ABSTRACT This paper offers an account of institutional testimonial justice and describes one way that it breaks down, which we call institutional opacity. An institution is opaque when it becomes resistant to epistemic evaluation and understanding by its agents and users. When one cannot understand the inner workings of an institution, it becomes difficult to know how to comport oneself testimonially. We offer an account of an institutional ethos to explain what it means for an institution to be testimonially just; (...) we then describe how an ethos of institutional testimonial justice can break down when the institution becomes opaque. An opaque institution is especially problematic for individuals and groups already rendered epistemically vulnerable during their interactions with that institution, which we call epistemically vulnerabilised individuals. We articulate the features of an encounter between an epistemically vulnerabilised individual and an opaque institution. We end by tracing ameliorative strategies that could help repair a deteriorated institutional ethos of testimonial justice. (shrink)

Havi Carel uses phenomenology to explore how illness modifies the ill person's body, values, and world. Carel argues that illness has received little philosophical attention. Phenomenology of Illness develops a phenomenological framework for illness and a systematic understanding of illness as a philosophical tool.

Health research initiatives worldwide are growing in scope and complexity, particularly as they move into the developing world. Expanding health research activity in low- and middle-income countries has resulted in a commensurate rise in the need for sound ethical review structures and functions in the form of Research Ethics Committees (RECs). Yet these seem to be lagging behind as a result of the enormous challenges facing these countries, including poor resource availability and lack of capacity. There is thus an urgent (...) need for ongoing capacity and resource development in these regions in general, and in Africa in particular. Similarly, there is a need for research and initiatives that can identify existing capacity and funding and indicate the areas where this needs to be developed.This discussion paper argues that the Mapping African Research Ethics Capacity (MARC) project is a timely initiative aimed at identifying existing capacity. MARC provides a platform and tool on the Council on Health Research for Development's (COHRED) Health Research website (HRWeb), which can be used by RECs and key stakeholders in health research in Africa to identify capacity, constraints and development needs. MARC intends to provide the first comprehensive interactive database of RECs in Africa, which will allow for the identification of key relationships and analyses of capacity. The potential of MARC lies in the mapping of current ethical review activity onto capacity needs. This paper serves as a starting point by providing a descriptive illustration of the current state of RECs in Africa. (shrink)

In the debate on peace ethics in Germany, it is constantly argued that the ‘doctrine of just war’ must be replaced by a ‘doctrine of just peace’. The criteriology of just war can at best be preserved within a doctrine of just peace. However, it is often overlooked that—although the word ‘peace’ may sound nicer than ‘war’—a doctrine of just peace is also fraught with great difficulties in terms of content. The concept of peace can be interpreted in different ways; (...) the concept of justice must even be differentiated if it is to have meaning at all. Ultimately, the two concepts point to a different understanding of tradition and historicity: while the doctrine of just war takes its criteria from the tradition, the idea of just peace attempts to draw conclusions for the present from drafts or blueprints of the future. However, since the drafts can turn out differently, new conflicts will arise precisely for this reason. Talk of ‘just peace’ might be more pleasing to the public, but does not necessarily have to be more restrictive in terms of violence. (shrink)

L’article interroge, à travers une vignette clinique, le désir d’enfant et l’infertilité secondaire en étant à l’écoute des enjeux inconscients et des représentations socioculturelles gabonaises. Il repère comment le recours à l’ amp n’exclut pas l’adhésion aux croyances traditionnelles de la malédiction. La recherche s’appuie sur une méthodologie qualitative et intègre la libre réalisation de l’arbre généalogique. L’utilisation de la médiation projective permet d’investiguer les liens familiaux, conjugaux et la place fantasmatique de l’enfant dans l’espace généalogique. L’analyse souligne, sur le (...) plan intrapsychique, une conflictualité œdipienne non résolue. Elle pointe le passage obligé par la maternité pour accéder à un statut social valorisé soutien de l’identité féminine. (shrink)

Patient support tools have drawn on a variety of disciplines, including psychotherapy, social psychology, and social care. One discipline that has not so far been used to support patients is philosophy. This paper proposes that a particular philosophical approach, phenomenology, could prove useful for patients, giving them tools to reflect on and expand their understanding of their illness. I present a framework for a resource that could help patients to philosophically examine their illness, its impact on their life, and its (...) meaning. I explain the need for such a resource, provide philosophical grounding for it, and outline the epistemic and existential gains philosophy offers. Illness often begins as an intrusion on one’s life but with time becomes a way of being. I argue that this transition impacts on core human features such as the experience of space and time, human abilities, and adaptability. It therefore requires philosophical analysis and response. The paper uses ideas from Husserl and Merleau-Ponty to present such a response in the form of a phenomenological toolkit for patients. The toolkit includes viewing illness as a form of phenomenological reduction, thematizing illness, and examining illness as altering the ill person’s being in the world. I suggest that this toolkit could be offered to patients as a workshop, using phenomenological concepts, texts, and film clips to reflect on illness. I conclude by arguing that examining illness as a limit case of embodied existence deepens our understanding of phenomenology. (shrink)

What is illness? Is it a physiological dysfunction, a social label, or a way of experiencing the world? How do the physical, social and emotional worlds of a person change when they become ill? And can there be well-being within illness? In this remarkable and thought-provoking book, Havi Carel explores these questions by weaving together the personal story of her own serious illness with insights and reflections drawn from her work as a philosopher. Carel's fresh approach to illness (...) raises some uncomfortable questions about how we all - whether healthcare professionals or not - view the ill and challenges us to become more thoughtful. 'Illness' unravels the tension between the universality of illness and its intensely private, often lonely, nature. It offers a new way of looking at a matter that affects every one of us. (shrink)

What is illness? Is it a physiological dysfunction, a social label, or a way of experiencing the world? How do the physical, social and emotional worlds of a person change when they become ill? And can there be well-being within illness? In this remarkable and thought-provoking book, Havi Carel explores these questions by weaving together the personal story of her own serious illness with insights and reflections drawn from her work as a philosopher. Carel shows how the concepts (...) and language used to describe illness today are inappropriate and misleading. Too often illness is viewed as a localised biological dysfunction while ignoring the actual experience of the ill person, their fears, their hopes, the way they interact with others and, ultimately, experience life. By focusing on the impact of illness on the ill person's life and reflecting on the experience of illness as lived from within, Carel shows how illness is a life-changing process rather than a limited physiological problem. Carel's fresh approach to illness raises some uncomfortable questions about how we all - whether healthcare professionals or not - view the ill and challenges us to become more thoughtful. "Illness" unravels the tension between the universality of illness and its intensely private, often lonely, nature. It offers a new way of looking at a matter that affects every one of us. For those who are ill, it offers insights on our ability to remain happy within the constraints of illness. (shrink)

In this article, I propose that illness is philosophically revealing and can be used to explore human experience. I suggest that illness is a limit case of embodied experience. By pushing embodied experience to its limit, illness sheds light on normal experience, revealing its ordinary and thus overlooked structure. Illness produces a distancing effect, which allows us to observe normal human behavior and cognition via their pathological counterpart. I suggest that these characteristics warrant illness a philosophical role that has not (...) been articulated. Illness can be used as a philosophical tool for the study of normally tacit aspects of human existence. I argue that illness itself can be integral to philosophical method, insofar as it facilitates a distancing from everyday practices. This method relies on pathological or limit cases to illuminate normally overlooked aspects of human perception and action. I offer Merleau-Ponty’s analysis of the case of Schneider as an example of this method. (shrink)

O que queremos dizer atualmente quando falamos sobre filosofia? Como a filosofia se relaciona com a ciência, com a política e a literatura? Que métodos o filósofo moderno utiliza, e como a filosofia progride? A filosofia é diferente de um lugar para outro? O que a filosofia pode fazer por nós? E o que não pode fazer? Este livro diz o que a filosofia é e também nos mostra a filosofia contemporânea em ação.

Illusions that produce perceptual suppression despite constant retinal input are used to manipulate visual consciousness. Here we report on a powerful variant of existing techniques, Continuous Flash Suppression. Distinct images flashed successively around 10 Hz into one eye reliably suppress an image presented to the other eye. Compared to binocular rivalry, the duration of perceptual suppression increased more than 10-fold. Using this tool we show that the strength of the negative afterimage of an adaptor was reduced by half when it (...) was perceptually suppressed by input from the other eye. The more likely the adaptor was completely suppressed, the larger the reduction of the afterimage intensity. Paradoxically, trial-to-trial visibility of the adaptor did not correlate with the degree of suppression. Our results imply that formation of afterimages involves neuronal structures that access input from both eyes, but that do not correspond directly to the neuronal correlates of perceptual awareness. (shrink)

This essay reviews a range of issues arising from the complex case of Terri Schiavo and the lessons the case raises for bioethicists. It argues that embedded in the case is a broader controversy than is immediately evident, one involving the definitions by which bioethics judge cases of extreme physical and psychological limits, in its principled form of address. Further, it argues that bioethicists who assume the issues involved in the case are settled miss the point of the emotional responses (...) it has brought forth. (shrink)

Chronic fatigue syndrome or myalgic encephalomyelitis remains a controversial illness category. This paper surveys the state of knowledge and attitudes about this illness and proposes that epistemic concerns about the testimonial credibility of patients can be articulated using Miranda Fricker’s concept of epistemic injustice. While there is consensus within mainstream medical guidelines that there is no known cause of CFS/ME, there is continued debate about how best to conceive of CFS/ME, including disagreement about how to interpret clinical studies of treatments. (...) Against this background, robust qualitative and quantitative research from a range of countries has found that many doctors display uncertainty about whether CFS/ME is real, which may result in delays in diagnosis and treatment for patients. Strikingly, qualitative research evinces that patients with CFS/ME often experience suspicion by health professionals, and many patients vocally oppose the effectiveness, and the conceptualization, of their illness as psychologically treatable. We address the intersection of these issues and healthcare ethics, and claim that this state of affairs can be explained as a case of epistemic injustice. We find evidence that healthcare consultations are fora where patients with CFS/ME may be particularly vulnerable to epistemic injustice. We argue that the marginalization of many patients is a professional failure that may lead to further ethical and practical consequences both for progressive research into CFS/ME, and for ethical care and delivery of current treatments among individuals suffering from this debilitating illness. (shrink)

Propositions of law are based upon normative judgement. The interpretation and application of legal provisions rest upon a judgement that determines which weight must be attributed to some point of view or perspective. In this respect, legal theory has a normative character. Its normative character does not preclude legal theory from being a scientific discipline. The scientific character of legal theory is not located in the possibility of testing the correctness of its theories. Rather, legal theory owes it scientific character (...) to the shared standards of production and evaluation of legal arguments: the grammar of justice. (shrink)

The maxim to understand the law literally resembles Holmes ' Plain Meaning Approach. But these approaches should not be considered as the expression of a naïve legal epistemology. They rather stress that the law ought to be interpreted as it is understood by the prudent citizen. In this way, the ideal of the rule of law is best guaranteed.

We develop a broader, more fine-grained taxonomy of forms of ‘transformative experience’ inspired by the work of L.A. Paul. Our vulnerability to such experiences arises, we argue, due to the vulnerability, dependence, and affliction intrinsic to the human condition. We use this trio to distinguish a variety of positively, negatively, and ambivalently valenced forms of epistemically and/or personally transformative experiences. Moreover, we argue that many transformative experiences can arise gradually and cumulatively, unfolding over the course of longer periods of time.

We propose that certain forms of chronic illness can be transformative experiences, in the sense described by L.A. Paul.

Phenomenology is a useful methodology for describing and ordering experience. As such, phenomenology can be specifically applied to the first person experience of illness in order to illuminate this experience and enable health care providers to enhance their understanding of it. However, this approach has been underutilized in the philosophy of medicine as well as in medical training and practice. This paper demonstrates the usefulness of phenomenology to clinical medicine. In order to describe the experience of illness, we need a (...) phenomenological approach that gives the body a central role and acknowledges the primacy of perception. I present such a phenomenological method and show how it could usefully illuminate the experience of illness through a set of concepts taken from Merleau-Ponty. His distinction between the biological body and the body as lived, analysis of the habitual body, and the notions of motor intentionality and intentional arc are used to capture the experience of illness. I then discuss the applications this approach could have in medicine. These include narrowing the gap between objective assessments of well-being in illness and subjective experiences which are varied and diverse; developing a more attuned dialogue between physicians and patients based on a thick understanding of illness; developing research methods that are informed by phenomenology and thus go beyond existing qualitative methods; and providing medical staff with a concrete understanding of the impact of illness on the life-world of patients. (shrink)

The experience of illness is a universal and substantial part of human existence. Like death, illness raises important philosophical issues. But unlike death, illness, and in particular the experience of being ill, has received little philosophical attention. In Phenomenology of Illness Havi Carel argues that the experience of illness has been wrongly neglected by philosophers and provides a distinctively philosophical account of illness. Using phenomenology, Carel explores how illness modifies the ill person's body, values, and world. The aim (...) of Phenomenology of Illness is twofold: to contribute to the understanding of illness through the use of philosophy and to demonstrate the importance of illness for philosophy. Phenomenology of Illness develops a phenomenological framework for illness and a systematic understanding of illness as a philosophical tool. (shrink)

Bundel besprekingen van ideeënromans met filosofische thema's.

In this paper I explore the tacit underlying sense of bodily certainty that characterizes normal everyday embodied experience. I then propose illness as one instance in which this certainty breaks down and is replaced by bodily doubt. I characterize bodily doubt as radically modifying our experience in three ways: loss of continuity, loss of transparency, and loss of faith in one's body. I then discuss the philosophical insights that arise from the experience of bodily doubt. The paper uses a Humean (...) framework with regards to bodily certainty, treating it as a taken for granted tacit aspect of normal experience. I argue that although bodily certainty is not rationally justifiable, we are nonetheless unable to reject it. Bodily certainty is thus revealed to be part of our brute animal nature. I conclude by suggesting that the study of pathology is a philosophical method useful for illuminating tacit aspects of experience. (shrink)

Can one be ill and happy? I use a phenomenological approach to provide an answer to this question, using Merleau-Ponty’s distinction between the biological and the lived body. I begin by discussing the rift between the biological body and the ill person’s lived experience, which occurs in illness. The transparent and taken for granted biological body is problematised by illness, which exposes it as different from the lived experience of this body. I argue that because of this rift, the experience (...) of illness cannot be captured within a naturalistic view and propose to supplant this view with a phenomenological approach. The latter approach accounts for changes in the ill person’s relationship to her social and physical world. These changes, I argue, cannot be captured by a naturalistic perspective. I then propose the notion of health within illness as a useful concept for capturing the experience of well-being reported by some ill people. I present empirical evidence for this phenomenon and assess its philosophical significance. Finally, I suggest that adaptability and creativity are two common positive responses to illness, demonstrating that health within illness is possible. The three elements combined – the transformed body, health within illness and adaptability and creativity – serve as the basis for a positive answer to the question posed above. (shrink)

Résumé Les affinités paradoxales que la recherche a pu pointer entre la « secte » philosophique épicurienne et la secte chrétienne dans les premiers siècles de notre ère sont rappelées puis examinées dans le détail du premier document attestant une rencontre précise entre les deux sectes, le récit des Actes des Apôtres qui montre Paul discutant avec les Épicuriens et les Stoïciens d’Athènes, puis nous restitue le discours de Paul devant l’Aréopage d’Athènes. Il apparaît que Paul se pose en philosophe (...) pour exposer sa doctrine en des termes jusqu’à un certain point compatibles avec une doctrine matérialiste voire polythéiste. (shrink)

In so far as the Tao Te Ching and the Chuang Tzu are life-philosophies, they are philosophies of solitude. My aim in the following pages is to explain and defend this claim, clarifying the distinctive kind of solitude that is taught by Lao Tzu and Chuang Tzu.

Is Tom Shakespeare disabled, or simply distinct in stature? And if the latter, what makes that distinction important?For more than a decade, the British sociologist has been a critical voice in the sociology of difference. The son of a physician with achondroplasia “widely admired as a doctor and as a disabled role model” ,1 Shakespeare fils also has achondroplasia, is the father of children with the condition and, like his father, is professionally successful. As his book’s back cover announces, Shakespeare (...) has “taught and researched sociology at the Universities of Cambridge, Sunderland, Leeds, and Newcastle. He has written and broadcast extensively about disability and genetics, and his co-authored books include The Sexual Politics of Disability, Exploring Disability, and Genetic Politics.”This volume brings together a decade of papers that, Shakespeare says, “draws on my experience of being a disabled person, and the son, father, husband and friend of disabled people”1 to argue the following thesis: “Disability results from the interplay of individual and contextual factors. In other words, people are disabled by society and by their bodies.”1 That argument, he suggests, has resulted in the “breakdown of my relationship with the mainstream of the UK disabled people’s movement”, whose members advance a model of disability based wholly on social construction. Shakespeare sees that as simplistic and no longer viable despite of the extraordinary gains made by those seeking parity through advancement of the social construction thesis.1According to Shakespeare, his former confrères in the British disability movement see as a betrayal his rejection of their argument, one he formerly endorsed, and thus perhaps a repudiation of a generation of admittedly successful activism. To them, in other words, Shakespeare is no longer disabled but disabling, and that judgment must …. (shrink)

The phenomenological method has been fruitfully used to study the experience of illness in recent years. However, the role of illness is not merely that of a passive object for phenomenological scrutiny. I propose that illness, and pathology more generally, can be developed into a phenomenological method in their own right. I claim that studying cases of pathology, breakdown, and illness offer illumination not only of these experiences, but also of normal function and the tacit background that underpins it. In (...) particular, I claim that the study of embodiment can be greatly enhanced, and indeed would be incomplete, without attending to bodily breakdown and what I term bodily doubt. I offer an analogy between illness and Husserl’s epoché, suggesting that both are a source of distancing, and therefore motivate a reflective stance. (shrink)

This article analyses the phenomenon of epistemic injustice within contemporary healthcare. We begin by detailing the persistent complaints patients make about their testimonial frustration and hermeneutical marginalization, and the negative impact this has on their care. We offer an epistemic analysis of this problem using Miranda Fricker's account of epistemic injustice. We detail two types of epistemic injustice, testimonial and hermeneutical, and identify the negative stereotypes and structural features of modern healthcare practices that generate them. We claim that these stereotypes (...) and structural features render ill persons especially vulnerable to these two types of epistemic injustice. We end by proposing five avenues for further work on epistemic injustice in healthcare. (shrink)

The world of disability theory is currently divided between those who insist it reflects a physical fact affecting life quality and those who believe disability is defined by social prejudice. Despite a dialogue spanning bioethical, medical and social scientific literatures the differences between opposing views remains persistent. The result is similar to a figure-ground paradox in which one can see only part of a picture at any moment. This paper attempts to find areas of commonality between the opposing camps, and (...) thus to rearrange the figures of the paradox at a fundamental level. The purpose is first to identify areas in which common ground can be achieved, and secondarily, to clarify the areas in which disagreement continues. While a general and unified theory of physical difference/disability is beyond the scope of this paper the result may advance that general goal. (shrink)

In which a scientist searches for an empirical explanation for phenomenal experience, spurred by his instinctual belief that life is meaningful. What links conscious experience of pain, joy, color, and smell to bioelectrical activity in the brain? How can anything physical give rise to nonphysical, subjective, conscious states? Christof Koch has devoted much of his career to bridging the seemingly unbridgeable gap between the physics of the brain and phenomenal experience. This engaging book--part scientific overview, part memoir, part futurist (...) speculation--describes Koch's search for an empirical explanation for consciousness. Koch recounts not only the birth of the modern science of consciousness but also the subterranean motivation for his quest--his instinctual belief that life is meaningful. Koch describes his own groundbreaking work with Francis Crick in the 1990s and 2000s and the gradual emergence of consciousness as a legitimate topic for scientific investigation. Present at this paradigm shift were Koch and a handful of colleagues, including Ned Block, David Chalmers, Stanislas Dehaene, Giulio Tononi, Wolf Singer, and others. Aiding and abetting it were new techniques to listen in on the activity of individual nerve cells, clinical studies, and brain-imaging technologies that allowed safe and noninvasive study of the human brain in action. Koch gives us stories from the front lines of modern research into the neurobiology of consciousness as well as his own reflections on a variety of topics, including the distinction between attention and awareness, the unconscious, how neurons respond to Homer Simpson, the physics and biology of free will, dogs, Der Ring des Nibelungen, sentient machines, the loss of his belief in a personal God, and sadness. All of them are signposts in the pursuit of his life's work--to uncover the roots of consciousness. (shrink)

This article develops the concept of wrongful depathologization, in which a psychiatric disorder is simultaneously stigmatized and trivialized. We use OCD as a case study to argue that cumulatively these two effects generate a profound epistemic injustice to OCD sufferers, and possibly to those with other mental disorders. We show that even seemingly positive stereotypes attached to mental disorders give rise to both testimonial injustice and wilful hermeneutical ignorance. We thus expose an insidious form of epistemic harm that has been (...) overlooked in the literature. (shrink)

This article examines the philosophical role of illness. It briefly surveys the philosophical role accorded to illness in the history of philosophy and explains why illness merits such a role. It suggests that illness modifies, and thus sheds light on, normal experience, revealing its ordinary and therefore overlooked structure. Illness also provides an opportunity for reflection by performing a kind of suspension (epoché) of previously held beliefs, including tacit beliefs. The article argues that these characteristics warrant a philosophical role for (...) illness. While the performance of most philosophical procedures is volitional and theoretical, however, illness is uninvited and threatening, throwing the ill person into anxiety and uncertainty. As such it can be viewed as a radical philosophical motivation that can profoundly alter our outlook. The article suggests that illness can change the ways in which we philosophise: it may shape philosophical methods and concerns and change one's sense of salience and conception of philosophy. (shrink)

In this paper we propose that our understanding of pathocentric epistemic injustices can be enriched if they are theorised in terms of predicaments. These are the wider socially scaffolded structures of epistemic challenges, dangers, needs, and threats experienced by ill persons due to their particular emplacement within material, social, and epistemic structures. In previous work we have described certain aspects of these predicaments - pathocentric epistemic injustices, pathophobia, and so on. We argue that thinking predicamentally helps us integrate the various (...) social, epistemic, and practical obstacles experienced by ill persons and also unify the many concepts available for theorising them (microaggessions, epistemic injustices, and so on). (shrink)

What counts as health or ill health? How do we deal with the fallibility of our own bodies? Should illness and disease be considered simply in biological terms, or should considerations of its emotional impact dictate our treatment of it? Our understanding of health and illness had become increasingly more complex in the modern world, as we are able to use medicine not only to fight disease but to control other aspects of our bodies, whether mood, blood pressure, or cholesterol. (...) This collection of essays foregrounds the concepts of health and illness and patient experience within the philosophy of medicine, reflecting on the relationship between the ill person and society. Mental illness is considered alongside physical disease, and the important ramifications of society's differentiation between the two are brought to light. Health, Illness and Disease is a significant contribution to shaping the parameters of the evolving field of philosophy of medicine and will be of interest to medical practitioners and policy-makers as well as philosophers of science and ethicists. (shrink)

The article deals with the question of persuasion by comparing two passages taken from a text written by Victor Hugo entitled Claude Gueux The first passage is taken from the first part of the text in which Hugo tells the story of the murder of the director of the Clairvaux prison workshop perpetrated by a prisoner, Claude Gueux, followed by the latter’s trial and execution. The second passage studied is taken from the second part of the text in which Hugo (...) argues against the death penalty. This article begins with an intuitive sense that the styles of these passages are “different”: the second one clearly shows Hugo’s persuasive intention, which is to say his effort to make his position be accepted. That said, does this extract have semantic properties that the descriptive passage does not have? The hypothesis advanced is that the organization of contents is of a similar nature in both passages of Claude Gueux and that it is only in an enunciative way that the passages are distinguishable. This enunciative difference allows the militant passage’s locutor to portray himself in a favorable light and, herewith, to convince the reader to his point of view. It is, hence, but in an indirect manner that Hugo’s persuasive intention appears; as it is without a semantic mark. (shrink)

More people desperately require an organ than become donors themselves. When discussing organ donation, people mainly consider the question whether they want to donate, whereas empirically they are more likely to be on the receiving end. So it is rational for each of us to join the organ donor register and to agree to donate our relative’s organs, if we are ever in that situation.

More people desperately require an organ than become donors themselves. When discussing organ donation, people mainly consider the question whether they want to donate, whereas empirically they are more likely to be on the receiving end. So it is rational for each of us to join the organ donor register and to agree to donate our relative’s organs, if we are ever in that situation.

(No abstract is available for this citation).