This book remedies a gap in the on-going debate on community by a transparent and thorough analysis of the work of French philosopher Jean-Luc Nancy.

Name der Zeitschrift: Byzantinische Zeitschrift Jahrgang: 109 Heft: 2 Seiten: 837-860.

High-quality doctor-patient communication in end-of-life care results in better quality of life for patients. In linguistically and culturally diverse societies, language discordant consultations become daily practice, leading to difficulties in eliciting patient preferences toward end-of-life care. Although family members invariably act as informal interpreters, this may cause some ethical dilemmas. We present a case of a palliative patient whose son acted as an interpreter. This case generated a triple- layered ethical dilemma: how to safeguard patient autonomy against paternalistic interventions by (...) family members, how to respect the relational context in which patient autonomy can be realized, and how to respect the ethno-cultural values of the patient and his family. These issues are being discussed and reflected upon within the framework shared decision making involving informal- and professional interpreters. The complementary use of professional interpreters next to family members acting as informal interpreters is recommended. (shrink)

Information and computer technology has come to play an increasingly important role in medicine, to the extent that e-health has been described as a disruptive innovation or revolution in healthcare. The attention is very much focused on the technology itself, and advances that have been made in genetics and biology. This leads to the question: What is changing in medicine today concerning e-health? To what degree could these changes be characterized as a ‘revolution’? We will apply the work of Thomas (...) Kuhn, Larry Laudan, Michel Foucault and other philosophers—which offers an alternative understanding of progress and revolution in medicine to the classic discovery-oriented approach—to our analysis. Nowadays, the long-standing curative or reactive paradigm in medicine is facing a crisis due to an aging population, a significant increase in chronic diseases and the development of more expensive diagnostic tools and therapies. This promotes the evolution towards a new paradigm with an emphasis on preventive medicine. E-health constitutes an essential part of this new paradigm that seeks to solve the challenges presented by an aging population, skyrocketing costs and so forth. Our approach changes the focus from the technology itself toward the underlying paradigm shift in medicine. We will discuss the relevance of this approach by applying it to the surge in digital self-tracking through health apps and wearables: the recognition of the underlying paradigm shift leads to a more comprehensive understanding of self-tracking than a solely discovery-oriented or technology-focused view can provide. (shrink)

Rationale: In this article, I argue that we need a new perspective in the debate on autonomy in medicine, to understand many of the problems we face today – dilemmas that are situated at the intersection of autonomy and heteronomy, such as why well informed and autonomous people make unhealthy lifestyle choices. If people do not choose what they want, this is not simply caused by their lack of character or capability, but also by the fact that absolute autonomy is (...) impossible; autonomous individuals are ‘contaminated’ by heteronymous aspects, by influences from ‘outside’. Consequently, there are many good reasons to question the widely accepted hierarchical opposition of autonomy (progress) versus heteronomy (paternalism) in medicine. In an earlier article an analysis is made of the neologism ‘oughtonomy’ to support the thesis that when it comes down to human existence, autonomy and heteronomy are intertwined, rather than being merely opposites. Methods: In this article, I reflect upon how social conditions might improve our ‘choice architecture’, what Thaler & Sunstein have called ‘nudging’: how to change individual health choices without being paternalistic? I explore the extent to which both oughtonomy and nudging are able to challenge the question of autonomy in today’s medicine. Results and Conclusions: Autonomy may and should be a shared target in today’s medicine, but we should never forget that it is always intertwined with heteronomy. Starting from this perspective, progress in medicine demands far more than the increase of autonomy. (shrink)

For years now, autonomy has been discussed as one of the central values in health care. Understood as self-realization, it is opposed to paternalism which is conceived as an intolerable occurrence of heteronomy. Although different concepts have been developed to nuance this opposition, when it comes to health care discourse, heteronomy is still the enemy of autonomy. In our article, we defend the thesis that autonomy is only achievable as heteronomy. We are not arguing for an expansion of the meaning (...) of autonomy, but are attempting to conduct an analysis which lays bare the ‘disrupting’ attendance of heteronomy within the principle of autonomy. Autonomy does not begin where heteronomy ends, but can only begin if heteronomy is already involved. To emphasize this, we prefer to elaborate a new concept: ‘oughtonomy’. This concept is inspired by Jacques Derrida’s distinction between ‘difference’ and ‘differance’. We will develop the concept of oughtonomy from a deconstructive reading of Kant’s idea of autonomy, inspired by philosophers such as Jacob Rogozinski, Jean-Luc Nancy and others. In addition to a first exploration of this concept, this article also discusses the possible consequences of oughtonomy for current debates concerning health care. Our quest for a new understanding of autonomy is motivated by the concern that, although the accent on autonomy as self-realization and independence has many advantages, we should also bear in mind the countless disadvantages. (shrink)

In the last two decades Information and Computer Technology has come to play an increasingly important role in medicine and health care. Many medical practitioners and scholars wonder: will e-health cause a paradigm shift in health care? To answer this question we provide a philosophical analysis of the concept of the 'paradigm shift' through the work of Michel Foucault, Thomas Kuhn and Larry Laudan. Their work offers key insights to a comprehensive understanding of major evolutions in medicine. Nowadays the long-standing (...) curative paradigm in medicine is facing important challenges due to an aging population, a significant increase in chronic diseases and the development of more expensive diagnostic tools and therapies. This promotes the evolution towards a new paradigm in medicine with an emphasis on preventive, predictive and personalized care. E-health constitutes an essential part of this new paradigm that seeks to solve the challenges presented by an aging population, skyrocketing costs and so forth. On the other hand the characteristics of e-health will be strongly determined by this new paradigm. 'Will e-health cause a paradigm shift in medicine?' might not be the right question to pose. Rather, we should ask how the underlying paradigm shift, from discovery and cure to prevention and prediction, acts as a facilitator to embrace ICT in health care. This analysis is of crucial importance in understanding the impact of digital health care applications and provides a necessary framework for the emerging, dynamic system of e-health. (shrink)

Today, the improper is not only a philosophical issue; it is also a political question. In particular, striving to abandon the improper is central to the contemporary political agenda in many Western countries. Given the risks of a political agenda abandoning the improper in a proper way and realizing a “closed community,” contemporary philosophers such as Roberto Esposito and Jean-Luc Nancy have thought about the relationship between the proper and improper. It is remarkable that Martin Heidegger is an exemplary figure (...) in the analyses of both philosophers. I will analyze Heidegger's line of thought on this issue and how Esposito and Nancy have responded to it. Both Esposito and Nancy state that it is “impossible to abandon the improper in a proper way” in their writings on community. Every proper existence is always marked by impropriety, Nancy and Esposito argue; there is no “original” or “proper” commonality that would liberate us from all things improper. Even before one can appropriate one's property, it is already traversed by the improper. The question “how not to abandon properly the improper?” is in fact one of the imperatives behind their arguments: if indeed the proper is always already, in one way or another, related to or contaminated by the improper, it is indeed an illusion to think we can simply leave the improper behind. (shrink)

Rationale, aims and objectives : Evidence-based medicine (EBM) claims to be based on 'evidence', rather than 'intuition'. However, EBM's fundamental distinction between quantitative 'evidence' and qualitative 'intuition' is not self-evident. The meaning of 'evidence' is unclear and no studies of quality exist to demonstrate the superiority of EBM in health care settings. This paper argues that, despite itself, EBM holds out only the illusion of conclusive scientific rigour for clinical decision making, and that EBM ultimately is unable to fulfil its (...) own structural criteria for 'evidence'. Methods : Our deconstructive analysis of EBM draws on the work of the French philosopher, Jacques Derrida. Deconstruction works in the name of justice to lay bare, to expose what has been hidden from view. In plain language, we deconstruct EBM's paradigm of 'evidence', the randomized controlled trial (RCT), to demonstrate that there cannot be incontrovertible evidence for EBM as such. We argue that EBM therefore 'auto-deconstructs' its own paradigm, and that medical practitioners, policymakers and patients alike ought to be aware of this failure within EBM itself. Results : EBM's strict distinction between admissible evidence (based on RCTs) and other supposedly inadmissible evidence is not itself based on evidence, but rather, on intuition. In other words, according to EBM's own logic, there can be no 'evidentiary' basis for its distinction between admissible and inadmissible evidence. Ultimately, to uphold this fundamental distinction, EBM must seek recourse in (bio)political ideology and an epistemology akin to faith. (shrink)

More than ever, the way we live our lives has become subject to our own decisionmaking. Our whole way of living, in particular what we do to our body, has become the expression of personal lifestyle choices. Because we can make changes to our body according to our own individual preferences, every aspect of our life begins to be seen as the result of individual and voluntary decisions. The comparison with advertising is pertinent here: we should no longer accept the (...) way we are but can choose from a variety of options. Go to any supermarket and look around: innumerable products are promoted because of their healthy ingredients, whether to lower our cholesterol or heighten our natural resistance. And, of course, we buy what is on offer. (shrink)

This essay explores Jean‐Luc Nancy's rethinking of political space in terms of an ontological ‘being‐with’. It elucidates how Nancy's thinking of community emerges out of the French philosopher's reworking of Heidegger's crucial notion of Mitsein. For Nancy, although Heidegger argues that Dasein is always already also Mitsein, Mitsein is nonetheless also occluded by the priority accorded to Dasein. The consequences for the way in which community or the space of the political is configured are profound since traditional conceptions of the (...) subject of community thus remain unreconstructed. Nancy however does reconstruct community by emphasising that the primal ontological conditions of community are not conceived as the One, the Other or the We, but as the ‘with’, ‘relationality’, and the ‘between’. The question of being thereby becomes the question of being‐with. (shrink)

French philosopher Jean-Luc Nancy is acting uneasily when it comes to contemporary politics. There is a sort of agitation in his work in relation to this question. At several places we read an appeal to deal thoroughly with this question and ‘ qu’il y a un travail à faire ’, that there is still work to do. From the beginning of the 1980s with the ‘Centre de Recherches Philosophiques sur le Politique’ and the two books resulting out of that, until (...) the many, rather short texts he published on this topic during the last years of the century, the question of politics crosses very clearly Nancy’s work. He not only fulminates against the contemporary philosophical ‘content’ with democracy. Instead of defending a political regime, he wants to think the form of politics in the most critical and sceptical way. To Nancy, the worst thing we can do in thinking contemporary politics, is taking it for granted that we know what politics is about today, given the evidence of the global democracy. So to him, we almost have to be at unease when it comes to politics. On the other hand, in thinking contemporary democracy, the work of Claude Lefort is undeniably the main reference. Long before the collapse of the Berlin Wall and the upsurge of an all-too-easy anti-Marxism, Lefort articulated in a nuanced way the formal differences between totalitarianism and democracy. According to Lefort, the specific ‘form’ of democracy is that it never becomes an accomplished and fulfilled form as such. In a certain sense, the only ‘form’ of democracy is formlessness, a form without form. In a democracy, the place of power becomes literally ‘ infigurable ’ as Lefort says. Democracy stands for formlessness or the relation to a void. Nancy objects so to say against a ‘Leformal’ conception of democracy – the empty place, the formless, the ‘ infigurable ’ or ‘ sans figure ’, the ever yet to come. ... This conception of democracy would still be caught in the infinite metaphysical, dialectical horizon of immanentism, while it pretends to have already left that horizon behind it, presenting itself as the finite alternative to the infinite totalitarian politics. Democracy as formlessness is indeed no longer based on a metaphysical Idea, Figure, or Truth. We want to clear up the philosophical sky of Nancy’s remarks by confronting them with some thoughts of Lefort. (shrink)

Victims of disaster suffer, not only at the very moment of the disaster, but also years after the disaster has taken place, they are still in an emotional journey. While many moral perspectives focus on the moment of the disaster itself, a lot of work is to be done years after the disaster. How do people go through their suffering and how can we take care of them? Research on human suffering after a major catastrophe, using an ethics of care (...) perspective, is scarce. People suffering from disasters are often called to be in distress and their emotional difficulties ‘medicalised’. This brings them often into a situation of long term use of medication, and one can wonder if medication is of help to them in the long run. In our paper, we will explore another moral perspective, focusing on the importance of the victims’ narrative and their lived experiences. We will use Paul Ricoeur’s phenomenological reflections from ‘Suffering is not the same as pain’ for conceptualizing human suffering and how to apply it to victims of disaster. Ricoeur suggests that suffering is not a quantity that can be measured, but a characteristic that should be studied qualitatively in interpersonal and narrative contexts. Above all, the perspective of care and listening could offer an opportunity to reconcile people from their loss and suffering. (shrink)

More than four years ago, Anders Breivik launched his apocalyptic raid in Norway. His killing raid was not an action standing on its own but a statement to invite people to read his manifesto called 2083. A European Declaration of Independence. The highly despicable and disgusting mission of Anders Breivik addresses us whether we like it or not. Maybe there are good reasons to read and analyze Breivik’s ‘oration?’ He confronts us with many questions we cannot simply run away from: (...) What about the Islamization? How could this happen in secular Norway? What about the role of religion in European societies? In this article, I will argue that Breivik’s plea can only happen from within a secular society in which the homogeneity already has been lost, which allows him to deal with religion and politics on a very specific basis. In no way whatsoever, the context of our secular society forced Breivik to do what he did. However Breivik could only construct his actions and ideas within the (Christian) democratic context he lives in. I will analyze this with the writings of Hannah Arendt on political theology and the complex relationship between politics and religion and a late secular society. (shrink)

In one of his latest books, La pensée dérobée, Jean-Luc Nancy continues writing about the major themes of his work up until now: community, sense, being as being with, or singular plural being. These themes come together in a witnessing of the world “as such”: that is to say,the world here and now in which we are living in common. The sense of the world is nothing but this being-in-common. This makes Nancy a thinker of “globalization”, albeit in a very (...) specific way, one concerned with the way in which we are “world”. One way to argue this is to consider the way in which Nancy's workis larded with enumerations. Very often he “recites” our singular plural being by giving lists of the diversity of “things”. This is also the case for a few of the texts in La pensée dérobée. In trying to catch an echo of these “recitals”, I want to review the theme world in Nancy's oeuvre and ask the question if and how Nancy thinks of our global coexistence nowadays. A part of this text was presented at the 4th annual conference of The Society for European Philosophy at the Manchester Metropolitan University. (shrink)

Nancy’s deconstruction of Christianity mainly consist of a reworking of Christian and traditional philosophical notions, a process by which he demonstrates how these notions have virtually exhausted themselves. He has examined how such notions contain, as their very condition, the possibility of their own exhaustion. As a result, Nancy’s project of a deconstruction of Christianity is actually a ‘reading’ of Christianity deconstructing itself, i.e. of Christianity’s raison d’être containing at the same time the possibility of its own exhaustion. Or as (...) Derrida would have phrased it, Christianity’s construction generates its deconstruction at the same time. This text tries to summarise the outlines of such deconstruction and its the rise in Nancy’s work, from his earlier publications up until La déclosion in 2005. (shrink)

Jean-Luc Nancy has not written a single work dedicated entirely to the problem of justice or related themes, but nevertheless, topics such as right, justice, judgement or law appear in various places in Nancy’s work. Besides ‘Lapsus judicii’ and ‘Dies irae’, the theme of justice particularly comes up and in two small texts: ‘Cosmos Basileus’ and ‘Human Excess’. These texts are crucial to understand Nancy’s point of view in juridical matters but are largely left aside in secondary literature, probably because (...) of their enigmatic character. In this article we explore the cluster of juridical questions in ‘Cosmos Basileus’ and ‘Human Excess’ and argue why today, for Nancy, an ontological perspective is needed to cope with juridical questions. For him, justice is in the first place bound up with the fact of our co-existence, with what is unique about every existence in its co-existence with other creations. He claims, first, that freedom is responsibility and the act of doing justice to existence and, second, that sharing the world is the law of the world. We will discuss these two claims and conclude with Nancy’s plead for ontological reflection within juridical topics. (shrink)

In this article, a close study of Jean-Luc Nancy’s The Experience of Freedom is offered. After presenting the book’s main argument, i.e. a non-metaphysical thinking of freedom, we turn to the question of subjectivity and freedom in relation to the eventfulness of freedom itself. The article closes by questioning certain surprising tendencies in Nancy’s work. So, for instance, one might note a return of the concept of destiny (and therefore of a certain form of metaphysics) in Nancy’s debate with Heidegger. (...) Throughout, this essay seeks to relate the theme of freedom to other works of Nancy, including his recent deconstruction of Christianity, and to the debate with Heidegger and Derrida that takes place around the question of the freedom of the human being. (shrink)

Il y a plus de quinze ans, Jean-Luc Nancy a publié La communauté désoeuvrée. Les clefs pour comprendre l’enjeu de cette question communautaire, ce sont la «négativité sans emploi» de Bataille et ce que Blanchot a nommé le «désoeuvrement». Chaque fois qu’on parle dans notre culture d’une crise de notre socialité fragmentée, on peut constater qu’en-dessous de cette complainte se trouve unschéma dialectique : la communauté originaire a été perdue mais à la fin elle peut être reconstituée complétement. L’objectif de (...) Nancy, c’est d’échapper à cette dialectique, parce que ce n’est que devant la disparition de tout fondement onto-théo-Iogique que la question de la communauté puisse vraiment être posée : se mettre en quête de ce que nous sommes, sans qu’un Dieu ou un chef doive s’en occuper. Pour le moment, cette question est encore captive de la logique métaphysique de l’immanentisme. C’est la logique d’une humanité qui prétend fonder sa propre communauté comme une oeuvre, comme un ouvrage à fabriquer et é achever, et par lequel on reste captif de l’immanence de sa propre existence. C’est une logique à défaire.More than fifteen years ago, Jean-Luc Nancy published The inoperative community. The key to understanding the issue of the question of community was Bataille’s concept of “negativity without use” and Blanchot's “idleness”. Whenever one speaks, in our culture, of a crisis of our fragmented sociality, one can notice an underlying dialectic scheme: the original community was lost, but in the end, it can becompletely rebuilt. Nancy’s objective is to escape this dialectic, for the question of community can properly be raised only once the onto-theological foundations have been relinquished. One may seek to discover who we are without having to rely on a god or a leader. For the moment, this question is trapped in the logic of immanence. It is the logic of a humanity which claims to establish its own community as a piece of work, to be put together and completed, thus remaining imprisoned in the immanence of one’s own existence. This logic must be undone. (shrink)

In his short text ‘La déconstruction du christianisme’ from 1998, the French philosopher Jean-Luc Nancy set up the preliminaries for his ‘deconstruction of Christianity’. This differs from a plea or a criticism of Christianity. It is the question if atheism is the very antipode of religion or if religion has a sort of auto-critical gesture towards itself. We love to say that we are – we moderns – no longer Christians, but maybe the Christian aspects of our existence are so (...) evident, that we are no longer conscious of them. It is his thesis that Christian thinking or onto-theology in a more general way – thinking of the world out of a first Cause, a Supreme God, etc – lies itself at the basis of a thinking of the world and nothing but the world. Ontotheology, so is Nancy’s thesis, dismantled or autodeconstructed itself and became more and more, a thinking of the immanent world. In this respect, he seems to affirm the classic thesis of secularisation: in a society based on religion, the sense of the world is situated above the world, or has an over-worldwide status. In a secular society, sense would finally be immanent in the world. The truth is that he questions nothing but this thought. Take for example the question whether our existence has a meaning. The thought that it really has and that it is attached to existence by some self constitutive instance – whether it is a God or a subject – is present as well in Christianity as in atheism. Nancy tries to think the sense of the world out of the transcendental conditions of our existence. An atheist world is a world in which sense is no longer attached to the world, but where it is the condition of our Being-in-the-world as such. The world does not have sense, it is sense, and this naked existence means that we have to exist in the sense that we are. We are exposed to the world and to ourselves, and that is the sense of existence, of our being-together-in-the world. (shrink)