Truth-telling in healthcare practice can be regarded as a universal communicative virtue; however, there are different views on what consequence it has for giving or diminishing hope. The aim of this article is to explore the relationship between the concepts of truth-telling and hope from a relational ethics approach in the context of healthcare practice. Healthcare staff protect themselves and others to preserve hope in the care of seriously sick patients and in end-of-life care. This is (...) done by balancing truth-telling guided by different conditions such as the cultural norms of patients, family and staff. Our main conclusion is that the balancing of truth-telling needs to be decided in a mutual understanding in the caring relationship, but hope must always be inspired. Instead of focusing on autonomy as the only guiding principle, we would like to propose that relational ethics can serve as a meaningful perspective in balancing truth-telling. (shrink)

Background Nurses play an integral role in the care of children hospitalised with a serious illness. Although information about diagnostics, treatments, and prognosis are generally conveyed to parents and caregivers of seriously ill children by physicians, nurses spend a significant amount of time at the child’s bedside and have an acknowledged role in helping patients and families understand the information that they have been given by a doctor. Hence, the ethical role of the nurse in truth disclosure to children (...) is worth exploring. Methods A systematic academic database and grey literature search strategy was conducted using CINAHL, Medline Psych Info, and Google Scholar. Keywords used included truth, children, nurse, disclosure, serious illness, and communication. A total of 17 publications of varying types were included in the final data set. Ethical Considerations As this was a review of the literature, there were no direct human participants. Empirical studies included in the review had received ethics approval. Results Of the 17 articles included in the review, only one directly reported on the experiences of nurses asked to withhold the truth from patients. Empirical studies were limited to HIV-positive children and children diagnosed with cancer and the dying child. Conclusion A paucity of literature exploring the experiences, attitudes, and beliefs of nurses with regard to truth-telling to seriously ill children is evident. Little consideration has been given to the role nurses play in communicating medical information to children in a hospital setting. The 17 articles included in the review focused on cancer, and HIV, diagnosis, and end-of-life care. Further research should be undertaken to explore the experiences and attitudes of nurses to clinical information sharing to children hospitalised with a wide range of serious illnesses and in diverse clinical scenarios. (shrink)

Truth-telling to competent patients is widely affirmed as a cardinal moral and biomedical obligation in contemporary Western medical practice. In contrast, Chinese medical ethics remains committed to hiding the truth as well as to lying when necessary to achieve the family's view of the best interests of the patient. This essay intends to provide an account of the framing commitments that would both justify physician deception and have it function in a way authentically grounded in the familist (...) moral concerns of Confucianism. It reflects on the moral conditions and possibilities for sustaining a Confucian understanding of truth-telling and consent in mainland China. (shrink)

This article provides a philosophical response to the need for truth-telling about colonial history, focussing on the Australian context. The response consists in inviting philosophers and the public to engage in social-justice practices specified by a model called Distributed Truth-Telling (DTT), which integrates the historiography of injustices affecting Indigenous peoples with insights from social philosophy and cultural evolution theory. By contrast to official and large-scale truth commissions, distributed truth-telling is a set of non-elitist (...) practices that weave three components: first, multisite, multiformat, and multiscale inquiries into injustices; second, remedial imaginings and reasoning about moral repair and reconciliated futures; and finally, emotions suitable for motivating agents to cooperatively plan and implement moral revolutions. Distributed truth-telling can entrench virtuous feedback loops that contribute to moral revolutions. However, vicious feedback loops associated with collective denial and biases can impair distributed truth- telling and thwart moral revolutions. (shrink)

Ethical principles are not mere abstract concepts of academic interest. They have to be applied by care providers in the real world under complex, challenging and often perplexing conditions. This paper discusses, through the case of an ethnic minority patient with metastasis of bowel cancer, the ethical dilemma of truth-telling and withholding information about poor prognosis. It highlights the complexities of applying ethical principles in a different cultural milieu, reflecting on different ethical frameworks and justifications. The paper also (...) discusses some of the wider implications of the practices, issues and controversies of truth-telling about prognosis in cross-cultural communication relevant to clinical practice. (shrink)

Background: Truth-telling toward terminally ill patients is a challenging ethical issue in healthcare practice. However, there are no existing ethical guidelines or frameworks provided for Chinese nurses in relation to decision-making on truth-telling of terminal illness and the role of nurses thus is not explicit when encountering this issue. Objectives: The intention of this paper is to provide ethical guidelines or strategies with regards to decision-making on truth-telling of terminal illness for Chinese nurses. Methods: (...) This paper initially present a case scenario and then critically discuss the ethical issue in association with ethical principles and philosophical theories. Instead of focusing on attitudes toward truth disclosure, it aims to provide strategies regarding this issue for nurses. It highlights and discusses some of the relevant ethical assumptions around the perceived role of nurses in healthcare settings by focusing on nursing ethical virtues, nursing codes of ethics, and philosophical perspectives. And Confucian culture is discussed to explicate that deontology does not consider family-oriented care in China. Conclusion: Treating each family individually to explore the family’s beliefs and values on this issue is essential in healthcare practice and nurses should tailor their own approach to individual needs regarding truth-telling in different situations. Moreover, the Chinese Code of Ethics should be modified to be more specific and applicable. Finally, a narrative ethics approach should be applied and teamwork between nurses, physicians and families should be established to support cancer patients and to ensure their autonomy and hope. Ethical considerations: This paper was approved by the Ethics Committee of The Second Affiliated Hospital of Guangzhou Medical University. The authors have obtained consent to use the case study and it has been anonymised to preserve the patient's confidentiality. (shrink)

Truth-telling for terminally ill patients is a challenging ethical and social issue for Chinese health care professionals. However, despite the existence of ethical and moral standards for nurses, they frequently encounter moral dilemmas when making decisions about truth-telling to patients with end-stage diseases in China. This article aims to provide ethical strategies for clinical nurses in China regarding truth-telling decisions for terminally ill patients on the basis of their individual autonomy. This article first presents (...) a common case scenario in China and then critically discusses ethical issues related to ethical principles and philosophical theories. The aim is to provide the much needed strategy for truth-telling for nurses who are terminally ill rather than to focus on attitudes toward disclosure. This article focuses on nursing morality, ethics, norms, and philosophy in health care and discusses countermeasures taken by nurses in truth-telling decision-making in combination with Chinese Confucian culture. The analysis identifies key ethical strategies tailored to Chinese nurses’ practices, emphasizing individual autonomy, cultural sensitivity, and family dynamics in truth-telling decisions. The complexity of end-of-life illness requires Chinese nurses to strengthen the communication training needed to deliver bad news, as well as critical and autonomous thinking and good communication skills when implementing patient- and family-centered care, to achieve true delivery of bad news, thereby increasing patient autonomy and promoting more successful collaboration among patients, families, and providers. To improve the quality of care. Chinese nurses should integrate ethical principles with Confucian values to enhance patient-centered communication, respecting autonomy while adapting to cultural nuances in end-of-life care. (shrink)

The study examines how truth-tellers and truth-telling can be cultivated in the context of post-truth politics in the U.S. Following Foucault, it is not concerned with examining the problem of truth, with the philosophical question of how truth is determined, but with the problem of truth-tellers or truth-telling as a practical activity of self-improvement. To this end, the study traces the emergence and nature of post-truth politics in the U.S. and (...) analyzes its relation to patterns of fascist propaganda and the psychological appeal of authoritarian leaders through a psycho-social perspective. To counter the nature and ubiquity of post-truth politics, the unrelenting flow of lies, disinformation, and conspiracy theories disseminated by the far-right news and information ecosystem, the author argues that educators can help students recognize truth-tellers and become truth-tellers themselves by employing certain pedagogical strategies, informed by Foucault’s analysis of parrhesia, that can equip them to criticize and resist post-truth propaganda and demagogues. (shrink)

This article aims to examine critically the ‘cultural incompatibility’ argument, which asserts that disclosure of cancer-related information to patients is incompatible with Turkey’s cultural context. For this purpose, a brief overview of the approach to truth-telling in Turkey will first be provided, followed by the claims of two different Turkish authors on the issue and a critical analysis of their approach. It will be contended that this argument has actually been formulated with paternalistic concerns and it may be (...) playing an important role in shaping the approach of Turkish health care professionals to the issue. The article will then examine, in the light of study findings and case reports from Turkey, the concept of patient autonomy as it applies to truth-telling issues. It will be concluded that truth-telling can be compatible with Turkey’s cultural context, provided that health care professionals place more emphasis on good communication with their patients. (shrink)

The Varnished Truth gives us a careful, spirited, and fresh look at the multi-layered subject of deception and truth-telling in everyday life.

In this article, we entangle with Aaron Kuntz’s book The Responsible Methodologist, extending the conversation beyond research into the realms of teaching, learning, and daily lived practices as twenty-first century academics. Kuntz advocates for parrhesiastic living and inquiry, defined as truth-telling and intervention toward ends of disrupting normative practices of knowing and being and enacting socially just ends. We grapple with three philosophical ∼ theroetical propositions made by Kuntz: entangled knowing ∼ being; citizenship; and logics of extraction. Utilizing (...) examples from our own lived experiences, pedagogy, and inquiry, we open a series of philosophical and theoretical dialogues around these three topics to better understand their possibilities and limitations, grappling, and debating how they are jumping off points for living more parrhesiastically. (shrink)

In this article I want to focus on a specific function that promises fulfil in our lives: their role as a way of shaping our character. To make my case, I will present an account of truth-telling based on Bernard Williams’ work on genealogy and on the virtues of truth. This account will highlight how our selves (or characters) are not static entities in time, that they are not immediately transparent to us. Nonetheless, we seem to have (...) what I call a drive to be someone, to have a character. We need ways to ‘steady the mind’, that is, ways of shaping our selves to whom we are or want to be. The argument I will put forward is that promises are one of the resources we have for doing so. By making promises, we commit ourselves to acting in a certain way and by doing that we also shape our selves. The argument will help us to answer some philosophical challenges raised against promises, notably about their rationality and about their relationship with vows and resolutions. Additionally, it will impact our thinking about contract law. What emerges from this article is an account of an important role played by promises that has been often neglected by the literature. (shrink)

Using a real-life case involving an accidental discovery of misattributed paternity as a springboard for discussion, I reflect on several practical and theoretical issues surrounding truth-telling in the doctor-patient relationship. I present the moral dilemma and identify arguments in favour of and against disclosure. I then examine the theoretical difficulties in balancing conflicting reasons and in establishing what constitutes the 'truth'. I conclude that withholding the information from the patients would be ethically permissible and, more generally, that (...) honesty is not always the best policy. (shrink)

Narrative ethics holds that if you ask someone what goodness is, as a basis of action, most people will first appeal to various abstractions, each of which can be defined only by other abstractions that in turn require further definition. If you persist in asking what each of these abstractions actually means, eventually that person will have to tell you a story and expect you to recognize goodness in the story. Goodness and badness need stories to make them thinkable and (...) to translate them into individual and collective actions. Yet after more than two decades of considering the issue, I do not believe that a collection of stories can by itself guide actions in ways that are sufficient to respond to ethical troubles in institutional settings. The question will always remain open for me, but my present belief is that narrative bioethics is always hyphenated, in the sense that guidance from stories needs to be allied with other ethical guidance. Each side of the hyphen qualifies the other side. The hyphenation I will argue for in this essay is “narrative-deontology.”. (shrink)

: International instruments now defend a "right to the truth " for victims of political repression and violence and include truth telling about human rights violations as a kind of reparation as well as a form of redress. While truth telling about violations is obviously a condition of redress or repair for violations, it may not be clear how truth telling itself is a kind of reparations. By showing that concerted truth (...) class='Hi'>telling can satisfy four features of suitable reparations vehicles, I defend the idea that politically implemented modes of truth telling to, for, and by those who are victims of gross violation and injustice may with good reason be counted as a kind of reparations. Understanding the doubly symbolic character of reparations, however, makes clearer why truth telling is unlikely to be sufficient reparation for serious wrongs and is likely to be sensitive to the larger context of reparative activity and its social, political, and historical background. (shrink)

Develops an approach to think normatively about the assignment of grades. Argues that grades should reflected reasonably estimated subject-matter competence rather than the quantity of submitted work or moral character. Responds to alternatives labeled "academic retributivism" and "academic consequentialism." Applies to the model to a variety of concrete grading policy issues.

Medicine has undergone substantial changes in the way medical dilemmas are being dealt with. Here we explore the attitude of Israeli physicians to two debatable dilemmas: disclosing the full truth to patients...

In general, most, but not necessarily all, patients want truthfulness about their health. Available evidence indicates that truth-telling practices and preferences are, to an extent, a cultural artefact. It is the case that practices among nurses and doctors have moved towards more honest and truthful disclosure to their patients. It is interesting that arguments both for and against truth-telling are established in terms of autonomy and physical and psychological harm. In the literature reviewed here, there is (...) also the view that truth-telling is essential because it is an intrinsic good, while it is argued against on the grounds of the uncertainty principle. Based on this review, it is recommended that practitioners ought to ask patients and patients' families what informational requirements are preferred, and research should continue into truth-telling in clinical practice, particularly to discover its very nature as a cultural artefact, and the other conditions and contexts in which truth-telling may not be preferred. (shrink)

Objective: To compare the attitudes of patients with cancer toward making changes in lifestyle, according to their awareness of the diagnosis.Method: Personal interviews with 50 patients with breast cancer, 24 patients with prostate cancer and 50 patients with colorectal cancer were conducted in a cancer hospital in Athens, Greece.Analysis: Multiple logistic regression models were used to estimate the odds ratio as a measure of the association of the characteristics of participants with changes in lifestyle.Results: Overall, 22.6% of the patients were (...) not aware of the diagnosis. Among the changes in lifestyle, 41.1% reported changing their diet to a healthier one, 22.6% of the smokers reduced or stopped smoking and 13.7% added new physical activity. Compared with uninformed patients, those who were aware of the diagnosis, after adjusting for the confounding effect of educational status , were 2.5 times as likely to make dietary changes . Among the other characteristics under study, older patients were less likely to add new physical activity than younger ones , and newly diagnosed patients were more likely to stop or reduce smoking than patients with a diagnosis made more than 12 months previously.Conclusion: Patients with cancer are motivated to attempt changes in lifestyle and can benefit from more factual information about the diagnosis. (shrink)

Background: Ethical problems are a universal phenomenon but rarely researched concerning patients dying from acute stroke. These patients often have a reduced consciousness from stroke onset and thereby lack ability to convey their needs and could be described as ‘incompetent’ decision makers regarding their own care. Objective: The aim of the study was to deepen the understanding of stroke team members’ reasoning about truth-telling in end-of-life care due to acute stroke. Research design: Qualitative study based on individual interviews (...) utilizing combined deductive and inductive content analysis. Participants and research context: A total of 15 stroke team members working in stroke units of two associated county hospitals in western Sweden participated. Ethical considerations: The study was approved by the Regional Ethics Review Board, Gothenburg, Sweden. Findings: The main findings were the team members’ dynamic movement between the categories ‘Truth above all’ and ‘Hide truth to protect’. Honesty was highly valued and considered as a reason for always telling the truth, with the argument of truth as common morality. However, the carers also argued for hiding the truth for different reasons such as not adding extra burden in the sorrow, awaiting a timely moment and not being a messenger of bad news. Withholding truth could both be seen as a way of protecting themselves from difficult conversations and to protect others. Discussion: The results indicate that there are various barriers for truthfulness. Interpreted from a virtue of ethics perspective, withholding of truth might also be seen as an expression of sound judgement to put the patient’s best interest first. Conclusion: The carers may need support in the form of supervision to be given space to reflect on their experience and thereby promote ethically justified care. Here, the multi-professional team can be of great value and contribute through inter-professional sharing of knowledge. (shrink)

The choice is clear: truth, justice, freedom or lies, injustice, bondage? The good life and a just society depend on truth telling, but perhaps we are more comfortable with lies and fake news? How can we recognize the truth when everyone does "what is right in their own eyes"? When we accept and expect lies, how is civil society possible? How can we decide what is true, good, and right? If everyone has their own moral compass, (...) is there any compass at all? This book addresses the skepticism about our capacity to know anything for sure and the inevitable consequences of moral relativism. The author says that skepticism and relativism cannot provide effective barriers against the drift by democracies into authoritarianism--characterized by the heavy use of state power to impose the culture of one kind of Me on us all. In the past religion provided a beacon of hope and as the bedrock for our society and its laws. Now, religion is confined to the private and often silent recesses of the person. How then can we speak of God, truth, power, and justice as a society? These are some of the questions that the book takes up. Long begins by saying that truth and freedom promote human flourishing and concludes by pointing us to how we can discern and practice truth telling as private citizens and as people of faith. (shrink)

Three years before his death, Michel Foucault delivered a series of lectures at the Catholic University of Louvain that until recently remained almost unknown. These lectures—which focus on the role of avowal, or confession, in the determination of truth and justice—provide the missing link between Foucault’s early work on madness, delinquency, and sexuality and his later explorations of subjectivity in Greek and Roman antiquity. Ranging broadly from Homer to the twentieth century, Foucault traces the early use of truth- (...) class='Hi'>telling in ancient Greece and follows it through to practices of self-examination in monastic times. By the nineteenth century, the avowal of wrongdoing was no longer sufficient to satisfy the call for justice; there remained the question of who the \u201ccriminal\u201d was and what formative factors contributed to his wrong-doing. The call for psychiatric expertise marked the birth of the discipline of psychiatry in the nineteenth and twentieth centuries as well as its widespread recognition as the foundation of criminology and modern criminal justice. Published here for the first time, the 1981 lectures have been superbly translated by Stephen W. Sawyer and expertly edited and extensively annotated by Fabienne Brion and Bernard E. Harcourt. They are accompanied by two contemporaneous interviews with Foucault in which he elaborates on a number of the key themes. An essential companion to Discipline and Punish, Wrong-Doing, Truth-Telling will take its place as one of the most significant works of Foucault to appear in decades, and will be necessary reading for all those interested in his thought.  . (shrink)

This article interrogates twelve step practice within Alcoholics Anonymous from the perspective of Foucault’s later work on governance, truth-telling and subjectivity. Recent critical studies of addiction tend to view self-help cultures like that of AA and related twelve step programs as integral parts of contemporary power/knowledge complexes, and thus as agents of the modern “will to knowledge” that Foucault often engages with. In line with the widespread Foucauldian critique of governmentality, addiction self-help culture is thus conceived as one (...) that primarily reproduces abstract, neoliberal norms on health and subjectivity. The argument put forward in this article aims to upset this framework attending to a number of features of twelve step practice that, arguably, bear striking resemblances to Foucault’s later discussions of ethics, care of self and truth-telling. In this, it is suggested that a close study of AA practices, might interrupt assumptions about contemporary addiction discourse and its relationship to issues of truth and power often reproduced in Foucauldian critiques. (shrink)

This paper examines the potential role of metaphors in helping healthcare professionals to communicate honestly with patients and in helping patients gain a richer and more nuanced understanding of what is being explained. One of the ways in which doctors and nurses may intentionally, or unintentionally, avoid telling the truth to patients is either by using metaphors that obscure the truth or by failing to deploy appropriately powerful and revealing metaphors in their discussions. This failure to tell (...) the truth may partly account for the observation by clinicians that patients sometimes make decisions that, from the perspective of their clinician, and given all that the clinician knows, seem unwise. For example, patients with advanced cancer may choose to undergo further, aggressive, treatment despite the fact that they are likely to accrue little or no benefit as a result. While acknowledging that the immediate task of telling patients the truth can be difficult for all those concerned, I argue that the long-term consequences of denying patients autonomy at the end of life can be harmful to patients and can leave doctors and nurses distressed and confused. (shrink)

This chapter contains sections titled: The Clinical Encounter Medical Paternalism Re‐examined Ethical Frameworks The Temptation to Deceive Different Forms of Deception Communicating Outside Medicine Character, Context, and Care References Further reading.

As ethical agents, teachers regularly must decide whether compliance to rules and norms is in the best interest of their students. Yet, teachers in the United States are educated to be passively obedient. In this paper, I argue that part of pre-service teacher education ought to learn ways of resisting. I describe one approach to verbal resistance, what Michel Foucault calls Truth-Telling. Building on a qualitative self-study with pre-service teachers, I explain how a form of team-teaching called Interruptions (...) can promote Truth-Telling. (shrink)

Truth-telling is often regarded as a challenge in Chinese medical practices given the amount of clinical and ethical controversies it may raise. This study sets to collect and synthesize relevant ethical evidence of the current situation in mainland China, thereby providing corresponding guidance for medical practices. This study looks into the ethical issues on the basis of the philosophy of deontology and utilitarianism and the ethical principles of veracity, autonomy, beneficence, and nonmaleficence. Chinese philosophy, context and culture are (...) also discussed to provide some suggestions for decision-making about disclosure in a medical setting. This study holds that, in order to respect the basic rights to which critically ill patients are entitled, decisions regarding truth-telling and their implementation should be carried out with thorough consideration, which can be achieved by critical thinking, well-developed and effective communication skills, the consideration of cultural context, an understanding of individual differences, and compliance with relevant laws and regulations. (shrink)

Empirical studies have now established that many patients make clinical decisions based on models other than Anglo American model of truth-telling and patient autonomy. Some scholars also add that current medical ethics frameworks and recent proposals for enhancing communication in health professional-patient relationship have not adequately accommodated these models. In certain clinical contexts where health professional and patients are motivated by significant cultural and religious values, these current frameworks cannot prevent communication breakdown, which can, in turn, jeopardize patient (...) care, cause undue distress to a patient in certain clinical contexts or negatively impact his/her relationship with the community. These empirical studies have now recommended that additional frameworks developed around other models of truth-telling; and which take very seriously significant value-differences which sometimes exist between health professional and patients, as well as patient's cultural/religious values or relational capacities, must be developed. This paper contributes towards the development of one. Specifically, this study proposes a framework for truth-telling developed around African model of truth-telling by drawing insights from the communitarian concept of ootọ́ amongst the Yoruba people of south west Nigeria. I am optimistic that if this model is incorporated into current medical ethics codes and curricula, it will significantly enhance health professional-patient communication. (shrink)

Background: Hematopoietic stem cell transplantation is a potential cure for a range of life-threatening diseases, but is also associated with a high mortality rate. Nurses encounter a variety of situations wherein they are faced with discussing bad news with hematopoietic stem cell transplantation patients. Research objective: The aim of this study was to explore the experiences and strategies used by Iranian nurses related to truth-telling and communicating bad news to hematopoietic stem cell transplantation patients. Research design: A qualitative (...) approach using content analysis of interview data was conducted. Participants and research context: A total of 18 nurses from the main hematopoietic stem cell transplantation center in Iran participated in semi-structured interviews. Ethical considerations: The Institutional Review Board of the Tabriz University of Medical Sciences and the Hematology-Oncology and Stem Cell Transplantation Research Center affiliated with the Tehran University of Medical Sciences approved the study. Findings: In the first main category, not talking about the disease and potential negative outcomes, the nurses described the strategies of not naming the disease, talking about the truth in indirect ways and telling gradually. In the second main category, not disclosing the sad truth, the nurses described the strategies of protecting patients from upsetting information, secrecy, denying the truth and minimizing the importance of the problem. The nurses used these strategies to minimize psychological harm, avoid patient demoralization, and improve the patient’s likelihood of a fast and full recovery. Discussion: The priority for Iranian hematopoietic stem cell transplantation nurses is to first do no harm and to help patients maintain hope. This reflects the Iranian healthcare environment wherein communicating the truth to hematopoietic stem cell transplantation patients is commonly considered inappropriate and avoided. Conclusion: Iranian nurses require education and support to engage in therapeutic, culturally appropriate communication that emphasizes effective techniques for telling the truth and breaking bad news, thereby potentially improving patient outcomes and protecting patient rights. (shrink)

Truth-telling is a project that is both gripping and problematic for Rousseau, as he is both captured by an ideal of telling as complete, undistorted discernment, documentation and communication, and also haunted by the fear that telling can never be this innocent. For Rousseau, as for Kant, telling does not leave the told untouched; rather, telling gives us a type of contact with objects that is marked and mediated by the process of telling (...) itself, and hence the possibility of immediately grasping objects through telling is forever lost to us. The drive to capture things in themselves, which originates, according to Kant, in a formal principle of reason, shows up in Rousseau's writings as a nostalgia that governs and animates inquiry. I will read Rousseau, and the traumas of truth-telling he articulates, as important pretexts for Kant's critical epistemology. Rousseau discloses tensions that infect his truth-telling practices. Kant seeks to neutralize these tensions, not by dissolving them, but rather by translating them into the terms of transcendental philosophy and thus showing how they can be defused and rendered harmless in their empirical form, so as to secure the possibility of proper truth-telling. (shrink)

In this paper several reasons as to why framing issues should be of greater interest to both medical ethicists and healthcare professionals are suggested: firstly, framing can help in explaining health behaviours that can, from the medical perspective, appear perverse; secondly, framing provides a way of describing the internal structure of ethical arguments; and thirdly, an understanding of framing issues can help in identifying clinical practices, such as non-directive counselling, which may, inadvertently, be failing to meet their own stated ethical (...) aims. The effect of framing on how individuals interpret information and how healthcare choices are influenced by framing are described. Next, the role of framing in ethical discourse is discussed with specific reference to Judith Jarvis Thomson’s philosophical mind experiment about abortion and the violinist. Finally, the implications of this analysis are examined for the practice of non-directive counselling, which aims at communicating information in a neutral, value-free way and thereby protecting patient autonomy. (shrink)

One way to characterise pragmatism is to see it as a philosophy that placed communication at the heart of philosophical, educational and political thinking. Whereas the shift from consciousness to communication can be seen as a major innovation in modern philosophy, it is not without problems. This article highlights some of these problems and suggests a way ‘forward’ by staging a discussion between pragmatism and deconstruction. Although there are striking similarities between pragmatism and deconstruction, it is argued that pragmatism and (...) deconstruction cannot sit as easily together as some authors assume. The reason for this is not that pragmatism and deconstruction are incompatible philosophies but rather that deconstruction occurs at the very heart of pragmatism. This implies that pragmatism can only retain its commitment to communication in philosophy, education and politics if it acknowledges and, in a sense, embraces the occurrence of deconstruction in communication. This suggests that the future of pragmatism as a philosophy for education o lies in its deconstruction, something which is expressed in the idea of a deconstructive rather than a deconstructed pragmatism. (shrink)

Being truthful with patients is a critical foundation of the doctor-patient relationship and is fundamental to development of trust. A professional commitment to truth telling may sometimes contradict other principles of bioethics, which may challenge decision-making for the doctor and/or the treatment team. Practitioners may fail to address all ethical or legal aspects of a case and therefore make inappropriate decisions.

Background: Cone Beam Computed Tomography (CBCT), the focus of a number of radiotherapy fundraising campaigns in the mid-2000s, was introduced accompanied by a fanfare of newness and discourses of ‘hope’, ‘inspiring clinical confidence’ and ‘accuracy’. The CBCT system, used in the delivery of Radiotherapy treatment, was incorporated into strategic planning priorities across the United Kingdom based on a rationale of self-evidence. During this time, the way in which the new system was discussed with patients was variable. Research objectives: The purpose (...) of this study was to uncover how experimental practices were embedded and enacted during the use of a new technological system, specifically relating to how patients were enrolled during introductory phases of technology adoption. Research design and context: Drawing on ethnographic work and interviews with staff members in one hospital, the study examines staff discussions prior to the introduction of the Cone-Beam CT imaging system in radiotherapy. It considers how staff views were at odds with practices that occurred during the ‘experimental’ stages of use and how these were shared with patients. Ethical considerations: Approval was obtained from the Local National Health Service Research Ethics Committee and National Health Service Main Research Ethics Committee (REC 07/Q1308/16) for the interview and ethnographic stages, respectively. All names have been changed and participants signed a consent form. Findings: Staff reported a lack of evidence, absence of proof and perturbing doubts with the X-ray volumetric imaging. Both patients’ and practitioners’ partial understanding about the risks and benefits of the system created incommensurable ideas regarding its use and what the patients’ role was during these introductory stages. Conclusion: Maintaining partial truth telling renders patients’ experiences of new treatment at odds with ‘experimental’ practice. This has wide-reaching implications for practice. (shrink)

Abstrak: Paper ini berbicara mengenai parrhesia, salah satu dari sekian banyak istilah teknis utama dari Michel Foucault. Parrhesia merupakan seminar terakhir yang didiskusikan Foucault di Universitas Calofornia di Berkeley, USA, di bawah judul: ‘Discourse on Truth: The Problemati- zation of Parrhesia.’ Seri seminar ini dan seksualitas sebagaimana didiskusikan dalam History of Sexuality vol. 2 dan 3, berikut semua bahan kuliah dan interviu selama dua tahun terakhir sebelum kematiannya, dilihat sebagai puncak dari tiga jurus berpikir Foucault, terutama dalam hal ini (...) jurus subyektivitas dan etika. Di sini terlihat, bagaimana manusia menyadari diri sebagai subjek bagi dirinya sendiri atau menjadi subjek etika. Ini berarti bahwa individu, berdasarkan kebebasan dan kema- tangannya, secara praktis mampu berhubungan dengan dirinya sendiri (rapport a soi). Dengan itu, ia dapat disebut sebagai parrhesiast, yang tidak hanya menyampaikan kebenaran kepada orang lain, tetapi juga mampu menyampaikan kebenaran kepada dirinya sendiri. Dengan kata lain, supaya bisa disebut sebagai parrhesiast, seorang individu harus memper- lihatkan dalam dirinya suatu hubungan erat antara apa yang ia katakan dengan apa yang ia perbuat. Teori dan praktek selalu harus berjalan beriringan. Seseorang boleh berbicara secara meyakinkan, namun ia juga harus bertindak dan berlaku benar dan baik. Kata-kata kunci: Foucault, parrhesia, intelektual, subyek, etika. Abstract: The paper presents one of Foucault’s many pregnant technical terms called πάρήσίά (parrhesia). Parrhesia is the main topic of his last seminar delivered at the University of California in Berkeley, USA, entitled “Discourse on Truth: The Problematization of Parrhesia.” These series of seminar and the issue of sexuality as discussed in his History of Sexuality vol. 2 and 3, added with all his lectures and interviews during the last two years before his death, are seen as the peak of his three axes of thought, namely the axis of subjectivity and ethics. There, we see how humanbeing is aware of him/her self as subject of him/her own self or of being the subject of ethics. This means that the invididual, based on his freedom and maturity, is practically able to relate with him/her self (rapport a soi). He is then to be called the parrhesiast, who not only tells the truth to other people, but also be able to tell the truth to him/her self. In other words, in order to be a parrhesiast, an individual should show in his/her life a correspondence between what he/she speaks and what he/she does. Theory and practice should go hand in hand. One can speak convincingly, yet is also to behave well. Keywords: Foucault, parrhesia, intellectual, subject, ethics. (shrink)