Discussing the workings of technology in care as aesthetic rather than as ethical or epistemological interventions focusses on how technologies engage in and change relations between those involved. Such an aesthetic study opens up a repertoire to address values that are abundant in care, but are as yet hardly theorized. Kamphof studies the problem that sensor technology reveals things about the elderly patients without the patients being aware of this. I suggest improvement of these relations may be considered in aesthetic (...) terms, for instance by developing the affective quality of people’s technological relationships. (shrink)

Surgeons who perform sex reassignment surgeries define their goals and evaluate their outcomes in terms of two kinds of results: aesthetic and functional. Since the neogenitals fashioned through sex reassignment surgeries do not enable reproductive function, surgeons must determine what the function of the genitals is or ought to be. A review of surgical literature demonstrates that questions of what constitute genital form and function, while putatively answered in the operating room, are not answerable in the discourses of clinical evaluation (...) used to define them. When the genitals—the word itself derived from the Latin genitas meaning to beget—are not reproductive, the question of their function shifts away from the biological and into other registers: pleasure, intimacy, sociality. As condensed sites of meaning and meaning-making around which selves, affects, resources, anxieties and futures are organized, the genitals signify in excess of the categories of “aesthetic” and “function” that surgeons use to assess them. Not reducible to either aesthetics or function, but constitutive of them both, this excess appears in surgical texts in the form of imagined futures of social and sexual engagement and demonstrates a powerful means by which properly sexed bodies are created. (shrink)

This paper reports on a particular aspect of a larger ethnographic study of nursing culture in an intensive therapy unit (ITU), accomplished through participant observation over a 12‐month period, followed by interviews with 15 nurses. The paper suggests that the ITU environment is perceived as ‘dangerous’, its dangerousness stemming from the ambiguity of its patients’ conditions. Drawing on anthropological concepts of liminality, pollution, anomaly and breaching of boundaries, the paper identifies various ambiguities inherent in ITU patients’ conditions. It then explores (...) the ways in which these anomalies are managed through sequestration and other ritual and symbolic practices. Notwithstanding the undoubted scientific reasons for particular nursing practices, the paper argues that there are also ritual and symbolic elements serving other more complex purposes, both protecting patients and staff and symbolising the highly valued phenomenon of keeping patients safe. The paper identifies a contradiction inherent in nursing work in this locale inasmuch as rituals and symbolism coexist with technical and research‐based elements of nursing care. (shrink)

Foucault and modern medicineModernity as a concept or ideal, resulting from the age of Enlightenment and the French Revolution gave hope of a better future and new possibilities. To be modern means an ‘enlightened’ individual and society, welcoming change and development. In this paper, I will discuss Foucault's analysis (1973) of problematics in medicine in eighteenth century France. Three themes prominent in the text are: ‘the birth of the clinic’, ‘the clinical gaze’ and the power‐knowledge relationship. Three problematics identified in (...) modern medicine by Foucault and which are particularly relevant to twentieth century medicine are: (i) the extension of the clinical gaze from the individual body to the wider population; (ii) the increasing medical intervention and use of technology in fundamental life processes; and (iii) the relationship between society and medicine. I will argue that Foucault's analysis is fraught with ambiguities. It is useful, however, for establishing an explanation for medicine today and for presenting a particular interpretation of modernity. (shrink)

Taking into account how much modern medicine is a function of—and at the same time has a function in—science and technology, it is hardly surprising that both the approach of science studies and the idea of the social and cultural construction of health, disease, and bodies overlap, generally and specifically, in the realm of the novel field of MEDICINE STUDIES. The work already done in science and technology studies as well as in social studies of medicine, together with the rich (...) tradition of medical history and philosophy of medicine, may be considered a solid base and a good vantage point for further analysis. By exploring the shifts of knowledge production in medicine we may be able to see the driving forces behind the ongoing development of medicine and the associated transformation of its social functions in a new light. Based on historiographical reconstructions we may come up with a much more broadly contextualized understanding of the ways in which science, technology, medicine and society interact and in what regard their mutual interdependencies have been undergoing profound changes for a number of decades. By tracing the channels through which key concepts defining the relationship of medicine and its social context are negotiated, we may further explore how our notions of health, disease, and humanity are continuously morphing alongside the incessant transformations of medicine. This editorial explores the aims and scope of MEDICINE STUDIES as a truly transdisciplinary endeavor. (shrink)

Prominent consumer depression manuals issued in recent years circulate a standard depression script as scientific knowledge. The script, asserting that a broad spectrum of depressions are brain illnesses that require antidepressant treatment, is in fact highly contested among researchers. This paper reviews the logical problematics of these manuals, and how such discourse promotes the diagnosis and pharmaceutical treatment of behaviors ranging from mild symptoms to severe depression. In keeping with the trends of pharmaceutical advertising and State health policy, these manuals (...) encourage consumers to self-scrutinize risky behavior, and to treat common behavioral and mood distresses with antidepressants. Ultimately, these activities of self-management function to produce a more productive citizen population. (shrink)

James F. Drane: A Liberal Catholic Bioethics. Muenster, DE: Lit Verlag. 2010, 290 Pages Content Type Journal Article Category Book Review Pages 771-774 DOI 10.1007/s11406-011-9319-4 Authors Andrew Papanikitas, Department of Education and Professional Studies, King’s College London, Strand Campus, London, WC2R 2LS UK Barbara Prainsack, Kings Institute of Social Science and Public Policy, King’s College London, Strand Campus, London, WC2R 2LS UK Journal Philosophia Online ISSN 1574-9274 Print ISSN 0048-3893 Journal Volume Volume 39 Journal Issue Volume 39, Number 4.

In his six 1983 lectures published under the title, Fearless Speech, Michel Foucault developed the theme of free speech and its relation to frankness, truth-telling, criticism, and duty. Derived from the ancient Greek word parrhesia, Foucault's analysis of free speech is relevant to the mentoring of medical students. This is especially true given the educational and social need to transform future physicians into able citizens who practice a fearless freedom of expression on behalf of their patients, the public, the medical (...) profession, and themselves in the public and political arena. In this paper, we argue that Foucault's understanding of free speech, or parrhesia, should be read as an ethical response to the American Medical Association's recent educational effort, Initiative to Transform Medical Education : Recommendations for change in the system of medical education. In this document, the American Medical Association identifies gaps in medical education, emphasizing the need to enhance health system safety and quality, to improve education in training institutions, and to address the inadequacy of physician preparedness in new content areas. These gaps, and their relationship to the ITME goal of promoting excellence in patient care by implementing reform in the US system of medical education, call for a serious consideration and use of Foucault's parrhesia in the way that medical students are trained and mentored. (shrink)

John Tradescant the Elder was probably born in England in the 1570s. The earliest known historical record of his life documents his marriage to Elizabeth Day, at Meopham on 18 June 1607.1 A long career working as gardener in the service of England’s nobility—among his employers were Robert and William Cecil, Edward Wotton, and George Villiers —provided numerous opportunities for travel abroad in pursuit of the exotic species for which his eminent employers clamored. As a result of his voyages, Tradescant (...) not only imported hundreds of plant varieties for his clients, but also amassed thousands of artefacts and other.. (shrink)

The ArgumentMontaigne'sEssayswere an exercise in self-knowledge carried out for more than twenty years in Montaigne's private library located in his mansion near Bordeaux. The library was a place of solitude as well as a place of knowledge, a kind ofheterotopiain which two sets of spatial relations coexisted and interacted: the social and the epistemic. The spatial demarcation and arrangement of the site – in both the physical and the symbolic sense – were necessary elements of the constitution of Montaigne's self (...) as an object of knowledge and as a subject of discourse. The spatial setting of the library made possible and constrained certain discursive patterns through which words were systematically linked to things, authority was correlated with access and visibility, and the epistemological was coordinated with the social. In this sense, Montaigne's library resembled other places of empirical knowledge of the late sixteenth and seventeenth centuries in which subjects of knowledge were constituted, objects were posited in their proper phenomenal fields and the entire structure of intellectual activity was reproduced through various cultural mechanisms. But the initial similarity is only apparent. The private library never became a culturally recognized place for knowledge of the self; its heterotopic structure could not have been reproduced without the concrete presence of an author and of a self, while Montaigne's skepticism systematically undermined the possibility of the author's position and of the identity of the self. (shrink)

A generation ago scientific ideas floated free in the air, as historians gazed up at them in wonder and admiration. From time to time, historians agreed, the ideas that made up the body of scientific truth became incarnate: they were embedded into the fleshly forms of human culture and attached to particular times and places. How this incarnation occurred was a great mystery. How could spirit be made flesh? How did the transcendent and the timeless enter the forms of the (...) mundane and the contingent? Platonist and providentialist perspectives offered ways of speaking about the mystery, but, in general, it remained unresolved at the core of orthodox idealist historiography.1. (shrink)

In the clinical practice of palliative medicine, recommended communication models fail to approximate the truth of suffering associated with an impending death. I provide evidence from patients' stories and empiric research alike to support this observation. Rather than attributing this deficiency to inadequate training or communication skills, I examine the epistemological premises of the biomedical language governing the patient-physician communication. I demonstrate that the contemporary biomedicine faces a fundamental aporetic occlusion in attempting to examine death. This review asserts that the (...) occlusion defines, rather than simply complicating, palliative care. Given the defining place of aporia in the care for the dying, I suggest that this finding shape the clinicians' responses to the needs of patients in clinical care and in designing palliative research. Lastly, I briefly signal that a genuinely apophatic voice construing the occlusion as a mystery rather than an aporia may be superior to the present communication and empathy models. (shrink)

Abraham Verghese proposes to renew medicine by training physicians to read the right texts—literary fiction and patients' bodies—with skilled attention. Analyzing Verghese's proposal with reference to Foucault's idea of the "clinical gaze," I find that Verghese conceives of patients as texts that only physicians can read, meaning that physicians become the storytellers of the bodies, lives, and deaths of the people they meet as patients. I conclude that Verghese's project is unsustainable and alternatively propose thinking analogically of physicians as ship (...) captains who maintain therapeutic distance to reopen interpretative spaces for communities outside of medicine. (shrink)

Medical schools are among the most important spaces for the history of the body. It is here that students come to know the anatomical bodies of their future patients and, through a process of cognitive and embodied practice, that the knowing bodies of future clinicians are also shaped. Practical and theoretical understandings of medicine are formed in these affective and historied buildings and in collaboration with a broad material culture of education. Medical schools are, however, both under-theorised and under-historicised. This (...) article integrates ‘materialist’ considerations of the body with Henri Lefebvre’s philosophy of space and rhythm in order to compare two markedly different spaces – the 19th-century Anatomy Department at Semmelweis University in Hungary and the mid-20th-century ‘skills laboratory’ at Maastricht University in the Netherlands. This comparison suggests that biomedical bodies are variously shaped by the agential and affective material histories present in the everyday experience of contemporary medical education. (shrink)

Maternity is a biological process that has increasingly changed into an authoritative medicalized phenomenon and requires techno-medical intervention today. Modern medicine perceives women’s procreative functions as pathological that need medical involvement and control. Medical biologists claim that the female body is destined to procreate in which medical sciences can assist them with techniques. But is a woman’s body biologically evolved merely for procreation? Or is it a sexist interpretation of her socially situated self? How can we justify the idea of (...) universality and neutrality of medical sciences in a social context? Arguing against deterministic biology, existential feminists advocate that female body is not merely a biological fact but rather a social situation under which the maternal act has become the essence of being a woman. Social situations influence medicine in a way that they are used as a rhetorical tool to achieve social desires authoritatively. The present paper explores and examines the increasing medicalization of female body and maternity through the lenses of biological determinism and phenomenological existentialism. I argue that medically supported theories of female body are socially interpreted that perpetuate the traditional role of women as mothers instead of emancipating them from their immanence. The paper discusses how the scientific model of medicine is implicitly influenced by socio-cultural forces and, consequently, tries to reduce social phenomena into biological factors to justify women’s inevitable destiny as motherhood. Thus, we need a de-medicalized model of medicine in order to comprehend the true meaning of maternal body and self. (shrink)

The built environment and the organisation of public spaces reflect the normative notions of male and female. Public toilets, amongst other widely common public spaces, underline these two opposing concepts and challenge the presence of transgender. Within the boundaries of public toilets, transgender and gender non-conforming individuals become a crucial point of debate, scrutiny and controversy. Analysing the politics of such gender-segregated space, this article explores the notion of uniformity and challenges the idea of single-ness as the absolute expression of (...) the self. (shrink)

Post-structuralist discourses have usually been associated with forms of critique and deconstruction of social, cultural and philosophical phenomena. However, this article attempts to provide a generative approach to understanding educational leadership through Michel Foucault’s notions of power and subjectification, and Judith Butler’s notions of performativity and discursive agency through re-signification. We argue that leadership is not simply a list of traits, characteristics or behaviours to be implemented. Rather, we argue that leaders are performatively constituted through everyday practices and discourses. The (...) aim is to interrupt prevailing discourses that often re-inscribe certain forms of meaning and understanding in educational leadership. This disruption subsequently provides possibility for putting forward otherwise silenced ideas about what leadership is and how leadership ‘identity’ (subjectivity) is formed, thus expanding the methodological tools scholars can use to talk about leadership. (shrink)

The article studies the tradicional locus of madhouse present in 2666 by Roberto Bolaño, but taking into consideration also the desert and the church as spaces where the enunciation of madness is expands: the madman’s truth. To this end, three aspects that configure the heuristic notion of lettered madhouse are analyzed: the digressive diagrams, the phobic philology, and enlightened hospice. In short, it shows how Bolaño elaborates in his novel a critical and ironic vision of Latin American literary intelligentsia or (...) the remnants of The lettered City of Angel Rama. (shrink)

As a system of knowledge, nursing has utilized a range of subjects and reconstituted them to reflect the thinking and practice of health care. Often drawn to a holistic model, nursing finds it difficult to resist the reductionist tendencies in biological and medical thinking. In this paper I will propose a relational approach to knowledge that is able to address this issue. The paper argues that biology is not characterized by one stable theory but is often a contentious topic and (...) employs philosophically diverse models in its scientific research. Biology need not be seen as a reductionist science, but reductionism is nonetheless an important current within biological thinking. These reductionist currents can undermine nursing knowledge in four main ways. Firstly, that the conclusions drawn from reductionism go far beyond their data based on an approach that prioritizes biological explanations and eliminates others. Secondly, that the methods employed by biologists are sometimes weak, and the limitations are insufficiently acknowledged. Thirdly, that the assumptions that drive the research agenda are problematic, and finally that uncritical application of these ideas can be potentially disastrous for nursing practice. These issues are explored through an examination of the problems reductionism poses for the issue of gender, mental health, and altruism. I then propose an approach based on critical realism that adopts an anti‐reductionist philosophy that utilizes the conceptual tools of emergence and a relational ontology. (shrink)

Technology and its interfaces with nursing care, patients and carers, and the home are many and varied. To date, healthcare services research has generally focussed on pragmatic issues such access to and the optimization of technology, while philosophical inquiry has tended to focus on the ethics of how technology makes the home more hospital like. However, the ethical implications of the ways in which technology shapes the subjectivities of patients and carers have not been explored. In order to explore this, (...) poststructural theory, in particular the work of Butler, Foucault, and Deleuze, is used to theorize the relationship between subjectivity and materiality as ethically mandated on producing rather than precluding the development of subjectivities in novel ways. This theoretical understanding is then utilized through a process of ‘plugged in’ as described by Jackson and Massie that aims to link empirical data, research, and philosophical inquiry. Through this process, it is suggested that power, which the empirical data demonstrate, is frequently exercised through medical discourses and restricts patients' and carers' ability to shape the material environment of the home as a place to live and be cared for in palliative stages of illness. Alternative discourses are suggested both from the empirical data as well as other research, which may offer patients and carers the possibility of reclaiming power over the home and their subjectivities. Finally, the dichotomy between the home and hospital, mediated via technology, is posited as being problematic. It is argued the dichotomy is false and should be moved away from in order to allow an ethical embrace of technology in palliative care. (shrink)

“Captured” in the hands of twenty-first-century structural biologists, “life itself” is taking on new form. The current trend towards molecularization in the life sciences is revealing that “life itself” is denser than the one-dimensional logic of a genetic code: it has a multidimensional material body, and its molecular structures, forces, and movements carry out the regulated work of the cell. Researchers are no longer satisfied reducing the organism to the coding systems embedded in computer software ; the organism now has (...) a mechanical architecture, and its molecular mechanisms have come to resemble the many kinds of machines with which we currently live and work. These include electronic circuitry, and the levers, switches, hinges, springs, locks, and clamps of modern day mechanical devices. These are the molecular machines that populate what is fast becoming the factory-floor of the cell... (shrink)

The ability to dominate or exercise will in social encounters is often assumed in social theory to define power, but there is another form of power that is often confused with it and rarely analyzed as distinct: logistics or the ability to mobilize the natural world for political effect. I develop this claim through a case study of seventeenthcentury France, where the power of impersonal rule, exercised through logistics, was fundamental to state formation. Logistical activity circumvented patrimonial networks, disempowering the (...) nobility and supporting a new regime of impersonal rule: the modern, territorial state. (shrink)

This article explores the way that senile dementia is represented in contemporary culture, with particular reference to texts which narrate the experience of caring for a parent or spouse with one form of the illness. These narratives raise problematic issues about the materiality of the body and its relation to individual identity, and the unstable relationship between memory and identity in postmodern culture, by drawing on the actual experience of bodily dependency and disorientating memory loss in dementia patients. These speculations (...) about the body, memory and the self are ultimately related in narratives of dementia to the inevitable process of aging and dying and the cultural meanings attached to it. The article places the representation of dementing illnesses within a Foucauldian narrative of surveillance and control in the discourse of aging and death in modern Western societies, redemptive views of illness in western culture and arguments about death in contemporary theory. (shrink)

Science, technology and human values have been the subject of enquiry in the last few years for social scientists and eventually the relationship between science and gender is the subject of an ong...

By ruling out questions of impairment from the social critique of disability, Disability Studies analyses establish a limit point in the field. Of course the setting of “limits” enables possibilities in multiple directions as well as fortifies boundaries of refusal. For instance, impairment becomes in DS simultaneously a productive refusal to interpret disabled bodies as inferior to non-disabled bodies and a bar to thinking through more active engagements with disability as materiality. Disability materiality such as conditions produced by ecological toxicities (...) serve as active switch-points for creative corporeal navigations of the interaction between bodies and environments.In fact in this paper we want to propose a more “lively” definition of disability materiality to existing definitions of impairment as limiting expressions of non-normative bodies. We have no useful ways of explaining disability as adaptation and it’s time we begin the process of theorizing more active ideas of materiality that extend existing ideas of disability beyond simplistic conceptions of socially rejected biologies made available by social constructivist thought. (shrink)

For Māori, a real opportunity exists to flesh out some terms and concepts that Western thinkers have adopted and that precede disciplines but necessarily inform them. In this article, we are intent on describing one of these precursory phenomena—Foucault’s Gaze—within a framework that accords with a Māori philosophical framework. Our discussion is focused on the potential and limits of colonised thinking, which has huge implications for such disciplines as education, among others. We have placed Foucault’s Gaze alongside a Māori metaphysics (...) and have speculated on the Gaze’s surveillant/expectant strategies with some key Māori primordial phenomena in mind, such as ‘te kore’ and ‘āhua’. We posit the Gaze as an entity and thus aim to render it more relevant to Māori, so that it can be addressed appropriately. We also preface that discussion by theorising on some of the challenges that confront us as Māori authors in even referring counter-colonially to the Gaze. Whilst we do not seek to destabilise the Gaze by positing it as a metaphysically based entity, we do hint at the possibility that critical indigenous philosophy may even for a short time bring the Gaze into focus for Māori. By introducing an awareness of an alternative metaphysics, we may have unsettled the self-certainty of the Gaze. (shrink)

The experience of researching as a Māori student within academia will often raise questions about how and whether the student’s research privileges Māori world views and articulates culturally specific epistemologies. This study offers some theorising, from the perspectives of a Maori doctoral student and her Maori supervisor, on the metaphysical nature of research for Maori. It emphasises that there is a space for speculative, creative and responsive thinking as a central method in the student’s doctoral research and describes how access (...) to free thinking has been only partly recognised in currently dominant methods of research. We describe this approach as ‘whakaaro’, and note its relationship to language itself, to the researcher and the interviewee, and in particular to the researcher’s intuitive and largely unknowable response to what an interviewee utters. In that act, the student envisages that she will expansively hint at the deep expression of the profoundly mysterious. Here, our thinking resonates with various Western and indigenous writings about research and adumbrates the potential of the whakaaro method without foreclosing against its various permutations. (shrink)

Since the introduction of ultrasound technology in the 1960s as a tool to visibly articulate the interiors of the pregnant body, feminist scholars across disciplines have provided extensive critique regarding the visual culture of fetal imagery. Central to this discourse is the position that fetal images occupy- as products of a visualizing technology that at once penetrates and severs pregnant and fetal bodies. This visual excision, feminist scholars describe, has led not only to an erasure of the female body from (...) fetal images but also to an erasure of the pregnant body in social, political, and biomedical discourses. Vital to feminist scholarship is, thereby, an engagement with fetal images in ways that reinscribe the pregnant body onto fetal images and into political discourses pertaining to reproductive rights. In this paper, similar to the feminist aim, I am interested in engaging with fetal images as way to gain agency for pregnant women and their bodies. The critical question that I ask is: Can we conceive of medical technology in an embodied way -one that interacts organically, dynamically, and through multisensory dimensions with pregnant bodies? In attempting to answer this question, I turn to Bruno Latour and Gilles Deleuze’s articulations of how bodies and machines interact to produce visual fact. (shrink)

This article sets the stage for a genealogy of the postgenomic body. It starts with the current transformative views of epigenetics and microbiomics to offer a more pluralistic history in which the ethical problem of how to live with a permeable body – that is plasticity as a form of life – is pervasive in traditions pre-dating and coexisting with modern biomedicine (particularly humoralism in its several ramifications). To challenge universalizing narratives, I draw on genealogical method to illuminate the unequal (...) distribution of plasticity across gender and ethnic groups. Finally, after analysing postgenomics as a different thought-style to genomics, I outline some of its implications for notions of plasticity. I argue that postgenomic plasticity is neither a modernistic plasticity of instrumental control of the body nor a postmodernist celebration of endless potentialities. It is instead closer to an alter-modernistic view that disrupts clear boundaries between openness and determination, individual and community. (shrink)

An anthropologist describes how he found himself at the vortex of a “clash of medical civilizations:” neoliberalism and the international primary health care movement. His involvement in a $6 million social change initiative in medical education became a basis to unlock the hidden tensions, contradictions and movements within the “primary care” phenomenon. The essay is structured on five ethnographic stories, situated on a continuum from “natural” species-level primary care to “unnatural” neoliberal primary care. Food is an element of all tales. (...) Taking the long view of history/prehistory permits us to better recognize ideological distortions in order to more capably transform medicine. (shrink)

This article draws on Foucault's concept of the exercise of power and Gramsci's concept of hegemony to examine how women used cosmetic surgery to exercise power over their bodies and lives. The analysis is rooted in two feminist perspectives on cosmetic surgery. The first argues that women who elect to have their bodies surgically altered are victims of false consciousness whose bodies are disciplined by the hegemonic male gaze. The second asserts that women who undergo elective cosmetic surgery exercise free (...) choice in controlling their bodies and lives. By examining sites wherein power is exercised by and over women, the authors argue for a synthesis of these two perspectives. They find that the women achieved greater power and control over their bodies and lives when they embodied hegemonic ideals of feminine beauty. Cosmetic surgery can be empowering for individual women while reinforcing the hegemonic ideals that oppress women as a group. (shrink)

This article focuses on the events surrounding a homosexual Romanian man's attempt to be recognized as a refugee in Britain. Numerous themes emerge such as the nature of authenticity, knowledge, identity, pleasure, evidence and the homosexual refugee as being caught in between two legal apparatuses (that is, fleeing from the hostility of one legal regime and then trying to gain refugee status, and thus legal protection, via a British Immigration Tribunal). In this article, the corporeality and sensuality of legal practices (...) are exposed in the form of `practices of truth'. That is, in this case medico-legal `living individuals' were to perceive, hear, speak, touch and penetrate the `secrets' of Mr Vraciu's body in order to authenticate his sexual identity for the purposes of law. This case also demonstrates the existence of a differend between what I describe as the self-knowledge of homosexuality and the `legal' fact-based, or authorized knowledge of homosexual identity produced through practices of truth. (shrink)

In this article, I critically analyze the anthropological foundation of the bioethics of philosopher Jean-François Malherbe, particularly as presented in his book, Pour une Éthique de la Médecine. Malherbe argues that such practices as organ donation and transplants, assisted reproduction, resuscitation, and other uses of biotechnologies in contemporary medicine are unethical because they go against essential human nature. Furthermore, he uses this position as a basis to prescribe public policy and institutional practice. In contrast, I argue not only that ‘human (...) nature’ is much more malleable and adaptive to changes in technology and society than Malherbe allows, but also that his criticisms of medicine and technoscientific development overstep the bounds of the social function of philosophical ethics, which is to inform and clarify public debate. Public policy and institutional practice is thus best left to the democratic political process under the parameters of the just rule of law. (shrink)

The Lourdes Hospital Inquiry: An inquiry into peripartum hysterectomy at Our Lady of Lourdes Hospital, Drogheda, Ireland, of 2006 recounts in detail the circumstances within which 188 peripartum hysterectomies were carried out at the hospital between 1974 and 1998. The findings of the inquiry have serious ramifications for Irish healthcare delivery and have implications for many professional groups, including midwives. The findings prompt clear questions about the relative position or power of midwives within maternity care. These questions are examined in (...) this article, through the analysis and application of various theoretical perspectives on power. Critical views of power focus on the socio‐political nature of oppressive structures within society and seek mechanisms to address these. Stemming from structure versus agency debates, Giddens's structuration theory examines the agency‐structure interaction and stresses the centrality of agents’ roles in the social reproduction of structures. Postmodernism, particularly drawing on the work of Michel Foucault, focuses on a fluid conception of power while also describing the nature of disciplinary power. It offers midwives a way of viewing power as productive and dispersed. Drawing on different aspects of these perspectives on power, helps us to understand midwives’ relative positions and power relations and how to enhance these to prevent future tragic outcomes such as those reported in the inquiry report. (shrink)

In this paper I introduce a theoretical framework on care developed by the Norwegian nurse and philosopher Kari Martinsen, and I argue that this approach has relevance not only within nursing, but also within clinical medicine. I try to substantiate this claim by analysing some of the key concepts in this approach, and I illustrate the potential clinical relevance of this approach by applying it in relation to two care scenarios. Finally, I discuss some of the concerns that have been (...) raised in relation to the aim of highlighting care in medicine. (shrink)

A Foucauldian assessment of the common presumption that genetic information is potent and thus oppressive demonstrates that the concern may be misplaced. Foucault's concept of “technologies of self” reveals that genetic power originates not only from the potency of genetic information but from the penchant of individuals to victimize themselves in the name of optimal health, enhanced intelligence, perfect babies, or would-be immortality. Rather than seeking liberation from the power of the new genetics, Foucault's reinterpretation of the ancient understanding of (...) concern for the self offers the possibility to avoid control by the scientific discourse. His ethical response calls for resistance rather than opposition and places responsibility for resistance in the hands of the subject. Characteristically, he avoids a generalizable form of morality but clarifies that resistance includes acknowledging the human appetite for perfection and subordinating science to ethical and aesthetic matters. (shrink)

The aim of this article is to present a conceptual review and analysis of symptom understanding. Subjective bodily sensations occur abundantly in the normal population and dialogues about symptoms take place in a broad range of contexts, not only in the doctor’s office. Our review of symptom understanding proceeds from an initial subliminal awareness by way of attribution of meaning and subsequent management, with and without professional involvement. We introduce theoretical perspectives from phenomenology, semiotics, social interactionism, and discourse analysis. Drew (...) Leder’s phenomenological perspectives deal with how symptom perception occurs when any kind of altered balance brings forward a bodily attention. Corporeality is brought to explicit awareness and perceived as sensations. Jesper Hoffmeyer’s biosemiotic perspectives provide access to how signs are interpreted to attribute meaning to the bodily messages. Symptom management is then determined by the meaning of a symptom. Dorte E. Gannik’s concept “situational disease” explains how situations can be reviewed not just in terms of their potential to produce signs or symptoms, but also in terms of their capacity to contain symptoms. Disease is a social and relational phenomenon of containment, and regulating the situation where the symptoms originate implies adjusting containment. Discourse analysis, as presented by Jonathan Potter and Margaret Wetherell, provides a tool to notice the subtle ways in which language orders perceptions and how language constructs social interaction. Symptoms are situated in culture and context, and trends in modern everyday life modify symptom understanding continuously. Our analysis suggests that a symptom can only be understood by attention to the social context in which the symptom emerges and the dialogue through which it is negotiated. (shrink)

Medicine maintains a distinction between the medical symptom -- the patient''ssubjective experience and expression, and the privileged medical sign -- the objective findings observable by the doctor. Although the distinction is not consistently applied, it becomes clearly visible in the undefined, medically unexplained disorders of women patients. Potential impacts of genderized interaction on the interpretation of medical signs are addressed by re-reading the diagnostic process as a matter of social construction, where diagnosis results from human interpretation within a sociopolitical context. (...) The discussion is illustrated by a case story and empirical evidence of the gendering in the doctor-patient relationship. The theoretical analysis is supported by semiotic perspectives of bodily signs, feminist theory on experience, and Foucault''sideas about medical perception and gaze, and concludes that a medical diagnosis is seldom a biological fact, but the outcome of a process where biological, cultural and social elements are interwoven. Further deconstruction of the chain of signs from a feminist perspective, assigning validity to the voice of the woman patient, might broaden the understanding of women''shealth, illness and disease. (shrink)

This article analyses Jeanette Winterson's Written on the Body, discussing its use of the female body as a text and, more specifically, as a palimpsest. The article aims to demonstrate that the novel's genderless narrator uses the beloved's body as a palimpsest since in trying to celebrate it, s/he is unable to depict it as it is and merely inscribes a set of meanings onto it. The female body is described through two major sets of images: as a landscape, via (...) a colonial language, and as a diseased body, via an anatomical language. The article discusses this particular use of the female body as a traditional way of describing it, which is confirmed by the novel's wide use of literary references from canonical texts. The novel, then, appears to be positioned outside a feminist or lesbian tradition, since it is not able to represent the female body in a new and fertile way and draws too much on an all-male literary tradition, configuring itself as a palimpsest just like the body it is trying to describe. (shrink)

The paper treats several ontological questions about certain nineteenth-century and contemporary medical and scientific conceptualizations of hereditary relation. In particular, it considers the account of mid-nineteenth century psychiatric thought given by Foucault in Psychiatric Power: Lectures at the Collège de France, 1973–1974 and Abnormal: Lectures at the Collège de France, 1974–1975 . There, Foucault argues that a fantastical conceptual prop, the ‘metabody,’ as he terms it, was implicitly supposed by that period’s psychiatric medicine as a putative ground for psychiatric pathology. (...) After presenting the heart of Foucault’s thought on the ‘metabody,’ the paper investigates the possibility that a contemporary version of a ‘metabody’ may operate today as a conceptual analog of the nineteenth-century psychiatric theory and practice that Foucault began to expose in the texts examined here. It speculates that we might identify a contemporary genetic version of a ‘metabody’ in a particular current conception of the gene as replicator, an item marked by an ambiguous temporal ontology. (shrink)