코로나-19 시국에 호명되는 평범한 일상이라는 표어는 코로나 이전의 시기를 정상성의 범주로 규정한다. 정상과 비정상의 이분법으로 현 사태를 보면, 코로나라는 문명사적 파국은 블랙스완의 비유처럼 예측하지 못한 우발적 사건이 된다. 하지만 아도르노는 정상성의 문화가 자연과 동물에 대한 절대적 폭력에 기초해 있다고 말한다. 그에게 정상성은 죽음인데, 그 이유는 평범한 일상이야말로 잘못된 사회가 타자화시킨 것들에 대한 지배에 기초해 있기 때문이다. 오늘날 인간의 기대수명은 100세를 바라보고 있다. 하지만 인간의 사회적 주체성, 그 사회적 생명은 그러한 기대수명에 부합하는가? 100세를 산다 한들, 개인이 사회 속에서 자유하지 못하면, 그러한 (...) 건강성은 병든 건강성일 뿐이다. 평범한 일상의 회복이라는 표어가 범람하는 요즘, 아도르노와 함께 이 사태를 해석할 때, 우리는 정상성이야말로 죽음이고 평범한 일상이야말로 시대의 질병이라는 진실을 발견하게 된다. 이 글의 목적은 아도르노와 함께 건강성의 모순을 해독하여 정상성의 문화를 사회적 병리의 관점으로 규명하는 것이다. 이를 위해, 이 글은 지성·과학기술·동물지배에 대한 아도르노의 성찰을 경유하여, 오늘날 개인이 경험하는 고통은 평범한 일상의 정상성 속에 있는 죽음에 바탕을 두고 있음을 주장할 것이다. (shrink)

In most other nations, insurance for medical care is called sickness insurance, and it covers sick people. In the United States, we have “health insurance,” and its major carriers — commercial insurers, large employers, and increasingly government programs — strive to avoid sick people and cover only the healthy. This perverse logic at the heart of the American health insurance system is the key to reform debates.Focusing on sick people versus healthy people might seem a (...) strange way to view the coverage issue. Most discussions of insurance categorize people into other groupings: the insured versus the uninsured; Caucasian whites versus other racial and ethnic groups; men versus women; poor and low-income people versus everybody else; children, adults, and the elderly; or citizens versus immigrants and undocumented aliens. More recently, health researchers have begun talking about “vulnerable populations,” using most of the same demographic groupings and adding other illness-inducing factors such as social isolation, stress, and impoverished neighborhoods. But as I will show, insurance plans now use premiums, cost-sharing, and other design features in ways that indirectly divide each of these groups into the sick and the healthy, to the detriment of the sick. By shifting the costs of illness onto people who use medical care — that is, sick people — market-oriented reforms of the last few decades have eroded insurance in the name of strengthening it. (shrink)

Between Sickness and Health is about illness rather than disease, and recovery rather than cure. The book argues that illness is an experience, represented by the feeling that 'I am not myself'. From the book's phenomenological point of view, feelings of illness cannot be 'unreal' or 'fake', whatever their biological basis, nor need they be categorised as 'physical', 'psychosomatic' or 'psychiatric'. The book challenges the disease-centred ethos of medicine and medical education. It demonstrates that a clearer conception of illness, (...) as distinct from disease, is therapeutic. The feeling that 'I am once again myself' can return, in some degree, whatever state the body is in. Resilience becomes more available when it is seen as a set of personal skills that can be developed, rather than as an inborn trait. Possibilities of wellness are enhanced by recognising that medical and other therapies can either support or impede recovery, as can human relationships and the socio-political environment. The book's many clinical examples are drawn from the author's broad experience as a neurologist, rehabilitation physician and systemic family therapist. Between Sickness and Health will be useful for students, practitioners and academics, and also for anyone who has been or might one day be ill. (shrink)

BackgroundKnowledge about the psychosocial experiences of sick-listed workers in the first months of sick leave is sparse even though early interventions are recommended. The aim of this study was to explore psychosocial experiences of being on sick leave and thoughts about returning to work after 8–12 weeks of sickness absence.MethodsSixteen individuals at 9–13 weeks of sick leave participated in semi-structured individual interviews. Data was analyzed through Giorgi’s descriptive phenomenological method.ResultsThree themes emerged: energy depleted, losing normal life, (...) searching for a solution. A combination of health, work, and family challenges contributed to being drained of energy, which affected both work- and non-work roles. Being on sick leave led to a loss of social arenas and their identity as a contributing member of society. Participants required assistance to find solutions toward returning to work.ConclusionEven in this early stage of long-term sick leave, sick listed workers faced complex challenges in multiple domains. Continuing sick leave was experienced as necessary but may challenge personal identity and social life. Those not finding solutions may benefit from additional early follow-up that examine work-related, social and personal factors that influence return to work. (shrink)

Recent years have witnessed a growing interest in the measurement of health status. One of the most well-known health status instruments is the Sickness Impact Profile (SIP). This paper examines the nature, development and testing of the SIP (and its UK equivalent the FLP). The practical merits of these instruments are explained, and some cautionary remarks are offered about their limitations.

A key public health measure has received far too little attention over the course of the Covid‐19 pandemic: paid sick leave policies that encourage people at risk of spreading disease to stay home rather than come to work. The United States is one of the only developed countries that fails to guarantee paid sick leave at the federal level, leaving a patchwork of state and private policies that undersupply time off when people are contagious and protect top (...) wage earners at wildly disproportionate rates compared with what workers with lower incomes experience. Other countries have shown that sick leave mandates are neither unjustified burdens on employers nor gratuitous giveaways to employees. In fact, sick leave saves on health care costs by making employees less likely to infect coworkers, to be absent for longer themselves, or to need treatment in expensive hospital emergency departments. Nationally guaranteed sick leave is urgently needed to promote public health. (shrink)

Cherie Moraga’s play, Heroes and Saints, and Helena Maria Viramontes’ novel, Under the Feet of Jesus, offer readers perspectives on the lives of migrant farm workers in California that challenge the moral imagination and conscience. Both focus on health hazards of pesticides and on the often prohibitive difficulty of getting health care for those who fall ill as a result of exposure. This paper offers a reflection on the direct political and moral appeal these works present to readers (...) who may not see or acknowledge the sacrifices sustained by those whose undercompensated labors are an integral part of our food systems. (shrink)

Lifestyle-induced diseases are becoming a burden on healthcare, actualizing the discussion on health responsibilities. Using data from the National Association for Heart and Lung Diseases ’s 2015 Health Survey, this study examined the public’s attitudes towards personal and social health responsibility in a Norwegian population. The questionnaires covered self-reported health and lifestyle, attitudes towards personal responsibility and the authorities’ responsibility for promoting health, resource-prioritisation and socio-demographic characteristics. Block-wise multiple linear regression assessed the association between attitudes (...) towards health responsibilities and individual lifestyle, political orientation and health condition. We found a moderate support for social responsibility across political views. Respondents reporting unhealthier eating habits, smokers and physically inactive were less supportive of health promotion policies. The idea that individuals are responsible for taking care of their health was widely accepted as an abstract ideal. Yet, only a third of the respondents agreed with introducing higher co-payments for treatment of ‘self-inflicted’ conditions and levels of support were patterned by health-related behaviour and left-right political orientation. Our study suggests that a significant support for social responsibility does not exclude a strong support for personal health responsibility. However, conditional access to healthcare based on personal lifestyle is still controversial. (shrink)

The recent increased prevalence of diseases related to unhealthy lifestyles raises difficulties for healthcare insurance systems traditionally based on the principles of risk-management, solidarity, and selective altruism: since these diseases are, to some extent, predictable and avoidable, patients seem to bear some responsibility for their condition and may not deserve full access to social medical services. Here, we investigate with objective criteria to what extent it is warranted to hold patients responsible for their illness and to sanction them accordingly. We (...) ground our analysis on a series of minimal conditions for ‘practical’ and for ‘moral’ responsibility attribution. By applying these criteria consistently, we highlight that individual responsibility applies to risk-taking life choices rather than stigmatized sickness. We explain that responsibility is a matter of degree, that it varies across life-history, and can be affected by factors beyond the patients’ grasp. We point out that scientific knowledge about the effect of these factors generates responsibilities for other parties such as public health agencies and private industry. The upshot of our analysis is that health policies targeting the ‘liable’ undeserving sick are mostly unwarranted, and tend to increase unequal treatment of already vulnerable groups: the unlucky sick. (shrink)

On the heels of the groundbreaking Obergefell v. Hodges ruling legalizing same-sex marriage in the United States, the lesbian, gay, bisexual, and transgender movement for marriage equality has received unprecedented coverage. Few people, however, have heard of the marriage equality movement for people with disabilities. In order to understand the lack of coalition between the two movements, as well as the invisibility of the PWD marriage equality movement, I provide a conceptual analysis of both marriage movement discourses. Drawing on Cathy (...) Cohen's work on secondary marginalization in the black community, I argue that both LGBT folks and PWD actively obscure the most needy, most dependent, and most queer members of their respective communities to gain sympathy and support from a independent, heteronormative majority. However, bringing the two movements into dialogue can help us rethink intimate relationships, marriage, and who counts as a citizen worthy of rights. (shrink)

The essay seeks to bring William James into dialogue with Friedrich Nietzsche around the issue of the nature of sickness, and its overcoming or convalescence. It is, at first glance, folly to reconcile religious rebirth with the convalescence that led Nietzsche to the “great health.” To try and see beyond this folly, we will consider carefully the site in which health emerges for both thinkers. This discussion is further motivated by an interest in the prospects for religion after (...) the death of God. (shrink)

In this systematic review, we summarized and evaluated the evidence for effects of, and associations between, immersive nature-experience on mental, physical and social health promotion outcomes. Immersive nature-experience was operationalized as non-competitive activities, both sedentary and active, occurring in natural environments removed from everyday environments. We defined health according to the World Health Organization’s holistic and positive definition of health and included steady-state, intermediate, and health promotion outcomes. An electronic search was performed for Danish, English, (...) German, Norwegian, and Swedish articles published between January 2004 and May 2017. Manual approaches, e.g., bibliographies from experts, supplemented the literature search. Data were extracted from 461 publications that met the inclusion criteria. To assess the status and quality of the evidence for health promotion effects of immersive nature-experience, we focused on the subset of studies based on controlled designs (n = 133). Outcome level quality of the evidence was assessed narratively. Interventions most often involved adventure-based activities, short-termed walking, and seated relaxation in natural environments. We found positive effects on a range of health promotion outcomes grouped under psychological wellbeing (n = 97; ≈55% positive; ≈13% mixed; ≈29% non-significant; 2% negative); psychosocial function (n = 67; ≈61% positive; ≈9% mixed; ≈30% non-significant); psychophysiological stress response (n = 50; ≈58% positive; ≈18% mixed; ≈24% non-significant), and cognitive performance (n = 36; ≈58% positive; ≈6% mixed; ≈33% non-significant; 3% negative); and social skills and relationships (n = 34; ≈70% positive; ≈7% mixed; ≈22% non-significant). Findings related to outcomes categorized under physical health, e.g., risk of cardiovascular disease, were less consistent (n = 51; ≈37% positive; ≈28% mixed; ≈35% non-significant). Across the types of interventions and outcomes, the quality of the evidence was deemed low and occasionally moderate. In the review, we identify, discuss, and present possible solutions to four core methodological challenges associated with investigating immersive nature-experience and health outcomes: 1) intervention and program complexity; 2) feasibility and desirability of randomization; 3) blinding of participants and researchers; and 4) transferability and generalizability. The results of the review have been published as a popular-scientific report and a scientific research overview, both in Danish language. (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)

The article uses a producer-consumer theory from philosophy of mind and language to analyse the meaning of basic health concepts like disease, illness and sickness. The core idea of the producer-consumer perspective is that a person who has an incomplete understanding of a term can associate it with the same concept as a linguistic expert, if both of them are willing to defer to the same contextual or general norms of meaning. Using “disease” as an example, the article argues (...) that the producer-consumer theory implies that if patients were normally willing to defer to a standard expert concept of disease, it would be reasonable to assume that the concept of disease is this concept. However, it is empirically well documented that many patients are not willing to defer to health workers’ understanding of lay health concepts like “disease”. This means that the overall conceptual analysis of disease and other lay health concepts should be pluralistic—the concepts belong within what Wittgenstein calls different language-games. This conceptual pluralism is inconsistent with assumptions many theorists have made when attempting to develop general definitions of basic concepts of ill health. Furthermore, the pluralistic analysis has striking implications for how conceptions of meaning should be accepted as sound; participants in health discourses are entitled to use basic health terms like “health” and “illness” in accordance with their own language-games, and health workers should therefore acknowledge a diversity of meaning in patient communication. Nevertheless, health professionals can often secure a communicative platform of shared concepts by understanding patients’ language games, and by achieving contextual aims of agreement about meaning. (shrink)

This paper discusses the accounts given of the nature of religious affectivity by Nietzsche, Otto and Bataille and pursues their shared claim as to the primacy of the affective dimension of religion over its conceptual, doctrinal and moral elements and to the development of a religious critique of Christianity. The first section clarifies the nature of Nietzsche’s religiosity and reconstructs his critique of Christianity from this perspective. In subsequent sections Nietzsche’s critique of Christianity is compared to both Otto’s critical defence (...) and Bataille’s ‘Nietzschean’ critique of it. Three themes are proposed as evaluative criteria for the comparative evaluation of the three thinkers undertaken. Firstly, the task of rethinking the nature of religious affectivity in ‘impersonalist’ or ‘a-subjective’ terms. Secondly, the role of the notion of ‘immanence’ in both the rethinking of transcendence given the demise of the transcendent and in a reconceiving of the critique of religion in general, and Christianity in particular, in non-oppositional terms. Thirdly, the question of the ‘autonomy of religion’ not only in relation to the ‘theoretical’, ‘moral’ and ‘aesthetic’ domains but also, ultimately, to the ‘human’ itself. In short, the thinkers considered are evaluated in terms of what they seek to formulate, namely, a radically non-anthropomorphic conception of religion. It is argued that only Bataille attains to both senses of ‘immanence’ identified in the paper in his development of a non-transcendent notion of transcendence and a critique of Christianity that finds suppressed ‘traces’ of the impersonal and a-moral force of the ‘sacred’ operative within it. (shrink)

Edgar Lee Masters published numerous poems, plays, and novels between 1900 and 1942; most go unread, with the exception ofSpoon River Anthology, which is among the most popular works of American poetry of the twentieth century. This collection of poems tells of the lives of the inhabitants of a fictional American town—Spoon River, Illinois. Many of the poems consider sickness and health in the community, and the insight they offer into human responses to illness continues to be relevant today, (...) contributing not only to the lasting popularity ofSpoon River Anthology, but also the literary value of the work. (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)

Within the ever-growing body of research on sickness presenteeism, studies of perceived consequences are scarce and equally rare are joint considerations of beneficial and harmful effects. This study examined how experienced and expected consequences of the behavior are related to presenteeism. Positive and negative effects were considered simultaneously and comprehensively. This approach allowed us to capture the trade-off process of individuals in deciding to work or call in sick when ill. In a cross-sectional online survey, 591 working adults in (...) Germany rated a thoroughly developed pool of specific experienced or potential consequences of working while sick and gave an overall judgment of effects. The results show that perceptions of effects are consistent with behavior. Individuals who exhibit presenteeism do so primarily because of work-related effects such as the completion of one’s work tasks and the meeting of deadlines. Few specific effects stand out and can largely explain attendance behavior and the overall assessment of effects. The findings are consistent with the assumptions of the health belief model and the expectancy value theory of work motivation and they relate to the health-performance framework. They demonstrated that benefits and costs of the behavior are simultaneously weighed in the decision to engage in presenteeism or not. (shrink)

In response to cancer, patients may be thrown into precarious processes of remaking their purpose, identity, and connections to the world around them. Thoughtful and thorough responses to these issues can be supported by person-centered phenomenological approaches to caring for patients. The importance of perspectives on illness offered by theoretical phenomenology will become apparent through the example of the experience of nausea, or perhaps more accurately put—chemo sickness. The focus here is on how chemo sickness alters one's way of relating (...) to the world. I will examine the phenomenon of nausea through the lens of the phenomenological concept of mood—an existential feeling that engenders a diffused tone permeating through one's world and shapes the envisioned possibilities on one's horizon. (shrink)

ABSTRACT In this article, the author offers a reconstruction and criticism of Brian Leiter's interpretation of Nietzsche's criticism of conventional morality in Nietzsche on Morality. Leiter's interpretation is said to falter because it attributes to Nietzsche an implausible combination of positions. First, Nietzsche is said to be a value antirealist. But he is also said to defer to the value of the flourishing of his audience, who are limited to a certain subset of “higher” humans. The author argues that, in (...) spite of Leiter's attempt to defend this view, he ultimately fails to explain how Nietzsche can be confident in the normative force of the higher humans' flourishing and, so, his criticism of morality. Since the author takes the problems of Leiter's reading to bear on a prevalent general reading of Nietzsche, the author concludes with a brief sketch of a plausible alternative. (shrink)

ABSTRACT Though the ideas of health and sickness are very much at the heart of Nietzsche’s mature thought, scholars have offered little on what exactly he means by sickness. This is particularly true when Nietzsche presents his conception of sickness in more narrowly physiological terms, as he does explicitly in the Third Essay of On the Genealogy of Morality. In this paper, I present an account of what Nietzsche means by physiological sickliness and sickness, and how these notions are (...) related to asceticism. In particular, I argue that for Nietzsche human beings have been subject through all of history to epidemics of nervous inhibition and exhaustion. In explaining these physiological conditions, I detail the basic understanding of the nervous system in the nineteenth century and show how Nietzsche’s diagnosis of sickness in this system explains many of the mysterious elements of the Third Essay. In my final section, I sketch out the meaning of the ascetic ideal against the backdrop of this nervous sickness. (shrink)

Medicalization occurs when an aspect of embodied humanity is scrutinized by the medical industry, claimed as pathological, and subsumed under medical intervention. Numerous critiques of medicalization appear in academic literature, often put forth by bioethicists who use a variety of “lenses” to make their case. Feminist critiques of medicalization raise the concerns of the politically disenfranchised, thus seeking to protect women—particularly natal sex women—from medical exploitation. This article will focus on three feminist critiques of medicalization, which offer an alternative narrative (...) of sickness and health. I will first briefly describe the philosophical origins of medicalization. Then, I will present three feminist critiques of medicalization. Liberal feminism, trans feminism, and crip feminism tend to regard Western medicine with a hermeneutics of suspicion and draw out potential harms of medicalization of reproductive sexuality, gender, and disability, respectively. While neither these branches of feminism—nor their critiques—are homogenous, they provide much-needed commentaries on phallocentric medicine. I will conclude the paper by arguing for the continual need for feminist critiques of medicalization, using uterus transplantation as a relevant case study. (shrink)

Over the past century, the “right to health” has been recognized by medical organizations and governments across the globe. This essay calls for recognition of a parallel “right to be sick” intended to reframe physician attitudes toward patient autonomy and the right to refuse care. Rather than seeking to discourage allopathic medicine or to question laws requiring involuntary treatment when indicated by the collective welfare, the goal is to have the medical and public health communities reconceptualize their (...) attitudes toward individuals who reject unsought guidance and care. (shrink)

The meaning of dignity in health care has been primarily explored using interviews and surveys with various patient groups, as well as with health care practitioners. Philosophical analysis of dignity is largely avoided, as the existing philosophical literature is complex, multifaceted and of unclear relevance to health care settings. The aim of this paper is to develop a straightforward philosophical concept of dignity which is then applied to existing qualitative research. In health care settings, a patient (...) has dignity when he or she is able to live in accordance with his or her standards and values. Accordingly, health care practitioners respect a patient's dignity when they refrain from transgressing the patient's standards and values, or refrain from forcing the patient to transgress his or her standards and values. This concept is shown to explain and illuminate most of the key qualitative findings. It therefore provides a more coherent and synthesised concept of dignity in health care. (shrink)

Medicine and its allied health sciences have for too long been peripherally involved in work on human rights. Fifty years ago, the door to greater involvement was opened by Article 25 of the Universal Declaration of Human Rights, which underlined social and economic rights: “Everyone has the right to a standard of living adequate for the health and well-being of himself and his family, including food, clothing, housing, and medical care and necessary social services, and the right to (...) security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”. (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)

Durante su desarrollo el niño se enfrenta a eventos que plantean demandas difíciles de satisfacer como la enfermedad y la hospitalización. La Organización Mundial de Salud define la salud como un estado de completo bienestar físico, mental y social, pero no existe consenso en la literatura sobre el término bienestar. El objetivo del artículo es realizar una revisión bibliográfica acerca del concepto bienestar en niños, asociado al proceso salud - enfermedad y a la hospitalización. Los niños experimentan bienestar cuando predominan (...) sus emociones positivas, estas favorecen la salud, las negativas, pueden provocar estados patológicos y son frecuentes en la hospitalización. Esa realidad amerita ser transformada. El bienestar en niños hospitalizados constituye un reto para las ciencias médicas para penetrar las bases del nivel secundario de atención. Throughout their development, children face events that pose hard-to-satisfy demands for them such as illness and hospitalization. The World Health Organization defines health as a state of complete physical, mental, or social well-being; however, there is no consensus in literature about the term "well-being". The objective of the article is to do a bibliographic review on the concept of children well-being associated to the health-illness process and to hospitalization. Children experience the state of well-being when positive emotions, which favor health, prevail. Negative feelings, on the other hand, can cause pathological states and they are common in hospitalization. That reality merits transformation. Hospitalized children's well-being presents a challenge for medical sciences in order to get inside the basis of secondary health care attention. (shrink)

The concept of the sick role entered sociology in 1951 when Talcott Parsons creatively separated the sick person out of the doctor–patient dyad. The idea became fundamental in the subdiscipline of medical sociology. By the 1990s, the concept had almost disappeared from the research literature. Beyond the generational and theoretical changes that explain how the sick role idea could become irrelevant or unnecessary to sociologists, there were two immediate factors: the negative politicization of the concept and the (...) shift of medical sociologists to a focus on applied health behavior. In the later, fragmented discipline of sociology, final, total abandonment was still uncertain. (shrink)

Intensive care units provide focused, aggressive medical intervention to critically ill patients. Physicians responsible for ICU triage must decide which patients are sick enough to require this level of care and which can be managed on the general wards. While some patients are too well for the ICU, intensivists increasingly rely on another category, “too sick to benefit,” when denying ICU admission, even if beds are readily available. Recent studies indicate that between 19 and 37 percent of patients (...) refused ICU admission were declined because they were thought too sick to benefit from it, suggesting that physician use of this category is common in ICU triage.The idea of being too sick to benefit may seem paradoxical given that ICUs exist to treat the sickest of the sick. There is, however, increasing awareness that some diseases progress despite maximal intervention. Although there have been systematic attempts to define these diseases—most notably during the medical futility debates of the 1980s and early 1990s—there is little evidence about which conditions make a patient too sick to benefit from ICU admission. In the absence of a clear understanding of which diseases progress despite maximal care, ICU triage under the category “too sick to benefit” is currently done on a case‐by‐case basis. Contemporary decisions about who is too sick to benefit thus raise a number of ethical issues about what constitutes standard of care, the role of health care providers' judgments of quality of life in triage, and the just allocation of resources.Addressing these ethical concerns requires us to better define the population of critically ill adults who are too sick to benefit—a conceptual and empirical project. In this article, I recommend employing a diagnostic concept from the neonatal literature: namely, a lethal disease. (shrink)

One of most pertinent and acute risks that the world is now facing is emerging or re-emerging zoonotic diseases. This article focuses on culling as a measure for zoonotic disease control, specifically the culling of 11,000 badgers as part of the Randomized Badger Culling Trial in the UK and the culling exercises in Singapore. The independent expert panel that devised the UK study concluded that reactive culling was ineffective in reducing the cases of bovine tuberculosis in cattle. The panel also (...) concluded that proactive culling was not cost-effective. Behind the scarcity of empirical evidence to support culling, the resultant reduction in biodiversity can actually harm both animals and humans. Public health policies should be evidence-based, culturally adaptable and ethically justified; a novel biomedical and public health approach, named One Health, plausibly provides a reasonable ethical framework as well as research and interventional methods that square with that framework. OH recognizes that nonhuman animals and humans are interlinked in both sickness and health, since we all share the same ecosystem. OH could potentially replace standard public health strategies, as it provides alternative evidence-based methods for biomedical research and adds a non-anthropocentric component to an ethical decision-making process. (shrink)

Resumen En el presente trabajo se investigan los alcances y las consecuencias que se desprenden de utilizar a Heidegger en el campo de la filosofía de la medicina. Con este fin, la investigación se divide en los siguientes puntos: 1) se explicitará en qué puede consistir una “antropologización” del pensamiento heideggeriano; 2) se ofrecerá una descripción general respecto de las teorías de la salud y enfermedad más significativas y actuales en el campo de la teoría de la medicina; 3) nos (...) detendremos en el análisis relacionado con el problema de la enfermedad desde una perspectiva heideggeriana, para finalmente, 4) ofrecer algunas reflexiones críticas en relación con el análisis ofrecido.In this contribution we investigate the scope and consequences that arise from applying Heidegger in the field of philosophy of medicine. For this purpose, the paper is divided in the following points: First, we will make explicit the meaning of an “anthropologization” of Heidegger's thought. Second, an overview of the most significant contemporary theories of health and disease in the field of theory of medicine will be offered. Third, we will interpret the meaning of disease from a Heideggerian perspective. Finally, 4) we will offer some critical reflections offered in relation to the analysis. (shrink)

Parsons’ sick role concept has become problematic in the face of the increased significance of chronic illnesses and the growing emphasis on lifestylecentred health promotion. Both developments de-limit the medical system so that it extends into the world of health, fundamentally changing the doctor-patient relationship. But as the sick role is firmly based on the reciprocities of a resiliently capitalist achievement society it still informs normative expectations in the field of health and illness. The precarious (...) social position of chronic patients between being governed by and being consumers of medicine, I will argue, can only be adequately understood if one involves, as Parsons did, the moral economy surrounding health and illness. (shrink)

Much academic work (in philosophy, economics, law, etc.), as well as common sense, assumes that ill health reduces well-being. It is bad for a person to become sick, injured, disabled, etc. Empirical research, however, shows that people living with health problems report surprisingly high levels of well-being - in some cases as high as the self-reported well-being of healthy people. In this chapter, I explore the relationship between health and well-being. I argue that although we have (...) good reason to believe that health problems causing pain and death typically do reduce well-being, health problems that limit capabilities probably don't reduce well-being nearly as much as most people suppose. I then briefly explore the consequences of this conclusion for political philosophy and ethics. If many health problems don't significantly reduce well-being, why should governments go to great expense to prevent or treat them? Why should parents be obliged to ensure the health of their children? (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)