In this paper I briefly summarize Pellegrino’s phenomenological analysis of the ethics of the physician–patient relationship. In delineating the essential elements of the healing relationship, Pellegrino demonstrates the necessity for health care professionals to understand the patient’s lived experience of illness. In considering the phenomenon of illness, I identify certain essential characteristics of illness-as-lived that provide a basis for developing a rigorous understanding of the patient’s experience. I note recent developments in the systematic delivery of health care that make it (...) difficult for health care professionals to realize Pellegrino’s ethical model of the role of healer. Such developments limit both the physician’s freedom to act on behalf of the patient without the constraint of third parties and the physician’s freedom to act in light of his or her own ethical or religious convictions. Given these difficulties, I note MacIntyre’s call for the development of moral communities, as an alternative to the prevailing culture, and share a first-hand example illustrating how intentional Christian community provides an alternative nurturing context that permits the full development of the healing relationship. (shrink)

Yet, the central conviction that informs this volume is that phenomenology provides extraordinary insights into many of the issues that are directly addressed ...

This essay argues that philosophical phenomenology can provide important insights into the patient-physician relationship. In particular, it is noted that the physician and patient encounter the experience of illness from within the context of different "worlds", each "world" providing a horizon of meaning. Such phenomenological notions as focusing, habits of mind, finite provinces of meaning, and relevance are shown to be central to the way these "worlds" are constituted. An eidetic interpretation of illness is proposed. Such an interpretation discloses certain (...) essential characteristics that pertain to the experience of illness, per se , regardless of its manifestation in terms of a particular disease state. It is suggested that, if a shared world of meaning is to be constituted between physician and patient, the eidetic characteristics of illness must be recognized by the physician. Keywords: phenomenology, patient-physician relationship, illness-as-lived, habits of mind, relevance, eidetic CiteULike Connotea Del.icio.us What's this? (shrink)

In this paper I reflect upon my personal experience of chronic progressive multiple sclerosis in order to provide a phenomenological account of the human experience of disability. In particular, I argue that the phenomenological notion of lived body provides important insights into the profound disruptions of space and time that are an integral element of changed physical capacities such as loss of mobility. In addition, phenomenology discloses the emotional dimension of physical disorder. The lived body disruption engendered by loss of (...) mobility includes a change in the character of surrounding space, an alteration in one's taken-for-granted awareness of objects, the disruption of corporeal identity, a disturbance in one's relations with others, and a change in the character of temporal experience. The loss of upright posture is of particular significance since it not only concretely diminishes autonomy but affects the way one is treated by others. Such a change in posture is, therefore, particularly disruptive in the social world of everyday life. An understanding of the lived body disruption engendered by disability has important applications for the clinical context in devising effective therapies, as well as for the social arena in determining how best to resolve the various challenges posed by chronic disabling disorders. (shrink)

This paper suggests that the paradigm of lived body (as it is developed in the works of Merleau-Ponty, Sartre and Zaner) provides important insights into the experience of illness. In particular it is noted that, as embodied persons, we experience illness primarily as a disruption of lived body rather than as a dysfunction of biological body. An account is given of the manner in which such fundamental features of embodiment as bodily intentionality, primary meaning, contextural organization, body image, gestural display, (...) lived spatiality and temporality, are disrupted in illness causing a concurrent disorganization of the patient's self and world. The paradigm of lived body has important applications for medical practice. It provides a fuller account of illness than does the prevailing reductionist Cartesian paradigm of body, more directly addresses the existential predicament of illness, and orients the clinical focus around the personhood of the patient. (shrink)

This essay argues that, while much has been gained by medicine's focus on the spatial aspects of disease in light of developments in modern pathology, too little attention has been given to the temporal experience of illness at the subjective level of the patient. In particular, it is noted that there is a radical distinction between subjective and objective time. Whereas the patient experiences his immediate illness in terms of the ongoing flux of subjective time, the physician conceptualizes the illness (...) as a disease state according to the measurements of objective time. A greater understanding of this disparity in temporal experiencing provides insights into the lived experience of illness and can preclude difficulties in communication between physician and patient. (shrink)

Book reviewed in this article: The Meaning of Illness. By S. Kay Toombs.

In this essay I discuss Edith Stein's analysis of empathy and note its application in the field of clinical medicine. In identifying empathy as the basic mode of cognition in which one grasps the experiences of others, Stein notes, 'I grasp the Other as a living body and not merely as a physical body'. The living body is given in terms of five distinctive characteristics - characteristics that disclose important facets of the illness experience. Empathy plays an important role in (...) clinical practice in aiding physicians to grasp the content of first-person reports of bodily disorder, and to comprehend the meaning of illness-as-lived. I suggest that an important task for medical education should be that of developing students' capacity for empathic understanding and I note several ways in which this task might be accomplished. (shrink)

Book reviewed in this article: The Meaning of Illness. By S. Kay Toombs.

In this paper, I argue that clinically-oriented practical and theoretical approaches to the problem of pain should more carefully heed narrative and phenomenological research. I begin with the work of S. Kay Toombs, contending that her phenomenological account of multiple sclerosis demonstrates how a degenerative condition attendant with pain ultimately effect a constriction of one’s world. Drawing upon two of artist Yosl Bergner’s depictions of the story, I then present a reading of Kafka’s “The Vulture” as a literary account (...) of the constrictive movement of acute, localized pain to chronic, systemic pain. I conclude by discussing the implications of literary and phenomenological accounts of pain for its diagnosis, management, and treatment. (shrink)

It is my purpose in this thesis to explore the "reality" of illness, using philosophical phenomenology as a guide. In particular, I am concerned to show that the experience of illness, rather than representing a shared "reality" between physician and patient, represents in effect two quite distinct "realities". Philosophical phenomenology focuses on the nature of experience, and particularly upon the manner in which all experience is structured by the activity of consciousness. In so doing phenomenology emphasizes the unique nature of (...) experiencing and particularly the correlation between the perceiver and that which is perceived. Meaning is seen to be a function of the activity of individual consciousness. In the first chapter consideration is given to some basic concepts which are fundamental for phenomenology and a distinction is made between "own world" and "common world." In the second chapter these concepts are shown to provide insights into the nature of the discrepancy between the physician's and the patient's understanding of illness. Consideration is given to the manner in which the separate worlds of the physician and patient are constituted. It is argued that it is through attentional focusing that the sense of illness is made explicit for the individual. An analysis is provided of the manner in which such attentional focusing is determined. In the third chapter consideration is given to the question of how it is possible to construct a shared world of meaning between patient and physician, given the unique nature of experiencing. An eidetic interpretation of illness is proposed and attention is directed towards some ways in which we do, in fact, come to some understanding of the Other. In the final chapter it is suggested that the notion of healing presupposes a shared world between physician and patient. A distinction is made between healing and curing disease. It is noted that the manner in which the "reality" of illness is defined directly influences the way in which the end of the patient/physician relationship is defined. It is argued that the end of the patient/ physician relationship is healing and that healing is a mutual act which is accomplished within the context of a shared world between physician and patient. (shrink)

Drawing upon the life and work of S. Kay Toombs, I explore the impact and import of phenomenological accounts of disability for the existentialist tradition. Through the case of multiple sclerosis, a noncongenital, late-onset, and degenerative disability, I show how the general structures that emerge from its lived experience largely support a mere-difference view of disability and highlight the need for an equitably habitable world. I further argue that phenomenological accounts of disability demonstrate accessibility to be the defining feature (...) of what it means to be embodied as we are. I conclude with a discussion of the more general philosophical relationship between disability, embodiment, and existentialism. (shrink)

In order to gain greater insight into the nature of corporate social responsibility (CSR) during a time of crisis, the study examines the commitment of firms to continue to engage in CSR activity despite financial pressures to divert their slack resources elsewhere. The setting of the study is CSR activity during the perhaps unprecedented global crisis associated with the COVID-19 pandemic. Based on a qualitative research method approach, both a variety of media sources and the relevant academic literature are reviewed (...) in order to identify examples of CSR activity related specifically to COVID-19. The examples are then categorized and situated according to Professor Archie Carroll’s well-known CSR Pyramid framework describing the economic, legal, ethical, and philanthropic domains of CSR. As such, this study is the first to extend the rich literature stream utilizing Carroll’s CSR Pyramid within the unique context of a global pandemic. (shrink)

In Feminist Phenomenology and Medicine, the editors have assembled a collection of papers on important topics that should be addressed in the modern phenomenology of medicine - topics which do not exclusively focus on illness, disability, bodily deterioration or pathologies, as seen for instance in prior work of the philosophers S Kay Toombs, Frederik Svenaeus, and Havi Carel. The contributors met at a congress on feminist phenomenology and medicine in Sweden in 2011, and come from a variety of relevant (...) disciplines including bioethics, philosophy of medicine, feminism and gender studies. All contributors are well-known, major players within their particular fields.Although it seems obvious that new developments in medicine, such as organ transplantation and plastic surgery, will push the boundaries of normality within the medical discourse, this volume is the first of its kind to offer a collection of essays exploring a variety of medical conditions that are situated within the gray zo .. (shrink)

A large slice of contemporary phenomenology of medicine has been devoted to developing an account of health and illness that proceeds from the first-person perspective when attempting to understand the ill person in contrast and connection to the third-person perspective on his/her diseased body. A proof that this phenomenological account of health and illness, represented by philosophers, such as Drew Leder, Kay Toombs, Havi Carel, Hans-Georg Gadamer, Kevin Aho, and Fredrik Svenaeus, is becoming increasingly influential in philosophy of medicine (...) and medical ethics is the criticism of it that has been voiced in some recent studies. In this article, two such critical contributions, proceeding from radically different premises and backgrounds, are discussed: Jonathan Sholl’s naturalistic critique and Talia Welsh’s Nietzschean critique. The aim is to defend the phenomenological account and clear up misunderstandings about what it amounts to and what we should be able to expect from it. (shrink)

This study examined the ethical issues experienced by nurses working in a small group of elderly persons’ care settings in the UK, using a survey questionnaire previously used in other countries for examining the cultural aspects of ethical issues. However ‘culture’ relates not only to ethnicity but also the organizational culture in which care is delivered. Nurses working in elderly persons’ care settings described a range of issues faced when caring for elderly terminally ill people, which illustrated the different needs (...) of patients, relatives, professionals and society. These issues related to the unique needs of elderly people (such as dementia sufferers) and could have an impact on patients’ quality of death. (shrink)

We provide an introduction to network theory, evidence to support a connection between molecular network structure and neuropsychiatric disease, and examples of how network approaches can expand our knowledge of the molecular bases of these diseases. Without systematic methods to derive their biological meanings and inter‐relatedness, the many molecular changes associated with neuropsychiatric disease, including genetic variants, gene expression changes, and protein differences, present an impenetrably complex set of findings. Network approaches can potentially help integrate and reconcile these findings, as (...) well as provide new insights into the molecular architecture of neuropsychiatric diseases. Network approaches to neuropsychiatric disease are still in their infancy, and we discuss what might be done to improve their prospects. (shrink)

We provide a suitable theoretical foundation for the notion of the quantum coherent state which describes the electrostatic field due to a static external macroscopic charge distribution introduced by the author in 1998 and use it to rederive the formulae obtained in 1998 for the inner product of a pair of such states. (We also correct an incorrect factor of 4π\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$4\pi$$\end{document} in some of those formulae.) Contrary to what one might expect, (...) this inner product is usually non-zero whenever the total charges of the two charge distributions are equal, even if the charge distributions themselves are different. We actually display two different frameworks that lead to the same inner-product formulae, in the second of which Gauss’s law only holds in expectation value. We propose an experiment capable of ruling out the latter framework. We then address the problem of finding a product picture for QED—i.e. a reformulation in which it has a total Hamiltonian, arising as a sum of a free electromagnetic Hamiltonian, a free charged-matter Hamiltonian and an interaction term, acting on a Hilbert space which is a subspace (the physical subspace) of the full tensor product of a charged-matter Hilbert space and an electromagnetic-field Hilbert space. (The traditional Coulomb gauge formulation of QED isn’t a product picture in this sense because, in it, the longitudinal part of the electric field is a function of the charged matter operators.) Motivated by the first framework for our coherent-state construction, we find such a product picture and exhibit its equivalence with Coulomb gauge QED both for a charged Dirac field and also for a system of non-relativistic charged balls. For each of these systems, in all states in the physical subspace (including the vacuum in the case of the Dirac field) the charged matter is entangled with longitudinal photons and Gauss’s law holds as an operator equation; albeit the electric field operator (and therefore also the full Hamiltonian) while self-adjoint on the physical subspace, fails to be self-adjoint on the full tensor-product Hilbert space. The inner products of our electrostatic coherent states and the product picture for QED are relevant as analogues to quantities that play a rôle in the author’s matter-gravity entanglement hypothesis. Also, the product picture provides a temporal gauge quantization of QED which appears to be free from the difficulties which plagued previous approaches to temporal-gauge quantization. (shrink)

I outline some of my work and results on my matter-gravity entanglement hypothesis, according to which the entropy of a closed quantum gravitational system is equal to the system’s matter-gravity entanglement entropy. The main arguments presented are: that this hypothesis is capable of resolving what I call the second-law puzzle, i.e. the puzzle as to how the entropy increase of a closed system can be reconciled with the asssumption of unitary time-evolution; that the black hole information loss puzzle may be (...) regarded as a special case of this second law puzzle and that therefore the same resolution applies to it; that the black hole thermal atmosphere puzzle can be resolved by adopting a radically different-from-usual description of quantum black hole equilibrium states, according to which they are total pure states, entangled between matter and gravity in such a way that the partial states of matter and gravity are each approximately thermal equilibrium states ; that the Susskind–Horowitz–Polchinski string-theoretic understanding of black hole entropy as the logarithm of the degeneracy of a long string cannot be quite correct but should be replaced by a modified understanding according to which it is the entanglement entropy between a long string and its stringy atmosphere, when in a total pure equilibrium state in a suitable box, which ) goes over, at strong-coupling, to a black hole in equilibrium with its thermal atmosphere. The modified understanding in is based on a general result, which I also describe, which concerns the likely state of a quantum system when it is weakly coupled to an energy-bath and the total state is a random pure state with a given energy. This result generalizes Goldstein et al.’s ‘canonical typicality’ result to systems which are not necessarily small. (shrink)