In this article we find some sufficient and some necessary ${\Sigma^1_1}$ -conditions with oracles for a model to be resplendent or chronically resplendent. The main tool of our proofs is internal arguments, that is analogues of classical theorems and model-theoretic constructions conducted inside a model of first-order Peano Arithmetic: arithmetised back-and-forth constructions and versions of the arithmetised completeness theorem, namely constructions of recursively saturated and resplendent models from the point of view of a (...) model of arithmetic. These internal arguments are used in conjunction with Pabion’s theorem that ensures that certain oracles are coded in a sufficiently saturated model of arithmetic. Examples of applications are provided for the theories of dense linear orders and of discrete linear orders. These results are then generalised to other ω-categorical theories and theories with a unique countable recursively saturated model. (shrink)

In this article we find some sufficient and some necessary \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\Sigma^1_1}$$\end{document} -conditions with oracles for a model to be resplendent or chronically resplendent. The main tool of our proofs is internal arguments, that is analogues of classical theorems and model-theoretic constructions conducted inside a model of first-order Peano Arithmetic: arithmetised back-and-forth constructions and versions of the arithmetised completeness theorem, namely constructions of recursively saturated and (...) class='Hi'>resplendent models from the point of view of a model of arithmetic. These internal arguments are used in conjunction with Pabion’s theorem that ensures that certain oracles are coded in a sufficiently saturated model of arithmetic. Examples of applications are provided for the theories of dense linear orders and of discrete linear orders. These results are then generalised to other ω-categorical theories and theories with a unique countable recursively saturated model. (shrink)

In this article we find some sufficient and some necessary \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\Sigma^1_1}$$\end{document} -conditions with oracles for a model to be resplendent or chronically resplendent. The main tool of our proofs is internal arguments, that is analogues of classical theorems and model-theoretic constructions conducted inside a model of first-order Peano Arithmetic: arithmetised back-and-forth constructions and versions of the arithmetised completeness theorem, namely constructions of recursively saturated and (...) class='Hi'>resplendent models from the point of view of a model of arithmetic. These internal arguments are used in conjunction with Pabion’s theorem that ensures that certain oracles are coded in a sufficiently saturated model of arithmetic. Examples of applications are provided for the theories of dense linear orders and of discrete linear orders. These results are then generalised to other ω-categorical theories and theories with a unique countable recursively saturated model. (shrink)

In this paper we show that in every |T |+-resplendent model N , for every A ⊆ N such that |A | ≤ |T |, the group Autf of strong automorphisms is the least very normal subgroup of the group Aut and the quotient Aut/Autf is the Lascar group over A . Then we generalize this result to every |T |+-saturated and strongly |T |+-homogeneous model.

Stress is prevalent in our daily life, and people often make moral decision-making in a stressful state. Several studies have indicated the influence of acute stress on moral decision-making and behavior. The present study extended the investigation to chronic stress, and employed a new approach, the CNI model, to add new insights regarding the mechanism underlying the association between chronic stress and moral decision-making. A total of 197 undergraduates completed the Perceived Stress Scale and made moral decision-making on a (...) series of deliberately designed moral dilemmas. The results indicated that the high-stress group (one standard deviation above the mean) preferred more deontological options than the low-stress group (one standard deviation below the mean). Process-dissociation analysis revealed that the two groups had differences on deontological inclinations but not on utilitarian inclinations. And CNI model analyses suggested that the high-stress group showed a stronger general preference for inaction than the low-stress group did, but there were no significant differences in sensitivity to consequences or sensitivity to moral norms between the two groups. Finally, the implications of our findings were discussed. (shrink)

Twenty years ago, the biopsychosocial model was proposed by George Engel to be the new paradigm for medicine and psychiatry. The model assumed a hierarchical structure of the biological, psychological and social system and simple interactions between the participating systems. This article holds the thesis that the original biopsychosocial model cannot depict psychiatry's reality and problems. The clinical validity of the biopsychosocial model has to be questioned. It is argued that psychiatric interventions can only stimulate but (...) not determine their target systems, because intervention and outcome are only loosely coupled. Thus, psychiatric interventions have in principle limited ranges which differ according to the type of intervention and according to the system to be stimulated. Psychosocial interventions face far more obstacles to be overcome than psychopharmacogical therapy. (shrink)

Chronic myeloid leukemia (CML) is a cancer of the hematopoietic system initiated by a single genetic mutation which results in the oncogenic fusion protein Bcr-Abl. Untreated, patients pass through different phases of the disease beginning with the rather asymptomatic chronic phase and ultimately culminating into blast crisis, an acute leukemia resembling phase with a very high mortality. Although many processes underlying the chronic phase are well understood, the exact mechanisms of disease progression to blast crisis are not yet revealed. In (...) this paper we develop a mathematical model of CML based on causal Bayesian networks in order to study possible disease progression mechanisms. Our results indicate that an increase of Bcr-Abl levels alone is not sufficient to explain the phenotype of blast crisis and that secondary changes such as additional mutations are necessary to explain disease progression and the poor therapy response of patients in blast crisis. (shrink)

Chronic childhood disease brings psychological challenges for families and carers as well as the children. Roger Bradford explores how they cope with these challenges, the psychological and social factors that influence outcomes and the ways in which the delivery of services can be improved to promote adjustment. Drawing on concepts from health psychology and family therapy, the author proposes a multi-level model of care which takes into account the child, the family and the wider care system and how they (...) interrelate and influence each other. (shrink)

Chronic pain is one of the most disabling medical conditions globally, yet, to date, we lack a satisfying theoretical framework for research and clinical practice. Over the prior decades, several frameworks have been presented with biopsychosocial models as the most promising. However, in translation to clinical practice, these models are often applied in an overly reductionist manner, leaving much to be desired. In particular, they often fail to characterize the complexities and dynamics of the lived experience of chronic pain. Recently, (...) an enactive, affordance-based approach has been proposed, opening up new ways to view chronic pain. This model characterizes how the persistence of pain alters a person’s field of affordances: the unfolding set of action possibilities that a person perceives as available to them. The affordance-based model provides a promising perspective on chronic pain as it allows for a systematic investigation of the interactive relation between patients and their environment, including characteristic alterations in the experience of their bodies and the space they inhabit. To help bridge the gap from philosophy to clinical practice, we unpack in this paper the core concepts of an affordance-based approach to chronic pain and their clinical implications, highlighting aspects that have so far received insufficient attention. We do so with an analogy to playing video games, as we consider such comparative illustration a useful tool to convey the complex concepts in an affordance-based model and further explore central aspects of the lived experience of chronic pain. (shrink)

The central hyperexcitability observed in animal models supports a pathophysiological explanation for chronic human pain. Novel information on cholecystokinin (CCK) upregulation offers a rationale for reduced opioid response in neuropathic pain. However, the basic information provided by scientists should not lead clinicians to equate experimental models to chronic human conditions. Clinicians should provide careful reports and attempt to classify pathophysiologically clinical conditions that have so far been grouped generically. [blumberg et al.; coderre & katz; dickenson; wiesenfeld-hallin et al.].

Living things are often plastic during their early development and are moulded by the environment. Many human fetuses have to adapt to a limited supply of nutrients, and in doing so they permanently change their physiology and metabolism. These programmed changes may be the origins of a number of diseases in later life, including coronary heart disease, stroke, diabetes and hypertension.

Chronic post-surgical pain (CPSP) represents a highly prevalent and significant clinical problem. Both major and minor surgeries entail risks of developing CPSP, and cancer-related surgery is no exception. As an example, more than 40% of women undergoing breast cancer surgery struggle with CPSP years after surgery. While we do not fully understand the pathophysiology of CPSP, we know it is multifaceted with biological, social, and psychological factors contributing. The aim of this review is to advocate for the role of response (...) outcome expectancies in the development of CPSP following breast cancer surgery. We propose the Cognitive Activation Theory of Stress (CATS) as an applicable theoretical framework detailing the potential role of cortisol regulation, inflammation, and inflammatory-induced sickness behavior in CPSP. Drawing on learning theory and activation theory, CATS offers psychobiological explanations for the relationship between stress and health, where acquired expectancies are crucial in determining the stress response and health outcomes. Based on existing knowledge about risk factors for CPSP, and in line with the CATS position, we propose the SURGEry outcome expectancy (SURGE) model of CPSP. According to SURGE, expectancies impact stress physiology, inflammation, and fear-based learning influencing the development and persistence of CPSP. SURGE further proposes that generalized response outcome expectancies drive adaptive or maladaptive stress responses in the time around surgery, where coping dampens the stress response, while helplessness and hopelessness sustains it. A sustained stress response may contribute to central sensitization, alterations in functional brain networks and excessive fear-based learning. This sets the stage for a prolonged state of inflammatory-induced sickness behavior – potentially driving and maintaining CPSP. Finally, as psychological factors are modifiable, robust and potent predictors of CPSP, we suggest hypnosis as an effective intervention strategy targeting response outcome expectancies. We here argue that presurgical clinical hypnosis has the potential of preventing CPSP in women with breast cancer. (shrink)

Let T be a complete countable first order theory and λ an uncountable cardinal. Theorem 1. If T is not superstable, T has 2 λ resplendent models of power λ. Theorem 2. If T is strictly superstable, then T has at least $\min(2^\lambda,\beth_2)$ resplendent models of power λ. Theorem 3. If T is not superstable or is small and strictly superstable, then every resplendent homogeneous model of T is saturated. Theorem 4 (with Knight). For each μ (...) ∈ ω ∪ {ω, 2 ω } there is a recursive theory in a finite language which has μ resplendent models of power κ for every infinite κ. (shrink)

Chronic pain patients often miss receiving acknowledgement for the multidimensional struggles they face with their specific conditions. People suffering from chronic pain experience a type ofinvisibilitythat is also borne by other chronically ill people and their respective medical conditions. However, chronic pain patients face both passive and active exclusion from social participation in activities like family interactions or workplace inclusion. Although such aspects are discussed in the debates lead by the bio-psycho-social model of pain, there seems to be (...) a lack of a distinct interest in assessing more specifically the social aspects regarding chronic pain. As a result, the social aspects have yet to be taken into a more thorough theoretical consideration of chronic pain and to be practically implemented to help affected patients. By addressing chronic pain patients’ struggle for recognition, this paper attempts to shed light on some of these social aspects. We base this attempt on a theoretical framework that combines patients’ statements with an adaptation of Axel Honneth’s social-philosophical work onrecognition. Thus, this paper tries to make a suggestion on how the bio-psycho-social model of pain can live up to its name by helping to address more adequately some of the more neglected aspects in chronic pain patients’ suffering than has been possible to date. (shrink)

A distinguishing characteristic of the biomedical model is its compartmentalized view of man. This way of seeing human beings has its origin in Greek thought; it was stated by Descartes and to this day it still considers humans as beings composed of distinct entities combined into a certain form. Because of this observation, one began to believe that the focus of a health treatment could be exclusively on the affected area of the body, without the need to pay attention (...) to patient’s subjectivity. By seeing pain as a merely sensory response, this model was not capable of encompassing chronic pain, since the latter is a complex process that can occur independently of tissue damage. As of the second half of the twentieth century, when it became impossible to deny the relationship between psyche and soma, the current understanding of chronic pain emerges: that of chronic pain as an individual experience, the result of a sum of physical, psychological, and social factors that, for this reason, cannot be approached separately from the individual who expresses pain. This understanding has allowed a significant improvement in perspective, emphasizing the characteristic of pain as an individual experience. However, the understanding of chronic pain as a sum of factors corresponds to the current way of seeing the process of falling ill, for its conception holds a Cartesian duality and the positivist premise of a single reality. For phenomenology, on the other hand, the individual in his/her unity is more than a simple sum of parts. Phenomenology sees a human being as an intending entity, in which body, mind, and the world are intertwined and constitute each other mutually, thus establishing the human being’s integral functioning. Therefore, a real understanding of the chronic pain process would only be possible from a phenomenological point of view at the experience lived by the individual who expresses and communicates pain. (shrink)

While the biomedical model is still theleading paradigm within modern medicine and healthcare, and people with generalised chronicmusculoskeletal pain are frequent users of health careservices, their diagnoses are rated as having thelowest prestige among health care personnel. Anepistemological framework for understanding relationsbetween body, emotions, mind and meaning is presented.An approach based on a phenomenological epistemologyis discussed as a supplement to actions based on thebiomedical model.Within the phenomenological frame of understanding,the body is viewed as a subject and carrier ofmeaning, (...) and therefore chronic pain can be interpretedas a rational reaction to the totality of a person'slife situation. Search for possible hidden individualmeanings in painful muscles presupposes meeting healthpersonnel who view the person within a holistic frameof reference. (shrink)

As the world population ages, the patients per physician ratio keeps on increasing. This is even more important in the domain of chronic pathologies where people are usually monitored for years and need regular consultations.To address this problem, we propose an automated system to monitor a patient population, detecting anomalies in instantaneous data and in their temporal evolution, so that it could alert physicians. By handling the population of healthy patients autonomously and by drawing the physicians' attention to the patients–at-risk, (...) the system allows physicians to spend comparatively more time with patients who need their services. In such a system, the interaction between the patients, the diagnosis module, and the physicians is very important. We have based this system on a combination of stochastic models, fuzzy filters, and strong medical semantics. (shrink)

BackgroundPatients with chronic heart failure and their family caregivers may experience adverse emotional problems, such as depression. Mutuality, which refers to the relationship between caregivers and those they care for, is an important factor affecting depression in the dyads. The purpose of this study was to investigate the relationship between mutuality and depression in patients with CHF and their caregivers in China.MethodsIn this cross-sectional study, we used the Mutuality Scale and the Self-Rating Depression Scale to measure mutuality and depression of (...) patients and caregivers. We used SPSS version 26.0 and AMOS version 21.0 to analyze the data. An APIM was established to analyze the actor-partner effects of patient-caregiver mutuality and depression.ResultsA total of 250 dyads of patients and caregivers were included in the study. There were statistically significant differences in mutuality and depression between CHF patients and caregivers. The 4 dimensions of patients’ mutuality all have the actor effect on depression. There were 3 partner effects of caregivers’ “pleasurable activities”, “shared values”, and “reciprocity” on depression. Regarding caregiver depression, we only found an actor effect of caregivers’ “shared values” on depression.ConclusionThe relationship between patients and caregivers should be evaluated in the clinical setting, and it is very important to develop intervention measures to improve the adverse emotional problems affecting both patients and their caregivers. (shrink)

Chronic pain is one of the most disabling conditions globally, yet we are still missing a satisfying theoretical framework to guide research and clinical practice. This is highly relevant as research and practice are not taking place in a vacuum but are always shaped by a particular philosophy of pain, that is, a set of implicitly or explicitly prevailing assumptions about what chronic pain is and how it is to be addressed. In looking at recent history, we identify a promising (...) trend from neuro-centrism to the application of the biopsychosocial model. Unfortunately, due to its limited theoretical foundation, the biopsychosocial model is too often implemented in a reductionist, fragmented, and linear manner. In particular, it remains too vague concerning the relationship between involved biological, psychological, and social processes. Sanneke de Haan prominently labeled this the integration problem. In this paper, we introduce five different facets of the integration problem that every philosophy of pain needs to address: (i) ontological, (ii) conceptual, (iii) explanatory, (iv) methodologicalMethodological, and (v) therapeutic. We develop an enactive theory of chronic pain and outline how far it provides solutions to these different integration challenges. (shrink)

We expand the notion of resplendency to theories of the kind T + p", where T is a fi rst-order theory and p" expresses that the type p is omitted. We investigate two di erent formulations and prove necessary and sucient conditions for countable recursively saturated models of PA. Some of the results in this paper can be found in one of the author's doctoral thesis [3].

Chronic diseases represent the major illness burden of developed nations. A chronic disease databank system consists of parallel longitudinal data sets from diverse locations describing the courses of thousands of patients with chronic illness over many years. Illustrated by ARAMIS (The American Rheumatism Association Medical Information System), such data resources facilitate analysis of long term health outcomes and the factors associated with particular outcomes. A model for clinical investigation of contemporary disease is presented, based on the overwhelming prevalence of (...) chronic illness, the variability, complexity, and uniqueness of the individual patient course, the difficulties of traditional univariate reductionist approaches, and the time span required for study. In this model, data are systematically accrued and continually analyzed, and the data collected are gradually modified based upon evolving anticipation of future needs. The strategies underlying the development of ARAMIS are described, investigational results summarized, and future directions outlined. Keywords: ARAMIS, Chronic Disease Databanks, Prognosis, Health Outcomes CiteULike Connotea Del.icio.us What's this? (shrink)

Advance care planning is a process that encourages people to identify their values, to reflect upon the meanings and consequences of serious illness, to define goals and preferences for future medical treatment and care, and to discuss these goals with family and health-care providers. Advance care planning is especially important for those who are chronically ill, as patients and their families face a variety of complex healthcare decisions. Participating in advance care planning has been associated with improved outcomes; yet, (...) despite over 25 years of public awareness campaigns, research, and interventions developed to increase participation, advance care planning completion rates for people with chronic illnesses are no different than those in the general public (approximately 25%).Advance care planning has traditionally used an individualistic approach to autonomy, which puts forward an understanding of agents as independent, rational and self-interested persons. Because this individualistic approach has been largely unsuccessful in improving advance care planning uptake, a re-examination of the philosophical underpinnings of this practice and an exploration of alternative frameworks is warranted. In offering this exploration, we briefly outline two current perspectives on autonomy: the individualistic view and the relational view as articulated by feminist philosophers. Using a critical examination of the theoretical and empirical work on this topic, we argue that the individualistic view of autonomy does not sufficiently capture the relational and social complexities of the decision-making process of advance care planning. To offer a counterpoint, we examine the relational view of autonomy and suggest that this perspective is better aligned with the process of advance care planning. Specifically, we demonstrate that a relational model of autonomy is well suited to exploring advance care planning for four main reasons: (1) it recognizes the importance of relationships, (2) it reflects the fluctuating nature of autonomy in chronic illness, (3) it recognizes vulnerability, and (4) it is consonant with empirical work examining the advance care planning process. (shrink)

The comorbidity of chronic pain and opioid addiction is a serious problem that has been growing with the practice of prescribing opioids for chronic pain. Neuroimaging research has shown that chronic pain and opioid dependence both affect brain structure and function, but this is the first study to evaluate the neurophysiological alterations in patients with comorbid chronic pain and addiction. Eighteen participants with chronic low back pain and opioid addiction were compared with eighteen age- and sex-matched healthy individuals in a (...) pain-induction fMRI task. Unified structural equation modeling (SEM) with Lagrange multiplier (LM) testing yielded a network model of pain processing for patient and control groups based on 19 a priori defined regions. Tests of differences between groups on specific regression parameters were determined on a path-by-path basis using z-tests corrected for the number of comparisons. Patients with the chronic pain and addiction comorbidity had increased connection strengths; many of these connections were interhemispheric and spanned regions involved in sensory, affective, and cognitive processes. The affected regions included those that are commonly altered in chronic pain or addiction alone, indicating that this comorbidity manifests with neurological symptoms of both disorders. Understanding the neural mechanisms involved in the comorbidity is crucial to finding a comprehensive treatment, rather than treating the symptoms individually. (shrink)

Recent research shows that 20% of children face a form of chronic illness during childhood. The illness and its associated physical and mental challenges can affect such children's ‘being’ and influence how they develop as people. A significant aspect of a child's life that can be profoundly influenced by a chronic illness is education. This study employed a phenomenological approach to shed more light on the special education of such children. Temporality and embodiment were examined as two philosophical bases in (...) the phenomenological education of children with such chronic illnesses. Also, this educational model highlights that phenomenological understanding, and the healing connection in education, can increase the affected children's positive self-concept, directing them towards a satisfying and happy life. (shrink)

To address the growing costs associated with chronic illness care, many countries, both developed and developing, identify increased patient self‐management or self‐care as a focus of healthcare reform. Health coaching, an implementation strategy to support the shift to self‐management, encourages patients to make lifestyle changes to improve the management of chronic illness. This practice differs from traditional models of health education because of the interactional dynamics between nurse and patient, and an orientation to care that ostensibly centres and empowers patients. (...) The theoretical underpinnings of coaching reflect these differences, however in its application, the practices arranged around health coaching for chronic illness self‐management reveal the social regulation and professional management of everyday life. This becomes especially problematic in contexts defined by economic constraint and government withdrawal from activities related to the ‘care’ of citizens. In this paper, we trace the development of health coaching as part of nursing practice and consider the implications of this practice as an emerging element of chronic illness self‐management. Our purpose is to highlight health coaching as an approach intended to support patients with chronic illness and at the same time, problematize the tensions contained in (and by) this practice. (shrink)

Self‐management is often presented as a panacea for chronic disease care. It plays an important role at the policy level and increasingly guides the delivery of health care services. Self‐management approaches to care are founded on traditional individualistic views of autonomy in which the patient is understood as being independent, rational, self‐interested, and self‐governing. This conceptualization of autonomy has been challenged, particularly by feminist scholars. In this paper I review predominant critiques of self‐management and the traditional individualistic view of autonomy. (...) I propose that a relational approach to autonomy, which is premised on social embeddedness and attends to social, political, and material conditions, is a more sound conception of autonomy capable of taking into consideration the complexities of illness experiences. I suggest that integrating a relational perspective of autonomy into self‐management will be valuable in guiding its progression and elaborate ways in which self‐management research and practice could benefit from incorporating a relational approach to autonomy. (shrink)

We prove results about nonstandard formulas in models of Peano arithmetic which complement those of Kotlarski, Krajewski, and Lachlan in [KKL] and [L]. This enables us to characterize both recursive saturation and resplendency in terms of statements about nonstandard sentences. Specifically, a model M of PA is recursively saturated iff M is nonstandard and M-logic is consistent.M is resplendent iff M is nonstandard, M-logic is consistent, and every sentence φ which is consistent in M-logic is contained in a (...) full satisfaction class for M. Thus, for models of PA, recursive saturation can be expressed by a (standard) Σ 1 1 -sentence and resplendency by a ▵ 1 2 -sentence. (shrink)

Considerable heterogeneity among pediatric chronic pain patients may at least partially explain the variability seen in the response to behavioral therapies. The current study tested whether autistic traits and attention-deficit/hyperactivity disorder symptoms in a clinical sample of children and adolescents with chronic pain are associated with socioemotional and functional impairments and response to acceptance and commitment therapy treatment, which has increased psychological flexibility as its core target for coping with pain and pain-related distress. Children and adolescents aged 8–18 years were (...) recruited. Patients and their parents completed questionnaires pre- and post-ACT of 17 sessions. Correlational analyses and mixed-effects models were used to assess the role of autistic traits and ADHD symptoms in pretreatment functioning and ACT-treatment response. Outcome variables were degree to which pain interfered with daily activities, socioemotional functioning, psychological inflexibility, and pain intensity. Autistic traits and ADHD symptoms, pain frequency, and pain duration were measured at pretreatment only. Higher autistic traits were associated with greater pain interference, higher depression, and greater psychological inflexibility. Higher ADHD symptomatology was associated with greater pretreatment pain interference, lower emotional functioning, greater depression, and longer duration of pain. Across patients, all outcome variables, except for sleep disturbances and school functioning, significantly improved from pre- to post-ACT. Higher autistic traits were associated with greater pre- to post-ACT improvements in emotional functioning and sleep disturbance and non-significant improvements in pain interference. ADHD symptomatology was not associated with treatment outcome. The current results showed that neuropsychiatric symptoms in pediatric chronic pain patients are associated with lower functioning, particularly pain interfering with daily life and lower socioemotional functioning. The results suggest that not only pediatric chronic pain patients low in neuropsychiatric symptoms may benefit from ACT, but also those high in autism traits and ADHD symptoms. With the present results in mind, pediatric chronic pain patients higher in autistic traits may actually derive extra benefit from ACT. Future research could assess whether increased psychological flexibility, the core focus of ACT, enabled those higher in autism traits to cope relatively better with pain-related distress and thus to gain more from the treatment, as compared to those lower in autism traits. Moreover, to address specific effects of ACT, inclusion of an appropriate control group is key. (shrink)

Leading paradigms of clinical ethics consultation closely follow a biomedical model of care. In this paper, we present a theoretical reflection on the underlying biomedical model of disease, how it shaped clinical practices and patterns of ethical deliberation within these practices, and the repercussions it has on clinical ethics consultations for patients with chronic illness. We contend that this model, despite its important contribution to capturing the ethical issues of day-to-day clinical ethics deliberation, might not be sufficient (...) for patients presenting with chronic illnesses and navigating as “lay experts” of their medical condition(s) through the health care system. Not fully considering the sources of personal knowledge and expertise may lead to epistemic injustice within an ethical deliberation logic narrowly relying on a biomedical model of disease. In caring “for” and collaboratively “with” this patient population, we answer the threat of epistemic injustice with epistemic modesty and humility. We will propose ideas about how clinical ethics could contribute to an expansion of the biomedical model of care, so that important aspects of chronic illness experience would flow into clinical-ethical decision-making. (shrink)