Response —Liminality and the Mirage of Settlement
AbstractLittle and colleagues ’ (1998) paper describing a key aspect of cancer patients ’ experience, that of “liminality,” is remarkable for giving articulation to a very common and yet mostly overlooked aspect of patient experience. Little et. al. offered a formulation of liminality that deliberately set aside the concept’s more common use in analysing social rituals, in orde r to grasp at the interior experience that arises when failing bodily function and awareness of mortality are forced into someone’s consciousness, as occurs with a diagnosis of cancer. We set out the reasons as to why this analysis was s...
Source: Journal of Bioethical Inquiry - April 1, 2022 Category: Medical Ethics Source Type: research
Pragmatic pluralism: Mutual tolerance of contested understandings between orthodox and alternative practitioners in autologous stem cell transplantation
AbstractHigh-dose chemotherapy and autologous stem cell transplantation (ASCT) is used to treat some advanced malignancies. It is a traumatic procedure, with a high complication rate and significant mortality. ASCT patients and their carers draw on many sources of information as they seek to understand the procedure and its consequences. Some seek information from beyond orthodox medicine. Alternative beliefs and practices may conflict with conventional understanding of the theory and practice of ASCT, and ‘contested understandings’ might interfere with patient adherence to the strict and demanding protocols required f...
Source: Journal of Bioethical Inquiry - April 1, 2022 Category: Medical Ethics Source Type: research
“CRISPR for Disabilities: How to Self-Regulate” or Something?
AbstractThe development of the CRISPR gene editing technique has been hyped as a technique that could fundamentally change scientific research and its clinical application. Unrecognized is the fact that it joins other technologies that have tried and failed under the same discourse of scientific hype. These technologies, like gene therapy and stem cell research, have moved quickly passed basic research into clinical application with dire consequences. Before hastily moving to clinical applications, it is necessary to consider basic research and determine how CRISPR/Cas systems should be applied. In the case of single gene ...
Source: Journal of Bioethical Inquiry - April 1, 2022 Category: Medical Ethics Source Type: research
Response —A Commentary on Miles Little et al. 1998. Liminality: A major category of the experience of cancer illness. Social Science & amp; Medicine 47(10): 1485-1494
AbstractThis paper by Miles Little and colleagues identified the state they described as “liminal” within the trajectory of cancer survivorship. Since that time the concept of liminality has provided a powerful model to explore some of the difficulties experienced by people with severe and chronic illness. In this commentary I consider the expanding application of liminality not jus t to a widening range of medical conditions but to the consequences of therapeutic interventions as well and how this expansion has enriched and challenged its use as a conceptual tool. (Source: Journal of Bioethical Inquiry)
Source: Journal of Bioethical Inquiry - April 1, 2022 Category: Medical Ethics Source Type: research
A Discursive Exploration of Values and Ethics in Medicine: The Scholarship of Miles Little
(Source: Journal of Bioethical Inquiry)
Source: Journal of Bioethical Inquiry - April 1, 2022 Category: Medical Ethics Source Type: research
Discourse Communities and the Discourse of Experience
AbstractDiscourse communities are groups of people who share common ideologies, and common ways of speaking about things. They can be sharply or loosely defined. We are each members of multiple discourse communities. Discourse can colonize the members of discourse communities, taking over domains of thought by means of ideology. The development of new discourse communities can serve positive ends, but discourse communities create risks as well. In our own work on the narratives of people with interests in health care, for example, we find that patients speak of their illness experiences as victims of circumstance; policy m...
Source: Journal of Bioethical Inquiry - April 1, 2022 Category: Medical Ethics Source Type: research
Response —The Corruption of Character in Medicine
AbstractSome people change dramatically over time, and often those changes result partly from what they have chosen to do for a living. Drawing on the work of Richard Sennett and Sandeep Jauhar, I explore how practicing in a market-driven medical system can corrupt the character of doctors. (Source: Journal of Bioethical Inquiry)
Source: Journal of Bioethical Inquiry - April 1, 2022 Category: Medical Ethics Source Type: research
Response —The Road Less Travelled: Why did Miles Little Turn to Qualitative Research and Where Did This Lead?
AbstractMiles Little is an Australian surgeon, poet, and philosopher whose published work spans diverse topics in surgery, medicine, philosophy, and bioethics. In 1974 he co-authored a survey that included an analysis of interviews conducted with amputees. This was his first foray into qualitative research. Twenty years later he established a research centre at the University of Sydney that initiated a programme of qualitative research in cancer medicine. For twenty years after that, the centre acted as a hub for research that applied qualitative methods from the social sciences to study the experiences of people who endur...
Source: Journal of Bioethical Inquiry - April 1, 2022 Category: Medical Ethics Source Type: research
An Archeology of Corruption in Medicine
AbstractCorruption is a word used loosely to describe many kinds of action that people find distasteful. We prefer to reserve it for the intentional misuse of the good offices of an established social entity for private benefit, posing as fair trading. The currency of corruption is not always material or financial. Moral corruption is all too familiar within churches and other ostensibly beneficent institutions, and it happens within medicine and the pharmaceutical industries. Corrupt behavior reduces trust, costs money, causes injustice, and arouses anger. Yet it persists, despite all efforts since the beginnings of socie...
Source: Journal of Bioethical Inquiry - April 1, 2022 Category: Medical Ethics Source Type: research
Response —A Critical Response to “Discourse Communities and the Discourse of Experience”
AbstractIn their article Little, Jordens, and Sayers developed the notion of “discourse communities”—as groups of people who share an ideology and common “language”—with the support of seminal ideas from M.M. Bakhtin. Such communities provide benefits although they may also impose constraints. An ethical community would open to others’ discourse and be committe d to critique. Those commitments may counter the limitations of discourse communities. Since their paper was published in 2003, the notion of “discourse communities” has been widely adopted and applied in healthcare and beyond. Their ideas were inf...
Source: Journal of Bioethical Inquiry - April 1, 2022 Category: Medical Ethics Source Type: research
Response —An Extreme Ordeal: Writing Emotion in Qualitative Research
AbstractResponding to the stimulus afforded by Little et al. ’s “Pragmatic pluralism: Mutual tolerance of contested understandings between orthodox and alternative practitioners in autologous stem cell transplantation,” this paper explores how the norms of qualitative inquiry affect the representation of emotion in research reports. It describes a confl ict between the construction of emotion in qualitative research accounts and its application to analysis and theorization, whose origins may lie in researchers’ reticence when it comes to conveying or using the emotional features of data. The technical aspects of re...
Source: Journal of Bioethical Inquiry - April 1, 2022 Category: Medical Ethics Source Type: research
A Clinician ’s Obligation to be Vaccinated: Four Arguments that Establish a Duty for Healthcare Professionals to be Vaccinated Against COVID-19
AbstractThis paper defends four lines of argument that establish an ethical obligation for clinicians to be vaccinated against COVID-19. They are:(1) The obligation to protect patients against COVID-19 spread;(2) The obligation to maintain professional competence and remain available for patients;(3) Clinicians ’ role and place in society in relation to COVID-19;(4) The obligation to encourage societal vaccination uptake.These arguments stand up well against potential objections and provide a compelling case to consider acceptance of COVID-19 vaccination a duty for all clinicians. This duty brings with it the implication...
Source: Journal of Bioethical Inquiry - April 1, 2022 Category: Medical Ethics Source Type: research
Response —The Multiple Understandings in the Clinic Do Not Always Need to be Resolved
This article reflects on the assumption underlying the argument of Little et al. that"contested understandings" in the clinic are susceptible to reconciliation within a liberal framework described as"pragmatic pluralism". It is argued that no such reconciliation is possible or desirable because it is of the nature of the clinic that it provides a forum for multiple voices, ethical and cultural perspectives, and conceptual frameworks, and this is the source of its fecundity and creativity. Medicine itself cannot be represented by a single discourse, precisely because it is itself an unruly collection of ...
Source: Journal of Bioethical Inquiry - April 1, 2022 Category: Medical Ethics Source Type: research
Vascular Amputees: A Study in Disappointment
SummaryDespite optimistic reports about the results of amputation for advanced vascular disease, the patient ’s assessment of advantages and disadvantages is seldom acknowledged. A detailed social study of 67 amputees has revealed considerable disparity between the patient’s views and those of the medical staff. About a third of the patients are forced to retire from active work by the amputation; abou t three-quarters report a serious decline in their social activities; only about half are really independent with prostheses in the long term; a quarter report severe and intractable symptoms related to their amputation ...
Source: Journal of Bioethical Inquiry - April 1, 2022 Category: Medical Ethics Source Type: research
Ethical Design and Use of Robotic Care of the Elderly
AbstractThe Australian Royal Commission into Aged Care Quality and Safety acknowledged understaffing and substandard care in residential aged care and home care services, and recommendations were made that that the Australian Government should promote assistive technology within aged care. Robotic care assistants can provide care and companionship for the elderly —both in their own homes and within health and aged care institutions. Although more research is required into their use, studies indicate benefits, including enabling the elderly to live independently at home, assistance with medication and monitoring of safet...
Source: Journal of Bioethical Inquiry - March 21, 2022 Category: Medical Ethics Source Type: research
