I would first like to congratulate Dr Seale for producing a thought-provoking piece of research that has captured the imagination of the nation's media. 1 I would also like to point out an interesting discordance that I have noted with regard to the findings of this important research, which ought to stimulate further discussion. Although religious doctors were significantly less likely than their non-religious colleagues to provide continuous or deep sedation until death or to provide treatment with at least ….

Medicine, as Byron Good argues, reconstitutes thehuman body of our daily experience as a medical body,unfamiliar outside medicine. This reconstitution can be seen intwo ways: as a salutary reminder of the extent to which thereality even of the human body is constructed; and as anarena for what Stephen Toulmin distinguishes as theintersection of natural science and history, in which many ofphilosophy''s traditional questionsare given concrete and urgent form.This paper begins by examining a number of dualities between (...) themedical body and the body familiar in daily experience. Toulmin''s epistemological analysis of clinical medicine ascombining both universal and existential knowledge is thenconsidered. Their expression, in terms of attention,respectively, to natural science and to personal history, isexplored through the epistemological contrasts between themedical body and the familiar body, noting the traditionalphilosophical questions which they in turn illustrate. (shrink)

The growing abundance of medical technologies has led to laments over doctors’ sensory de-skilling, technologies viewed as replacing diagnosis based on sensory acumen. The technique of percussion has become emblematic of the kinds of skills considered lost. While disappearing from wards, percussion is still taught in medical schools. By ethnographically following how percussion is taught to and learned by students, this article considers the kinds of bodies configured through this multisensory practice. I suggest that three kinds of bodies (...) arise: skilled bodies; affected bodies; and resonating bodies. As these bodies are crafted, I argue that boundaries between bodies of novices and bodies they learn from blur. Attending to an overlooked dimension of bodily configurations in medicine, self-perception, I show that learning percussion functions not only to perpetuate diagnostic craft skills but also as a way of knowing of, and through, the resource always at hand; one’s own living breathing body. (shrink)

Interventions are medically necessary when they are vital in achieving the goal of medicine. However, with varying perspectives comes varying views on what interventions are (un)necessary and, thus, what potential treatment options are available for those suffering from the myriad of conditions, pathologies and disorders afflicting humanity. Medical necessity's teleological nature is perhaps best illustrated in cases where there is debate over using contentious medical interventions as a last resort. For example, whether it is appropriate for those suffering (...) from body integrity dysphoria to receive healthy limb amputations. This paper explores how one's perception of medicine's goal underpins whether interventions are necessary or unnecessary, using the controversial topic of therapeutic amputation as an example. By contrasting ‘classical’ amputations with their more contentious counterparts, it highlights how the idea of medical necessity influences and restrains clinical decision-making. The paper starts by giving an account of body integrity dysphoria, focusing on the debate concerning elective amputation's justifiability. It then introduces Georges Canguilhem's vitalist theory of health, paying particular attention to his emphasis on adaptability. Then, this paper uses his theory as a lens through which to evaluate the appropriateness of therapeutic amputation as a medically necessary procedure. Ultimately, the paper highlights how the label of medical necessity is withheld from potential therapeutic interventions because they fail to conform to pre-established ideas of medicine's purpose and that by doing so, potential harm befalls those who are left with no effective treatments and must look for solutions in the non-clinical world. (shrink)

This is the first volume to systematically explore the range of contemporary thought concerning the body and draw out its crucial implications for medicine.

With an increasing number of individuals living with chronic illness and pain, integrative approaches offering self-management support are needed. This book proposes a multi-layered framework integrating the body/self/environment that cultivates wholeness as an authentic embodied presence in alignment with a reflexive self.

These essays examine the ways in which the consideration of ethical questions is shaped by the structures of knowledge and communication at work in clinical ...

Nathaniel Hawthorne’s The Birthmark offers a sharp lens through which to examine power, purity, and personal identity. Scientist and spiritual idealist, Aylmer, is obsessed with “correcting” the only flaw he perceives in his wife Georgina, the imprint of a small red hand on her pale cheek. For Alymer, this one “imperfection” reaches deep into Georgina’s heart, a sign of sin, decay, and mortality. It is the natural that must be overcome with science. Drawing on Hawthorne’s tragic fiction, this paper questions (...) the influence of stigma, power dynamics, and mind-body dualism in constructing disability identity within the framework of medical and spiritual practices of care. Whether in the role of a spiritual leader, chaplain, or medical professional, people providing care must first address ableism and perceptions of normalcy in relation to their own identity and calling before offering professional advice to disabled people seeking guidance or support. It is only as professional fields adopt a posture marked by courageous humility that healing practices will promote the flourishing of all people, including those with disabilities. (shrink)

In this paper we analyse some misleading theses concerning the oldcontroversy over the relation between mind and body presented incontemporary medical literature. We undertake an epistemologicalclarification of the axiomatic structure of medical methods. Thisclarification, in turn, requires a precise philosophical explanation ofthe presupposed concepts. This analysis will establish two results: (1)that the mind-body dualism cannot be understood as a kind of biologicalvariation of the subject-object dichotomy in physics, and (2) that thethesis of the incompatibility between somatic (...) and psychosomatic medicineheld by naturalists and others lacks solid epistemologicalfoundation. (shrink)

This article analyses the depiction of mental and physical pain in Sophoclean tragedy, showing how Sophocles uses medical imagery to explore fundamental problems in the personality and behaviour of his protagonists. It argues that the concentration of medical language at certain moments in particular plays not only makes the scenes more graphic and credible, but also articulates the causes and consequences of the characters’ predicament. Particular attention is given to Ajax’s delusions and maddening shame, Heracles’ agony and Deianeira’s (...) mistake, and Philoctetes’ intransigence and resentment. Sophocles’ sustained and detailed engagement with medical language and thought reveals him to be (no less than Aeschylus or Euripides) deeply interested in the wider intellectual and scientific issues of his time. (shrink)

Medical imaging has provided insight into the living body that were not possible beforehand. With these methods a revolution in medical diagnosis and biomedical research has begun. Problematic aspects on the other hand are arising from the highly constructive properties of image production, which use complicated physical and physiological effects. Images are established via highly complicated combinations of technology and contingently chosen mathematical and algorithmic solutions. In addition, image construction follows properties of the human visual and cognitive (...) system to allow for the discrimination of the desired categories. It is no wonder that the visualizations referring to the body also show effects which have no physiological correlation within the body. Still such images are often used as if they were one-to-one correlates of the body. This has impacts, e.g. for their use as standardizing instances, resulting in new definitions of the normed healthy body, sickness or pathologies, maleness and femaleness and in determinisms as opposed to the brain's plasticity and variability, both in time and space, inter- as well as intra-individually. (shrink)

The state currently grants the medical profession a monopolistic entitlement on the legal use of medical technology. As physicians are duty bound to not expose people to medically unnecessary harm, individuals who wish to engage in Body Modification Practices are effectively precluded from doing so as only physicians are legally entitled to use medical technology. In this article, I argue this is incompatible with respect for persons. Abolishing the medical monopoly allows us to meet the (...) demands of respect for persons by granting access to technology, whilst still upholding physicians’ right to refuse to provide requested services and thereby determine the boundaries of their profession according to what they consider to be the internal morality of medicine. (shrink)

Medical tourism describes a new pattern of movement of people for medical care, particularly from wealthier to poorer countries. Using the example of Thailand, where annually a million non-Thai patients seek medical treatment, this article provides a critical analysis of the political economic contexts for this medical migration. Drawing on urban geography and heterodox economics, the article considers medical tourism as an interaction of bodily, national, and global scales shaped by processes of globalization. This approach (...) provides a thick context for the transnational care of bodies while proposing that the bodily scale also has a role in reformulating the scale of the nation. (shrink)

In this paper we address the objectivist logic of bipolar gender attribution, the entitlement of ideal masculine virtues, and the repression of so-called non-male characteristics in persons who live with chronic disabling conditions. More specifically, we show how the living experience of chronic disability continues to be co-opted by patriarchal strategies designed to keep particular bodies both invisible and silent.

In lieu of an abstract, here is a brief excerpt of the content:Religion and the Body in Medical ResearchCourtney S. Campbell (bio)AbstractReligious discussion of human organs and tissues has concentrated largely on donation for therapeutic purposes. The retrieval and use of human tissue samples in diagnostic, research, and education contexts have, by contrast, received very little direct theological attention. Initially undertaken at the behest of the National Bioethics Advisory Commission, this essay seeks to explore the theological and religious (...) questions embedded in nontherapeutic use of human tissue. It finds that the “donation paradigm” typically invoked in religious discourse to justify uses of the body for therapeutic reasons is inadequate in the context of nontherapeutic research, while the “resource paradigm” implicit in scientific discourse presumes a reductionist account of the body that runs contrary to important religious values about embodiment. The essay proposes a “contribution paradigm” that provides a religious perspective within which research on human tissue can be both justified and limited.The retrieval and use of human tissue samples for diagnostic, therapeutic, research, and educational purposes represent further developments in scientific study of the human body as a source of medical information. Following the completion of its examination of the ethical and policy issues pertaining to human cloning in the spring of 1997, the National Bioethics Advisory Commission (NBAC) returned to the set of questions for which it had been originally constituted, including ethical issues that arise in human subjects research. One issue that proved controversial for the human genetics subcommittee of NBAC was the scientific, philosophical, and legal status of tissue and other body parts (usually surgical specimens) that had been retrieved from patients (not research subjects) who had given general consent to the use of their body materials for research and educational purposes. The subcommittee addressed questions about the adequacy of general versus specific [End Page 275] consent, the scientific merits of identifiable versus anonymous samples and claims about patient confidentiality, and the justification for patient refusals and requests that the materials be returned to the patient or discarded rather than made available for scientific research. In an effort to better understand the ramifications of research on human tissue, the subcommittee commissioned several background papers that examined these questions from ethical, legal, research, and religious perspectives. What follows is a modified version of the report on religious considerations originally presented to the genetics subcommittee of NBAC.The central question examined in this article is whether tissue banking for purposes of research presents distinctive theological issues or prompts objections from religious communities or scholars. Religious discussion of human organs and tissues has focused largely on donation for therapeutic purposes (what I describe as the “donation paradigm”); hence, there is very little direct consideration of nontherapeutic uses of such tissue. It is possible, however, to describe implications and suggest inferences by considering (1) religious attitudes to the human body and to organs, tissues, and cells removed from the body, and (2) religious discussions of modes of transfer of body parts, such as donations, offerings, sales, and abandonment. By and large, this discussion will reflect themes that emerge from the central Western religious traditions, with some attention given to Eastern and Native perspectives.The Body: Religious Holism, Scientific Reductionism, Private PropertyThe human body as an organic totality has long been the subject of theological reflection and a symbol for religious communities. However, much less attention has been devoted to the religious status of organs, tissues, cells, and DNA. The reflection of religious scholars and communities on the status of body parts has been prompted by the necessity to confront practical questions in personal and public health and in communal life, such as justifications for surgery, autopsies, organ donation, or burial. Scientific and research interest in parts of the body can sometimes conflict with religious values about bodily integrity. Indeed, E. Richard Gold cites the “disparate claims of scientific investigation and religious belief on the body” as the exemplary case of incommensurate values regarding the body. According to Gold (1996, p. 149), “The body, from a scientific viewpoint, is a source of knowledge of physical development, aging, and disease. From a religious perspective, the body is understood [End Page 276] as a sacred object, being created in the image... (shrink)

This paper examines the introduction of European anatomy to Japan via translated medical texts in the eighteenth century. It argues how detailed illustrations of the body found in the texts presented a new discourse by which to objectify and control the body, and new metaphors and analogies by which to view society. Inspection of bodily parts through dissection and the reading of anatomical texts marked a transition to Western forms of science, to ‘reliable’ knowledge which was certified (...) by the social status of the author. By looking at one important text, the Kaitai shinsho [A New Book of Anatomy] , it will be shown that changes in representations of the body reflect the social construction of gender. (shrink)

Other than the historical writings, the edition of which has yet to begin, Series VIII of the Academy Edition of Leibniz’s writings, presenting his “natural-scientific, medical, and technical” contributions, has been, since the project began in 1923, consistently deemed to be of low priority, and it is only very recently that the project has got fully underway. Coming, as it does, nearer to the end of the edition of the complete works, Series VIII has the advantage of accumulating some (...) of the ‘run-off’ of the philosophical writings, that is, texts of philosophical import that for whatever reason were not initially deemed sufficiently philosophical to be included in Series II or VI. Currently in preparation are the writings on chemistry, hydrology, and other natural sciences. The medical and ‘biological’ manuscripts, identified as ‘LH III’, will be edited likely some years from now.2 On our reading of these manuscripts, all or most are of at least some interest to the scholar of Leibniz’s philosophy. (shrink)

The ever increasing ability of medical technology to reshape the human body in fundamental ways—from organ and tissue transplants to reconstructive surgery and prosthetics—is something now largely taken for granted. But for a philosopher, such interventions raise fundamental and fascinating questions about our sense of individual identity and its relationship to the physical body. Drawing on and engaging with philosophers from across the centuries, Jenny Slatman here develops a novel argument: that our own body always entails (...) a strange dimension, a strangeness that enables us to incorporate radical physical changes. (shrink)

A company called Biojewellery has proposed to take a sample of bone tissue from a couple and to grow this sample into wedding rings. One of the ethical problems that such a proposal faces is that it implies surgery without medical need. To this end, only couples with a prior need for surgery are being considered. This paper examines the question of whether such a stipulation is necessary. It is suggested that, though medical need and the provision of (...) health and wellbeing is overwhelmingly the warrant for surgical intervention, there is no reason in principle why other, non-medical, projects such as jewellery creation might not also warrant surgical intervention. Implicitly, this line of thought forces us to consider the proper place of surgical intervention—that is, to ask what surgeons are for. (shrink)

In this article, I argue that the medical conceptualization of gender identity in the United States has entered a “new regime of truth.” Drawing from a mixed-methods analysis of medical journals, I illuminate a shift in the locus of gender identity from external genitalia and pathologization of families to genes and brain structure and individualized self-conception. The sexed body itself has also undergone a transformation: Sex no longer resides solely in genitalia but has traveled to more visible (...) parts of the body, implicating racialized aesthetic ideals in its new formulation. The re-imagining of gender identity as genetically and neurologically inscribed and the expanding locus of sex correspond to an inversion of the relationship between gender identity and the sexed body as well as shifts in medical jurisdiction. Whereas psychiatrists in the 1960s, ’70s, and ’80s understood gender as stemming from genital sex, the less popular idea that gender identity precedes the sexed body has gained traction in recent decades. If gender identity once derived from the sexed body, the sexed body must now be brought into alignment with gender identity. The increasing legitimacy of self-defined gender identity, the expanding definition of racialized sex, and the inversion of the sex–gender identity relationship elevates the role of surgeons in producing racialized and sexed bodies. (shrink)

The concept of a digital twin comes from engineering.1 It refers to a digital model of an artefact in the real world, which takes data about the artefact itself, data about other such artefacts, among other things, as inputs. The idea is that the maintenance of artefacts—such as jet engines—can be vastly improved if we work with digital twins that simulate actual objects. Similarly, personalised medicine might benefit from the digital modelling of body parts or even whole human bodies. (...) A medical digital twin could use data about the patient, more general population data, and other inputs to generate predictions about the patient. This could lead to highly personalised interventions and nuanced judgments about the patient’s health. Matthias Braun2 discusses this intriguing prospect, asking how we should think about the way in which a digital twin could represent a patient. I will respond to Braun’s striking suggestion that we can regard a digital twin as an extension of the patient’s body. Notably, Braun does not compare his just-mentioned idea with the extended mind thesis popularised by Andy Clark and David Chalmers.3 But I am sure many readers will be reminded of the extended mind thesis. Accordingly, I will consider this comparison. I cannot discuss this comparison in detail, nor fully evaluate Braun’s suggestion. But I can say something about how we might approach this comparison, and provide some …. (shrink)

In common law, the traditional rule has been that there is no property in excised human tissue. In an era of widespread commodification of tissue, however, the practical reasons behind this position are increasingly outdated, while the philosophical grounds are paradoxical. This no-property rule has been construed so as to deprive tissue providers of ongoing rights, whereas researchers, universities, and biotechnology companies are prone to assume that once they acquire proprietary rights, those rights are complete and undifferentiated. That position can (...) and should be remedied, drawing on a modified Lockean concept of property in what we have laboured to create, and a more sophisticated jurisprudential understanding of property in the body as a bundle of rights. Particularly in the case of women’s tissues, such as ova and umbilical cord blood, this model can offer more effective protection against the global ‘enclosures’ of bodily tissue. (shrink)

Abstract:Under capitalism, bodies are oppressed in the interest of profit through exploitative labor conditions, effects of environmental pollution, neoliberal austerity, and privatized healthcare. Advertising, mainstream media, and corporate rhetoric present the controlled, well-groomed body as a prerequisite for employability and enlist norms of personal responsibility to stigmatize supposedly defective bodies. Against this current, body liberation movements with varying ways of understanding power and the intersection of different forms of oppression are achieving modest success. This paper examines the obstacles (...) which have prevented people with medically caused body odor conditions from enunciating such a counter-ideology so far. It argues that ecosocialism, ecopsychology, and ecofeminism offer frameworks for challenging exclusion and harassment in the workplace as well as in public spaces like libraries. It rejects the capitalist identification of self-improvement with the consumption of increasing numbers of commodities and treatments intended to suppress “nature” in favor of corporate-dictated versions of “civilization.”. (shrink)

Using three paradigm cases of persons living with Parkinson's Disease (PD) the authors make a case for augmenting and enriching a Cartesian medical account of the pathophysiology of PD with an enriched understanding of the lived body experience of PD, the lived implications of PD for a particular person's concerns and coping with the illness. Linking and adding a thick description of the lived experience of PD can enrich caregiving imagination and attunement to the patient's possibilities, concerns and (...) constraints. The work of Merleau-Ponty is used to articulate the middle terms of the lived experience of dwelling in a lifeworld. Examining lived experience of embodied intentionality, skilled bodily capacities as highlighted in Merleau-Ponty's non-mechanistic physiology opens new therapeutic, coping and caregiving possibilities. Matching temporal rhythms can decrease the stress of being assisted with activities of daily living. For example, caregivers and patients alike can be taught strategies for extending their lived bodily capacities by altering rhythms, by shifting hyperactivity to different parts of the body and other strategies that change the perceptual experience associated with walking in different environment. A medical account of the pathophysiology of PD is nessessary and useful, but not sufficient for designing caregiving in ways that enrich and extend the existential skills of dwelling of persons with PD. The dominance of mechanistic physiology makes caregivers assume that it is the 'real discourse' about the disease, causing researchers and caregivers alike to overlook the equally real lived experience of the patient which requires different descriptive discourses and different sources of understanding. Lack of dialogue between the two discourses is tragic for patients because caregivers need both in order to provide attuned, effective caregiving. (shrink)

“Bodily autonomy” has received significant attention in bioethics, medical ethics, and medical law in terms of the general inviolability of a patient’s bodily sovereignty and the rights of patients to make choices (e.g., reproductive choices) that concern their own body. However, the role of the body in terms of how it can or does contribute to a patient’s capacity for, or exercises of their autonomy in clinical decision-making situations has not been explicitly addressed. The approach to (...) autonomy in this paper is aligned with traditional theories that conceive autonomy in terms of an individual’s capacities for, and exercises of rational reflection. However, at the same time, this paper extends these accounts by arguing that autonomy is, in part, embodied. Specifically, by drawing on phenomenological conceptions of the experience of autonomy, we argue that, in principle, the body is a necessary component of the capacity for autonomy. Secondly, through the presentation of two different cases, we highlight ways in which a patient’s body can contribute to the autonomy of treatment choices. Ultimately, we hope to encourage others to explore additional conditions under which a concept of embodied autonomy should be employed in medical decision making, how its underlying principles might be operationalised in clinical situations, and its consequences for approaches to patient autonomy in healthcare practice, policy, and law. (shrink)

Throughout the 20th century, philosophers have criticized the scientific understanding of the human body. Instead of presenting the body as a meaningful unity or Gestalt, it is regarded as a complex mechanism and described in quasi-mechanistic terms. In a phenomenological approach, a more intimate experience of the body is presented. This approach, however, is questioned by Jacques Lacan. According to Lacan, three basic possibilities of experiencing the body are to be distinguished: the symbolical (or scientific) (...) class='Hi'>body, the imaginary (or ideal) body and the real body. Whereas the symbolical body is increasingly objectified (and even digitalized) by medical science, the phenomenological perception amounts to an idealization of the body. The real body cannot be perceived immediately. Rather, it emerges in the folds and margins of our efforts to symbolize or idealize the body, which are bound to remain incomplete and fragile. In the first part of the article (1-3), Lacan's conceptual distinction between the symbolical, the imaginary and the real body will be explained. In the second part (4-5), this distinction will be further clarified by relying on crucial chapters in the history of anatomy (notably Mundinus, Vesalius, Da Vinci and Descartes). (shrink)