This study explores young people’s perceptions of their existential well-being during the transition after leaving care. We use the theoretical framework of ‘existential well-being,’ which is a relational approach. The study deploys participatory action research methodology and involves peer research with 74 young people leaving care aged 17–32 in Finland (2011–2012) and England (2016–2018). The data was gathered through semi-structured interviews and thematically analysed.We identified three inter-linking categories of existential well-being related to the basic issues (...) of being a person: who one is and where one belongs. Self-feeling involves the importance of how one feels about oneself and one’s physical and mental health and security. Self-realisation relates to one’s hopes and the means for making one’s own decisions in everyday life. Belonging concerns the confidence one expresses in one’s supportive social networks.The findings highlight that, alongside the practical issues of out-of-home care, attention should increasingly focus on young people's reflections on their own lives, and an ethics of care should be developed to better meet their needs. These findings argue for the need to further support young people’s psychosocial and mental health in child welfare policy and practice. (shrink)

Patients with a life-threatening illness can be confronted with various types of loneliness, one of which is existential loneliness (EL). Since the experience of EL is extremely disruptive, the issue of EL is relevant for the practice of end-of-life care. Still, the literature on EL has generated little discussion and empirical substantiation and has never been systematically reviewed. In order to systematically review the literature, we (1) identified the existential loneliness literature; (2) established an organising framework for (...) the review; (3) conducted a conceptual analysis of existential loneliness; and (4) discussed its relevance for end-of-life care. We found that the EL concept is profoundly unclear. Distinguishing between three dimensions of EL—as a condition, as an experience, and as a process of inner growth—leads to some conceptual clarification. Analysis of these dimensions on the basis of their respective key notions—everpresent, feeling, defence; death, awareness, difficult communication; and inner growth, giving meaning, authenticity—further clarifies the concept. Although none of the key notions are unambiguous, they may function as a starting point for the development of care strategies on EL at the end of life. (shrink)

Martin Heidegger’s existential account of care in _Being and Time_ (2010) provides us with an opportunity to reimagine what the proper theoretical grounding of an ethic of care might be. Heidegger’s account of care serves to deconstruct the two primary foundations that an ethic of care is often based upon. Namely, that we are inevitably interdependent upon one another and/or possess an innate disposition to care for fellow humans in need. Heidegger’s account reveals that (...) both positions are founded upon an ontic (meaning factual existence), as opposed to an ontological (which refers to the nature of being), understanding of care. The distinctions between an ontic and ontological understanding of care are significant. Yet, I maintain that they are not completely incompatible. Both Heidegger and care ethicists contend that our existence with others is understood through a relational ontology. Furthermore, there are certain ontological structures from Heidegger which resonate with an ethic of care. Two key existential structures are leaping-ahead and being-guilty. These existential structures are latent in care ethics, and by explicitly revealing them I reinforce the connection between Heidegger’s account and care theory. Lastly, I develop the theoretical foundations of care ethics by proposing an existential ethic of care. (shrink)

Personal recovery entails the idea of learning to live a good life in the face of mental illness. It takes place in a continuous dynamic between change and acceptance and involves the existential dimension in the broadest sense. With cognitive self-regulation and empowerment as central elements, however, current models of recovery mostly have an individual focus instead of a relational one. Furthermore, there seems to be an emphasis on the component of change. Little attention is payed to the role (...) and integration of dealing with loss in personal recovery. In this paper, the role of loss in mental illness will be elaborated from an existential perspective. This will be done by relating existential changes to possibly disruptive experiences of loss in wider experience. With the help of several perspectives on dealing with loss it will be argued this can be integrated in processes of recovery. Then, it will be elaborated how reexperiencing a state of being surrounded, or being included, being held is a necessary part of recovery. The result consists of a refinement of the view on personal recovery. The aim of this paper is therefore twofold: (1) to arrive at a better understanding of what existential loss and loss in wider experience in the context of psychopathology entails, and (2) to further develop perspectives on recovery in mental health care. (shrink)

Patients with a life-threatening illness can be confronted with various types of loneliness, one of which is existential loneliness (EL). Since the experience of EL is extremely disruptive, the issue of EL is relevant for the practice of end-of-life care. Still, the literature on EL has generated little discussion and empirical substantiation and has never been systematically reviewed. In order to systematically review the literature, we (1) identified the existential loneliness literature; (2) established an organising framework for (...) the review; (3) conducted a conceptual analysis of existential loneliness; and (4) discussed its relevance for end-of-life care. We found that the EL concept is profoundly unclear. Distinguishing between three dimensions of EL—as a condition, as an experience, and as a process of inner growth—leads to some conceptual clarification. Analysis of these dimensions on the basis of their respective key notions—everpresent, feeling, defence; death, awareness, difficult communication; and inner growth, giving meaning, authenticity—further clarifies the concept. Although none of the key notions are unambiguous, they may function as a starting point for the development of care strategies on EL at the end of life. (shrink)

Promoting recovery has become more and more important in the care of patients with severe mental disorders such as psychosis. Recovery is a personal process of growth involving hope, self-identity, meaning in life, and responsibility. Obviously, these components pertain, at least in part, to a psychotherapeutic care perspective. Yet, up to now, recovery has mainly been taken into account in transforming health services and as a general framework for supportive therapy. Existential phenomenology abdicates a theoretical stance and (...) considers issues such as death anxiety, isolation, responsibility, and meaning. Thus, it is likely to provide some insight into the psychotherapeutic aspects of recovery. Furthermore, existential psychotherapy allows powerful insights for adopting a recovery-oriented attitude and to provide useful themes for discussing issues allowing patients to gain meaning and hope. This paper describes these elements to give clinicians insights into this complex topic. (shrink)

This article discusses the key existential stakes of implementing biometrics in human lifeworlds. In this pursuit, we offer a problematization and reinvention of central values often taken for granted within the “ethical turn” of AI development and discourse, such as autonomy, agency, privacy and integrity, as we revisit basic questions about what it means to be human and embodied. Within a framework of existential media studies, we introduce an existential ethics of care—through a conversation between existentialism, (...) virtue ethics, a feminist ethics of care and post-humanist ethics—aiming to deepen and nuance our understanding of the human behind “human-centered” AI directives. The key argument is that biometrics implicates humans through unprecedented forms of objectification, through which the existential body—the relational, intimate and frail human being—is at risk. We interrogate these risks as they become visible at three sites where embodied humans are challenged by biometrics, and thus where the existential body is challenged by the biometric body. This occurs through reductionism (biometric passports nailing bodies to identities, removing human judgment and compromising agency at the AI border), enforced transparency (smart home assistants surveying human intimacies and invading intimate spaces in the bedroom) and the breaching of bodily integrity (chipping bodies to capture sensory data, challenging the very concept of bodily integrity through self-invasive biohacking). Our existential ethics of care is importantly not a solutionist list of principles or suggestions, but a manifesto for a way of thinking about the ethical challenges of living with biometrics in today’s world, by raising the right questions. We argue that a revitalized discussion of the basic existential stakes within human lived experience is needed and should serve as the foundation on which comprehensive frameworks can be built to address the complexities and prospects for ethical machines, responsible biometrics and AI. (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)

In The Decline of the West Spengler puts forward a type of philosophical anthropology, an account of the structures of human experiential consciousness and a method of “physiognomic” analysis, which I argue has dimensions that can be understood as akin to existential phenomenology. Humanity, for Spengler, is witness to the creative flux of “Becoming” and constructs a world of phenomena bounded by death, underpinned by the two prime feelings of dread and longing and structured by the two forms of (...) Destiny (Time) and Direction (Space). Human existence, Spengler argues, is future-directed and open in the sense that there is a certain degree of freedom in the ways in which humanity can actualize its existential possibilities. In the course of elaborating the existential implications of this future-orientation, Spengler introduces the concept of care (Sorge), the fundamental experiential structure. (shrink)

We have conducted a small qualitative empirical study into the problems that nurses encounter in delivering existential support in their care of dying patients. We found that nurses are confronted with four types of problem: determining whether the patient actually has put a genuine question for existential support on the agenda; assessing what the import of such a question is; devising an adequate procedure for offering existential support; and organizing adequate support for themselves. Our analysis shows (...) that it takes a ‘fine-tuned antenna’ from nurses to determine these existential questions, which are often put indirectly and in a variety of forms. We have attempted to show that the subtleties of the communicative dimension of palliative terminal care require an intricate set of virtues on the part of the nurse. We have analysed these virtues in a bottom-up approach, inferring them directly from the material obtained from interviews. The framework utilized is the Aristotelian one of striking the right balance between the poles of a morally relevant dimension. (shrink)

Background: According to ethical guidelines, healthcare professionals should be able to provide care that allows for the patients’ values, customs and beliefs, and the existential issues that are communicated through them. One widely discussed issue is existential loneliness. However, much of the debate dealing with existential loneliness concludes that both the phenomenon and the concept are quite vague. Aim: To clarify what constitutes existential loneliness, and to describe its lived experiences. A further aim was to (...) provide a definition of existential loneliness that can function as a tool for identifying the phenomenon and for differentiating it from other kinds of loneliness. Method: A literature review including theoretical and empirical studies. Different search strategies were used to gather the articles included in the study. The analysis of the empirical studies had an interpretative approach. The articles were also analysed with the aim of providing a definition of existential loneliness. This was done by means of criteria such as language, uniqueness, theory and usefulness. This study is not empirical and does therefore not require an ethics review. Results: The analysis resulted in two main characteristics. The first one was perceiving oneself as inherently separated (disconnected) from others and from the universe. The second one brings out emotional aspects of EL, such as isolation, alienation, emptiness and a feeling of being abandoned. The empirical findings were divided into two categories: experiences of EL and circumstances in which EL arises. A definition of EL is also suggested, based on the two main characteristics identified. Conclusion: In order to meet patients’ needs, it is an ethical duty for healthcare staff to be able to recognise experiences of EL, that is, to communicate with the patients about these experiences in an appropriate manner. This in turn demands knowledge about existential issues and skills to deal with them. (shrink)

This article is about the therapeutic use of photography in mental health care. We will first describe the intelligent nature of perception as we understand on the basis of neurobiological research findings. We will link our interpretation of visual perception with the phenomenology of perception from the theory of Merleau‐Ponty.. Then we will discuss how patients in mental health care with mental health problems may profit by an experiential approach that is concomitant with the existential reality described (...) by Merleau‐Ponty. The experiential approach we go into more detail is Focusing. We will demonstrate the limitations and feasibility of Focusing in the procedures of working with photography as a therapeutic medium. (shrink)

Peirce’s True Gorgias is a brief dialogue from his essay “Grounds of Validity of the Laws of Logic”, published in 1869. The True Gorgias exposes the fallacy of existential import. It has received no sustained attention in the secondary literature, perhaps because the fallacy is now familiar. Peirce’s assessment of the fallacy involved in the reasoning, however, changes between 1865 and 1869, and he only arrives at the contemporary account of existential import in 1880. Moreover, a careful examination (...) of the context in which the True Gorgias appears reveals it provides an argument in support of Peirce’s early Aristotelian realism about universals in contradistinction to non-Aristotelian varieties of realism advocated by W.T. Harris, editor of the journal in which the True Gorgias was published. (shrink)

A signal challenge of twenty-first century psychiatry is the effective treatment of existential/spiritual suffering in palliative care. This chapter will concentrate on research to assess the therapeutic potential of psilocybin to assuage that suffering. If a “psychedelic experience” can facilitate an acceptance of impending death, and reduce the existential suffering of those who endure it, it could prove to be a valuable intervention where one is sorely needed. The therapeutic use of psilocybin with dying patients (hereinafter patients) (...) raises numerous questions about research trial design, the model of psychiatry that might accommodate it, and the kind of experience it induces. Are these the sorts of experience that psychiatric treatment should effect on troubled patients? Is spiritual care within the ambit of psychiatry? There are epistemological questions as to the veridicality of the psychedelic experience. How much credence should we give it? I will argue in cautious support of ongoing research to evaluate the therapeutic use of psilocybin in palliative care. This argument can be extended to research on its therapeutic use in psychotherapy. The chapter will focus on four questions: (1) what is the ethical justification for this research on patients? (2) What types of research trial design are best used to assess the purported benefits of a psychedelic drug experience? (3) What is the epistemic warrant of the “mystical” and “noetic” facets of this experience? (4) What models of (a) psychiatry and (b) drug action could accommodate the therapeutic use of psilocybin in palliative care? (shrink)

In ancient China, a revered Taoist sage named Zhuangzi told many parables. In Existential Psychology and the Way of the Tao, a selection of these parables will be featured. Following each parable, an eminent existential psychologist will share a personal and scholarly reflection on the meaning and relevance of the parable for psychotherapy and contemporary life. The major tenets of Zhuangzi's philosophy are featured. Taoist concepts of emptiness, stillness, Wu Wei (i.e. intentional non-intentionality), epistemology, dreams and the nature (...) of reality, character building in the midst of pain, meaning and the centrality of relationships, authenticity, self-care, the freedom that can come from one's willingness to confront death, spiritual freedom, and gradations of therapeutic care are topics highlighted in this book. (shrink)

In this paper we offer an appreciation and critique of patient-led care as expressed in current policy and practice. We argue that current patient-led approaches hinder a focus on a deeper understanding of what patient-led care could be. Our critique focuses on how the consumerist/citizenship emphasis in current patient-led care obscures attention from a more fundamental challenge to conceptualise an alternative philosophically informed framework from where care can be led. We thus present an alternative interpretation of (...) patient-led care that we call ‘lifeworld-led care’, and argue that such lifeworld-led care is more than the general understanding of patient-led care. Although the philosophical roots of our alternative conceptualisation are not new, we believe that it is timely to re-consider some of the implications of these perspectives within current discourses of patient-centred policies and practice. The conceptualisation of lifeworld-led care that we develop includes an articulation of three dimensions: a philosophy of the person, a view of well-being and not just illness, and a philosophy of care that is consistent with this. We conclude that the existential view of well-being that we offer is pivotal to lifeworld-led care in that it provides a direction for care and practice that is intrinsically and positively health focused in its broadest and most substantial sense. (shrink)

Summary Care and cure have been described as different kinds of ethical approaches to clinical situations. Female concerns in nursing care have been contrasted with masculine, cure orientated physician's attitudes. Ethics in such different voices may have sociologic determinants, but they do not represent intrinsic distinctions. Medicine has shown a divergent development, on the one hand stressing cure in a deterministic and instrumental way, on the other hand being aware that disease is as much a pathographic as a (...) biographic, care‐requiring existential situation. Disease is a breakdown of the living organism, to be cured by therapeutic efforts, but it is also the distressing failure of the lived body, requiring concern and care. Based on Lévinas’ ethics of encounter, it is suggested that any interpersonal relatedness is based on concern for the other, being grounded on an essentially ethical interaction. The clinical encounter is a paradigm of such ethics‐based relationships, which necessarily builds on awareness of the other qua other, and is concerned with fulfilling the therapeutic mandate. Caring for the other means doing one's best to help her/him, so that care and cure are inextricably interwoven, although care is the more fundamental form of human relatedness. Thus, neither gender nor professional tasks can allow for a caring attitude to develop without curing concerns, just as trying to cure without caring is unthinkable. (shrink)

While there is a great deal to agree with in the essay Expanded Terminal Sedation in End-of-Life Care there is, we think, a need to more fully appreciate the humanistic side of both palliative and end-of-life care.1 Not only does the underlying philosophy of palliative care arguably differ from that which guides curative medicine,2 dying patients are in a uniquely vulnerable position given our cultural disinclination towards open discussions of death and dying. In this brief response, we (...) critically engage Gilbertson et al ’s essay and seek to contextualise the perspective they put forward. According to Cassell, we should distinguish between pain and suffering.3 The former often gives rise to the latter, but suffering has other causes. This includes existential distress, indicating that, unlike pain, suffering is not simply physiological phenomena. Suffering involves the disintegration of the person, meaning that it can impact patient autonomy. Certainly, that a patient is suffering does not equate to a lack autonomy. Nevertheless, we should take care when making decisions in circumstance where the integrity of our embodied personhood is under threat, something that is clearly the case for those who are dying, particularly those who have refractory symptoms while doing so. Generally speaking, refractory symptoms are those which are intractable. They persist despite attempts at palliation. While this implies that such symptoms—and the suffering they cause—cannot be reversed this is not necessarily the case. Not only can the symptoms experienced by dying patients change …. (shrink)

Our work represents the culmination of a study that is a search for a method. It is a search that has led us away from the remnants of Cartesianism that are found in Sartre’s Critique of Dialectical Reason, which we do not deal with here, and toward a comparative study of Karl Marx and Maurice Merleau-Ponty, which we do take up in detail. The present manuscript argues, in fact, that both Marx and Merleau-Ponty operate with a method that may be (...) called an existential dialectic.By means of careful and extended analysis of The Structure of Behavior we attempt to uncover Merleau-Ponty’s method, calling special attention to its sometimes ignored dialectical character. We then proceed to argue that Marx is operating with a type of phenomenological/existential method, and this is true not only of the young Marx but also of the mature Marx of the Grundrisse and Capital. Finally, with the assistance of Lukacs’ History and Class Consciousness, we point up the dialectical character of Marx’s method. Thus, it is by uncovering this approach in the text of each of these thinkers and by comparing the method of each man with that of the other that we show that both Marx and Merleau-Pontyoperate with an existential dialectical method.This in depth methodological comparison of Marx and Merleau-Ponty represents the first study of its kind. It is hoped that “The Existential Dialectic of Marx and Merleau-Ponty” will contribute to the on-going and important dialogue between Marxists and existentialists. (shrink)

In this essay we expand the notion of thinking by emphasizing the provocation and urgency to think and by reconceptualizing thinking as an embodied practice. The aim is to expand Lipman and Sharp’s approach to philosophical inquiry with children and show how other ways of thinking can be included. We strive to unfold a way of “thinking” that is both different from rationality (critical thinking) as well as from creative and caring thinking. In the first part of the paper, we (...) discuss the merits of Lipman and Sharp’s critical, creative and caring thinking within the Community of Philosophical Inquiry (CPI). We then expand Lipman/Sharp’s philosophical method through Ekkehart Marten’s Five-finger Model, which allows for different philosophical approaches. In the second half of the paper, we draw on Martin Heidegger’s What is called thinking? to develop his concept of the “call” to think together with its related notions of provocation and urgency. Building on this, we draw on Maurice Merleau-Ponty to show how this call is not an intellectual activity or mere exercise of the “mind” but rather affects our entire existence. As such, thinking becomes a response to an existential urgency that is an embodied practice. Using concepts like embodiment, affect, and sensibility, we try to widen our conception of thinking in a CPI. Finally, we hope this will allow facilitators to hear the unique voice of every child so that no one is left unheard. (shrink)

A subset of people with severe mental health conditions feels they are on the verge of losing control, even in the absence of external threats or triggers. Some go to extreme ends to avoid affective arousal and associated expectations of a possible, impending catastrophe. We have learned about such phenomenological, emotional challenges in a group of individuals with severe, composite mental health problems and psychosocial disabilities. These individuals have had long treatment histories in the mental health care system. They (...) have been encountered at a specialized inpatient ward offering exposure-based therapy that aims at restoring self-regulation and recovery. We describe the phenomenology of anxiety and fear presented by these service users, a fear we have coined existential catastrophe anxiety. We also suggest a set of underlying, interacting, psychological mechanisms that may give rise to ECa, before comparing ECa with three other constructs previously described in the literature—annihilation anxiety, ontological insecurity, and affect phobia. These comparisons show several similarities, but also unique qualities with ECa and its suggested underlying mechanisms. The conceptualization of ECa may aid clinicians in addressing extreme experiential turmoil and engage service users in empowering therapeutic projects. (shrink)

Background In research on co-creation in nursing, a caring manner can be used to create opportunities for the patient to reach vital goals and thereby increase the patient’s quality of life in palliative home care. This can be described as an ethical cornerstone and the goal of palliative care. Nurses must be extra sensitive to patients’ and their relatives’ needs with regard to ethical and existential issues and situations in home care encounters, especially at the end (...) of life. Aim The aim of this study was to explore nurses’ experiences of dealing with ethical and existential issues through co-creation at the end of life in palliative home care. Research design, participants, and research context The material consisted of texts from interviews with 12 nurses in a home care context. A hermeneutical approach was used, and the method was inspired by a thematic analysis. Ethical considerations Informed consent was sought from the participants regarding study participation and the storage and handling of data for research purposes. Ethical permission to conduct the study was given from organizations that participated in this study. Findings A main theme and four subthemes emerged. The main theme was “Deep co-creative relationships are needed to manage ethical and existential issues at the end of life.” A model was created to display the findings and relations between ethical issues and situations and the need for a deep trustful caring relationship to solve problems in palliative home care. Discussion Together, the themes can be considered as a tool for learning and dealing with ethical and existential issues at the end of life in home care. The themes can also be seen as a part of nurses’ ethical competence within this context. Conclusion The quality of life at the end of life can be improved through co-creation, despite difficult ethical and existential issues. Future research should focus on co-creation from the patients’ perspective. (shrink)

An educated healthcare professional or student is sensitive and able to make good judgements, understanding existential challenging issues. It is argued that the ideas within phenomenology and hermeneutics can function as a basis for comprehension. This article focuses on how choice of perspective and knowledge is of importance to what we do in practice. However, education does not consist of mere accumulation of knowledge and ways of explanation. We do not become competent practitioners by being able to reproduce philosophical (...) ideas. These are merely perspectives by means of which we can seek to go beyond what we take for granted, or what we assume to know, thus enabling us to take a new direction understanding problems and issues that until now may have been hidden to us. In other words, understanding is of an existential character, whereas an observing healthcare professional must be aware and open to the mental aspects of life. It is therefore important to attune ourselves to being sensitive to and aware of experiences from our lifeworld, understanding what they imply. It is argued that literature provides insight into human nature through the written depiction of real or imagined experiences. To develop such narrative imagination, it is suggested that literature should be part of the curriculum of various educations. This is relevant to healthcare professionals who thereby can get an important insight into human nature and begin to develop the self‐awareness and sensitivity to others that is so central to care. (shrink)

Our work represents the culmination of a study that is a search for a method. It is a search that has led us away from the remnants of Cartesianism that are found in Sartre’s Critique of Dialectical Reason, which we do not deal with here, and toward a comparative study of Karl Marx and Maurice Merleau-Ponty, which we do take up in detail. The present manuscript argues, in fact, that both Marx and Merleau-Ponty operate with a method that may be (...) called an existential dialectic.By means of careful and extended analysis of The Structure of Behavior we attempt to uncover Merleau-Ponty’s method, calling special attention to its sometimes ignored dialectical character. We then proceed to argue that Marx is operating with a type of phenomenological/existential method, and this is true not only of the young Marx but also of the mature Marx of the Grundrisse and Capital. Finally, with the assistance of Lukacs’ History and Class Consciousness, we point up the dialectical character of Marx’s method. Thus, it is by uncovering this approach in the text of each of these thinkers and by comparing the method of each man with that of the other that we show that both Marx and Merleau-Pontyoperate with an existential dialectical method.This in depth methodological comparison of Marx and Merleau-Ponty represents the first study of its kind. It is hoped that “The Existential Dialectic of Marx and Merleau-Ponty” will contribute to the on-going and important dialogue between Marxists and existentialists. (shrink)

Being aware of social injustices can cause existential and mental pain; comes with a burden; and may impede a flourishing life. However, I shall argue that this is not a reason to despair or to choose to be willfully ignorant. Rather, it’s a reason to conclude that being conscious is not enough. Rather, during times of oppression, resisters must also prioritize well-being. One way to do this is by extending what I refer to as solidarity care. I begin (...) by providing an account of solidarity care. I then offer pragmatic ways in which one can extend solidarity care to others. I conclude by responding to two possible worries. (shrink)

Background: As frail older people might have difficulties in expressing themselves, their needs are often interpreted by others, for example, by significant others, whose information health care staff often have to rely on. This, in turn, can put health care staff in ethically difficult situations, where they have to choose between alternative courses of action. One aspect that might be especially difficult to express is that of existential loneliness. We have only sparse knowledge about whether, and in (...) what way, the views of frail older persons and their significant others concerning existential loneliness are in concordance. Objective: To contrast frail older (>75) persons’ experiences with their significant others’ perceptions of existential loneliness. Methods: A case study design was chosen for this study. Individual interviews with frail older persons (n = 15) and interviews with their significant others (n = 19), as well as field notes, served as a basis for the study. A thematic analysis was used to interpret data. Ethical considerations: This study was conducted in accordance with the principles of research ethics. Findings: The findings showed three themes: (1) Meaningless waiting in contrast to lack of activities, (2) Longing for a deeper connectedness in contrast to not participating in a social environment and (3) Restricted freedom in contrast to given up on life. Discussion: Knowledge about the tensions between older persons’ and their significant others’ views of existential loneliness could be of use as a basis for ethical reflections on the care of older people and in the encounter with their significant others. Conclusion: It is of importance that health care professionals listen to both the frail older person and their significant other(s) and be aware of whose voice that the care given is based on, in order to provide care that is beneficial and not to the detriment of the older person. (shrink)

Contemporary society is rife with instability. Contemporary genetic research has raised and given life to the one-time science fiction specter: the clone. The scarcity of natural energy sources has led to greater manipulation of atomic or nuclear energy and as a result greater danger. And the promises of globalization have, in some cases, delivered their intended results, but in many other ways they have created even greater social and economic gaps. An urgent commentary in the tradition of Herbert Marcuse's One (...) Dimensional Man or even Sigmund Freud's Civilization and Its Discontents, Raphael Sassower's powerful new book is a culmination of many years of research and thought carefully arranged into an extended essay on our contemporary social, cultural, and existential orientation in the modern world. (shrink)

Since the inception of the Pastoral Care Movement, the approach to pastoral care has evolved from the traditional shepherd model to a more clinical, client-centred method. This evolution requires a thorough analysis of recent trends and dynamics in pastoral care, especially in relation to key theological theories and the Church’s role in providing support. Today, the landscape of pastoral care covers a range of topics, including ecotheology, global existential crises and the Church’s involvement in addressing (...) these issues. Additionally, this examination reveals conclusions about theological shortcomings and inconsistencies in emphasis within pastoral care.Contribution: This article provides a critical overview of pastoral care in its current form and context, examining its relevance to the existential needs of the postmodern social milieu and its role in the church today. It offers a critical evaluation of pastoral care within contemporary culture. (shrink)

In this paper, we argue that our moral concern for future well-being should reduce over time due to important practical considerations about how humans interact with spacetime. After surveying several of these considerations (around equality, special duties, existential contingency, and overlapping moral concern) we develop a set of core principles that can both explain their moral significance and highlight why this is inherently bound up with our relationship with spacetime. These relate to the equitable distribution of (1) moral concern (...) in a universe that we can only causally affect in one temporal direction; (2) access to the benefits from using spacetime as a resource; and (3) the burdens of care given (1) and (2). We conclude by considering the practical implications of our argument and find that, while it is often assumed that a preference for present over future well-being weakens the case for existential risk mitigation, this likely is not the case. (shrink)

Background: With rapidly ageing population worldwide, loneliness among older adults is becoming a global issue. Older migrants are considered being a vulnerable population and ethical issues are often raised in care for elderly. A deeper sense of loneliness, existential loneliness is one aspect of loneliness also described as the ultimate loneliness. Making oneself understood or expressing emotions, have shown to be particularly challenging for older migrants which could lead to experience of existential loneliness. Ageing and being a (...) migrant are potential triggers for experiencing existential loneliness. There appears to be, however, little known about being a migrant experiencing existential loneliness in old age. Aim: This study explored older migrants’ experience of existential loneliness. Research design: Qualitative study. Participants and research context: Data were collected through interviews (n = 15) with older (>65) migrants’ in Swedish nursing homes or senior citizen centres. A thematic analysis was performed to analyse the data. Ethical considerations: The study was conducted in accordance with the principles of research ethics. Findings: The result was described in terms of three themes: (1) Choices made in life, (2) seeking reconciliation with life and (3) thoughts about death and dying in a foreign country. Discussion: Ethical reflection and knowledge about how older migrants’ life story can lead to experiencing existential loneliness, could be of use in care for older migrants’. Conclusion: This study indicates that the experience of existential loneliness derived from being a migrant is a long-term and significant process. Migration was a hope of creating a meaningful life, the experience of existential loneliness occurred as migrants sought reconciliation with life, reflected upon their past choices, and thought about death and dying in a foreign country. (shrink)

Recently ethical implications of human resource management have intensified the focus on care perspectives in management and organization studies. Appeals have also been made for the concept of organizational care to be grounded in philosophies of care rather than business theories. Care perspectives see individuals, especially women, as primarily relational and view work as a means by which people can increase in self-esteem, self-develop and be fulfilled. The ethic of care has received attention in feminist (...) ethics and is often socially construed as a feminine ethic. Although well developed in the caring professions there remains no model or definition of the care ethic in management literature with little care research undertaken. This paper develops the concept of the care ethic using Heidegger’s philosophy, namely, care is fundamental to human being. To show Heideggerian care, an individual notices, pays attention to another and responds in ways to empower and enable. In a study which aimed to analyze women’s lived experience of career, we applied the philosophically grounded methodology hermeneutic phenomenology. Findings revealed the power of Heideggerian care, Sorge, as a key factor in creating meaning. From this, we propose that care has potential as a theoretical and philosophically based construct with strong practical implications. It provides a way of understanding the care ethic, lies at the heart of our being, and is essential to meaning in our grelationships and undertakings. Crucially, it can provide reprieve from the existential angst that trademarks our being. (shrink)

The Covid-19 pandemic and the repeated lockdowns have caused substantial spiritual and existential suffering, not the least for persons with dementia who may have had more difficulties than others in grasping the reality of what was going on. Therefore, it is important to address spirituality within this sector of the population when considering global health and ethics and technology in a pandemic outbreak. This contribution starts firstly with a definition of spirituality and spiritual care. Secondly, based on the (...) works of Elizabeth MacKinlay and Laura Dewitte, the article demonstrates how spirituality can be nurtured in the dementia ward through “spiritual reminiscence.” Finally, I briefly reflect on how spiritual care in the dementia ward was affected by the Covid-19 pandemic. (shrink)

The experience of illness raises profound issues concerning the sense or non-sense of human existence as a whole: does life have meaning when it is marked by suffering? And what meaning would it bear, in this case? These questions are asked by both caregivers and recipients of care when they come into contact with limits, pain, and death. In this regard, the existential condition of homo patiens is ambiguous: it can lead either to nihilism and despair or to (...) a higher level of awareness and responsibility. Studies on resilience, post-traumatic growth, and meaning-making processes seem to suggest that in difficult situations the search for meaning comes most clearly to the fore, so that the possibility of finding meaning in life can be a protective factor and a key therapeutic resource, while meaninglessness increases weakness and vulnerability. But what is meant by “meaning” in the illness experience and how may it be integrated into one’s personal life story? This question is answered here in terms of narrative methods that can enhance healthcare practitioners’ capacity to approach their patients with sensitivity and deep understanding and guide them to find meaning in their lives, despite all. (shrink)

Nursing Ethics has published several pleas for care ethics and/or relationality as the most promising ethical foundation for midwifery philosophy and practice. In this article, we stand by these calls, contributing to them with the identification of the structural form of violence that a care ethical relational approach to reproductive care is up against: that of “maternal separation”. Confronted with reproductive and obstetric violence globally, we show that a hegemonic racialized, instrumentalized, and individualized conception of pregnancy is (...) responsible for a severance of relationalities that are essential to safe reproductive care: (1) the relation between the person and their child or reproductive capabilities; and (2) the relation between the pregnant person and their community of care. We pinpoint a separation of the maternal relation in at least two discursive domains, namely, the juridical-political and the ethical-existential. Consequently, we plea for a radical re-imagination of maternal relationality, envisioning what care ethical midwifery, including abortion care, could be. (shrink)

We might describe the philosophical issue of human freedom and moral responsibility as an existential metaphysical problem. Problems of this kind are not just a matter of theoretical interest and curiosity: They address issues that we care about and that affect us. They are, more specifically, relevant to the significance and value that we attach to our lives and the way that we lead them. According to the orthodox view, there is a tidy connection between skepticism and pessimism. (...) Skepticism threatens a wide range of interests and concerns that themselves rest on the foundation of our self-conception as responsible moral agents. From this perspective, whereas skepticism licenses a degree of pessimism about our human predicament, the defeat of skepticism serves to vindicate optimism. In recent years this orthodox view of the relationship between skepticism and pessimism has been challenged. It has been argued, for example, that skepticism may be defended in much more optimistic terms. While we have reason to accept skepticism, we have no reason to draw any bleak or depressing consequences from this. Another way of severing the orthodox connection between skepticism and pessimism is to reject skepticism but deny that this will serve to secure or salvage any unqualified form of optimism. This chapter reviews and contrasts these various positions and approaches, beginning with an account of P. F. Strawson’s particularly influential statement of the relationship between the skeptical challenge and pessimism. (shrink)

Background: Providing nursing care for patients with end-stage renal disease entails dealing with existential issues which may sometimes lead not only to ethical problems but also conflicts within the team. A previous study shows that physicians felt irresolute, torn and unconfirmed when ethical dilemmas arose. Research question: This study, conducted in the same dialysis care unit, aimed to illuminate registered nurses’ experiences of being in ethically difficult situations that give rise to a troubled conscience. Research design: This (...) study has a phenomenological hermeneutic approach. Participants: Narrative interviews were carried out with 10 registered nurses working in dialysis care. Ethical considerations: The study was approved by the Ethics Committee of the Faculty of Medicine, Umeå University. Results: One theme, ‘Calling for a deliberative dialogue’, and six sub-themes emerged: ‘Dealing with patients’ ambiguity’, ‘Responding to patients’ reluctance’, ‘Acting against patients’ will’, ‘Acting against one’s moral convictions’, ‘Lacking involvement with patients and relatives’ and ‘Being trapped in feelings of guilt’. Discussion: In ethically difficult situations, the registered nurses tried, but failed, to open up a dialogue with the physicians about ethical concerns and their uncertainty. They felt alone, uncertain and sometimes had to act against their conscience. Conclusion: In ethical dilemmas, personal and professional integrity is at stake. Mistrusting their own moral integrity may turn professionals from moral actors into victims of circumstances. To counteract such a risk, professionals and patients need to continuously deliberate on their feelings, views and experiences, in an atmosphere of togetherness and trust. (shrink)

Arne Grøn’s reading of Søren Kierkegaard’s authorship revolves around existential challenges of human identity. The 35 essays that constitute this book are written over three decades and are characterized by combining careful attention to the augmentative detail of Kierkegaard’s text with a constant focus on issues in contemporary philosophy. Contrary to many approaches to Kierkegaard’s authorship, Grøn does not read Kierkegaard in opposition to Hegel. The work of the Danish thinker is read as a critical development of Hegelian phenomenology (...) with particular attention to existential aspects of human experience. Anxiety and despair are the primary existential phenomena that Kierkegaard examines throughout his authorship, and Grøn uses these negative phenomena to argue for the basically ethical aim of Kierkegaard’s work. In Grøn’s reading, Kierkegaard conceives human selfhood not merely as relational, but also a process of becoming the self that one is through the otherness of self-experience, that is, the body, the world, other people, and God. This book should be of interest to philosophers, theologians, literary studies scholars, and anyone with an interest not only in Kierkegaard, but also in human identity. (shrink)

Purpose of the study is explication of ethical and existential conditions of realization of human responsibility for the protection and recreation of the environment on a scale of the common world with all the other living beings. The crisis of the environment is the crisis of human morality. For responsible environmental management, it is necessary to form the ecological consciousness of society and reinterpret the anthropocentrism on the ethical foundations. The theoretical basis of the research is the analysis of (...) ethical and existential dimensions of understanding of the human environment ranging from the sphere of the home and the natural environment to the dimension of the common world of people and all the entities. The work clarifies the genesis of the concept of home from the ancient "oikos", household to the idea of home as a "hub", a base for mental and physical mobility in the contemporary technosphere. Correspondent to the transformation of the living world of mankind is the concept of communication and universal discourse of norms and values of human coexistence of J. Habermas, К.-О. Apel, D. Böhler, W. Kuhlmann, and others. The domain of the ecological consciousness and behaviour also requires motivation at the level of human feelings, beliefs, and convictions, which is represented by the philosophic and religious thought of H. Jonas, O. Leopold, K. M. Меуеr-Abich, A. Naess, the pope Francis, and others. As the result, the study proves the relevance of the concept of care about the common home based on the recognition of the value of the existence of all beings. Originality. The study explicates the genesis and meaning of the ethos of the common home with values of love, care, openness, solidarity, freedom, and responsibility which is proved to be the ethical and existential condition of the solution of the environmental crisis. The traditional anthropocentrism is reinterpreted towards the duty of people to be the centre of the responsibility for the existence of all beings that requires both reason and care. Conclusions. The ethics of care for our common home completes the moral duty of people as providers of the universal discourse who represent the interests of all beings. Concern for the preservation of the human environment and of all creation makes it possible for humanity to realize its universal responsibility in the world. The contemporaneous science and religious thought modify anthropocentrism to the holistic ethical understanding of human’s mission to be responsible for all beings. (shrink)

Religion and spirituality are integral to the philosophy of palliative care, shaping its approach to spiritual care. This article aims to examine the discourses within palliative care research to illuminate prevailing assumptions regarding spiritual care. Eighteen original articles were analyzed to examine how spiritual care is understood within palliative care. The analysis, informed by Foucault, aimed to identify recurring discourses. The finding reveals that, in palliative care research, spirituality is viewed as enigmatic yet (...) inherently human and natural, assuming that every individual has a spiritual dimension. The analysis points to healthcare professionals being expected to hold certain qualities to put spiritual care into practice. The analysis also reveals that in the analyzed articles, the concept of spiritual care is rooted in a Christian context, with the belief that all individuals possess inherent spirituality or religiosity, a concept often associated with Christian theology. The included articles often utilize theological terms and emphasize a monotheistic viewpoint. Spirituality is articulated as a complex, distinct concept, challenging clear definitions and professional responsibilities. Further, a moral formation of healthcare professionals is described, interpelling and ascribing qualities that healthcare professionals need to provide spiritual care. (shrink)

Research documents that many chronic non-malignant pain patients experience existential, spiritual and religious needs; however, research knowledge is missing on if and how physicians approach these needs. We conducted a systematic review to explore the extent to which physicians address these needs in their communication with chronic non-malignant pain patients and to explore the facilitators and challenges of this communication. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, searching Embase, Medline, Scopus and PsycINFO. The quality (...) of the included articles was assessed based on design-specific screening tools. We included four of 2337 screened articles and found the quality to be good. Physicians’ communication about existential, spiritual and religious needs was given low priority and depended on the patients’ own initiative, except when clinicians were interested in holistic care. Patient dissatisfaction with the physician’s attention to these needs was related to higher pain and depression. Physicians’ challenges for addressing these needs were their tendency to prioritize physiological aspects and close further elaboration of existential needs when addressed by the patients. The main facilitator was the individual physician’s willingness to listen with openness and empathy to the patients’ existential concerns. A tentative conclusion is that physicians rarely meet the existential, spiritual and religious needs of their chronic non-malignant pain patients. This might be due to higher priority of physical aspects, lack of time and a lack of knowledge about the importance of and training in the ability to address these needs. Further research is needed on physicians’ communication about existential, spiritual and religious needs and on their training in here. (shrink)

In this article, we investigate how the concept of Care Biography and related concepts are understood and operationalised and describe how it can be applied to advancing our understanding and practice of holistic and person‐centred care. Walker and Avant's eight‐step concept analysis method was conducted involving multiple database searches, with potential or actual applications of Care Biography identified based on multiple discussions among all authors. Our findings demonstrate Care Biography to be a novel overarching concept derived (...) from the conjunction of multiple other concepts and applicable across multiple care settings. Concepts related to Care Biography exist but were more narrowly defined and mainly applied in intensive care, aged care, and palliative care settings. They are associated with the themes of Meaningfulness and Existential Coping, Empathy and Understanding, Promoting Positive Relationships, Social and Cultural Contexts, and Self‐Care, which we used to inform and refine our concept analysis of Care Biography. In Conclusion, the concept of Care Biography, can provide a deeper understanding of a person and their care needs, facilitate integrated and personalised care, empower people to be in control of their care throughout their life, and help promote ethical standards of care. (shrink)

The current medical approach to erectile dysfunction (ED) consists of physiological, psychological and social components. This paper proposes an additional framework for thinking about ED based on phenomenology, by focusing on the theory of sexual projection. This framework will be complementary to the current medical approach to ED. Our phenomenological analysis of ED provides philosophical depth and illuminates overlooked aspects in the study of ED. Mainly by appealing to Merleau-Ponty’s Phenomenology of Perception, we suggest considering an additional etiology of ED (...) in terms of a weakening of a function of sexual projection. We argue that sexual projection can be problematized through cognitive interferences, changes in the ‘intentional arc’, and modifications in the subject’s ‘body schema’. Our approach further highlights the importance of considering the ‘existential situation’ of patients with ED. We close by reflecting briefly on some of the implications of this phenomenological framework for diagnosis and treatment of ED. (shrink)

This paper first distinguishes governance (collective, autonomous self-regulatory processes) from government (externally-imposed mandatory regulation); it proposes that the second of these is essentially incompatible with a conception of the medical humanities that involves imagination and vision on the part of medical practitioners. It next develops that conception of the medical humanities, as having three distinguishable aspects (all of them distinct from the separate phenomena popularly known as “arts-in-health”): first, an intellectual enquiry into the nature of clinical medicine; second, an important (...) dimension of medical education; third, a resource for moral and aesthetic influences upon clinical practice, supporting “humane health care” as the moral inspirations behind organised medicine. Medical humanities sustains these three aspects through paying proper attention to the existential and subjective aspects of medicine. By encouraging authentic imagination among health care practitioners, medical humanities aligns well with both humane health care and governance in the sense of self-regulation. However, it can neither be achieved mechanistically nor well-measured through proxies such as patient satisfaction. Above all, it should not be allowed to supply, through inappropriate qualitative “targets,” new forms of management tyranny. (shrink)

Resumen: Este artículo de investigación, desde los límites intrínsecos de los §§. 39-42 de la obra Ser y Tiempo, busca tematizar la mismidad del Dasein, en tanto saber de un sí-mismo no cósico que es correlato de la existencialidad y la facticidad de este ente, desde el modo de aparecer del existenciario cuidado, precisamente aquel encargado de dotar de unidad o totalidad estructural a los momentos constitutivos del ser-en-el-mundo como tal. Este análisis es ejercido con el fin de potenciar una (...) posible vinculación entre cuidado y mismidad, donde, según parece, la mismidad se constituye como condición necesaria y suficiente del cuidado, responsable no solo de favorecer su unidad temática, sino el tránsito de la impropiedad a la propiedad existencial.: From the intrinsic limits of §§. 39-42 of the work Being and Time, this research paper seeks to thematize the Selfhood of Dasein understood as a non-thingness wisdom of self, the which is correlative of the existentiality and facticity of this entity. This searching is carried out from the mode of appearing of existential Care, precisely this existential word is responsible for endowing of unit and / or structural totality to the constitutive moments of the being-in-the-world as such. This analysis also is exercised in order to enhance a possible link between Care and Selfhood, where, as it seems, the Selfhood is constituted as a neccesary and sufficient condition of Care. This Selfhood is responsable for not only to favor the unity of Care, but the transition from impropriety to existential property of Dasein. (shrink)

Nel Noddings identifies four core problems with the primary education system in the United States. First, there is no established caring relationship between educational authorities and students. Second, there is no continuity in student-teacher relationships. Third, Common Core neglects deep existential questions in its educational approach. Fourth, Common Core does not emphasize connections between the disciplines to each other or to real-life problems. The four problems with the primary education system identified by Noddings contribute to the fake news problem (...) in the following way: The first two problems sow the seeds for future distrust of expertise; The third problem deadens students’ critical thinking skills and curiosity for knowledge; and the fourth problem plays into the structure of how fake news is designed and consumed. I will argue that Noddings’ education reform proposal is the ideal solution for addressing these problems. (shrink)

Man suffers from a very particular fate, namely that of being besieged by questions which he cannot answer and cannot ignore either. The ability to pose questions like these is a key characteristic of the fundamental existential situation of mankind. Every person must find his or her own particular method of coping with such questions. This makes up a significant part of the human maturing process. People with dementia, having already found their personal solution to cope with the problem (...) of these unanswerable questions, radically stumble into this existential situation once again. The problem of this repetition is that the people with dementia can only make limited use, if indeed any use at all, of their previously successful biographical strategies. The drama of human existence as such thus repeats itself within a person with dementia. We must recognise the seriousness of this task. We thus must support people with dementia in coping existentially with this renewed task in the best possible way. The existential dignity of this task is no different from that of a young person. This insight is very important for the care of patients: people with dementia should be recognised as a people in an existential situation. (shrink)