The article focuses on the impact of the concept of self-care on persons who are understood as incapable of self-care due to their physical and/or mental ‘incapacity’. The article challenges the idea of this health care concept as empowerment and highlights the difficulties for persons who do not fit into this concept. To exemplify this, the self-care concept is discussed with regard to persons with Alzheimer’s disease (AD). In (...) the case of persons with AD, self-care is interpreted in many different ways—depending on the point of view, for instance as an affected person or a carer. To prevent a marginalisation of the growing group of elderly persons with dementia, the article argues that concepts such as those of personhood, wellbeing, autonomy, rationality and normality have to be re-thought with regard to an increasingly ageing population. Taking into account that AD as a socio-medical construct has to be understood in the context of power relations, the article focuses on the mutual influence between the concepts of self-care and of AD and its possible impact on governing dementia and AD in particular. Michel Foucault’s considerations on ‘technologies of the self’ provide the basis for the discussion of the self-care concept within existing societal power relations. (shrink)

High moral standards and adherence to a moral code have long been strong tenets of the profession of medicine, even though there have been occasional lapses that have led to renewed calls for a revitalization of moral integrity in medicine. Certainly, a moral component has generally been held to be an important aspect of the concept of a physician.

The fiduciary nature of the patient-physician relationship requires clinicians to act in the best interest of their patients. Patients are vulnerable due to their health status and lack of medical knowledge, which makes them dependent on the clinicians’ expertise. Competent patients, however, may reject the recommendations of their physician, either refusing beneficial medical interventions or procedures based on their personal views that do not match the perceived medical indication. In some instances, the patients’ refusal may jeopardize their health or life (...) but also compromise the clinician’s moral responsibility to promote the patient’s best interests. In other words, health professionals have to deal with patients whose behavior and healthcare decisions seem counterproductive for their health, or even deteriorate it, because of lack of knowledge, bad habits or bias without being the patients’ free voluntary choice. The moral dilemma centers on issues surrounding the limits of the patient’s autonomy and the clinician’s role to promote the well-being of the patient. In this paper we argue that the use of manipulative strategies, albeit considered beneficent, defeats the purpose of patient education and therefore should be rejected; and the appropriate strategy is to empower patients through patient education which enhances their autonomy and encourages them to become full healthcare partners as opposed to objects of clinical intervention or entities whose values or attitudes need to be shaped and changed through education. First, we provide a working definition of the concept of patient education and a brief historical overview of its origin. Second, we examine the nature of the patient-physician relationship in order to delineate its boundaries, essential for understanding the role of education in the clinical context. Third, we argue that patient education should promote self-rebiasing, enhance autonomy, and empower patients to determine their therapeutic goals. Finally, we develop a moral framework for patient education. (shrink)

This paper provides a philosophical critique of professional stereotypes in medicine. In the course of this critique, we also offer a detailed analysis of the concept of care in health care. The paper first considers possible explanations for the traditional stereotype that caring is a province of nurses and women, while curing is an arena suited for physicians and men. It then dispels this stereotype and fine tunes the concept of care. A distinction between ‘caring (...) for’ and ‘caring about’ is made, and concomitant notions of parentalism are elaborated. Finally, the paper illustrates, through the use of cases, diverse models of caring. Our discussion reveals the complexity of care and the alternative modes of caring in health care. (shrink)

Interpretations of family carer empowerment in much nursing research, and in home‐care practice and policy, rarely attend explicitly to families’ choice or control about the nature, extent or length of their involvement, or control over the impact on their own health. In this article, structural empowerment is used as an analytic lens to examine home‐care nurses’ interactions with families in one Western Canadian region. Data were collected from 75 hrs of fieldwork in 59 interactions (18 nurses (...) visiting 16 families) and interviews with 12 nurses and 11 family carers. Generally, nurses prioritized client empowerment, and their practice with families appeared oriented to supporting their role and needs as carers (i.e. rather than as unique individuals beyond the caring role), and reinforcing the caring role through validation and recognition. Although families generally expressed appreciation for these interactions, a structural empowerment lens illustrates how the broad context of home care shapes the interpretation and practice of empowerment in ways that can, paradoxically, be disempowering for families. Opportunities to effectively support family choice and control when a client is being cared for at home are discussed. (shrink)

Empowerment, an already central concept in public health, has gained additional relevance through the expansion of mobile health (mHealth). Especially direct-to-consumer self-testing app companies mobilise the term to advertise their products, which allow users to self-test for various medical conditions independent of healthcare professionals. This article first demonstrates the absence of empowerment conceptualisations in the context of self-testing apps by engaging with empowerment literature. It then contrasts the service these apps provide with two (...) widely cited empowerment definitions by the WHO, which describe the term as a process that, broadly, leads to knowledge and control of health decisions. We conclude that self-testing apps can only partly empower their users, as they, we argue, do not provide the type of knowledge and control the WHO definitions describe. More importantly, we observe that this shortcoming stems from the fact that in the literature on mHealth and in self-testing marketing, empowerment is understood as a goal rather than a process. This characterises a shift in the meaning of empowerment in the context of self-testing and mHealth, one that reveals a lack of awareness for relational and contextual factors that contribute to empowerment. We argue that returning to a process-understanding of empowerment helps to identify these apps’ deficits, and we conclude the article by briefly suggesting several strategies to increase self-testing apps’ empowerment function. (shrink)

The aim of this paper is to introduce a correction into the notion of self-directed adult learning by way of conjoining it with philosophically elaborated notions of autonomy, self-reflectiveness, and maturity. The basic premise of this intervention is that in andragogical theorizing, learners’ self-directedness ought not to be thought as obvious and thus beyond question. Since adult selves are not transparent but socially, culturally, and discoursively constructed, adult educators are encouraged to think of themselves as facilitators of (...) adult learners’ self-awareness and self-directedness in their learning processes. Adult learners need to be assisted in developing critical skills that can be used to eliminate distortions in their perception of social reality, in understanding their own personalities, their needs and decisions concerning continuing education. The problematization of the concept of human autonomy amid external influences, is first discussed in Immanuel Kant’s idea of maturity as an ability to use one’s understanding without guidance from another. I then turn to Habermas’s philosophy of communicative action and three knowledge-constitutive interests where the human interest in emancipation comes to the fore. Its significance for critical adult learning is further emphasized in line with Stephen Brookfield’s and Jack Mezirow’s association of self-directed learning with empowerment, understood as freeing consciousness from its dependence on hypostatized powers. Drawing on Foucault’s work, I argue that attaining the state of autonomy requires practice in “the care for oneself” which amounts to the lifelong endeavor to create and govern oneself and to learn how not to be governed. The agenda for adult education for citizenship opted for in this paper attributes essential significance to learnable skills of critical reasoning, deliberation, and self-reflectiveness which all operate within three proposed dimensions of adult education: experiential learning, literacy, and vocationalism. (shrink)

The aim of this paper is to introduce a correction into the notion of self-directed adult learning by way of conjoining it with philosophically elaborated notions of autonomy, self-reflectiveness, and maturity. The basic premise of this intervention is that in andragogical theorizing, learners’ self-directedness ought not to be thought as obvious and thus beyond question. Since adult selves are not transparent but socially, culturally, and discoursively constructed, adult educators are encouraged to think of themselves as facilitators of (...) adult learners’ self-awareness and self-directedness in their learning processes. Adult learners need to be assisted in developing critical skills that can be used to eliminate distortions in their perception of social reality, in understanding their own personalities, their needs and decisions concerning continuing education. The problematization of the concept of human autonomy amid external influences, is first discussed in Immanuel Kant’s idea of maturity as an ability to use one’s understanding without guidance from another. I then turn to Habermas’s philosophy of communicative action and three knowledge-constitutive interests where the human interest in emancipation comes to the fore. Its significance for critical adult learning is further emphasized in line with Stephen Brookfield’s and Jack Mezirow’s association of self-directed learning with empowerment, understood as freeing consciousness from its dependence on hypostatized powers. Drawing on Foucault’s work, I argue that attaining the state of autonomy requires practice in “the care for oneself” which amounts to the lifelong endeavor to create and govern oneself and to learn how not to be governed. The agenda for adult education for citizenship opted for in this paper attributes essential significance to learnable skills of critical reasoning, deliberation, and self-reflectiveness which all operate within three proposed dimensions of adult education: experiential learning, literacy, and vocationalism. (shrink)

The aim of this paper is to introduce a correction into the notion of self-directed adult learning by way of conjoining it with philosophically elaborated notions of autonomy, self-reflectiveness, and maturity. The basic premise of this intervention is that in andragogical theorizing, learners’ self-directedness ought not to be thought as obvious and thus beyond question. Since adult selves are not transparent but socially, culturally, and discoursively constructed, adult educators are encouraged to think of themselves as facilitators of (...) adult learners’ self-awareness and self-directedness in their learning processes. Adult learners need to be assisted in developing critical skills that can be used to eliminate distortions in their perception of social reality, in understanding their own personalities, their needs and decisions concerning continuing education. The problematization of the concept of human autonomy amid external influences, is first discussed in Immanuel Kant’s idea of maturity as an ability to use one’s understanding without guidance from another. I then turn to Habermas’s philosophy of communicative action and three knowledge-constitutive interests where the human interest in emancipation comes to the fore. Its significance for critical adult learning is further emphasized in line with Stephen Brookfield’s and Jack Mezirow’s association of self-directed learning with empowerment, understood as freeing consciousness from its dependence on hypostatized powers. Drawing on Foucault’s work, I argue that attaining the state of autonomy requires practice in “the care for oneself” which amounts to the lifelong endeavor to create and govern oneself and to learn how not to be governed. The agenda for adult education for citizenship opted for in this paper attributes essential significance to learnable skills of critical reasoning, deliberation, and self-reflectiveness which all operate within three proposed dimensions of adult education: experiential learning, literacy, and vocationalism. (shrink)

The aim of this paper is to introduce a correction into the notion of self-directed adult learning by way of conjoining it with philosophically elaborated notions of autonomy, self-reflectiveness, and maturity. The basic premise of this intervention is that in andragogical theorizing, learners’ self-directedness ought not to be thought as obvious and thus beyond question. Since adult selves are not transparent but socially, culturally, and discoursively constructed, adult educators are encouraged to think of themselves as facilitators of (...) adult learners’ self-awareness and self-directedness in their learning processes. Adult learners need to be assisted in developing critical skills that can be used to eliminate distortions in their perception of social reality, in understanding their own personalities, their needs and decisions concerning continuing education. The problematization of the concept of human autonomy amid external influences, is first discussed in Immanuel Kant’s idea of maturity as an ability to use one’s understanding without guidance from another. I then turn to Habermas’s philosophy of communicative action and three knowledge-constitutive interests where the human interest in emancipation comes to the fore. Its significance for critical adult learning is further emphasized in line with Stephen Brookfield’s and Jack Mezirow’s association of self-directed learning with empowerment, understood as freeing consciousness from its dependence on hypostatized powers. Drawing on Foucault’s work, I argue that attaining the state of autonomy requires practice in “the care for oneself” which amounts to the lifelong endeavor to create and govern oneself and to learn how not to be governed. The agenda for adult education for citizenship opted for in this paper attributes essential significance to learnable skills of critical reasoning, deliberation, and self-reflectiveness which all operate within three proposed dimensions of adult education: experiential learning, literacy, and vocationalism. (shrink)

In this paper, I discuss the ethics of care as a response to impartialist ethical theories. In section 1, I contrast Gilligan’s critique of impartial ethical theories with other objections to impartialism. In section 2, I analyze some of the ways in which impartialists have attempted to understand the ethics of care since the publication of Gilligan’s text. In section 3, I argue against proponents of impartialism and show that care constitutes an ethical theory in its own (...) right, not one which is dependent or parasitic upon impartialism. In section 4, I contrast care ethic’s conception of the self with that offered by traditional ethical theories, and argue that the most important distinction between the care and impartialist accounts of morality lies in the conception of the moral self which informs each of these approaches. (shrink)

In my paper, I propose to investigate the philosophical underpinnings of representative indigenous Japanese psychotherapeutic approaches, particularly that of Morita and Naikan therapies, that have, at their foundations, distinctly Buddhist psychological tenets, and that offer to deal with mental health issues in a manifestly different way compared with their western counterparts. I offer a comprehensive account of how the characterizations of madness and mental illness have been shifting over the last two hundred years in Japanese society and culture, and how (...) this has affected mental health care in Japan. Finally, the ways in which modern day thinkers, such as Daisetz Teitaro Suzuki and Keiji Nishitani have been re-shaping the concepts of the self in Japanese religion and philosophy while, at the same time, taking care to remain faithful to the original East Asian sensibilities will also be expounded and connected to the themes of mental health and mental illness. (shrink)

Our goal was to explore self‐care practices among men who have sex with men in the context of Mpox in Brazil. This study used qualitative research methods, including interviews and thematic analysis, to collect and analyze data from male participants across the Brazilian territory. The narratives unveil men's perspectives on self‐care, risk reduction, and health beliefs during the Mpox pandemic. Our findings highlight a multifaceted approach to self‐care among men, encompassing hygiene, physical contact management, (...) mask usage, skin lesion vigilance, and adherence to official guidelines. Men's attitudes toward sexual behaviors emphasize the importance of reducing sexual partners, practicing safe sex, and combating misinformation through accurate information dissemination. The development of these behaviors and self‐care practices can be facilitated by nurses guided by Dorothea Orem's Self‐Care Theory, supported by patient‐centered care, with strategies to address and confront the stigma associated with the disease and provide emotional support. Thus, the study underscores the pivotal role of self‐care in mitigating infection risks, especially in the context of emerging infectious diseases. It acknowledges the impact of socio‐cultural factors and healthcare policies on men's preventive measures. However, it also recognizes limitations, such as potential bias due to stigma concerns and a nonrepresentative sample. Ultimately, the research advocates for tailored education, promotion of gender equity, and healthcare empowerment to effectively manage health risks in such contexts. (shrink)

This paper will offer an alternative paradigm to healthcare delivery by introducing the concept of mutuality and empowerment into the existing health-wealth model. The backdrop is provided by Better Health, Better Care (Scottish Government 2007), Section 1 of which is entitled ‘Towards a Mutual NHS’. In detail, the paper will: revisit what is meant by mutuality; advance the meaning of the `public interest’; explore empowerment and community empowerment and its relationship to health; and introduce a (...) model, which tries to link these concepts and terms together. It is hoped that this analysis will help researchers and practitioners alike further appreciate the important concept of mutuality and empowerment into the existing health-wealth model. (shrink)

The paper studies two fundamentally different forms in which the concept of care makes its comeback in twentieth-century thought. We make use of a distinction made by Peter Sloterdijk, who argues that the ancient and medieval ‘ascetic’ ideal of self-enhancement through practice has re-emerged in the nineteenth and twentieth centuries, particularly in the form of a rehabilitation of the Hellenistic notion of self-care (epimeleia heautou) in Michel Foucault’s late ethics. Sloterdijk contrasts this return of (...) class='Hi'>self-care with Martin Heidegger’s concept of being-in-the-world as ‘total care’ (Sorge), an utterly ‘secularized’ understanding of the human being as irreducibly world-embedded that rejects the classical ascetic ideal of world-secession. We examine further the historical roots and emergence of these contrasting contemporary reappropriations of care in the Western tradition of thought and show them to be rooted in two different ontologies and ethics of the self as either world-secluded or world-immersed, autonomous or constitutively relational. The historical point of divergence of these two approaches to care, we argue, can be found in the Christian transformation of Hellenistic ethics. (shrink)

The word ‘empowerment’ has become a popular term, widely used as an important claim, also within the health services. In this paper the concept's philosophical roots are traced from Freire and his ‘Pedagogy of the Oppressed’ to the philosophical thoughts of Hegel, Habermas, and Sartre. An understanding of the concept, as a way to facilitate coping and well‐being in patients through reflection and dialogue, emerges. Within an empowerment strategy the important claim on the nurse and the (...) patient will be to reveal the patient's own resources and limitations in times with sickness and reduced functionality to promote the patient's choice to act and cope. From this point of view an education‐programme for the frail elderly is outlined. If the nurse wants to empower the elderly patient she has to be willing to be educated through the dialogue with the patient, and to look for the patient's own meaning of being frail and elderly. The coping and self‐care solutions for the patient may then even be different from the preferences of the nurse, and this does not mean that the empowerment strategy is a failure or that the patient then has to continue without the assistance from the nurse. Within an empowerment strategy, in the Freirerian sense, the important thing is that both the patient and the nurse together critically reflect on the meanings of the sickness so that the patient can be able to make his own conscious choices. (shrink)

In his moral psychology, Prof. Frankfurt pays special attention to two strongly related issues which should be given pride of place in every genuine account of human action and behaviour: these issues are the problem of personal autonomy and what I would like to call the problem of self-constitution. The first concerns the question what it means to be a fully human, rational agent, i.e., someone who is accountable for and in one way or another conscious of what he (...) does and desires; the second concerns the question how human beings become selves or persons with a particular identity, i.e., somebody who is not only accountable for and conscious of his or her own deeds, desires and preferences at a given time, but also able to identify with his or her personal life-history, as a through time related structure of deeds, beliefs, volitions, preferences and desires.In the following, I shall first of all formulate a rather free interpretation of the important and penetrating reflections of Prof. Frankfurt on the concept of care, which, as I understand it, accounts for the interdependence of autonomy and self-constitution. I shall then formulate a critical reflection and some related questions, more or less inspired by Charles Taylor’s investigations of the constitution of the self and the problem of rational autonomy. As is well known, Taylor has been partly influenced by Frankfurt’s writings on these issues, but of course — and that’s what my questions will be about — I leave it to Prof. Frankfurt to determine how well Taylor’s suggestive account of the constitution of the authentic self fits the Frankfurtian descriptive metaphysics of human mind and action. (shrink)

In the heated debates over identity politics, few theorists have looked carefully at the conceptualizations of identity assumed by all sides. Visible Identities fills this gap. Drawing on both philosophical sources as well as theories and empirical studies in the social sciences, Martín Alcoff makes a strong case that identities are not like special interests, nor are they doomed to oppositional politics, nor do they inevitably lead to conformism, essentialism, or reductive approaches to judging others. Identities are historical formations and (...) their political implications are open to interpretation. But identities such as race and gender also have a powerful visual and material aspect that eliminativists and social constructionists often underestimate.Visible Identities offers a careful analysis of the political and philosophical worries about identity and argues that these worries are neither supported by the empirical data nor grounded in realistic understandings of what identities are. Martín Alcoff develops a more realistic characterization of identity in general through combining phenomenological approaches to embodiment with hermeneutic concepts of the interpretive horizon. Besides addressing the general contours of social identity, Martín Alcoff develops an account of the material infrastructure of gendered identity, compares and contrasts gender identities with racialized ones, and explores the experiential aspects of racial subjectivity for both whites and non-whites. In several chapters she looks specifically at Latino identity as well, including its relationship to concepts of race, the specific forms of anti-Latino racism, and the politics of mestizo or hybrid identity. (shrink)

STAJDUHAR K, FUNK L, JAKOBSSON E and ÖHLÉN J. Nursing Inquiry 2010; 17: 221–230A critical analysis of health promotion and ‘empowerment’ in the context of palliative family care-givingTraditionally viewed as in opposition to palliative care, newer ideas about ‘health-promoting palliative care’ increasingly infuse the practices and philosophies of healthcare professionals, often invoking ideals of empowerment and participation in care and decision-making. The general tendency is to assume that empowerment, participation, and self-care (...) are universally beneficial for and welcomed by all individuals. But does this assumption hold for everyone, and do we fully understand the implications of health-promoting palliative care for family caregivers in particular? In this study, we draw on existing literature to highlight potential challenges arising from the application of ‘family empowerment’ strategies in palliative home-care nursing practice. In particular, there is a risk that empowerment may be operationalized as transferring technical and medical-care tasks to family caregivers at home. Yet, for some family caregivers, a sense of security and support, as well as trust in professionals, may be equally if not more important than empowerment. Relational and role concerns may also at times take precedence over a desire for empowerment. The potential implications of ‘family empowerment’ are explored in this regard. ‘Family empowerment’ approaches need to be accompanied by a strong understanding of how to best support individual palliative family caregivers. (shrink)

Self‐care, or self‐management, is presented in healthcare policy as a precursor to patient empowerment and improved patient outcomes. Alternatively, critiques of the self‐care agenda suggest that it represents an over‐reliance on individual autonomy and responsibility, without adequate support, whereby ‘self‐care’ is potentially unachievable and becomes ‘care left undone’. In this sense, self‐care contributes to a blame culture where ill‐health is attributed to personal behaviours or lack thereof. Furthermore, self‐ (...) class='Hi'>care may represent a covert form of rationing, as the fiscal means to enable effective self‐care and supplement, or replace, self‐care capacities, is not provided. This paper explores these arguments through a contemporary ethical analysis of the self‐care agenda. The terms self‐care and self‐management are used interchangeably throughout whereby self‐management is understood as a point in the wider self‐care continuum. (shrink)

Nurse engagement, empowerment and strong relationships among staff, residents and families, are essential to attract and retain a suitably qualified and skilled nursing workforce for safe, quality care. There is, however, limited research that explores engagement, empowerment and relational coordination in long‐term care (LTC). Nurses from an older persons’ mental health and dementia LTC unit in Australia participated in this study. Forty‐one nurses completed a survey measuring psychological empowerment, work engagement and relational coordination. Twenty‐nine nurses (...) participated in individual interviews to further explore these concepts. Although nurses reported high psychological empowerment and work engagement, their relationships with key stakeholders varied. Our findings suggest that nurses in LTC require both supports and opportunities to contribute as active members of the multiprofessional care team that includes tailored education, professional development and positive interactions within the care team. Regular support is needed to enable nurses to feel empowered, foster relationships and communication, and facilitate work engagement. Based on these findings, we suggest that it is important to find ways to ensure that all who provide care perceive that they are part of the whole care team and able to contribute to the care and well‐being of people in LTC. (shrink)

This text through the direct use to Foucault’s work and using the concepts of ‘care of the self’ and biopolitics is questioning and analyzing resistance and practices of freedom. Mainly, from the Foucault’s courses at the College de France and the methodological tools found there, here I present a discussion about Gilles Deleuze’s contributions to Foucault’s thought and I develop a dialog where I try to explain the concepts of domination, power, ethics, esthetics and the relationship of the (...) self with himself. (shrink)

Care work may be connected with emotional and psychological exhaustion but also gratification, reward, and self-empowerment. Caregivers experience both positive and negative emotional states in caring situations, and further studies on the rewarding and energizing aspects of care may help us to broaden our understanding of how we can reduce the degree of burden while increasing the sense of satisfaction. This article shows how the focus on emotion is a necessary step to show the ambivalences and (...) the grey areas connected with the concept of care as well as to challenge the not fully explored assumption that care is often associated with burden and stress and viewed as a result of circumstances. It reports the findings of a micro-situated study of daily care activities among 80 caregivers. Care is seen as a strategic site to grasp deeper insights into the interactional mechanisms through which the emotional dynamics revolving around care produce unanticipated outcomes in terms of symbolic and practical productivity. (shrink)

Spinoza and Education offers a comprehensive investigation into the educational implications of Spinoza’s moral theory. Taking Spinoza’s naturalism as its point of departure, it constructs a considered account of education, taking special care to investigate the educational implications of Spinoza’s psychological egoism. What emerges is a counterintuitive form of education grounded in the egoistic striving of the teacher to persevere and to flourish in existence while still catering to the ethical demands of the students and the greater community. -/- (...) In providing an educational reading of Spinoza’s moral theory, this book sets up a critical dialogue between educational theory and recent studies which highlight the centrality of ethics in Spinoza’s overall philosophy. By placing his work in a contemporary educational context, chapters explore a counterintuitive conception of education as an ethical project, aimed at overcoming the desire to seek short-term satisfaction and troubling the influential concept of the student as consumer. This book also considers how education, from a Spinozistic point of view, may be approached in terms of a kind of cognitive therapy serving to further a more scientifically adequate understanding of the world and aimed at combating prejudices and superstition. -/- Spinoza and Education demonstrates that Spinoza’s moral theory can further an educational ideal, where notions of freedom and self-preservation provide the conceptual core of a coherent philosophy of education. As such, it will appeal to researchers, academics and postgraduate students in the fields of philosophy of education, theory of education, critical thinking, philosophy, ethics, and Spinoza studies. (shrink)

Mhealth technology is mushrooming world-wide and, in a variety of forms, reaches increasing numbers of users in ever-widening contexts and virtually independent from standard medical evidence assessment. Yet, debate on the broader societal impact including in particular mapping and classification of ethical issues raised has been limited. This article, as part of an ongoing empirically informed ethical research project, provides an overview of ethical issues of mhealth applications with a specific focus on implications on autonomy as a key notion in (...) the debate. A multi-stage model of references to the potential of mhealth use for strengthening some or other form of self-determination will be proposed as a descriptive tool. It illustrates an assumed continuum of enhanced autonomy via mhealth broadly conceived: from patient to user autonomy, to improved health literacy, and finally to the vision of supra-individual empowerment and democratised, participatory health and medicine as a whole. On closer examination, however, these references are frequently ambivalent or vague, perpetuating the at times uncritical use of established autonomy concepts in medical ethics. The article suggests zooming in on the range of autonomy-related aspects against the backdrop of digital innovation and datafied health more generally, and on this basis add to existing frameworks for the ethical evaluation of mhealth more specifically. (shrink)

In this article, I claim that Mary Wollstonecraft and Edmund Burke both conceive of the rights of man as a medium for individuals to care for and cultivate the self. Beginning with Michel Foucault’s doubts that a concern with the care of the self can be found in modern political thought, I turn to Wollstonecraft and Burke in order to show that their debate turns precisely on the question of whether the rights of man enables or (...) disables a care of the self. For Wollstonecraft, on the one hand, the rights of man provide women with a means to overcome a destructive set of virtues—such as beauty, chastity, and modesty—that leave them spiritually destitute and deeply unhappy. For Burke, on the other hand, such rights devastate the system of manners that had previously nurtured the self’s relation to itself. Regardless of this disagreement, my key claim is that both thinkers conceive of the rights of man not just as a juridical construction but also as a comprehensive way of life. In this way, I extend Foucault’s notion of the care of the self—along with his conception of ethics, conversion, and personal cultivation—to a foundational debate in the human rights tradition. (shrink)

“Democratization” has recently become a popular trope in Western public discourses on medicine, where it refers to patient participation in the gathering and distribution of health-related data using various digital technologies, in order to improve healthcare technically and socially. We critically analyze the usage of the term from the perspective of the “politics of buzzwords.” Our claim is that the phrase works primarily to publicly justify the dramatic increase in the application of information and data technologies in healthcare and therefore (...) fosters the corresponding industry. As a buzzword, “democratizing healthcare” is characterized by vagueness, which is why it receives meaning only through a word collective—a group of words that provide it with a context and are often used together with it. We examine key terms associated with “democratization” in the healthcare discourse—participation, empowerment, and personalized medicine—and show that the buzzword receives rhetorical power through the ambiguous reference to these concepts. As a consequence, the idea of “democracy” becomes diluted into meaning merely “access to,” and “healthcare” is reduced to the notion of a preventive, nonacute, monitored form of medical care. (shrink)

Despite receiving considerable philosophical attention, the concept of autonomy remains contested. In this paper, we diagnose one source of the continuing problem—an excessive emphasis on reflective self-appraisal in the dominant procedural models of autonomy—and suggest a solution. We argue that minimalist conceptions of rational self-appraisal are subject to fatal counterexamples. Yet, attempts to provide a more robust account of rational self-appraisal are too demanding to capture our intuitions about who counts as an autonomous agent. We argue (...) that no procedure of rational reflection will confer autonomy; rather autonomy is a matter of an agent’s actions flowing from her substantive commitments. Instead of rational self-reflection, autonomous actions are the product of the motive of care, which anchors an agent’s occurent desires to her system of value. (shrink)

This paper offers critical reflection on the contemporary tendency to approach health care in instrumentalist terms. Instrumentalism is means-ends rationality. In contemporary society, the instrumentalist attitude is exemplified by the relationship between individual consumer and a provider of goods and services. The problematic nature of this attitude is illustrated by Michael Oakeshott’s conceptions of enterprise association and civil association. Enterprise association is instrumental; civil association is association in terms of an ethically delineated realm of practices. The latter offers a (...) richer ethical conception of the relation between person and society than instrumentalism does. Oakeshott’s conception is further illustrated by reflection on the connection between morality and religion that he explores in an early essay concerning “religious sensibility”. Religious sensibility turns on the acknowledgement of the vulnerability of the self to the vicissitudes of life. This vulnerability cannot be bargained over instrumentally without imperilling the self. Religious sensibility is thus a valuable resource for criticising instrumentalist attitudes. It allows for the cultivation of ethical self-understanding that is essential to comprehending the conditions in virtue of which genuine civil life is possible. These conditions need to be taken into account in health care. Health care is not simply about substantive wants. It also necessarily concerns the universal and constant condition of being prey to illness that is the common lot of all citizens. (shrink)

The notion of care is a fundamental and constitutive element of any conception of therapy. It is present throughout history in diverse therapeutic practices, from the philosophical schools of antiq...

Definition of the problemHealth Apps are becoming increasingly important for a preventive and responsible orientation of the health system. Currently, most of these digital health applications (DiGA) are based on so-called self-tracking technologies which record physiological and psychological data via sensors, usually combined with personalized everyday information. In the last few years, these digital developments have launched an intense and clearly polarized debate about the opportunities and dangers of self-tracking in healthcare.ArgumentsAfter a brief overview of medical self-tracking, (...) this essay wants to systematize and check the polarized discourse on the basis of its decisive individual and social potentials. It turns out that self-measurement techniques have long been an integral part of medical practice in diagnostics and therapy.ConclusionThe area of tension between individual empowerment and potential loss of control by the users will be emphasized as being especially important for the implementation of health Apps in primary health care. Finally, possible implications for the current design of the new German Digital Care Law (Digitale-Versorgung-Gesetz) are shown and some existing “blind spots” are highlighted. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Losing the Self:Detachment in Meister Eckhart and Its Significance for Buddhist-Christian DialogueCharlotte RadlerThe purpose of this article is to probe Meister Eckhart's concepts of self—or, rather, no-self—detachment, and indistinct union, and their positive implications for Buddhist-Christian dialogue. I will examine potential affinities between Eckhart and Buddhist thought with the modest hope of identifying areas in Eckhart's mysticism that may present themselves as particularly ripe for Buddhist-Christian (...) conversations.On April 15, 1329, Pope John XXII issued the bull "In agro dominico" that condemned tenets of Meister Eckhart's teaching. Pope John XXII, who had also dealt harshly with the spiritual Franciscans, was truly concerned about Eckhart's seductive impact on the uneducated in the pews.1 Eckhart's claim that every human's true identity, attainable through detachment, is divine must have created dreams in some of an unmediated experience of and union with the divine, and nightmares in others of the bypassing of the Church's structures, sacraments, and hierarchies.Eckhart, a University of Paris teacher and a preacher, bases his mysticism in part on Proclus and Dionysius the Areopagite. Similarly to Proclus, Eckhart proposes that the soul's circular journey runs from the nothingness of the God beyond God, the God beyond the Trinity, into the somethingness of the world, and back to the nothingness of the God beyond the God. There is a firm ontological link between the One, the Trinity, and creation, which means that creation in its core is Trinitarian and One. In his interpretations of Job 22:14 and Ps. 61:12, Eckhart demonstrates that God is never static as One or Three or creation, but God is at once dialectically One and flowing out into the persons of the Trinity and flowing over into creation.2 This continuity between the Creator and creature, time and eternity, sanctifies creation and transience in all its grittiness and overcomes a duality between Creator and creature similar to the interpretation of samsara and nirvana (conditioned reality is Boundless Openness in Mahayana thought). Furthermore, Eckhart maintains that the One, as transparent and transcendent nothingness, encompasses and penetrates all. The wondrous truth, for Eckhart, is that we are truly all in all, just like the center of the circle is everywhere and its circumference nowhere.3 [End Page 111]To his audience, Eckhart repeatedly underscores that the soul is ontologically rooted in the nothingness of the divine unity and is thus in its deepest essence divine. In fact—and here we find profound resonances with tenets of Buddhist thought such as the concept of no-self (anatta or anatma)—the self's only true existence is the divine nothingness. Contrary to such thinkers as Thomas Aquinas, Eckhart focuses on the principal existence of things in the godhead and maintains that the human being does not possess a true substantial existence or "I" apart from God.4 Hence, the "I" or self can never constitute the foundation of reality. Because of the human being's absolute ontological dependence on God, Eckhart can assert that "where God is, there is the soul, and where the soul is, there is God."5 In his writings, Eckhart therefore differentiates between the true existence that creatures have in their original cause, the esse virtuale, and the particular and ephemeral existence that creatures possess in themselves, the esse formale.6 Thus, instead of autonomy and possessive individualism, "theonomy" implies the realization of the human being's full potential.While the autonomous, individual self is a form of negative nothingness or no-self, it paradoxically constitutes the greatest attachment for the human being. The clinging to the self causes what David Tracy refers to as an individual and cultural terror of transience.7 In the journey toward union, the soul must carefully release itself from all its attachments and detach itself from all its possessiveness. Eckhart's existential letting-go and letting-be imply the profoundest respect for existence itself as well as recognition of the ontological interconnectedness of all life.One of the foremost representatives of the apophatic tradition, Eckhart hooks up the praxis of apophasis to the notion of detachment, the stripping away of... (shrink)

The aim of this paper is to offer theoretical insights into the care of the self, which often initiates therapist-patient relationships in clinical practice. The reason is that when patients care about their health status, they are inclined to establish a therapeutic relationship with physical therapists. Hence, the care for self may bridge the world of the patient's private experiences and the world of the healthcare system together with its interventions, which is represented by the (...) physical therapist In this framework, care means not only the patient's choice to undergo therapy but also his/her commitment to sustaining its effects in private life. This involves educational interventions by the physiotherapist who inscribes him/herself in his/her patients’ care of the self in order to alter their habits of physical exercise, diet, personal hygiene, body posture, etc. The argument in this paper is informed by the concepts of ethics developed by Michel Foucault and Richard Shusterman. (shrink)

Drawing from Kohut's conceptualisation of self, Riker sets out how contemporary America's formulation of persons as autonomous, self-sufficient individuals is deeply injurious to the development of a vitalizing self-structure-a condition which lies behind much of the mental illness and social malaise of today's world. By carefully attending to Kohut's texts, Riker explains the structural, functional, and dynamic dimensions of Kohut's concept of the self. He creatively extends this concept to show how the self (...) can be conceived of as an erotic striving for connectedness, beauty, and harmony, separate from the ego. Riker uses this distinction to reveal how social practices of contemporary American society foster skills and traits to advance the aims of the ego for power and control, but tend to suppress the needs of the self to authentically express its ideals and connect with others. The book explores the impact that this view can have on clinical practice, and concludes by imaginatively constructing an ideal self-psychological society, using Plato's Republic as a touchstone. Informed by self psychology and philosophy, this book is essential reading for psychoanalysts, psychotherapists and philosophers, seeking to revisit and revise constructions of both self and humanity. (shrink)

In this paper I examine the concept of cross-temporal personal identity (diachronicity). This particular form of identity has vexed theorists for centuries -- e.g.,how can a person maintain a belief in the sameness of self over time in the face of continual psychological and physical change? I first discuss various forms of the sameness relation and the criteria that justify their application. I then examine philosophical and psychological treatments of personal diachronicity(for example,Locke's psychological connectedness theory; the role of (...) episodic memory) and find each lacking on logical grounds, empirical grounds, or both. I conclude that to achieve a successful resolution of the issue of the self as a temporal continuant we need to draw a sharp distinction between the feeling of the sameness of one's self and the evidence marshaled in support of that feeling. (shrink)

Stuart Murray's 'Care and the self: biotechnology, reproduction, and the good life' utilizes Foucault's "care of the self" to examine health domains in its title. The present author discusses three important articulations of concern with the Foucauldian concepts of care of the self that are absent in the work of Murray and others: first, the voluntarism and individualism inherent in ideas about care of the self; second, the absence of the interactional and (...) relational; and, third, the perpetuation of the interpretation of Foucault's concept of governmentality, 'the conduct of conduct', as primarily coercive. (shrink)

This paper deals with Care of the Self under globalization. The first part refers to Johann P. Arnason’s interpretation of Jan Patočka’s work on super-civilization and shows the contradictions facing people in the Modern Era. It suggests that the concept of moderateness is an adequate point of departure for handling the various contradictions of the current epoch. The second part looks at selected aspects of Confucian philosophy in which moderateness, that is, the permanent search for a “middle (...) position” is an integral part of that philosophical tradition. The critical actualisation of Confucianism as proposed for instance by Heiner Roetz is seen as an appropriate way of developing the dialogical characteristics of Confucian philosophy. In the last part it is stressed that critical theory is of relevance when identifying various forms of suffering and because of its ability to understand and critically evaluate diverse cultural and social contexts. (shrink)

This book aims to understand why women are the targets of online hate speech and how we can stop this from occurring.

The concept of ‘empowerment’ is used frequently in a number of professional areas, from psychotherapy to social work. But even if the same term is used, it is not always clear if the concept denotes the same goals or the same practice in these various fields. The purpose of this paper is to clarify the discussion and to find a plausible and useful definition of the concept that is suitable for work in various professions. Several suggestions (...) are discussed in the paper, for example control over life or health, autonomy, ability, self-efficacy, self-esteem, and freedom, and it is concluded that there are two plausible complementary uses, one as a goal and one as a process or approach. Empowerment as a goal is to have control over the determinants of one’s quality of life, and empowerment as a process is to create a professional relation where the client or community takes control over the change process, determining both the goals of this process and the means to use. (shrink)

The paper offers an analysis of Plato’s conception of the care of the self in his Gorgias. There are two components of the self-care: self-knowledge and self-control. The first part deals with self-knowledge. The second part asks the question, wether there can be a fixed model of the individual soul’s order. The third part of the paper deals with Plato’s conception of self-control. The last part is concerned with the problem of a (...) self-control training. (shrink)

Vulnerability and empowerment are central concepts of contemporary development theory and ethics. Vulnerability associated with human interdependence is a wellspring of values in care ethics, while vulnerability arising from social problems demands remedy, of which empowerment is frequently the just form. Development planners and aid providers focus upon improving the wellbeing of the most vulnerable – especially women – by empowering them economically, socially and politically. -/- Both vulnerability and empowerment are considered in this volume. Jay (...) Drydyk argues that empowerment is necessarily relational, not simply a matter of expanding choices. Christine Koggel reviews Drydyk’s discussion through the lens of feminist relational theory, considering how norms, structures and institutions shape, delimit, and promote empowerment. Gail Presbey examines empowerment in East African women’s lives through the writings and biography of Wangari Maathai. Stacy Kosko considers indigenous self-governance and participation in shared governance. Serene Khader reflects upon postcolonial feminist criticism of the concept of adaptive preference. Vida Panitch discusses the economic vulnerability that surrounds the global market in surrogate birth. Anupam Pandey provides a review of third world eco-feminist activism and literature. Ann Cudd envisions international humanitarian intervention to support female autonomy against oppressive state and social institutions. (shrink)

This paper considers the structure of the ethical subject found in Foucault’s late works on ethics, and gives an account of his two major ethical concepts: “care of the self” and “aesthetics of existence.” The “care of the self,” it is argued, gives Foucault a way of conceptualising ethics which does not rely on juridical categories, and which does not conceive the ethical subject on the model of substance. The “care of the self” entails (...) an understanding of the ethical subject as a process which is always in a relation, specifically in a relation to itself. Using his essay “What is an Author,” it is argued that the subject of the “aesthetics of existence,” like the author of a text, is understood to be fully immanent to the “object” which it is usually considered to be opposed to and separated from. Rather than aiming at a true expression of an “authentic” inner substance, Foucault’s “aesthetics of existence” leads instead to practices of “creativity,” whose form cannot be given in advance. (shrink)

In the wake of a pilot study that indicated that the experience of medical education appears to Inhibit moral development In medical students, increased attention needs to be given to the structure of medical education and the Influence it has on medical students. Interest in ethics and moral reasoning has become widespread in many aspects of professional and public life. Society has exhibited great interest in the ethical issues confronting physicians today. Considerable effort has been undertaken to train medical students, (...) interns, and residents In how to reason through medical-ethical dilemmas. Media attention has focused on Issues such as abortion, euthanasia, care of severely handicapped infants, organ transplantation, and so forth, producing heated debates in both the professional and lay literature over the morality of the various positions. The curriculum of medical education has paralleled and reflected this general Interest in medical ethics. Most medical schools now offer, and frequently require, course work in ethics. However, further research Is needed to better characterize and understand the relationship of medical education to moral development. (shrink)

We develop and test a process model demonstrating how leader charisma and constructive and destructive forms of narcissism interact to influence follower psychological empowerment and moral identity, using survey data from 667 direct reports of leaders from 13 different industries. Study results revealed that leader narcissism moderates the relationship between leader charisma and follower psychological empowerment such that when leaders possess a more constructive and less destructive narcissistic personality, their charisma has a stronger positive relationship with follower psychological (...) empowerment. Study results also revealed that follower psychological empowerment mediates the differential interactive effects of leader charisma and constructive and destructive narcissism on follower moral identity. Implications of these results for future theory development, research, and practice are discussed. (shrink)

Background The fourth section of the 1967 Abortion Act states that individuals (including health care practitioners) do not have to participate in an abortion if they have a conscientious objection. A conscientious objection is a refusal to participate in abortion on the grounds of conscience. This may be informed by religious, moral, philosophical, ethical, or personal beliefs. Currently, there is very little investigation into the impact of conscientious objection on service users in Britain. The perspectives of service users are (...) imperative in understanding the real-world consequences and potential impact of conscientious objection and should be considered when creating and reviewing policies and guidelines. This research provided a platform for women and those who can become pregnant to share their experiences and opinions at a time when these voices are largely excluded in the great tradition of Western political philosophy and law-making processes. Method Five service users were interviewed using a narrative interview approach to uncover their abortion journeys and experiences of conscientious objection. Findings The findings were presented as found poems and uncovered that doctors are not always: informing service users that they have a conscientious objection to abortion, giving service users enough information to access abortion (indirect referral), treating them non-judgmentally, and providing medically correct information. Service users did not experience burdens such as long waiting times and were still able to access legal abortion. However, service users did experience negative emotional effects, as they were often left feeling scared, angry, and hopeless when they were not referred and/or were mistreated. Conclusions Findings indicate that conscientious objection could work in practice. However, it is currently failing some individuals on an emotional level, as not all doctors are adhering to guidelines. Conscientious objection in Britain needs to be addressed, to ensure service users receive fair, impartial, non-judgmental care. (shrink)

Watsuji proposes a conception of the self as embodied and dynamic in constant cyclic relationship with the historical milieu. I argue that the concept of a relational individual can provide some solutions to the problem in environmental ethics of the spatial distance between an agent and the consequences of her actions. Indeed, by becoming aware of the interdependent relation between the self and the local shared milieu, one develops and recognizes feelings of care and belonging, which (...) promote more environmentally sensitive lifestyles. Furthermore, this care and awareness of interdependence can be expanded to a global level, including distant human beings and natural environments. Ethics thus emerges from the constant dynamic relation between the relational individual and the historical milieu. keywords: Watsuji Tetsurō—environmental ethics—sustainability— self—relational self— milieu— Japanese philosophy— historicity— spatial distance— Augustin Berque. (shrink)

Mobile health tools are often said to empower users by providing them with the information they need to exercise control over their health. We aim to bring clarity to this claim, and in doing so explore the relationship between empowerment and autonomy. We have identified three distinct models embedded in the empowerment rhetoric: empowerment as information, empowerment as control, and empowerment as values. Each distinct model of empowerment gives rise to an associated problem. These (...) problems, the Problem of Interpretation, the Value Alignment Problem, and the Priority Problem, show that mobile health tools in their current form are either insufficient for empowerment or are self‐defeating. These digital health technologies encourage users to adopt an individualized conception of autonomy, one that may weaken the doctor–patient relationship and undermine practices in shared decision making, and ultimately may not deliver on improving the health outcomes for those that need it the most. (shrink)

Over the last years, self-management has become a central value in the practice of mental health care. Patients are positioned as expertclients who are actively involved in the management of their disease. Some of the ideas that are implied in the concept of self-management may raise important and intriguing questions. For instance, in the context of psychiatry impaired agency and altered self-experience are often part of the psychopathological process itself. The capacity to manage oneself may (...) be impeded by the very problem that needs to be managed. Therefore, how should self-management be conceived in... (shrink)

After noting why the issue of the use of animals in medical education and research needs to be addressed, this article briefly reviews the historical positions on the role of animals in society and describes in more detail the current positions in the wide spectrum of positions regarding the role of animals in society. The spectrum ranges from the extremes of the animal exploitation position to the animal liberation position with several more moderate positions in between these two extremes. Then (...) the philosophical issue of the moral agency of animals is discussed in terms of an explication of the concept of rights and the concept of personhood. Further research is suggested concerning institutional policies regarding medical students who refuse to do physiology dog labs or other assignments which involve the suffering and/or death of animals. (shrink)