Background:Many frail older persons who die in Swedish nursing homes need assisted bodily care. They must surrender their bodies to the authority of assistant nurses, which may affect their autonomy and dignity of identity. While assistant nurses claim to support older persons’ wishes, older persons claim they have to adapt to assistant nurses' routines. The provider–receiver incongruence revealed here warrants investigation.Aim:To describe the elements of assisted bodily care, as performed in a nursing home.Research design:Data were collected (...) through thirty-nine observations of assisted bodily care, analyzed with qualitative content analysis.Participants and research context:Seventeen older persons and twenty-two assistant nurses from a Swedish nursing home.Ethical considerations:The research was conducted in line with the Declaration of Helsinki, further approved by the regional ethics committee.Findings:Findings show that assisted bodily care consists of assistant nurses’ practical work, performed at a high tempo. Assistant nurses still attempt to adapt this work to the older persons’ wishes for self-determination, taking into account their day-to-day state of health. In spite of time pressure and occasional interruptions, there is room for consideration and affection in assisted bodily care.Discussion:Assistant nurses try to promote older persons’ dignity of identity, but sometimes fail, possibly due to lack of time. They nevertheless seem to know the older persons well enough to adapt the assisted bodily care according to their preferences and to support self-determination. This indicates that openness to older persons’ lifeworlds may be more important than the amount of time available.Conclusion:Nursing home contexts might benefit from adopting a person-centered palliative care perspective, highlighting the value of relationships and shared decision-making. If so, older persons and assisted nurses could agree on practices and goals in assisted bodily care beforehand. Such routines may be time-saving and beneficial to all. (shrink)

Pain is unpleasant. It is something that one avoids as much as possible. One might then claim that one wants to avoid pain because one cares about one's body. On this view, individuals who do not experience pain as unpleasant and to be avoided, like patients with pain asymbolia, do not care about their body. This conception of pain has been recently defended by Bain [2014] and Klein [forthcoming]. In their view, one needs to care about one's body (...) for pain to have motivational force. But does one need to care about one's body qua one's own? Or does one merely need to care about the body that happens to be one's own? In this paper, I will consider various interpretations of the notion of bodily care, in light of a series of pathological cases in which patients report pain in a body part that they do not experience as their own. These cases are problematic if one adopts a first-personal interpretation of bodily care, according to which pain requires one to care about what is represented as one's own body. Th.. (shrink)

Since 2008, in Flanders, we organize immersion sessions in a simulated context with the aim of stimulating student nurses and health professionals to learn virtuous caring. In this contribution, we first outline the purpose of this experiential learning: the cultivation of moral character. We come to the core of what we mean by moral character for care. We refer to Joan Tronto and Stan van Hooft to claim that caring is central to all aspects of nursing practice and is (...) the basis of its moral quality. We also stipulate that caring involves the integration of action with emotions, motivations, and knowledge. Second, we briefly explain how the immersion sessions in the care ethics lab take place and, in particular, reflect on what it yields in terms of experiences for the participants who take on the role of simulant patients in this experiential learning process. We focus on the significant role contrast experiences play in these experiences. Especially the negative contrast experiences do not wear off easily; care professionals remember even long after the immersion session and continue to carry them with them as a “corporeal built-in alarm.” Third, we discuss the role of contrast experiences in cultivating moral character for care. In particular, we explore the role of the body in the kind of knowing it cultivates and, by extension, its role in cultivating virtuous caring. By referring to specific philosophical ideas of Gabriël Marcel, Hans Jonas and Emmanuel Levinas, we try to understand how contrast experiences bring about an integration of virtuous action into knowledge, motivation, and emotion. We conclude that we need more space for contrast experiences in cultivating moral character. More attention should be paid to the role of the body in this learning process. (shrink)

What are the ethics of child genital cutting? In a recent issue of the journal, Duivenbode and Padela (2019) called for a renewed discussion of this question. Noting that modern health care systems...

The Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization plunged the United States into a devastating public health crisis. While we have some evidence of the deep harms that ab...

Frédérique de Vignemont argues on the basis of several empirical counterexamples that Bain and Klein are wrong about the relationship between pain and bodily care. I argue that the force of the putative counterexamples is weak. Properly understood, the association between pain and care is preserved in a way that is consistent with both de Vignemont's own views and the empirical facts.

Whereas caring is commonly perceived as a moral virtue or a socially beneficial ethical practice, resentment appears to represent its opposite. Advocates of care ethics have vehemently criticized the abstract and aloof nature of traditional ethical theories and argue that care ethics offers a perspective from which we may appreciate interpersonal sensitivity and responsiveness to individuals, per se. Following in the philosophical tradition of Nietzsche and Scheler, resentment—taken as the emotional state of lingering animosity towards individuals, combined with (...) the inclination to withhold assistance and abstain from caring—is often identified as an unjustified and unethical disposition. The paper aims to challenge this perspective and support the moral and historical validity of resentment in specific situations. It thereby recalls a social historical dimension to the often merely physiologically and individually dominated discourse about aging. Drawing on Jean Améry’s seminal account, I suggest viewing resentment as an attitude that asserts the authority to reevaluate the historical situation and to challenge the primacy of immediate needs (the here-and-now of a person in need of care). From this perspective, resentment too displays sensitivity to individuals and their life stories, yet it invokes a sense of justice that exceeds the temporal framework of caring if restrained to bodily and physiological needs. To illustrate this argument, this paper recounts an incident in a nursing home in postwar Germany, in 1986. (shrink)

This paper explores the ambiguous notion of bodily integrity, focusing on male and female circumcision. In the empirical part of the study we describe and analyse the various meanings that are given to the notion of bodily integrity by people in their daily lives. In the philosophical part we distinguish (1) between a person-oriented and a body-oriented approach and (2) between four levels of interpretation, i.e. bodily integrity conceived of as a biological wholeness, an experiential wholeness, an (...) intact wholeness, and as an inviolable wholeness. We argue that bodily integrity is a prima facie principle in its own right, closely connected with, but still fundamentally different from, the principle of personal autonomy, that is, autonomy over the body. (shrink)

Children's autonomy includes, as far as possible, self-determination, bodily integrity and the right to influence outcomes. Limits to bodily integrity, which involves no touching without the child's consent or tacit agreement, are discussed. The clinical, legal and ethics literature tends to agree that children may give valid consent to major recommended treatment from around 12 years but may not refuse it until they are legal adults. Research shows that young children are more aware of their bodily integrity (...) and autonomy, of morality and decision making, than was assumed in the past. Adults therefore need to inform children and respect their initially instinctive efforts to protect their bodily integrity. Unlike assent, consent involves patients being adequately informed and being able to accept or refuse proposed treatment. Reasons are given for adults’ need to consult with children when determining their best interests. Beyond words, giving or withholding consent also involves emotions of fear, trust and courage, besides embodied reactions of cooperating with treatment or resisting it, in which young children actively engage. Some clinicians work with the informed cooperation of young children who need lifesaving treatment, and at times accept their refusal. Reasons for differences between mainstream experts’ views and clinical practices are considered. (shrink)

As a form of functional diversity, spinal cord injury expressed by tetraplegia is one of the most serious events that can impact people, affecting their family and socioeconomic life. The type of care relationship established in these cases will be essential for preserving autonomy. The objective of this study was to understand how care relationships influence the autonomy of people with tetraplegia and the dynamics that trigger practices of autonomy violation, maintenance and promotion. This research is inspired by (...) problematization as a methodology using the Arch of Maguerez as an analytical approach strategy that enables an engagement between empirical and theoretical data. Some models of care relationships identified in this study either promote or violate autonomy: the protectionist model, based on the biomedical interpretation model of disability and the bodily impediments caused by spinal cord injury; the participatory model, involving the patient's interest in adapting to their new condition of family and community life, seeking to understand the practical aspects of daily life; the sharing model, in which the complicity and understanding of new forms of bodily expression allow the caregiver to be almost an extension of the tetraplegic person's body; the delegate model, which occurs in relationships with professional caregivers; and the emancipatory model, which seeks to empower the patient, highlight potentialities, and encourage autonomy. The key components of these conceptual care models guided the elaboration of hypotheses for intervention with the objective of maintaining and promoting the autonomy of people with tetraplegia through supported care. (shrink)

The degree of success in creating quality care for people suffering from dementia is limited despite extensive research. This article describes healthcare providers’ experience with the ethical challenges and possibilities in the relationship with patients suffering from dementia and its impact on quality care. The material is based on qualitative, in-depth individual narrative interviews with 12 professional healthcare providers from two different nursing homes. The transcribed interview texts were subjected to a phenomenological–hermeneutical interpretation. To provide quality care (...) to patients with dementia, the healthcare providers emphasized the importance of sensing and understanding the patients’ emotional and bodily expressions through sentient attentiveness and recognition of the patient as a person. They also described reciprocity of expressions in the relationship where the patient recognized them both as persons and healthcare providers. The analyses of the findings are, inter alia, discussed in light of Løgstrup’s relational philosophy of ethics. (shrink)

The degree of success in creating quality care for people suffering from dementia is limited despite extensive research. This article describes Healthcare providers’ experience with the ethical challenges and possibilities in the relationship with patients suffering from dementia and its impact on quality care. The material is based on qualitative, in-depth individual narrative interviews with 12 professional Healthcare providers from two different nursing homes. The transcribed interview texts were subjected to a phenomenological–hermeneutical interpretation. To provide quality care (...) to patients with dementia, the Healthcare providers emphasized the importance of sensing and understanding the patients’ emotional and bodily expressions through sentient attentiveness and recognition of the patient as a person. They also described reciprocity of expressions in the relationship where the patient recognized them both as persons and Healthcare providers. The analyses of the findings are, inter alia, discussed in light of Løgstrup’s relational philosophy of ethics. (shrink)

Background: Worldwide, older persons lack access to palliative care. In Sweden, many older persons die in nursing homes where care is provided foremost by assistant nurses. Due to a lack of beds, admission is seldom granted until the older persons have complex care needs and are already in a palliative phase when they move in. Objective: To describe assistant nurses’ perspectives of providing care to older persons at the end of life in a nursing home. Research (...) design: Data were collected in semi-structured individual interviews and analyzed with inductive qualitative content analysis. Participants and research context: Seven assistant nurses from a nursing home in Sweden were randomly selected. Ethical consideration: The research was approved by the local ethics committee. Results: Three main categories emerged; “Death a natural part of life”; “The older person’s well-being”; and “Care in the moment of death”; and seven sub-categories. The assistant nurses described themselves as knowing the older persons well enough to provide good end-of-life care. This was achieved by making small-talk while providing daily care. Relying on experience-based knowledge, they strove to provide end-of-life care built upon respect and engagement with the ambition to strengthen older persons’ dignity, for example, by lowering the tempo of care at the end of life, in spite of organizational restrictions. Discussion: The assistant nurses offered attentive end-of-life care, focusing upon bodily care. The existential needs of the older persons were not foregrounded. Conclusion: To develop their work, and to promote an ethical foundation for such care, assistant nurses might need support and education to be able to offer a care more in line with the aims of palliative care. Furthermore, the organization of care needs to promote, not impede, the realization of this development. (shrink)

Over the last fifty years a plethora of new spiritual practices has emerged in the Church of Sweden. Many fall within a category of holistic practices, aimed at engaging body, soul, and spirit. Among these, two categories are dominant: meditations and movement-based bodily practices. Some of these practices are contested by other Christians on a theological basis. The article asks: Who are the new ritual specialists teaching these practices? Why do they teach these practices? Why in the church? By (...) using a bottom-up perspective and studying practices which lie outside the traditional Christian religious rites, which has been the focus in research on the Church of Sweden, we find that the holistic practices are framed in a culture of care, focusing on bodily and spiritual wellbeing. We suggest that the predominance of women in body-movement practices should be understood as a generational feature rather than as an expression of the feminization of the church. Many of the leaders are women who were part of new spiritual movements as well as body-mind practices and various forms of dance in gyms and yoga studios in the 1990s and early 2000s, finding an openness to bringing their knowledge into the church. (shrink)

In this paper, I will provide a phenomenological analysis of somatic obsessions at times present in obsessive–compulsive disorder. I will compare two different types of bodily obsessions, which have a different neurological-physiological underpinning: anguishing awareness of one’s own heartbeat and of one’s own breathing. In addition, I will contrast these two with how one experiences one’s own liver. I will use the concepts "tactility obsessions” and "motility obsessions”, which I have coined for the purpose of this comparison. In other (...) words, these are obsessions concerning the felt sense of one’s autonomous organs and obsessions concerning one’s ability to voluntarily move. Ultimately, I claim that the core lived experience in somatic obsessive–compulsive disorder should not only be understood as having to do with intruding and "distorted thoughts” concerning bodily processes, but could also be understood as having to do with a felt sense of our organs interrupting and intruding our daily lives. (shrink)

This article suggests that one means for empathetically and imaginatively engaging the intersectional differences of otherness to find commonality while still honoring, recognizing, and celebrating those differences is found in the notion of embodied care—the framing of feminist care ethics in terms of its physical elements. Because embodiment remains a common denominator among humans despite the strength of intersectional differences, the body is an important means of connectivity and thus a basis for at least partial understanding between embodied (...) beings. However, this is a humble commonality born out of responsiveness and listening because the body is also the site of inscribed differences. Authentic care is always responsive and thus respectful of the one cared for. Framing care as performed bodily actions is an effort to capture a corporal basis for morality that has the potential to help us negotiate powerful narratives of socially constructed otherness in order to engage identity-based injustice without silencing the voices and experiences of difference and dissent. Care is described as a performance of the body/self, and how such performances of the body can spark understanding across intersectional differences. The article suggests dramaturgical exercises for developing skills of caring for unfamiliar others. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Bodily Arts: Rhetoric and Athletics in Ancient GreeceMindy FenskeBodily Arts: Rhetoric and Athletics in Ancient Greece by Debra Hawhee. Austin: University of Texas Press, 2004. Pp. xiv + 226. $40.00, hardcover.In Bodily Arts, Debra Hawhee constructs an often compelling, always interesting case for the conceptual and material linkages between the ancient arts of rhetoric and athletics. In so doing, Hawhee also highlights the integral role of (...) the musical arts to rhetorical and athletic training. Throughout the book, Hawhee weaves together close readings of multiple texts (poetry, oratory, sculpture, painting, architecture) in order to illuminate the intricate “network of overlapping practices” that connect the bodies of rhetoric, athletes, and musicians in Ancient Greece. To this reader, the central strengths of the study are methodological as well as conceptual. In terms of method, Hawhee carefully and with studied finesse integrates close readings of visual, spatial, and verbal texts and practices. In the wrong hands, this type of endeavor can easily appear as the worst kind of pastiche. Not so in this case where Hawhee manages the textual interpretation with deft expertise. Conceptually, the central premise that rhetoric was a practice that was fully embodied and, most importantly, that embodiment was not in a hierarchical relation to reason, rationality, and the mind is provocative. Hawhee argues that the relations of mind-body in Ancient Greek culture were understood as a complex interlocking system that, when trained through physical practices emphasizing rhythm, repetition, and response (to/with an encounter), resulted in the possible transformation of the very nature of the self. [End Page 197]In the process of constructing the argument for the connections between rhetorical and athletic training and performance, Bodily Arts moves through three phases. The Introduction and first three chapters lay the theoretical groundwork for the second phase: the introduction of the concept of phusiopoieses in Chapter 4. Chapters 5–7 then discuss the actual rhetorical and athletic spaces, practices, and bodies of and in phusiopoiesis.The introduction opens with description of a first-century BC bronze statue of an “Antikythera Youth” (3). Hawhee uses the mystery surrounding the identity of the figure (deciphered largely through interpretations of the actions implied by the stature of the statue) to articulate the connections between the body of the rhetor and the body of the athlete as well as to introduce the importance of the body to Greek values of hexis (comportment) and aretē (virtuosity). The Introduction also presents three critical relations that serve both as conceptual departure points as well as hail the multiple audiences of the book: relations of body and mind, learning and performing, and classical studies and rhetorical studies. Hawhee’s perspective is quite straightforwardly that rhetoric is an art that required physical training and physical performance.Chapter 1, “Contesting Virtuosity: Agonism and the Production of Aretē,” connects the values of agon and aretē and argues that the “very logic for linking rhetoric and athletics” lies at the heart of this relation (22). Hawhee argues that agon and aretē are less about ends (victory and virtue) and more centrally concerned with embodied processes. Agon, through Hawhee’s reading of Hesiod’s Work and Days, is articulated as a mode of encounter that produces a particular, and possibly transformative, response. Aretē is the bodily performance of virtuosity. Central to this performance, according to Hawhee’s interpretation of the Olympic ethos through Pindar’s poetry, is the activity of questing. Aretē is demonstrated rather than simply won or attained. Following these definitions of agon and aretē, the chapter moves to illustrating the shared language of rhetoric and athletics in terms of these values. Hawhee argues that this shared vocabulary confirms that sophistic rhetoric was understood and practiced as an embodied and agonistic art “fused and infused” with athletics (43).In Chapter 2, “Sophistic Mētis : An Intelligence of the Body,” Hawhee describes mētis as cunning and somatic becoming that “infuses the arts of rhetoric and athletics with a kind of bodily intelligence... not an explicit set of precepts but rather a tacit style of movement running through most kinds of actions, including thought” (47). Moreover, the movement of mētis [End Page 198] is corporeal. It... (shrink)

Through an original combination of phenomenology and psychoanalysis, Ingerslev and Legrand argue convincingly for a complex theoretical framework for making sense of bodily symptoms in psychopathology. The argument is particularly interesting because it manages to show how the theoretical efforts to arrive at a better understanding of bodily symptoms are connected closely with the ethical demand involved in the dialogical situation of therapy. The framework thus operates on two interconnected levels, on the one hand ensuring a more careful (...) clinical differentiation of bodily symptoms and, on the other, encouraging the clinician to adopt a responsive stance that allows for those symptoms to be recognized as... (shrink)

Public debate about who or what is to blame for the rising rates of obesity and overweight shifts between two extreme opinions. The first posits overweight as the result of a lack of individual will, the second as the outcome of bodily drives, potentially triggered by the environment. Even though apparently clashing, these positions are in fact two faces of the same liberal coin. When combined, drives figure as a complication on the road to health, while a strong will (...) should be able to counter obesity. Either way, the body’s propensity to eat is to be put under control. Drawing on fieldwork in several obesity clinics and prevention sites in the Netherlands, this paper first traces how this ‘logic of control’ presents itself in clinical practices targeted at overweight people, and then goes on to explore how these practices move beyond that logic. Using the concepts of ‘will’ and ‘drives’ as analytical tools, I sketch several modes of ordering reality in which bodies, subjects, food and the environment are configured in different ways. In this way it appears that in clinical practices the terms found in public discourse take on different meanings and may even lose all relevance. The analysis reveals a richness of practiced ideals. The paper argues, finally, that making visible these alternative modes of ordering opens up a space for normative engagements with obesity care that move beyond the logic of control and its critiques. (shrink)

The demand for bodily parts such as organs is increasing, and individuals in certain circumstances are responding by offering parts of their bodies for sale. Is there anything wrong in this? Kant had arguments to suggest that there is, namely that we have duties towards our own bodies, among which is the duty not to sell parts of them. Kant's reasons for holding this view are examined, and found to depend on a notion of what is intrinsically degrading. Rom (...) Harré's recent revision of Kant's argument, in terms of an obligation to preserve the body's organic integrity, is considered. Harré's view does not rule out all acts of selling, but he too ultimately depends on a test of what is intrinsically degrading. Both his view and Kant's are rejected in favour of a view which argues that it does make sense to speak of duties towards our own bodies, grounded in the duty to promote the flourishing of human beings, including ourselves. This provides a reason for opposing the sale of bodily parts, and the current trend towards the market ethic in health care provision. (shrink)

In medical care, the obtaining of informed consent is taken to be required prior to treatment in order to ensure that patients sufficiently understand the potential risks and benefits of a given medical procedure. In this paper, I begin by looking at the history of informed consent and consider how the norms and laws in medicine have evolved away from benevolent paternalism and toward a blanket obligation to obtain informed consent. In so doing, I consider what values might be (...) taken to underpin such a requirement. After dismissing some unsatisfactory answers, I offer a positive view as to the constellation of values I think informed consent ought to be protecting. I call these bodily self-sovereignty, which I take to be a coupling of two groups of values: autonomy and non-domination on the one hand, and self-ownership and personal integrity on the other. Given the connection between autonomy and responsibility, autonomy is both required for the act of consenting, and respected by allowing it. And, because of our special and inescapable relationship to our own bodies, this authorization is particularly important when our bodies are involved. So, I suggest that informed consent protects our self-sovereignty over our own bodies. (shrink)

Nurses working in forensic psychiatric settings face unique challenges in practice, where they take on a dual role of custody and caring. Patient resistance is widespread within these restrictive settings and can take many forms. Perhaps the most disturbing form of resistance entails a patient's weaponization of their bodily fluids, with nurses as their target. The tendency in assigning motive for this act is to relegate to the psychopathology of the patient. This paper will adopt a poststructuralist perspective to (...) reexamine this phenomenon as an act of resistance through the lens of Kristeva's concept of abjection. Patients confined in these settings have little sense of control, and in resistance may resort to the only thing available: their bodily fluids. By weaponizing the abject, patients actively violate and permeate the physical and psychological boundaries of nurses—the very boundaries considered crucial to safe and professional forensic psychiatric nursing practice. By recognizing this phenomenon as an act of resistance to confinement and loss of control, nurses may reorient their approach to care in forensic psychiatric settings. (shrink)

Practically every development in medicine in the post–World War II period distanced the physician and the hospital from the patient and the community, disrupting personal connections and severing bonds of trust. We need an ethics that include bodily mediated knowledge as a complement to intellectual knowledge. Care is a challenging concept to explore, in part because it is employed widely and often without thoughtful parsing. Moreover, it has gained increasing significance in ethical discourse.1 Since the 1980s, feminist theorists (...) have used the term care ethics to describe a relational approach to morality that does not rely on rubrics of adjudication such as rules or consequences. The.. (shrink)

In this article, we sought reconciliation between the “body‐as‐representation” and the “body‐as‐experience,” that is, how the body is represented in discourse and how the body of older people with cognitive impairment is experienced. We identified four contemporary “technologies” and gave examples of these to show how they influence how older people with cognitive impairment are often represented in acute care settings. We argued that these technologies may be mediated further by discourses of ageism and ableism which can potentiate either (...) the repressive or productive tendencies of these technologies resulting in either positive or negative care experiences for the older person and/or their carer, including nurses. We then provided examples from research of embodied experiences of older people with dementia and of how nurses and other professionals utilized their inter‐bodily experiences to inform acts of caring. The specificity and individuality of these experiences were more conducive to positive care experiences. We conclude the article by proposing that the act of caring is one way nurses seek to reconcile the “body‐as‐representation” with the “body‐as‐experience” to mitigate the repressive effects of negative ageism and ableism. The act of caring, we argue, is the essence of caring enacted through the provision of person‐centred care which evokes nurses to respond appropriately to the older person's “otherness,” their “variation of being” while enabling them to enact a continuation of themselves and their own version of normality. (shrink)

A contribution to the Common Knowledge symposium “Caroline Walker Bynum across the Disciplines,” this essay explores the side of Bynum's scholarly personality that may be regarded as comparativist. She is interested in comparison with regard to periods of time, with regard to ritual and gender-based religious practices in the Christian West, and with respect to similarities that might be claimed between elements of Christian and non-Christian cultures. Her thoughts about morphology, materiality, and gender extend beyond medieval Europe to the world (...) at large. Her coedited volume Gender and Religion (1986), the first of its kind, has figured importantly in the development of the field many call comparative religion. Here Bynum's impact on selected scholars of Buddhist, Hindu, Muslim, and Sikh religion — as well as of non-Western Christianity — is assessed. This essay concludes with the text of a response delivered by the author, who is a scholar of Hinduism, to Bynum's Lionel Trilling Lecture at Columbia University, “Am I My Body? Medieval Theories of Bodily Resurrection and Some Modern Implications” (1991). (shrink)

This article brings Catherine Malabou’s philosophy of the plasticity of biological life into dialogue with Anne Dufourmantelle’s concept of gentleness, theorizing gentle biologies at the intersections of both thinkers. It explores how, for both Malabou and Dufourmantelle, gentleness is not an innately occurring power or characteristic predetermined within biological life, but rather a force that must be plastically shaped, honed, practised. Further, if Dufourmantelle argues in Power of Gentleness (2018 [2013]) that gentleness can constitute a formidable resource for both transformation (...) and resistance, this gentleness will be seen to resonate with conceptualizations of plasticity across Malabou’s oeuvre as a similarly revolutionary potentiality. The article finishes by turning to engage with interdisciplinary work on gentleness in healthcare, arguing that such contexts constitute sites in which new modes of care towards Malabou’s and Dufourmantelle’s gentle biologies can be imagined. (shrink)

Substance addiction has been historically conceived and widely researched as a brain disease. There have been ample criticisms of brain-centred approaches to addiction, and this paper aims to align with one such criticism by applying insights from phenomenology of psychiatry. More precisely, this work will apply Merleau-Ponty’s insightful distinction between the biological and lived body. In this light, the disease model emerges as an incomplete account of substance addiction because it captures only its biological aspects. When considering addiction as a (...) brain disorder, it will be shown that research fails to account for the contextual, functional, and emotional aspects inherent to subjective health. It is concluded that, while the disease model is fundamental to our understanding of what happens in the brain, its brain-centred approach is cure-oriented. Instead, we suggest a care-orientated approach, which understands and treats the psychological feel as bodily experience situated in an environment, allowing for a more encompassing therapeutic perspective. (shrink)

In this paper, I discuss the role of care and competence, as well as their relationship to one another, in contemporary medical practice. I distinguish between two types of care. The first type, care1, represents a natural concern that motivates physicians to help or to act on the behalf of patients, i.e. to care about them. However, this care cannot guarantee the correct technical or right ethical action of physicians to meet the bodily and existential (...) needs of patients, i.e. to take care of them—care2. To that end, physicians must be competent in the practice of medicine both as evidence—based science (technical competence) and as patient—centered art (ethical competence). Only then, I argue, can physicians take care of (care2) patients’ bodily and existential needs in a compassionate and comprehensive manner. Importantly, although care1 precedes competence, competence—both technical and ethical—is required for genuine care2, which in turn reinforces an authentic care1. I utilize the play Wit, especially the character Jason Posner, and Francis Peabody’s exposition on caring for patients, to illustrate the role of care and competence in contemporary medical practice. (shrink)

In this paper, I explore the meaning of bodily integrity in disfiguring breast cancer. Bodily integrity is a normative principle precisely because it does not simply refer to actual physical or functional intactness. It rather indicates what should be regarded and respected as inviolable in vulnerable and damageable bodies. I will argue that this normative inviolability or wholeness can be based upon a person's embodied experience of wholeness. This phenomenological stance differs from the liberal view that identifies respect (...) for integrity with respect for autonomy (resulting in an invalidation of bodily integrity's proper normative meaning), as well as from the view that bodily integrity is based upon ideologies of wholeness (which runs the risk of being disadvantageous to women). I propose that bodily integrity involves a process of identification between the experience of one's body as “Leib” and the experience of one's body as “Körper.” If identification fails or is not possible, one's integrity is threatened. This idea of bodily integrity can support breast cancer patients and survivors in making decisions about possible corrective interventions. To implement this idea in oncology care, empirical-phenomenological research needs to establish how breast cancer patients express their embodied self-experiences. (shrink)

This article addresses the embodied nature of laboratory human—animal practices in order to understand the notions of care that take place within an institution of domination — the apparatus of animal experimentation. How is it possible to both love and harm in this context? Building on animal studies and feminist ethics, the theme of emotionality is explored in the section ‘loving animals’. Here it is demonstrated that empathy and affection for individual animals, as well as species, are strong components (...) of an experimental ethos expressed by the informants. The second empirical section deals with the issue of ‘killing well’. The good kill is supposed to be done with care: quickly and compassionately. This is performed by way of bodily measures of care, technological refinement and personal skills and, sometimes, with the help of a division of labour. In the concluding section, the empirical findings are read through the framework, where the feminist theoretical analysis of love, dependency and care from an embodiment perspective understands the dialectics of instrumentalisation and exploitation of — and care for — animals, not as something that goes on above or outside of relations, but rather as something that can be understood from within. ‘Mortal love’ is the attempt to capture and theorise this dialectic, arguing that emotions of love and friendship are not mere justifications for the harm and killing performed, but rather intrinsic dimensions of the embodied animaling of experimental human—animal relations. (shrink)

Background:Dignity is an important ideal in the nursing of older women who need municipal care. Dignity can be challenged when health is impaired by feeling grief and suffering associated with bodily changes and impaired functions. Aim and research questions:The study aimed to deepen the understanding of the meaning of dignity in the life of fragile older women who daily needed help from municipal care service. The research questions are: What is older women’s experience of dignity, and what (...) is it not to be met with dignity when needing service from municipality care? Research design: The study has a qualitative design, and the methodology is based on Gadamer’s ontological hermeneutics. Ten women receiving municipal care, aged from 66 to 91 were interviewed in their home environments. Kvale and Brinkmanns’ three levels of interpretation were applied in the analysis of the interviews: self-understanding, a critical understanding based on common sense, and theoretical understanding. Ethical considerations: The study follows the guidelines for good scientific practice according to the Declaration of Helsinki and was approved by the Norwegian Centre for Research Data. Results: The interviews revealed fragments of the women’s unique life history. Two themes emerged from the interpretation: Confirming encounters provide human dignity; and Not being confirmed as a human being violates human dignity. Conclusions:For the women, dignity is about feeling seen and understood by the individual nurse and this takes place both in conversation and in bodily care. Not being seen or confirmed gives rise to suffering. The reason for this seems to be lack of competence on the part of the staff or little continuity. (shrink)

This paper outlines Jesse Prinz’s theory that emotions represent values by registering bodily changes, discusses two objections, and concludes that Prinz’s theory stands in need of modification: while emotions do represent values, they do not do so in the first place by registering bodily changes, but by processing information about how things we care about fare in the world. The function of bodily changes is primarily to motivate and prepare us for action.

The bioethical principle of respect for a person’s bodily autonomy is central to biomedical and healthcare ethics. In this article, we argue that this concept of autonomy is often annulled in the maternity field, due to the maternal two-in-one body (and the obstetric focus on the foetus over the woman) and the history of medical paternalism in Western medicine and obstetrics. The principle of respect for autonomy has therefore become largely rhetorical, yet can hide all manner of unethical practice. (...) We propose that large institutions that prioritize a midwife–institution relationship over a midwife–woman relationship are in themselves unethical and inimical to the midwifery philosophy of care. We suggest that a focus on care ethics has the potential to remedy these problems, by making power relationships visible and by prioritizing the relationship above abstract ethical principles. (shrink)

This comment on the case presented in ‘Cholera and Nothing More’ argues that the physicians at this public-health centre did not have an ordinary clinician's obligations to promote the health of the people who came to them for care, as they were instead set up to serve a laudable and urgent public-health goal, namely, controlling a cholera outbreak. It argues that, nonetheless, these physicians did have some limited moral duties to care for other diseases they encountered—some ancillary-care (...) duties—arising from their voluntarily entering into a kind of intimate relationship with the patients they took in, one in which those patients effectively waive certain rights to bodily and medical privacy. (shrink)

Paper-based stool records are used in public and private residential homes throughout Denmark. Although they represent a simple technology, they are an important tool in ensuring proper personal hygiene for residents. This article shows how the use of stool records involves both scientific and everyday forms of knowledge. While the activity of keeping stool records derives its legitimation from the scientific study of feces, those who work with the stool records on a daily basis have found some very different applications (...) for the technology. These applications foster a variety of understandings of stool records in residential homes. Is it their aim to help satisfy biological needs? Is it to ensure control? Is it to ensure individual freedom? Is it to ensure efficiency? Is it to display professionalism? Is it to maintain order in the everyday operation of the residential home? To explore the answers to these questions, the article introduces insight from the work of the German sociologist Niklas Luhmann that bear upon how a mundane technology like stool records can function as a mediator between theory and practice, the body and the social, and between different care tasks in residential homes. (shrink)

This qualitative study examined hospital nurses’ methods in handling meal and nutrition care during inpatient time, with an underlying focus on undernourished older adult. Observations and interviews were used to document nurses’ methods through the span of a transition (defined by an entry, passage, and exit). The study finds inconsistencies in care methods due to institutional processes restricting both mealtime care and nutritional logging of information throughout hospitalization. It is concluded that the consequences of these inconsistencies must (...) be recognized and that new approaches to meals and nutritional care should be introduced in order to provide greater flexibility. Based on the assumption that mobilizing patient resources is pivotal for meal and nutritional care, it is argued that it may be important to mobilize patient resources during mealtime and in nutritional logging of information in order to increase the visibility of meal and nutritional care in patient transitions within the institution and across settings. Both nurses’ methods and institutions developmental initiatives regarding meal and nutritional care need to accommodate the differences between what in this paper is defined as social‐bodily care and text‐based care. This could be met through care methods that take place with, more than for the patient. (shrink)

The state of the art of contemporary philosophy and psychiatry is reviewed. Section 1 describes the new field as an international open society of ideas. Section 2 introduces values-based practice. Although originally a philosophy-into-practice initiative, values-based practice is now developing more strongly in areas of bodily medicine such as surgery. An example from surgery illustrates how values-based practice has been implemented as a partner to evidence-based practice in supporting shared clinical decision-making as the basis of best practice in contemporary (...) person-centered clinical care. Section 3 explores the difficulties presented by implementing values-based practice in mental health as illustrated by a case example of anorexia. This shows that these difficulties derive from the particularly intense challenges of values pluralism presented by anorexia. The resources of phenomenology provide the basis for an effective response to these challenges. Section 4 generalizes the argument of Section 3 showing that an effective response to the wider range of challenges of values pluralism arising across the board in mental health is available from the resources of the international open society of ideas of contemporary philosophy and psychiatry. The article concludes with a promissory note on values and a cautionary note on science. (shrink)

This book focuses on yoga’s transcultural dissemination in the twentieth and twenty-first centuries. In the course of this process, the term “yoga” has been associated with various distinctive blends of mental and physical exercises performed in order to achieve some sort of improvement, whether understood in terms of esotericism, fitness, self-actualization, body aesthetics, or health care. The essays in this volume explore some of the turning points in yoga’s historico-spatial evolution and their relevance to its current appeal. The authors (...) focus on central motivations, sites, and agents in the spread of posture-based yoga as well as on its successive (re-)interpretation and diversification, addressing questions such as: Why has yoga taken its various forms? How do time and place influence its meanings, social roles, and associated experiences? How does the transfer into new settings affect the ways in which yogic practice has been conceptualized as a system, and on what basis is it still identified as (Indian) yoga? The initial section of the volume concentrates on the re-evaluation of yoga in Indian and Western settings in the first half of the twentieth century. The following chapters link global discourses to particular local settings and explore meaning production at the micro-social level, taking Germany as the focal site. The final part of the book focuses on yoga advertising and consumption across national, social, and discursive boundaries, taking a closer look at transnational and deterritorialized yoga markets, as well as at various classes of mobile yoga practitioners. (shrink)

The aim of this article is to explore nuances within the field of bodily self-awareness. My starting-point is phenomenological. I focus on how the subject experiences her or his body, i.e. how the body stands forth to the subject. I build on the phenomenologist Drew Leder’s distinction between bodily dis-appearance and dys-appearance. In bodily dis-appearance, I am only prereflectively aware of my body. My body is not a thematic object of my experience. Bodily dys-appearance takes place (...) when the body appears to me as “ill” or “bad.” This is often the case when I experience pain or illness. Here, I will examine three versions of bodily dys-appearance. Whereas many phenomenological studies have explored cases of bodily dys-appearance, few studies have focused on the opposite of bodily dys-appearance, i.e. on bodily modes of being where the body appears to the subject as something good, easy or well. This is done in this article. When the body stands forth as good, easy or well to the subject, I suggest that the body eu-appears to this person. The analysis of eu-appearance shows that the subject can attend to her or his body as something positive and that this attention need not result in discomfort or alienation. Eu-appearance can take place in physical exercise, in sexual pleasure and in some cases of wanted pregnancies. I also discuss, briefly, the case of masochism. (shrink)

This dissertation investigates the metaphysics of human body parts; particularly, the epistemic conditions under which something can be said to be a “body part of” some particular human being. In this dissertation I draw on the hylomorphism of Aristotle and John Duns Scotus to argue that a necessary and sufficient condition on human bodily parthood is an object’s functioning for the sake of the whole human being and the maintenance of her biological life. I argue that, on this view (...) of bodily parthood, at least some prostheses or artificial organs are truly body parts of the human beings in whom they operate. I defend this view in reference to both Aristotelian and Scotistic hylomorphism, as well as answering objections raised by some contemporary views of bodily parthood as merely conventional. I argue that this has important implications for medical ethics, including potentially restricting medical interventions in end-of-life care and heightening the legal ramification of damage done to prostheses. I argue that investigation into the metaphysical questions surrounding body parts and their composition can illuminate hitherto underappreciated dimensions of ethical questions in medicine. (shrink)

This article presents the results of a study concerning the impact of physical changes accompanying female puberty. It examines the meanings these changes have for the girls themselves, as well as for their mothers and fathers. The hypothesis, essentially rooted in psychoanalytical theory, is that the reactions of mothers and fathers to the bodily changes of their daughter communicate messages about these changes that, in turn, impact on the girl’s perception and experience of her body. These messages are influenced (...) by the often unconscious desires, fantasies and fears of the adults as well as by societal gender images. Depending on how adult care providers confront the psychic issues raised by their daughter’s adolescence and, in turn, how they interact with their daughter during her transition to adulthood, these psychic events may either serve to perpetuate societal gender images or offer a means of revising them. (shrink)

The long-standing debate between cognitive and feeling theories of emotion stems, in part, from the assumption that cognition and thought are abstract, intellectual, disembodied processes, and that bodily feelings are non-intentional and have no representational content. Working with this assumption has led many emotions theorists to neglect the way in which emotions are simultaneously bodily and cognitive-evaluative. Even hybrid theories, such as those set forth by Prinz and Barlassina and Newen, fail to account fully for how the cognitive (...) and bodily elements of emotion are integrated. As a result, such accounts are unable to provide an adequate characterization of the intentionality or phenomenology of emotions. I will argue that an enactive account of emotions, one which characterizes them as a way of engaging with and making sense of one’s surroundings, can help us to overcome this false dichotomy between cognitive and body elements. What I call ‘ affective framing’ is at the core of emotional experience. It is the way in which we engage with and appraise our surroundings in and through bodily feelings of caring, so that the bodily and cognitive elements of emotion necessarily are fused. The notion of affective framing not only helps to clarify the relationship between bodily and cognitive elements of emotion, but also offers a useful way to make sense of both the intentional directedness and phenomenal character of emotional experience. (shrink)

An episiotomy is ‘an intrapartum procedure that involves an incision to enlarge the vaginal orifice,’1 and is primarily justified as a way to prevent higher degrees of perineal trauma or to facilitate a faster birth in cases of suspected fetal distress. Yet the effectiveness of episiotomies is controversial, and many professional bodies recommend against the routine use of episiotomies. In any case, unconsented episiotomies are alarmingly common, and some care providers in obstetric settings often fail to see consent as (...) necessary in context. In their article, ‘The ethics of consent during labour and birth: episiotomies,’ van der Pijl et al reiterate that consent is necessary for episiotomies. They specify, further, that the antenatal period is crucial for exchanging information, establishing trust between the birthing subject and provider, and exploring the birthing subject’s—rather than the care provider’s—values and preferences regarding episiotomies. They recommend an individualised approach, which would enable birthing subjects to choose how and when they want to give consent. I applaud van der Pijl et al on their practicable recommendations regarding consent for episiotomies. This is certainly a step in the right direction where respect for birthing subjects’ bodily autonomy and integrity is concerned. Still, we must be reminded that consent alone is not coextensive with autonomy. The conditions for securing informed consent in healthcare does not guarantee that one’s decision is truly reflective of their values. After all, even valid consent does not rule out ‘normatively significant external influence’.2 Consent acquisition for obstetric procedures present no …. (shrink)

This study explores the pivotal role of the body for political recognition and rights claims in child welfare “moral” interventions. I examine how the bodily figures in child welfare assessments, linking these manifestations to the concept of the moral economy of care. A sample of assessment reports from a Swedish municipality, all addressing violations of children’s bodies or integrity, are used as empirical material. I show how the psychosomatically suffering child is being best “heard” as vulnerable. I also (...) argue that such a moral economy of care silences children’s accounts of gendered and racial injustices. Furthermore, racialized moral divides are indicated when assessments of different child bodies are considered. A concluding remark points to a need for a child welfare moral economy of social justice that responds to structural intersecting injustices in childhoods, including to those of a racialized child welfare and its individualized and symptom-oriented services. (shrink)

It is widely accepted that children enjoy some form of a right to bodily integrity. However, there is little agreement about the precise nature and scope of this right. This paper offers a conceptual analysis of the child's right to bodily integrity, in order to further elucidate the relationship between the child's right to bodily integrity and considerations of autonomy. Following a discussion of Leif Wenar's work on the structure and justification of rights, I first explain how (...) the adult's right to bodily integrity can be distilled into separate elements that may plausibly be justified by different moral considerations. In particular, I claim that this analysis suggests that whilst the adult's right to bodily integrity is not wholly reducible to bodily autonomy, autonomy nonetheless remains entwined with our understanding of this right in a number of ways. On the basis of this discussion, I go on to outline three important complexities that arise when we consider the child's right to bodily integrity, before particularly focusing on the question of how third parties should determine whether or not to perform a physical interference upon a child who lacks decision-making capacity. Here, I raise some objections to Earp and Mazor's recent attempts to answer this question, before briefly defending an ‘autonomy-based interests’ account of permissible interference, an account that shares in what I take to be the spirit, if not the precise letter, of these earlier views. (shrink)

This book proposes an alternative to the consent model which is currently at the heart of patient self-determination and which is shown here to have fundamental flaws that constrain its effectiveness. The proposed model is a property model in which the patient’s bodily integrity is protected from unauthorised invasion, and their legitimate expectation to be provided with the relevant information to make an informed decision is taken to be a proprietary right. This model enables the courts to overcome the (...) requirement to prove causation in consent cases and offers a complementary approach to patient self-determination. (shrink)

The traditional Christian version of the Golden Rule, some modern philosophical reformulations, and the Confucian version are compared. It is argued that the Confucian version, in contrast with its Western parallels, is based on shu as bodily or somatic interpersonal care and love, and thus should be understood first of all as a human "way" rather than as a divine rule, a way grounded in the human heart and a way for the human community.

"There are books—few and far between—which carefully, delightfully, and genuinely turn your head inside out. This is one of them. It ranges over some central issues in Western philosophy and begins the long overdue job of giving us a radically new account of meaning, rationality, and objectivity."—Yaakov Garb, _San Francisco Chronicle_.

Van der Pijl et al outline data suggesting an alarmingly high incidence of violation of the bodily integrity of patients in labour, including episiotomies performed without patients’ consent, or over their explicit objection.1 Similar data have been reported from the USA and Canada.2 The authors appropriately conclude that explicit consent is required at the time of all invasive obstetrical procedures, including episiotomy. Commonsense adjustments to the duration and detail of consent under conditions of clinical urgency are appropriate and should (...) be familiar to any clinician involved in perinatal care, as well as non-obstetric proceduralists caring for acutely ill patients. However, complete omission of consent for any of these procedures is both disrespectful to patients’ autonomy and strongly associated with morbidity from birth-related psychosocial trauma.3–5 The true incidence of obstetrical procedures performed without patients’ consent is difficult to determine for multiple reasons, including sample selection, recall bias and patients’ reluctance to reengage with traumatic experiences; however, …. (shrink)

How can we think about bodily, earthly, and otherwise material aspects of care with Arendt? This Arendt Studies special section is focused on those questions. In the introduction, I offer reflections on the contemporary crisis of care, discuss the reception of Arendt's "care for the world" in the secondary literature, and locate her in dialogue with such thinkers and traditions as Heidegger, Foucault, and the feminist and Black ethics of care (Joan Tronto in particular). For (...) Arendt, I suggest, politically relevant care is neither fully private nor public but involves a more complex intertwining of the two that is sometimes acknowledged. The essay closes by pondering "earthly care" in the context of the emerging planetary politics. (shrink)