Psychological experiments allegedly show that people have a tendency to confabulate explanations of their behavior, because their conscious selves do not know why they do what they do, and therefore create the explanations that make most sense. This article explains why confabulation is neither a threat to interpretivist social science nor a threat to the presumption of first-person authority in Davidson’s interpretation theory. The reason is that the interpretative endeavor, which is necessary in order to identify and provide evidence for (...) confabulation is governed by a presumption of first-person authority. Explanations of confabulation thus depend on prior interpretations. (shrink)

An active ethically conscious consumer has been acclaimed as the new hero and hope for an ethically improved capitalism. Through consumers’ “voting” at the checkout, corporations are supposed to be held accountable for their conduct. In the literature on political consumerism, this has mainly been approached as political participation and governance. In this article, we do a critical review of this literature. We do so by questioning the existence of what we call a “generic active consumer model.” At the core (...) of this position, there is a belief that the active consumer is a universal entity, available across nations and time. Instead we call for an approach that takes accord of the ways consumers and consumer roles are framed in interactive processes in markets, governance structures, and everyday life. Consumers in different countries assess their responsibilities and their powers as consumers differently due to different institutionalizations within distinctive contexts. We also must take into account how the inertia of ordinary consumption and the moral complexities of everyday life restrict the adoption of an active consumerist role. Hence, the debate on political consumerism should make for a more realistic notion of ethical consumer-sovereignty and its role in improving the workings of capitalism. In our view, these findings have severe implications for understanding both theories of political consumption and the dynamics of political consumption per se. (shrink)

In this introductory essay, we will present a translational medical humanities approach where the humanities are not only an auxiliary to medical science and practice, but also an interdisciplinary space where both medicine and the humanities mutually challenge and inform each other. First, we explore how medicine’s attempt to tackle the nature–culture divide is emblematically expressed in the concept and practice of knowledge translation. Second, we compare and contrast KT as an epistemic ideology and a socio-medical practice, with concepts and (...) practices of translation developed in the human sciences. In particular, we emphasise Derrida’s understanding of translation as inherent in all meaning making, as a fundamentally textual process and as a process necessarily creating difference rather than semantic equivalence. Finally, we analyse a case from clinical medicine showing how a more refined notion of translation can enlighten the interaction between biomedical and cultural factors. Such a translational medical humanities approach also requires a rethinking of the concept of evidence in medicine. (shrink)

The evidence-based practice and evidence-based medicine movements have promoted standardization through guideline development methodologies based on systematic reviews and meta-analyses of best available research. EBM has challenged clinicians to question their reliance on practical reasoning and clinical judgement. In this paper, we argue that the protagonists of EBM position their mission as reducing uncertainty through the use of standardized methods for knowledge evaluation and use. With this drive towards uniformity, standardization and control comes a suspicion towards intuition, creativity and uncertainty (...) as integral parts of medical practice. We question the appropriateness of attempts to standardize professional practice through a discussion of the importance of uncertainty. Greenhalgh’s taxonomy of uncertainty is used to inform an analysis of the clinical reasoning occurring in a potentially life threatening emergency situation with a young patient. The case analysis is further developed by the use of the Canadian philosopher Bernard Lonergan’s theory about understanding and objective knowing. According to Lonergan it is not by getting rid of or even by reducing uncertainty, but by attending systematically to it and by relating to it in a self-conscious way, that objective knowledge can be obtained. The paper concludes that uncertainty is not a regrettable and unavoidable aspect of decision making but a productive component of clinical reasoning. (shrink)

Comparing preferences for sport participation between alternative and conventional sports, this article exhibits some differences across sport contexts, as well as across gender and class. However, the main finding is the major similarities of preferences and dominating social groups across the contexts. This indicates that a similar habitus is in play in the alternative context as in the conventional one, and that "real alternatives" are merely to occur inside established frames of sport provision.

Modern medicine is confronted with cultural crossings in various forms. In facing these challenges, it is not enough to simply increase our insight into the cultural dimensions of health and well-being. We must, more radically, question the conventional distinction between the ‘objectivity of science’ and the ‘subjectivity of culture’. This obligation creates an urgent call for the medical humanities but also for a fundamental rethinking of their grounding assumptions.Julia Kristeva has problematised the biomedical concept of health through her reading of (...) the anthropogony of Cura, who according to the Roman myth created man out of a piece of clay. JK uses this fable as an allegory for the cultural distinction between health construed as a ‘definitive state’, which belongs to biological life, and healing as a durative ‘process with twists and turns in time’ that characterises human living. A consequence of this demarcation is that biomedicine is in constant need of ‘repairing’ and bridging the gap between bios and zoe, nature and culture. Even in radical versions, the medical humanities are mostly reduced to such an instrument of repairment, seeing them as what we refer to as a soft, ‘subjective’ and cultural supplement to a stable body of ‘objective’, biomedical and scientific knowledge. In this article, we present a prolegomenon to a more radical programme for the medical humanities, which calls the conventional distinctions between the humanities and the natural sciences into question, acknowledges the pathological and healing powers of culture, and sees the body as a complex biocultural fact. A key element in such a project is the rethinking of the concept of ‘evidence’ in healthcare. (shrink)

After distinguishing two senses of 'analysis', the author claims that the purpose of Moore's analytical (meta-ethical) program in Principia Ethica was to serve as an indispensable tool for avoiding false judgments in substantial ethics and for establishing true ones. It is shown that Moore's analyses and assumptions are not normatively neutral in that, (1) he disagreed with other philosophers about the extension (as well as the intension) of moral terms, (2) he disagreed in extension with 'common-sense' morality. Finally, an attempt (...) is made to show that Moore's moral methodology, in which his analytical distinctions play the crucial part, is meant to be of practical value for everybody in their moral decisions. (shrink)

This paper reviews the literature on health and female homosexuality in Brazil and, along the way, outlines an alternative approach to reviewing academic literature. Rather than summarising the contents of previously published papers, we relate to these publications primarily as partakers in the creation of knowledge. Inspired by Actor-Network Theory, we apply ethnographic methods to understand the papers as study participants endowed with action. We also draw on the notions of inscription and intertextuality to trace the complex relationship between the (...) findings in the articles and the realities outside of them. We claim that ‘evidence’ is the product of translational processes in which original events, such as experiments, blood tests and interviews, are changed into textual entities. In addition, text production is seen as an absorption of everything else surrounding its creation. When events are turned into articles, the text incorporates the political environment to which original events once belonged. We thus observe a political text inscribed into the written evidence of sexually transmitted infections, and the practice of publishing about scientific vulnerabilities emerges as political action. In contrast with traditional ways of reviewing literature in medical scholarship, this article offers a reminder that although there is a connection between textual evidence and the reality outside publications, these dimensions are not neutrally interchangeable. (shrink)

As is well known, the Kāśikāvṛtti is the oldest extant rule-by-rule commentary on the Aṣṭādhyāyī of Pāṇini. Two major commentaries on it are available, the Nyāsa from the eighth century and the Padamañjarī, most likely from the eleventh century. In this article we focus on the term pradeśa, which is a familiar feature of the printed editions of the Kāśikāvṛtti on the sañjñā sūtras of the Aṣṭādhyāyī. A closer examination, however, shows that the sentence “Xpradeśāḥ — X... ity evamādayaḥ” is (...) not met with in either of the two commentaries. This has consequences for our understanding of the textual transmission of the Kāśikāvṛtti. (shrink)

The concept ‘hereditary breast cancer’ is commonly used to delineate a group of people genetically at risk for breast cancer—all of whom also having risk for other cancers. People carrying pathogenic variants of the BRCA1 and BRCA2 genes are often referred to as those having predisposition for ‘hereditary breast cancer’. The two genes, however, are when altered, associated with different risks for and dying from breast cancer. The main risk for dying for carriers of both genes is from ovarian cancer. (...) These biological facts are of philosophical interest, because they are the facts underlying the public debate on BRCA1/2 genetic testing as a model for the discussion of how to implement genetic knowledge and technologies in personalized medicine. A contribution to this public debate describing inherited breast cancer as ‘biological citizenship’ recently printed in Med Health Care and Philos illustrated how fragmented and detached from the biological and socio-political facts this debate sometimes is. We here briefly summarize some of the biological facts and how they are implemented in today’s healthcare based on agreed philosophical, ethical and moral principles. The suggestion of a ‘biological citizenship’ defined by hereditary breast cancer is incorrect and ill-advised. ‘Identity politics’ focusing hereditary breast cancer patients as a group based on a bundle of ill-defined negative arguments is well known, but is supported neither by scientific nor philosophical arguments. To those born with the genetic variants described, the philosophical rule of not doing harm is violated by unbalanced negative arguments. (shrink)

Empowerment and user participation represents an ideal of power with a strong position in the health sector. In this article we use text analysis to investigate notions of power in a program plan for health workers focusing on empowerment. Issues addressed include: How are relationships of power between users and helpers described in the program plan? Which notions of user participation are embedded in the plan? The analysis is based on Foucault’s idea that power which is made subject to attempts (...) of redistribution will re-emerge in other forms. How this happens, and with what consequences, is our analytical concern. The analysis is contrasted with ‘snapshots’ from everyday life in a nursing home. The program plan communicates empowerment as a democracy-building instrument that the users need. It is a tool for providing expert assistance to the user’s self-help. User participation is made into a tool which is external to the user him-/herself. Furthermore, the analysis shows that the plan’s image of empowerment presupposes an ‘élite user’ able to articulate personal needs and desires. This is not very applicable to the most vulnerable user groups, who thereby may end up in an even weaker position. By way of conclusion, we argue that an exchange of undesirable dominating paternalism for a desirable empowerment will not abolish power, but may result in more covert and subtle forms of power that are less open to criticism. The paper offers insights that will facilitate reflections on the premises for practising empowerment-oriented health care. (shrink)

This article tests the hypothesis that all pandemics are inherently translational. We argue that translation and translation theory can be fruitfully used to understand and manage epidemics, as they help us explore concepts of infectivity and immunity in terms of cultural and biological resistance. After examining the linkage between translation and coronavirus disease from three different yet interlinked perspectives—cultural, medical, and biocultural—we make a case for a translational medical humanities framework for tackling the multifactorial crisis brought about by the SARS-CoV-2 (...) infection. This innovative entanglement of perspectives has the merit of carving out a new space for translation research at the intersection of the sciences and the humanities, providing sustainable ways to conceptualize the production of science at times of crisis, and challenging conventional views of translation as a primarily linguistic and cultural phenomenon that traditionally does not engage with science. (shrink)

A patient-centred approach has gained increasing interest in medicine and other health sciences. Whereas there are discussions about the meaning of a patient-centred approach and what the concept entails, little is known about how the patient as a person is understood in patient-centred care. This article investigates understandings of the patient as a self in patient-centred care through physiotherapy of patients with chronic muscle pain. The material consists of interviews with five Norwegian physiotherapists working in a rehabilitation clinic. Drawing on (...) Kristeva’s discussion of subjectivity in medical discourse, the study highlights two different treatment storylines that were closely entwined. One storyline focuses on open singular healing processes in which the treatment was based on openness to a search for meaning and sharing. In this storyline, the “person“ at the centre of care was not essentialised in terms of biological mechanisms, but rather considered as a vulnerable, irrational and moving self. By contrast, the second storyline focused on goal-oriented interventions aimed at restoring the patient to health. Here, the person in the centre of the treatment was shaped according to model narratives about “the successful patient”; the empowered, rational, choosing and self-managing individual. As such, the findings revealed two conflicting concepts of the individual patient inherent in patient-centred care. On the one hand, the patient is seen as being a person in constant movement, and on the other, they are captured by more standardised terms designed to focus on a more stable notion of outcome of illness. Therefore, our study suggests that the therapists’ will to recognise the individual in patient-centred care had a counterpart involving a marginalisation of the singular. (shrink)

Summary This paper reports on the perspectives of elite athletes on anti-doping work in general and on the whereabouts system in particular, and uses a figurational perspective to explore the unintended consequences of the planned introduction of the whereabouts system. A cross-sectional survey of all the athletes in the Norwegian registered testing pool was carried out in 2006, using a structured questionnaire. Overall, 70.6% of the athletes agreed that doping was a problem in elite sport in general, but paradoxically only (...) 17.5% agreed that doping was a problem in their own sport. However, more than four in ten of the athletes agreed that the whereabouts information system made a contribution to a “cleaner” sport. Some athletes thought the system was unfair. The whereabouts information system had, despite all good intentions, outcomes other than those planned and intended by the WADA. Thus, athletes’ views might fruitfully be integrated with other perspectives when anti-doping work is developed further. (shrink)

When the patient applies for disability benefit in Norway, the general practitioner is required by the National Insurance Administration to confirm that the patient is unfit for work due to disease. Considering the important social role of medical certificates, they have been given surprisingly little attention by the medical critique. They may make essential differences to peoples’ lives, legitimise large social costs and, in addition, the GPs report that issuing certificates can be problematic. This article explores values, attitudes and persuasive (...) language in a selection of medical certificates written by GPs. We direct attention to such texts as significant social actors using a mixed rhetoric including certain values and attitudes. When arguing for granting the patient disability benefit, some GPs emphasised the ‘worthiness’ of the patient by pointing to positive attitudes approved by the national insurance: a will to work and participate, to cooperate and be motivated. Others pointed out the patient’s positive character in terms of universally accepted values, called for the reader’s sympathy, understanding and helpfulness or appealed to his/her willingness to be realistic and pragmatic and grant disability benefit. The dialogic style varied: some certifiers—although they argued for disability benefit—showed openness to possible opposing or alternative voices by displaying their own uncertainty. Others addressed the reader to share responsibility, demanding or urging for DB. This shifting rhetoric, we believe, mirrors that the GPs see themselves as the patient’s advocate, and that they may find themselves conflicted. We propose further studies within qualitative research to investigate the effect of this rhetoric on the reader, the decision-makers. In addition, to improve the quality and accuracy of these important documents, we suggest that medical schools introduce students to the making of text as a specific skill of medical practice. (shrink)

This article investigates the clinical reasoning process of physiotherapists working with patients with chronic muscle pain. The article demonstrates how physiotherapists work with clues and weigh up different plots as they seek to build consistent stories about their patient’s illness. The material consists of interviews with 10 Norwegian physiotherapists performed after the first clinical encounter with a patient. Using a narrative approach and Lonergan’s theory of interpretation, the study highlights how, like detectives, the therapists work with clues by asking a (...) number of interpretive questions of their data. They interrogatewhatthey have observed and heard during the first session, they also questionhowthe patient’s story was told, including the contextual and relation aspects of clue production, and they askwhythe patient’s story was told to them in this particular way at this particular time. The article shows how the therapists configure clues into various plots on the basis of their experience of working with similar cases and how their detective work is pushed forward by uncertainty and persistent questioning of the data. (shrink)