Les sages-femmes en France incarnent une subtile synthèse du cure et du care, entretenant une ambiguïté qui fonde une partie de leur identité professionnelle et qui brouille les pistes des stéréotypes de genre. En fonction du contexte social et politique qui conditionne leur mode d’exercice, ces professionnel.le.s développent spontanément des stratégies pour équilibrer les tensions qui existent entre ces deux pôles. Elles/ils vont ainsi promouvoir tantôt leurs compétences dans le care comme valeur ajoutée par rapport aux autres (...) acteurs médicaux, tantôt leur expertise médico-technique et leur autonomie de pratique, affirmant ainsi leur appartenance au monde médical et scientifique. Cet article s’inscrit dans une double approche d’analyse en sciences sociales et d’expérience professionnelle de trente années en tant que sage-femme. (shrink)

Although current literature about the “cure versus care” issue tends to promote a patient-centered approach, the disease-centered approach remains the prevailing model in practice. The perceived dichotomy between the two approaches has created a barrier that could make it difficult for medical students and physicians to integrate psychosocial aspects of patient care into the prevailing disease-based model. This article examines the influence of the formal and hidden curricula on the perception of these two approaches and finds that (...) the hidden curriculum perpetuates the notion that “cure” and “care” based approaches are dichotomous despite significant changes in formal curricula that promote a more integrated approach. The authors argue that it is detrimental for clinicians to view the two approaches as oppositional rather than complementary and attempt to give recommendations on how the influence of the hidden curriculum can be reduced to get a both-cure-and-care-approach, rather than an either-cure-or-care-approach. (shrink)

Two decades of research on euthanasia in the Netherlands have resulted into clear insights in the frequency and characteristics of euthanasia and other medical end-of-life decisions in the Netherlands. These empirical studies have contributed to the quality of the public debate, and to the regulating and public control of euthanasia and physician-assisted suicide. No slippery slope seems to have occurred. Physicians seem to adhere to the criteria for due care in the large majority of cases. Further, it has been (...) shown that the majority of physicians think that the euthanasia Act has improved their legal certainty and contributes to the carefulness of life-terminating acts. In 2005, eighty percent of the euthanasia cases were reported to the review committees. Thus, the transparency envisaged by the Act still does not extend to all cases. Unreported cases almost all involve the use of opioids, and are not considered to be euthanasia by physicians. More education and debate is needed to disentangle in these situations which acts should be regarded as euthanasia and which should not. Medical end-of-life decision-making is a crucial part of end-of-life care. It should therefore be given continuous attention in health care policy and medical training. Systematic periodic research is crucial for enhancing our understanding of end-of-life care in modern medicine, in which the pursuit of a good quality of dying is nowadays widely recognized as an important goal, in addition to the traditional goals such as curing diseases and prolonging life. (shrink)

Two cases of carcinoma of the stomach presenting during the same month and dying within four weeks of one another less than one year later are presented. One was treated symptomatically and the other received radical surgery. The care they received depended on decisions about diagnosis and treatment; the outcomes of these and the difficulties involved in evaluating monetary costs and quality of care are discussed in the light of recent interest in medical audit.

_Slow Cures and Bad Philosophers_ uses insights from the philosophy of Ludwig Wittgenstein to rethink bioethics. Although Wittgenstein produced little formal writing on ethics, this volume shows that, in fact, ethical issues permeate the entirety of his work. The scholars whom Carl Elliott has assembled in this volume pay particular attention to Wittgenstein’s concern with the thick context of moral problems, his suspicion of theory, and his belief in description as the real aim of philosophy. Their aim is not to (...) examine Wittgenstein’s personal moral convictions but rather to explore how a deep engagement with his work can illuminate some of the problems that medicine and biological science present. As Elliott explains in his introduction, Wittgenstein’s philosophy runs against the grain of most contemporary bioethics scholarship, which all too often ignores the context in which moral problems are situated and pays little attention to narrative, ethnography, and clinical case studies in rendering bioethical judgments. Such anonymous, impersonal, rule-writing directives in which health care workers are advised how to behave is what this volume intends to counteract. Instead, contributors stress the value of focusing on the concrete particulars of moral problems and write in the spirit of Wittgenstein’s belief that philosophy should be useful. Specific topics include the concept of “good dying,” the nature of clinical decision making, the treatment of neurologically damaged patients, the moral treatment of animals, and the challenges of moral particularism. Inspired by a philosopher who deplored “professional philosophy,” this work brings some startling insights and clarifications to contemporary ethical problems posed by the realities of modern medicine. _Contributors._ Larry Churchill, David DeGrazia, Cora Diamond, James Edwards, Carl Elliott, Grant Gillett, Paul Johnston, Margaret Olivia Little, James Lindemann Nelson, Knut Erik Tranoy. (shrink)

Substance addiction has been historically conceived and widely researched as a brain disease. There have been ample criticisms of brain-centred approaches to addiction, and this paper aims to align with one such criticism by applying insights from phenomenology of psychiatry. More precisely, this work will apply Merleau-Ponty’s insightful distinction between the biological and lived body. In this light, the disease model emerges as an incomplete account of substance addiction because it captures only its biological aspects. When considering addiction as a (...) brain disorder, it will be shown that research fails to account for the contextual, functional, and emotional aspects inherent to subjective health. It is concluded that, while the disease model is fundamental to our understanding of what happens in the brain, its brain-centred approach is cure-oriented. Instead, we suggest a care-orientated approach, which understands and treats the psychological feel as bodily experience situated in an environment, allowing for a more encompassing therapeutic perspective. (shrink)

Concepts. Health ; Disease ; Death -- Models and kinds. Causation and kinds ; Holism and reductionism ; Controversial diseases -- Evidence and inference. Evidence in medicine ; Objectivity and the social structure of science ; Inference ; Effectiveness, skepticism, and alternatives ; Diagnosis and screening -- Values and policy. Psychiatry: care or control? ; Policy ; Public health.

Phenomenology, Uncertainty and Care in the Therapeutic Encounter is the latest in a series of books where Mark Leffert explores the therapeutic encounter as both process and situation; looking for evidence of therapeutic effectiveness rather than accepting existing psychoanalytic concepts of theory or cure without question. Phenomenology, Uncertainty and Care in the Therapeutic Encounter contributes a new understanding of familiar material and brings a new focus to the care-giving and healing aspects of psychoanalysis and psychotherapy leading (...) to a shift in the analyst's identity from that of one who analyses to one who cares for and heals. This book will be of interest to Psychoanalysts and psychotherapists, neuroscientists and academics in the fields of psychiatry, comparative literature and literature and the mind. (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)

Summary Care and cure have been described as different kinds of ethical approaches to clinical situations. Female concerns in nursing care have been contrasted with masculine, cure orientated physician's attitudes. Ethics in such different voices may have sociologic determinants, but they do not represent intrinsic distinctions. Medicine has shown a divergent development, on the one hand stressing cure in a deterministic and instrumental way, on the other hand being aware that disease is as much a (...) pathographic as a biographic, care‐requiring existential situation. Disease is a breakdown of the living organism, to be cured by therapeutic efforts, but it is also the distressing failure of the lived body, requiring concern and care. Based on Lévinas’ ethics of encounter, it is suggested that any interpersonal relatedness is based on concern for the other, being grounded on an essentially ethical interaction. The clinical encounter is a paradigm of such ethics‐based relationships, which necessarily builds on awareness of the other qua other, and is concerned with fulfilling the therapeutic mandate. Caring for the other means doing one's best to help her/him, so that care and cure are inextricably interwoven, although care is the more fundamental form of human relatedness. Thus, neither gender nor professional tasks can allow for a caring attitude to develop without curing concerns, just as trying to cure without caring is unthinkable. (shrink)

First published in 1980, Caring and Curing is for all those involved in the 'caring professions' - medicine, social work, and the other health and welfare occupations. It is both an introduction to philosophy for the caring professions and a philosophy of those professions. The authors believe that the best way to introduce philosophy is to engage in it, to philosophize, and that the most exciting way to philosophize is to offer a reasoned but controversial point of view on matters (...) to which people are professionally committed. They argue, first, that there is an essential unity of the caring professions in that the concepts of health and welfare are different aspects of a single value judgement as to what sort of life a person should be enabled to live in his society. Secondly, they show the limits of scientific expertise in relation to human behaviour and argue that the education of medical and social workers should include broader humane disciplines to assist them in coping with the problems of ethics and values of all kinds in present-day society. Thus, the discussion introduces the main branches of philosophy and deals with many of the current moral dilemmas in medicine and social work. (shrink)

Providing a groundbreaking approach to reinventing health care, this book is a practical guide to placing patient healing back at the center of the hospital's mission. Drawing on a wealth of practical experience, the authors show health care professionals how to decrease costs and improve quality by restructuring hospital services around patients and their needs and by utilizing design and architecture to enhance the healing environment. Using the core concepts of systems theory, extensive research, and lessons from pioneering (...) hospitals, they present state-of-the-art health care practices that heal as well as cure. (shrink)

This paper applies crip theory (McRuer, 2006, 2018) as well as other key conceptual tools from disabled childhood studies (Runswick-Cole et al., 2018) and disability studies in education (Cousik & Maconochie, 2017) as a tactic intended to question and resist the story of overcoming as it manifests itself within the discourses and practices of self-regulation in early learning classrooms. This paper offers a brief overview of the range of self-regulation strategies enacted within educational settings in Ontario, Canada, that purport to (...) support young children in overcoming themselves on their way to normalcy. This paper also engages in crip theory as a strategy to both question and disrupt the taken for granted assumption that self-regulation entails a return towards or a sustaining of the efficient and productive neoliberal individual in school systems. Finally, this paper considers how we might not only invite but embrace the disruptions that occur when embodied differences refuse to be overcome by demands to self-regulate. Ultimately, a key aim of this paper is to resist how discourses and practices of self-regulation in Early Childhood Education and Care (ECEC) establish the overcoming narrative as a means to cure, fix or exclude embodied differences while contemplating the vibrant possibilities embedded within learning with and from disabled childhoods. (shrink)

Among the philosophies of special sciences, Philosophy of Medicine is an emerging field, even though the relationship between philosophy and medicine dates back to ancient times. Since the 1980s, t...

Over the past twenty years there has been a shift in medical law and practise to increasingly distrust the judgement of health professionals. An increasing number of codes of conduct, disciplinary bodies, ethics committees and bureaucratic policies now prescribe how health professional and health researchers should act and relate to their patients. The result of this, Mark Henaghan argues, has been to undermine trust and professional judgement in health professionals, while simultaneously failing to trust the patient to make decisions about (...) their care. This book will look at the issue of health professionals and trust comparatively in a number of countries including the USA, Canada, Australia, New Zealand and the UK. The book will show by historical analysis of legislation, case law, disciplinary proceedings reports, articles in medical and law journals and protocols produced by management teams in hospitals, how the shift from trust to lack of trust has happened. Drawing comparisons between situations where trust is respected such as in emergency situations, and where it is not for example routine decisions such as obtaining consent for an anaesthetic procedure, the book shows how this erosion of trust has the potential to dehumanise the special nature of the relationship between healthcare professionals and patients. The effect of this is that the practice of health care is turned into a mechanistic enterprise controlled by "management processes" rather than governed by trust and individual care and judgement. This book will be an invaluable resource for students and scholars of medical law and medical sociology, public policy-makers and a range of associated professionals, from health service managers to medical science and clinical researchers. (shrink)

Talk therapy is, by definition, difficult, if not impossible, to represent materially. Whereas other scholars have sought to do so by referencing Sigmund Freud’s drawings or the setting of his consulting room, this article looks instead to the use of cloth in Joanne Greenberg’s 1964 semiautobiographical novel I Never Promised You a Rose Garden. The two main treatments given to protagonist Deborah Blau were therapy sessions with Dr. Clara Fried, based on Frieda Fromm-Reichmann, and the “cold pack,” in which the (...) patient was restrained and wrapped in sheets drenched with ice water. The two treatments, this article argues, can be considered in parallel, and through analysis of the material descriptions of the cold pack, one can learn more about the talking cure. Namely, this article analyzes the care in both cases as one of constraint, giving material form to the metaphorical “holding environment” of psychoanalyst D. W. Winnicott. Deborah uses the cold pack to endure her psychosis and return to reality. Similarly, Winnicott describes the ideal therapeutic space as one that, by its reliability, allows regression in service of finding a new self and distinguishing between fantasy and the outside world. The aim of this article is thus twofold: one, to further elucidate the role of cloth in treating mental distress, and two, to understand more fully the therapeutic relationship via the literal and figurative constraint of treatment. (shrink)

This article gives a practice-based and theoretical overview of the transformation from a traditional hierarchical organization in the care and cure sector towards a so-called Community-driven organization providing human happiness to 6000 elderly people. The actual case study is intertwined with conceptual information for better understanding of the innovative transition which took place at Humanitas. The case description includes its initial situation, its new core values, mission and objectives and shows the sequence of emerging policies and interventions that (...) resulted in a stakeholder oriented business model for the care sector. The selected concepts are Graves'' Emerging Cyclical Level of Existence Theory (or Spiral Dynamics), Ken Wilber''s Four Quadrant Model, Roberts Simons'' Four Levers of Control and various elements from the European Corporate Sustainability Framework sponsored by the European Commission. The conclusion marks the match between theory and practice in transforming Humanitas Rotterdam into providing cure, care, housing and well-being to elderly people. (shrink)

Research on doctor-patient communication has characterized such interactions as being asymmetrical. The present article tries to shift emphasis away from the different orientations individuals bring to the communicative setting and attempts to highlight the different orientations ("voices") within a given individual. We draw on an in-depth analysis of discourse between a 2 l-year-old man who can be ascribed the roles of both patient and potential research subject and an interviewer who acts in both the role of medical staff and researcher. (...) Focusing our analysis on a limited number of linguistic forms (pronouns and demonstratives), it is argued that the use of the same form for different referents signals a conflation of two voices - the voice of health care ("caring") and the voice of "research." Furthermore, we argue that the voice of research is most likely to be interpreted by the patient/research subject within the framework of curing. As such, the present article promotes a shift in emphasis from different institutional - and as such often assumed to be preexisting - orientations between the communicating parties to differing orientations within the individual that cannot help but be misconstrued in terms of the curing voice. Our conclusion focuses on the ethical and discourse analytic implications of analyzing voices in a discussion. (shrink)

Abstract In his discourses on ‘the lily of the field and the bird of the air,’ Kierkegaard presents faith as the best possible response to our precarious and uncertain condition, and as the ideal way to cope with the insecurities and concerns that his readers will recognize as common features of human existence. Reading these discourses together, we are introduced to the portrait of a potential believer who, like the ‘divinely appointed teachers’—the lily and the bird—succeeds in leading a life (...) that is full of care, but free of worry. Such a portrait, we claim, echoes Kierkegaard’s portrait of the knight of faith in Fear and Trembling . In this essay we suggest that faith, as characterized in the ‘lily and bird’ discourses, is a kind of existential trust that would allow us to overcome worry, while remaining wholeheartedly engaged in the finite realm of our cares and concerns. We claim that Kierkegaard’s goal in these discourses is not to belittle our earthly cares, but to invite us to develop a modified attitude toward all that we are susceptible to worry about. Content Type Journal Article Category Article Pages 1-19 DOI 10.1007/s11153-011-9322-5 Authors Sharon Krishek, Department of Philosophy, The Hebrew University of Jerusalem, Jerusalem, Israel Rick Anthony Furtak, Department of Philosophy, Colorado College, Colorado Springs, CO, USA Journal International Journal for Philosophy of Religion Online ISSN 1572-8684 Print ISSN 0020-7047. (shrink)

In a new and important book entitled TheManagedCareBluesandHowtoCureThem, a lifetime consumer advocate and a surgeon who witnessed the excesses and unaccountable errors of his colleagues under fee for service explain with deft hands the promise of managed care, its problems, and solutions to them. Walter Zelman and Robert Berenson show empathy for the consumer backlash, provider resentment, and the patients' rights movement that has spawned a thousand bills to prevent possibly unethical actions. Yet they believe these efforts to regulate (...) managed care are misdirected and will prevent it from realizing its potential. (shrink)

This article gives a practice-based and theoretical overview of the transformation from a traditional hierarchical organization in the care and cure sector towards a so-called Community-driven organization providing human happiness to 6000 elderly people. The actual case study is intertwined with conceptual information for better understanding of the innovative transition which took place at Humanitas. The case description includes its initial situation, its new core values, mission and objectives and shows the sequence of emerging policies and interventions that (...) resulted in a stakeholder oriented business model for the care sector. The selected concepts are Graves' Emerging Cyclical Level of Existence Theory (or Spiral Dynamics), Ken Wilber's Four Quadrant Model, Roberts Simons' Four Levers of Control and various elements from the European Corporate Sustainability Framework sponsored by the European Commission. The conclusion marks the match between theory and practice in transforming Humanitas Rotterdam into providing cure, care, housing and well-being to elderly people. (shrink)

BackgroundHIV cure research involving cell and gene therapy has intensified in recent years. There is a growing need to identify ethical standards and safeguards to ensure cell and gene therapy (CGT) HIV cure research remains valued and acceptable to as many stakeholders as possible as it advances on a global scale.MethodsTo elicit preliminary ethical and practical considerations to guide CGT HIV cure research, we implemented a qualitative, in-depth interview study with three key stakeholder groups in the United (...) States: (1) biomedical HIV cure researchers, (2) bioethicists, and (3) community stakeholders. Interviews permitted evaluation of informants’ perspectives on how CGT HIV cure research should ethically occur, and were transcribed verbatim. We applied conventional content analysis focused on inductive reasoning to analyze the rich qualitative data and derive key ethical and practical considerations related to CGT towards an HIV cure.ResultsWe interviewed 13 biomedical researchers, 5 community members, and 1 bioethicist. Informants generated considerations related to: perceived benefits of CGT towards an HIV cure, perceived risks, considerations necessary to ensure an acceptable benefit/risk balance, CGT strategies considered unacceptable, additional ethical considerations, and considerations for first-in-human CGT HIV cure trials. Informants also proposed important safeguards to developing CGT approaches towards an HIV cure, such as the importance of mitigating off-target effects, mitigating risks associated with long-term duration of CGT interventions, and mitigating risks of immune overreactions.ConclusionOur study identified preliminary considerations for CGT-based HIV cure across three key stakeholder groups. Respondents identified an ideal cure strategy as one which would durably control HIV infection, protect the individual from re-acquisition, and eliminate transmission to others. Known and unknown risks should be anticipated and perceived as learning opportunities to preserve and honor the altruism of participants. Preclinical studies should support these considerations and be transparently reviewed by regulatory experts and peers prior to first-in-human studies. To protect the public trust in CGT HIV cure research, ethical and practical considerations should be periodically revisited and updated as the science continues to evolve. Additional ethics studies are required to expand stakeholder participation to include traditionally marginalized groups and clinical care providers. (shrink)

The article is a critical discussion of "contractualism" in moral and political philosophy as developed by john rawls and applied by w. G. Runciman. It attempts to clarify the sense in which contractualism is a moral theory and to assess its powers as a normative account of moral criticism. It argues that the structure of contractualism suggests an attractive way of formulating rival moral theories but not a way of arguing for any moral theory, That this reduces the force of (...) a contractualist critique of utilitarianism, And that contractualism is incomplete as a normative account of moral criticism. (shrink)

A motivation problem may arise when morally principled public policy calls for serious sacrifice, relative to ways of life and levels of well-being, on the part of the members of a free society. Apart from legal or other forms of “external” coercion, what will, could, or should move people to make the sacrifices required by morality? I explore the motivation problem in the context of morally principled public policy concerning our legacy for future generations. In this context the problem raises (...) special moral-psychological difficulties. My inquiry suggests pessimism regarding our ability to solve the motivation problem relative to what morality requires on behalf of future generations. (shrink)

The aim of this paper is to present and discuss nurses’ and physicians’ comments in a questionnaire relating to patients’ transition from curative treatment to palliative care. The four-page questionnaire relating to experiences of and attitudes towards communication, decision-making, documentation and responsibility of nurses and physicians and towards the competence of patients was developed and sent to a random sample of 1672 nurses and physicians of 10 specialties. The response rate was 52% , and over one-third made comments. The (...) respondents differed in their comments about three areas: the concept of palliative care, experiences of unclear decision-making and difficulties in acceptance of the patient’s situation. The responses are analysed in terms of four ethical theories: virtue ethics, deontology, consequentialism and casuistry. Many virtues considered to be appropriate for healthcare personnel to possess were invoked. Compassion, honesty, justice and prudence are especially important. However, principles of medical ethics, such as the deontological principle of respect for self-determination and the consequence of avoidance of harm, are also implied. Casuistry may be particularly helpful in analysing certain areas of difficulty—namely, what is meant by “palliative care”, decision-making and accepting the patient’s situation. Keeping a patient in a state of uncertainty often causes more suffering than necessary. Communication among the staff and with patients must be explicit. Many of the staff have not had adequate training in communicating with patients who are at the end of their life. Time for joint reflection has to be regained, and training in decision-making is essential. In our opinion, palliative care in Sweden is in need of improvement. (shrink)

Two of the most important concepts in medicine are “curing” and “caring”. Patients should enter clinical trials with the understanding that they benefit from the treatment or that there may be some benefit to others. In many cancer trials, for example, the best that can be hoped for is a prolongation of life. Whether or not life is prolonged, we argue that there exists an obligation which can be termed a “bond of responsibility” to provide appropriate palliative care within (...) the patient’s own cultural context.The Declaration of Helsinki,1 the principal code governing the conduct of medical research, shows this “bond of responsibility” to be at its core. A number of statements stand out: “the health of my patient will be my first consideration”2 and “a physician shall only act in a patient’s best interest when providing medical care which might have the effect of weakening the physical and mental …. (shrink)

A motivation problem may arise when morally principled public policy calls for serious sacrifice, relative to ways of life and levels of well-being, on the part of the meInbers of a free society. Apart from legal or other forms of “external” coercion, what will, could, or should move people to make the sacrifices required by morality? I explore the motivation problem in the context of morally principled public policyconcerning our legacy for future generations. In this context the problem raises special (...) moral-psychological difficulties. My inquiry suggests pessimism regarding our ability to solve the motivation problem relative to what morality requires on behalf of future generations. (shrink)

In Decent People, Norman Care explores how we may understand and be reconciled to the fragility of our moral nature. In his highly original vision of what it means to be a decent person, Care claims that our moral-emotional nature pressures us to seek relief from moralized pain - pain that comes from our awareness of our own wrongdoing, the suffering of current or future people, and our experience of indifference to moral imperatives. Care argues that decent (...) people are neither 'pure' nor self-righteous and that they are vulnerable to the need for forgiveness. Decent people may take morality seriously, but they are not guaranteed success at its challenges. (shrink)