women). My specific interest here is in films about migrant domestic workers in Hong Kong and Singapore. from the Philippines and Indonesia, who take up live-in housekeeping positions. The films about their lives range (...) from documentary to popular, low-budget horror to independent art cinema. While surveying the strengths and limitations of a handful of these films, I offer strategies for how to frame each film in terms of its director, production methods, distribution, and target audience. How and when might different genres be best used to engage students in critical thinking about care work and migrant labor? What stereotypes exist about migrant workers and what blind spots emerge in understanding paid care work? How can we promote dialogue about the often ambivalent relationship between caregiver and cared-for? (shrink)

Philosophy adds humanness to nursing and facilitates holistic care. Philosophies like Ubuntu which purports that a person is only a person through other people and emphasises community cohesion and caring for each other can add humanness to nursing. Because Ubuntu validates subjective experience and its meaning in the lifeworld, it exemplifies the basis of holistic and individualised caring in nursing. Although nurses can make their own philosophy through critical reflexivity, the convergent point is the goal of meaningful caring that (...) is, sustaining health and the well‐being of patients and significant others. Philosophy transcends job description, it encompasses visceral experience, personal beliefs and goals, resulting in purpose and deeper meaning to the nursing profession of caring as emulated by Florence Nightingale. While contemporary philosophy has been met with criticism as being detached from human concern, narrowly focussed and technical, it evokes critical thinking and promotes sociality in nursing practice. The Covid‐19 pandemic vividly brought philosophy to the fore as nurses sacrificially and vulnerably rose to the challenge of caring not only for the sick, but also for families who through infection control measures were deprived of sociality. This paper argues that philosophy adds humanness and substance to nursing in the context of COVID‐19. (shrink)

The word ‘empowerment’ has become a popular term, widely used as an important claim, also within the health services. In this paper the concept's philosophical roots are traced from Freire and his ‘Pedagogy of the Oppressed’ to the philosophical thoughts of Hegel, Habermas, and Sartre. An understanding of the concept, as a way to facilitate coping and well‐being in patients through reflection and dialogue, emerges. Within an empowerment strategy the important claim on the nurse and the patient will be to (...) reveal the patient's own resources and limitations in times with sickness and reduced functionality to promote the patient's choice to act and cope. From this point of view an education‐programme for the frail elderly is outlined. If the nurse wants to empower the elderly patient she has to be willing to be educated through the dialogue with the patient, and to look for the patient's own meaning of being frail and elderly. The coping and self‐care solutions for the patient may then even be different from the preferences of the nurse, and this does not mean that the empowerment strategy is a failure or that the patient then has to continue without the assistance from the nurse. Within an empowerment strategy, in the Freirerian sense, the important thing is that both the patient and the nurse together critically reflect on the meanings of the sickness so that the patient can be able to make his own conscious choices. (shrink)

Not all actions that are legal are necessarily morally correct. However, there are few protections for providers who are pressured to comply with actions and procedures that infringe on their religious beliefs regarding human dignity. The right of health care providers to freely act on religious convictions and refrain from cooperating with morally reprehensible tasks is often eschewed in favor of political correctness or is branded as discrimination. Adequate safeguards are urgently needed for health care workers at all (...) levels to ensure that they can continue to care for the sick and most vulnerable members of the community without violating the dictates of their conscience. This article examines the free exercise of religion as it pertains to medical provider conscience protections. The author argues for conscience protection legislation with a right of action. (shrink)

_Care of the Self: Ancient Problematizations of Life and Contemporary Thought_, by Lívia Flachbartová, Pavol Sucharek, and Vladislav Suvák, focus on different manifestations of “taking care of the self” present in ancient and contemporary thought.

In recent years society has come to expect more from the “socially-responsible” company and the global HIV/AIDS pandemic in particular has resulted in some critics saying that the “Big Pharma” companies have not been living up to their social responsibilities. Corporate social responsibility can be understood as the socio-economic product of the organizational division of labor in complex modern society. Global poverty and poor health conditions are in the main the responsibilities of the world’s national governments and international governmental organizations, (...) which possess society’s mandate and appropriate organizational capabilities. Private enterprises have neither the societal mandate nor the organizational capabilities to feed the poor or provide health care to the sick intheir home countries or in the developing world. Nevertheless, private enterprises do have responsibilities to society that can be categorized as what they must do, what they ought do, and what they can do. (shrink)

The point of departure for this article is a review of the discussion between Twaddle and Nordenfelt on the concepts of disease, illness, and sickness, and the objective is to investigate the fruitfulness of these concepts. It is argued that disease, illness, and sickness represent different perspectives on human ailment and that they can be applied to analyze both epistemic and normative challenges to modern medicine. In particular the analysis reveals epistemic and normative differences between the concepts. Furthermore, the article (...) demonstrates, against Nordenfelt's claim, that the concepts of disease, illness, and sickness can exist without a general theory of health. Additionally, the complexity of different perspectives on human ailment also explains why it is so difficult to give strict definitions of basic concepts within modern health care. (shrink)

The study of the cultural activity of the Spiritual missions of the Russian Orthodox Church in various regions of Russia is one of the urgent tasks in the context of the problematic field of the theory of regionalism, cultural studies and socio-philosophical knowledge. Russian settlements on the territory of the Yenisei River basin and the entry of ethnic groups and territories of Yakutia and Buryatia into the Russian Empire has become one of the most important stages of the integration of (...) the ethnic groups of Siberia into a single statehood. The Irkutsk Spiritual Mission received a more perfect organization, institutionalized by increasing the number of missionary camps, which for successful Christian activities carried out among pagans allowed the formation of school educational institutions for the education and upbringing of a new Buryat generation of children in the doctrinal Orthodox canons, and Russian cultural traditions. In this regard, one of the key tasks of the missionaries was to establish a rational view of further life in new Christian-type formations, which was realized in socio-cultural activities: providing medical care to sick representatives of other ethnic groups, a friendly attitude to people of a different faith and a sincere desire to guide them on the path of righteousness, etc. It should be noted that the largest share of foreigners in this territory belonged to Buddhists, which was reflected in the influence of lamas on doctrinal issues, including economic ones. Since Buddhism in the Russian Empire belonged to the section of tolerant religions, direct (administrative) pressure on it was impossible. There remained funds of an exclusively spiritual nature, to which Orthodox missionary work was directed. Today in the Russian Federation, Buddhism, as well as Islam, Catholicism and Protestantism, as well as some other faiths belong to the category of traditional religions, which organizationally operate within the framework of the modern Russian Constitution. (shrink)

This study is considered as a proposal to identify some metaphysical support of the self-care for a patient suffering from a chronic disease, as an extension of the bio-psycho-social paradigm. The methodology is dominated by a phenomenological perspective, supported by a hermeneutic conceptual analysis of the care of the self in Michel Foucault, focused on the Socratico-Platonic period and pervaded by the intention of having a translation and application to self-care. Foucault pleads for an aesthetics of the (...) self, called subjectivity, in which the subject is self-constituted through the so-called technologies of the self. The care of the self comes from the resignification of the philosophy as a way of life in which the subject is objectified. The translation and the applicability of the care of the self at the idea level to self-care are identified precisely in the acquisition of some important principles of the philosophy of care of the self from the Greek Antiquity: the role of awakener of consciousness of the one who is concerned about oneself as the first moment of the metaphor of awakening from the sleep, the ēthos as a way of being, a way of behaving and a life model. The pair self-knowledge – care of oneself justifies informing the former by the latter, in which being concerned about oneself means knowing oneself. Nevertheless, knowledge means care of the self where the self is synonymous with the soul and moreover, with the divine element in man. (shrink)

_Care of the Self: Ancient Problematizations of Life and Contemporary Thought_, by Lívia Flachbartová, Pavol Sucharek, and Vladislav Suvák, focus on different manifestations of “taking care of the self” present in ancient and contemporary thought.

Care of the soul is arguably the core concept in Patočka’s phenomenology. However, what is the soul? In this paper I seek to determine its ontological meaning, connecting the concept of caring for the soul with that of the movement of existence. Starting from Patočka’s affirmative presentation of Aristotle’s criticism of Plato, I interrogate the “orthodox” Platonic concept of caring for the soul and develop an alternative notion, putting emphasis on action in the world. I demonstrate the impossibility of (...) identifying the third movement with true existence, or with the care for the soul, whether conceived as the performance of philosophy or as political action. Finally, I outline a reinterpreted concept of care for the soul in which the self-moving of the soul is not ontologically prior to responding. The soul is inherent in action; and it is free only as responding to the world and responsible only in being free. (shrink)

The Nature of Suffering underscores the change that is taking place in medicine from a basic concern with disease to a greater focus on the sick person. Cassell centers his discussion on the problem of suffering because, he says, its recognition and relief are a test of the adequacy of any system of medicine. He describes what suffering is and its relationship to the sick person: bodies do not suffer, people do. An exclusive concern with scientific knowledge of (...) the body and disease, therefore, impedes an understanding of suffering and diminishes the care of the suffering patient. The growing criticism that medicine is not sufficiently humanistic does not go deep enough to provide a basis for a new understanding of medicine. New concepts in medicine must have their basis in its history and in the development of ideas about disease and treatment. Cassell uses many stories about patients to demonstrate that, despite the current dominance of science and technology, there can be no diagnosis, search for the cause of the patient's disease, prognostication, or treatment without consideration of the individual sick person. Recent trends in medicine and society, Cassell believes, show that it is time for the sick person to be not merely an important concern for physicians but the central focus of medicine. He addresses the exciting problems involved in such a shift. In this new medicine, doctors would have to know the person as well as they know the disease. What are persons, however, and how are doctors to comprehend them? The kinds of knowledge involved are varied, including values and aesthetics as well as science. In the process of knowing the experience of patient and doctor move to center stage. He believes that the exploration of the person will engage medicine in the 21st century just as understanding the body has occupied the last hundred years. (shrink)

Those who find their work meaningful often need to be more committed. Over-commitment, in turn, frequently results in stress, personal conflicts, and burnout. Such over-commitment, in other words, leads to employees needing to take more care of themselves. This paper considers the prospects for meaningful self-care in the context of working time reduction. For this, we consider the case of the four-day workweek, asking employees of such organizations to explain how they make meaning out of their newly found (...) time off. Conceptually, we rely upon the work of Michel Foucault, particularly his analysis of the care of the self. On its basis, we coded five self-care practices: (1) rest and recuperation, (2) professional and personal development, (3) domestic work, (4) balancing work, and (5) additional work. We conclude by highlighting the theoretical and practical implications of work reduction for the analytical, ethical, and practical pursuit of meaningful work. (shrink)

From the perspectives of Jewish tradition, particularly that of the Halakhah (Jewish law), this paper considers the policy problem of the balance in health care allocations between preventive and curative or crisis medicine. Since the value of human lives has a high degree of supremacy, and the duties to rescue imperiled life and to treat the sick are recognized, it might be argued that a basically curative policy should be favored. On the other hand, the duty of personal (...) health maintenance and safety would appear to argue in favor of a preventive policy. In balancing these considerations, it is suggested that the halakhic tradition can accommodate a preventive policy of health care because the duty to rescue is lessened or negatived by risk to the as-it-were rescuers. It is further suggested that Halakhah permits a non-divertable allocation of tax-generated funds to preventive health care. Keywords: Preventive medicine, curative medicine, value of human lives, duty to rescue, risk taking, Jewish law ( Halakhah ), charity tax CiteULike Connotea Del.icio.us What's this? (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.3 (2002) 255-259 [Access article in PDF] On the Evolution of Depression Mike W. Martin Keywords: Depression, morality, mental disorders, psychobiology, evolutionary psychiatry. In "Depression as a Mind-Body Problem," Walter Glannon outlines a psychosocial-physiological explanation of depression as a psychological response to chronic stress—today, especially social stress—in which cortisol imbalances disrupt neurotransmitters. Accordingly, treatment for depression should combine psychopharmacology and psychotherapy—a valuable reminder in light (...) of the current restrictions on funding for health care (Hobson and Leonard 2001). My comments focus, however, on Glannon's objections to evolutionary theorists who explain our capacity for depression as adaptive to the natural and social environment. His objections are implausible because he fails to distinguish depression as a mood and a disorder. What Is Depression? Explaining the psychology, sociology, physiology, and evolution of depression presupposes knowing what depression is and hence what is being explained. As a blunt but important distinction, let us contrast depression as a mood and as a mood disorder.As a mood, depression is a state of low spirits, typically involving painful and low affect (of a kind needing further specification). Not all negative low moods are depressions. It is notoriously difficult to distinguish depression from grief, sadness, gloom, and a host of additional ways to feel down—especially because today many people use "I'm depressed" as a blanket expression for virtually any low mood. For the purposes of this paper, it is not necessary to attempt a full-blown analysis of depressed moods (and emotions). I would emphasize, however, that depressed moods involve values. They involve negative evaluations of ourselves, major events in our lives, life in its entirety, or the values that have been guiding us. Typically, to be depressed is to experience such things as feelings of worthlessness, dejection about failures, despair and hopelessness, and loss of caring and commitment. Thus, we might be sad or grieving but not depressed because we retain a solid grip on what is valuable and worthwhile. In any case, there should be no general presumption that depressed moods are all bad or undesirable. Instead, we should be prepared to appreciate the importance of depressed moods in connection with questions of value, identity, and even moral insight (Martin 2000). Depressed persons are not necessarily sick.In contrast, depression as a mood disorder is, by definition, pathologic. Moreover, usually it is not a depressed mood, although it involves depressed moods. On the one hand, depression as a disorder is defined as pathologic, a notion that is itself understood in terms of values—the values of health and, indirectly, moral values that define what is culturally acceptable. Thus, even severe [End Page 255] grief can be nonpathologic, even though it involves depressed moods, when it is within the range of "culturally-sanctioned responses" (APA 2000, xxxi). On the other hand, only sometimes is depression a single pathologic mood, as in major depressive episodes that can strike with a terrifying and suicidal severity (APA 2000, 375). Usually, however, the pathology is not a single depressed mood, but instead a longer-term state involving recurring depressed moods and additional features, such as poor concentration, insomnia, poor appetite or overeating, and so on. For some purposes, such as research funding and billing insurance companies and government health providers, these pathologies can be equated with what is currently in the DSM. Yet, there are many additional states of suboptimal health, in which the DSM criteria are only partly met.What does Glannon mean by depression? He does not define it, but he makes it perfectly clear that he intends depression as a disorder. Or rather, it is a set of mental disorders, including the "depressive disorders" of major depressive disorder, dysthymic disorder, depressive disorder not otherwise specified, and a variety of bipolar disorders and some anxiety disorders. Glannon sometimes indicates his primary topic is "severe depression," which of course is not a DSM category (nor always a mark of pathology). For the most part, however, he says his topic is "chronic depression," which might suggest dysthymia, "a chronically depressed mood for most of... (shrink)

The paper deals predominantly with the theory of moral reconstruction in George H. Mead’s thinking. It also points out certain underdeveloped aspects of Mead’s social-psychological theory of the self and his moral philosophy, and attempts to develop them. Since Mead’s ideas concerning ethics and moral philosophy are anchored in his social psychology, the paper begins with a description of his theory and underlines some problematic areas and tries to solve them. The most important of these, as the author argues, is (...) the hypothesis that social conflicts should be seen as the root of reflective, discursive thinking. Unlike some of his contemporaries (such as Vygotsky), Mead failed to appreciate this aspect of the genesis of the dynamics of the self. (shrink)

How might philosophically based counseling avoid becoming just one more form of private therapy, to be set alongside all the others now sold to individual consumers? Although several practitioners of philosophical counseling have sought to distinguish their approach from psychotherapeutic models, Foucault’s critique of the dominant modern model of ethical reflection might be used to argue for their essential continuity with one another, based on their common acceptance of the primacy of the imperatives of knowledge. Foucault turned in his late (...) writings to ancient Greek models of ethics as ‘care of the self ’, delineating a self-relation prior to knowledge. This paper argues for the interest and importance for philosophical counseling of the idea of ethics as ‘care of the self ’ in articulating a model of ethical reflection distinct from both rationalist and irrationalist tendencies in modern thought and focussed on self-mastery conceived as addressing our relation to otherness rather than as authenticity or autonomy. Moreover, the ‘aesthetics of existence’ that Foucault prescribes to the present has a significant and affirmative relationship to po­litical life; this distinguishes it from the private and individualistic project, dismissed by Foucault as ‘the Californian cult of the self ’, for which philosophical counseling can all too readily be mistaken. (shrink)

ABSTRACTThe paper deals with Jan Patočka’s and Michel Foucault’s influential interpretations of the ancient Greek approach to care. At first sight, it might seem that Foucault’s care of the self is opposed to Patočka’s care of the soul. On closer reading, however, it becomes clear that the two interpretations lead to similar conclusions, as exemplified by the way the two authors interpret Plato’s Laches: both of them see it in relation to the issue of how to live (...) one’s life. Further on, the paper deals with the development of Patočka’s understanding of care of the self and his approach to the philosophy of history. It is revealed that Foucault’s approach to history is opposed to Patočka’s on a number of issues. Despite their diverging opinions, however, the two authors problematize the ancient Greek care of the self as an important issue in Western culture, emphasizing the therapeutic role of contemporary philosophy along the way. (shrink)

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)

With the broad interest in the concept of "self-care" within popular discourse, there is a growing focus among philosophers, scholars of religion, political theorists, and others on the idea of "spiritual exercises," the ethics of "the care of the self," and attending concepts, yet little has been written on the politics of this broad class of concerns. This book investigates the political consequences of practices of the self in the work of several key 20th-century thinkers-Pierre Hadot, Georges Friedmann, (...) Michel Foucault, Martin Luther King, Jr., and Audre Lorde. Using Hadot's working definition of spiritual exercises as "voluntary, personal practices intended to bring about a transformation of the individual, a transformation of the self," Daniel Wyche frames his argument with the questions: how, and under what conditions, can the ethics of "the care of the self" take the form of "the care of the other" in the sense of material political transformation and vice versa? Are there historical examples in which the two are coterminous? How might we articulate a genuinely holistic relationship between the two? He argues that understanding the politics of self-change necessarily entails that we reframe the practical and conceptual relationships between individual moral action and collective, systemic political life in such a way that ethics and politics can be thought together-neither prior to the other-and finds in King's political self-purification and Lorde's self-preservation forms that such a politics might take. (shrink)

This article reads Max Weber’s Collected Essays in the Sociology of Religion (1920/1921), in particular the first two sections, The Protestant Ethic and the Spirit of Capitalism and Confucianism and Taoism, as his comparative philosophy of life. While Weber’s thesis about the determining effect of Protestantism on the emergence of industrial capitalism has been taken as a justification for the superiority of Western culture and its uniqueness in the world, this article emphasizes Weber’s critique of Protestant asceticism and his pessimism (...) toward the West in the early twentieth century. Weber’s critique is deeply connected to his concerns about life and freedom and his imagination of an aesthetic way of life in Chinese Confucianism, in which he believes to have found a well-balanced rational culture that accepts and appreciates irrationalism, as expressed in Taoism. And, as the article observes, Weber’s philosophy of life centering on aesthetic self-cultivation inspired Michel Foucault’s concept of the care of the self in the 1980s. Weber’s sociology of religion thus articulates his vision of freedom in the age of global capitalism—it is his Confucian care of the self. (shrink)

A veteran nurse researcher and educator provides a spiritual perspective on the professional nurse's vocation of caring. Grounding each chapter in Scripture, O'Brien explores the Christian nurse's call to love as Jesus loved: without discrimination, reserve and, sometimes, reward.

This text through the direct use to Foucault’s work and using the concepts of ‘care of the self’ and biopolitics is questioning and analyzing resistance and practices of freedom. Mainly, from the Foucault’s courses at the College de France and the methodological tools found there, here I present a discussion about Gilles Deleuze’s contributions to Foucault’s thought and I develop a dialog where I try to explain the concepts of domination, power, ethics, esthetics and the relationship of the self (...) with himself. (shrink)

The main purpose of this paper is to clarify some senses of dignity that are particularly relevant for the treatment and care of the elderly. I make a distinction between two quite different ideas of dignity, on the one hand the basic kind of dignity possessed by every human being, and on the other hand the dignity which is the result of a person's merits, whether these be inherited or achieved. Common to both these ideas is that having a (...) dignity entails having a set of rights, in the case of basic dignity the set of rights which we call human rights, the rights which the United Nations, among others, has tried to determine. The dignities of merit also provide some rights, although normally rights with limited scope covering, for instance, a professional area. This observation gives my preliminary answer to the fundamental question of what distinguishes dignity from other high values that could be attached to humans. I discuss further a kind of value that might be mistaken for a kind of dignity, viz. what I call public status. This status is to be distinguished from social status (the status of e.g. kings, governors, and officials) that I take to be a proper dignity of merit. The public status is the status gained solely via public perception and not directly via any merits on the part of the dignified. Finally, I turn to the topic of the dignity of the elderly and try to determine whether there is some dignity peculiar to the elderly, and which is over and above the basicMenschenwrde. My two preliminary proposals are the following: the elderly have a dignity of wisdom and they have a highly general dignity of merit, which results from their life-long efforts and achievements, and for this they deserve our gratitude. (shrink)

This paper deals with Care of the Self under globalization. The first part refers to Johann P. Arnason’s interpretation of Jan Patočka’s work on super-civilization and shows the contradictions facing people in the Modern Era. It suggests that the concept of moderateness is an adequate point of departure for handling the various contradictions of the current epoch. The second part looks at selected aspects of Confucian philosophy in which moderateness, that is, the permanent search for a “middle position” is (...) an integral part of that philosophical tradition. The critical actualisation of Confucianism as proposed for instance by Heiner Roetz is seen as an appropriate way of developing the dialogical characteristics of Confucian philosophy. In the last part it is stressed that critical theory is of relevance when identifying various forms of suffering and because of its ability to understand and critically evaluate diverse cultural and social contexts. (shrink)

The practical aspect of ancient philosophy has been recently made a focus of renewed metaphilosophical investigation. After a brief presentation of three accounts of this kind developed by Martha Nussbaum, Pierre Hadot, and Michel Foucault, the model of the therapeutic argument developed by Nussbaum is called into question from the perspectives offered by her French colleagues, who emphasize spiritual exercise (Hadot) or the care of the self (Foucault). The ways in which the account of Nussbaum can be defended are (...) then discussed, including both a ‘negative’ defense, i.e. the indication of the weaknesses of Hadot and Foucault’s proposals, and a ‘positive’ one focused on the points in which Nussbaum can convincingly address doubts about her metaphilosophical account. In response to these analyses, some further remarks made by Hadot and Foucault are discussed in order to demonstrate that their accounts are not as distant from Nussbaum after all. Finally, a recent metaphilosophical study by John Sellars together with a therapeutic (medical) model developed by the author of the present article are suggested as providing a framework for potential reconciliation between all three accounts discussed and a resource for further metaphilosophical studies. (shrink)

This chapter philosophically examines the transformation of “Walter White” into “Heisenberg,” as depicted in the television series Breaking Bad, in terms of Søren Kierkegaard’s “stages of life” and Carl Jung’s “process of individuation.” Though Walt’s transformation is an oft-discussed topic regarding Breaking Bad, there has yet to appear in the philosophical literature an examination of this transformation in terms of Kierkegaard and Jung. Such an examination is important since it also addresses a number of the questions regarding the shift in (...) Walt’s moral compass given his terminal prognosis. That is to say, Walt’s transformation into Heisenberg in terms of Kierkegaard and Jung provides a moral account of his decisions without sacrificing a notion of his free-will or accepting the imminence of death as justification for the perpetration of evil. (shrink)

Calling on the methodology of psychology, the authors explore the way illness alters the self-image of the sick person, and the way the experience changes the person who is ill. The reader is taken through the psychological impacts of the first clinical moment when the patient realizes he or she is in the altered state of illness, as well as the subsequent effects of pain, hospitalization, being bed-ridden, fatigued or disabled. The central thesis is that an integral picture of (...) medicine must include social-cultural aspects, the institutionalization of health care, and an attempt to provide patient-centered care. The approach taken is the empirically based psychosocial reflection of the disturbances to a person's self-image caused by various kinds of illness. Focusing on the world of the patient, the authors relate to problems concerning self-image, pain, exhaustion, isolation, handicaps, aging, dying and death. The relationships between patients and medical personnel are also examined. Concluding the work is an excellent bibliography keyed to the chapters of the text. (shrink)

It has often been argued that Foucault’s turn to antique and early Christian care of the self, spiritual self-.practices and truth-telling (parrhesia) results from inquiries into the confession practices and pastoral power structures in the context of a genealogy of the desiring subject. This line of reasoning is in itself not incorrect, but – this article claims – needs to be complemented with an account of Foucault’s philosophical quest for freedom and for conditions, possibilities and modes of thinking and (...) acting differently vis-à-vis the normalizing regimes of power in science and, hence, in philosophy as an academic discipline. In this context a first turn to antique philosophy seen as a ‘way of life’ constructed through ascetic practices can be detected already writings from the late 1960s and early 1970s. Although indeed the project of the history of sexuality moved in a direction than Foucault had foreseen in the first volume published in 1976, earlier reflections on the need for free and critical philosophical thought relative to scientific ‘disciplines’ already prelude the later inquiries into care of the self, self-practices and parrhesia as productive for a critical philosophical attitude. (shrink)

Illness has a way of disorientating us, as if we are cast adrift in a foreign land. Like strangers in a dessert we seek oasis to recollect ourselves, find refuge and learn to build our own shelters. Using the philosophy of Levinas and Derrida, we can interpret health care providers (HCP), and the sites from which they act (e.g. hospitals), as _dwelling hosts_ that offer hospitality to strangers in this foreign land. While often the dwellings are physical (e.g. hospitals), (...) this is not always the case. Language represents a mobile home of refuge to the sick. Using language the HCP has built a shelter so as to dwell in the land of illness. However, while hospitality is an inviting concept, it also implies hostility. The door that opens may also be slammed shut. This article explores the paradox of the linguistic mobile home offered to patients. It highlights the power of language to construct a safe place in a strange land, but also explores the inherent violence. It ends with an exploration of the ways language can be used by HCP to assist patients to construct their own mobile shelters. (shrink)

The paper takes its cue from the emergence in our society of a new view of the adolescent, which a branch of the psychological literature has spelled out in terms of a passage from Oedipus to Narcissus. It is argued that pre-college ethics education should engage with this passage by deploying educational strategies modelled according to the Care of the Self paradigm but revisiting it through Kierkegaard’s idea of repetition. The latter prevents that paradigm from fostering a sort of (...) aestheticization of ethical life and allows us to mobilize it in ethics education. Against this backdrop two pedagogical methods—autobiographical writing and essay writing—are discussed as possible tools for a Care-of-the-Self-oriented education. (shrink)