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Loughlin M, Dolezal L, Hutchinson P, Subramani S, Milani R, Lafarge C. Philosophy and the clinic: Stigma, respect and shame. J Eval Clin Pract 2022; 28:705-710. [PMID: 36053567 PMCID: PMC9826409 DOI: 10.1111/jep.13755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 01/11/2023]
Abstract
Since its foundation in 2010, the annual philosophy thematic edition of this journal has been a forum for authors from a wide range of disciplines and backgrounds, enabling contributors to raise questions of an urgent and fundamental nature regarding the most pressing problems facing the delivery and organization of healthcare. Authors have successfully exposed and challenged underlying assumptions that framed professional and policy discourse in diverse areas, generating productive and insightful dialogue regarding the relationship between evidence, value, clinical research and practice. These lively debates continue in this thematic edition, which includes a special section on stigma, shame and respect in healthcare. Authors address the problems with identifying and overcoming stigma in the clinic, interactional, structural and phenomenological accounts of stigma and the 'stigma-shame nexus'. Papers examine the lived experience of discreditation, discrimination and degradation in a range of contexts, from the labour room to mental healthcare and the treatment of 'deviancy' and 'looked-after children'. Authors raise challenging questions about the development of our uses of language in the context of care, and the relationship between stigma, disrespect and important analyses of power asymmetry and epistemic injustice. The relationship between respect, autonomy and personhood is explored with reference to contributions from an important conference series, which includes analyses of shame in the context of medically unexplained illness, humour, humiliation and obstetric violence.
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Affiliation(s)
- Michael Loughlin
- Institute for Person-Centred Health and Social Care, School of Biomedical Sciences, University of West London, London, UK
| | - Luna Dolezal
- Department of Sociology, Philosophy and Anthropology, University of Exeter, Exeter, UK
| | - Phil Hutchinson
- Department of Psychology, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Supriya Subramani
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
| | - Raffaella Milani
- School of Human and Social Sciences, University of West London, London, UK
| | - Caroline Lafarge
- School of Human and Social Sciences, University of West London, London, UK
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Loughlin M, Bluhm R, Buetow S, Borgerson K, Fuller J. Reasoning, evidence, and clinical decision-making: The great debate moves forward. J Eval Clin Pract 2017; 23:905-914. [PMID: 28960730 DOI: 10.1111/jep.12831] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 08/16/2017] [Indexed: 02/06/2023]
Abstract
When the editorial to the first philosophy thematic edition of this journal was published in 2010, critical questioning of underlying assumptions, regarding such crucial issues as clinical decision making, practical reasoning, and the nature of evidence in health care, was still derided by some prominent contributors to the literature on medical practice. Things have changed dramatically. Far from being derided or dismissed as a distraction from practical concerns, the discussion of such fundamental questions, and their implications for matters of practical import, is currently the preoccupation of some of the most influential and insightful contributors to the on-going evidence-based medicine debate. Discussions focus on practical wisdom, evidence, and value and the relationship between rationality and context. In the debate about clinical practice, we are going to have to be more explicit and rigorous in future in developing and defending our views about what is valuable in human life.
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Affiliation(s)
- Michael Loughlin
- Department of Interdisciplinary Studies, MMU Cheshire, Crewe, UK
| | - Robyn Bluhm
- Department of Philosophy, Lyman Briggs College, Michigan State University, East Lancing, Michigan, USA
| | - Stephen Buetow
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | | | - Jonathan Fuller
- African Centre for Epistemology and Philosophy of Science, University of Johannesburg, Johannesburg, South Africa.,Toronto Philosophy of Medicine Network, University of Toronto, Toronto, Canada
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Loughlin M, Wyer P, Tanenbaum SJ. Teaching by (bad) example: what a confused attempt to "advance" EBM reveals about its underlying problems: commentary on Jenicek, M. (2015). Do we need another discipline in medicine? From epidemiology and evidence-based medicine to cognitive medicine and medical thinking. Journal of evaluation in clinical practice, 21:1028-1034. J Eval Clin Pract 2016; 22:628-33. [PMID: 27225855 DOI: 10.1111/jep.12552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 04/04/2016] [Indexed: 01/26/2023]
Abstract
Professor Jenicek's paper is confused in that his proposal to 'integrate' what he means by 'evidence-based scientific theory and cognitive approaches to medical thinking' actually embodies a contradiction. But, although confused, he succeeds in teaching us more about the EBM debate than those who seem keen to forge ahead without addressing the underlying epistemological problems that Jenicek brings to our attention. Fundamental questions about the relationship between evidence, knowledge and reason still require resolution if we are to see a genuine advance in this debate.
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Affiliation(s)
- Michael Loughlin
- Department of Interdisciplinary Studies, MMU Cheshire, Crewe, UK
| | - Peter Wyer
- Columbia University Medical Center, New York, NY, USA.
| | - Sandra J Tanenbaum
- Department of Health Services Management and Policy College of Public Health, The Ohio State University, Columbus Ohio, USA
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Loughlin M, Fuller J, Bluhm R, Buetow S, Borgerson K. Theory, experience and practice. J Eval Clin Pract 2016; 22:459-65. [PMID: 27431729 DOI: 10.1111/jep.12586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 05/25/2016] [Indexed: 01/06/2023]
Abstract
Despite its potential hazards, the activity of questioning theoretical frameworks and proposing solutions is necessary if progress is even to be possible. Intellectual history has by no means ended, so we cannot expect to have all the answers, and from time to time the activity of critical questioning will be frustrating. But intellectual progress requires us to continue the process of asking fundamental questions. The alternative to thinking in this way is indeed unthinkable.
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Affiliation(s)
- Michael Loughlin
- Department of Interdisciplinary Studies, MMU Cheshire, Crewe, UK
| | | | - Robyn Bluhm
- Department of Philosophy, Lyman Briggs College, Michigan State University, East Lansing, USA
| | - Stephen Buetow
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
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Loughlin M, Bluhm R, Fuller J, Buetow S, Borgerson K, Lewis BR, Kious BM. Diseases, patients and the epistemology of practice: mapping the borders of health, medicine and care. J Eval Clin Pract 2015; 21:357-64. [PMID: 25923823 DOI: 10.1111/jep.12370] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2015] [Indexed: 01/27/2023]
Abstract
Last year saw the 20th anniversary edition of JECP, and in the introduction to the philosophy section of that landmark edition, we posed the question: apart from ethics, what is the role of philosophy 'at the bedside'? The purpose of this question was not to downplay the significance of ethics to clinical practice. Rather, we raised it as part of a broader argument to the effect that ethical questions - about what we should do in any given situation - are embedded within whole understandings of the situation, inseparable from our beliefs about what is the case (metaphysics), what it is that we feel we can claim to know (epistemology), as well as the meaning we ascribe to different aspects of the situation or to our perception of it. Philosophy concerns fundamental questions: it is a discipline requiring us to examine the underlying assumptions we bring with us to our thinking about practical problems. Traditional academic philosophers divide their discipline into distinct areas that typically include logic: questions about meaning, truth and validity; ontology: questions about the nature of reality, what exists; epistemology: concerning knowledge; and ethics: how we should live and practice, the nature of value. Any credible attempt to analyse clinical reasoning will require us to think carefully about these types of question and the relationships between them, as they influence our thinking about specific situations and problems. So, the answers to the question we posed, about the role of philosophy at the bedside, are numerous and diverse, and that diversity is illustrated in the contributions to this thematic edition.
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Affiliation(s)
- Michael Loughlin
- Department of Interdisciplinary Studies, MMU Cheshire, Crewe, UK
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Loughlin M, Bluhm R, Fuller J, Buetow S, Upshur REG, Borgerson K, Goldenberg MJ, Kingma E. Philosophy, medicine and health care - where we have come from and where we are going. J Eval Clin Pract 2014; 20:902-7. [PMID: 25644615 DOI: 10.1111/jep.12275] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2014] [Indexed: 12/21/2022]
Affiliation(s)
- Michael Loughlin
- Department of Interdisciplinary Studies, MMU Cheshire, Crewe, UK
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Loughlin M, Bluhm R, Stoyanov DS, Buetow S, Upshur REG, Borgerson K, Goldenberg MJ, Kingma E. Explanation, understanding, objectivity and experience. J Eval Clin Pract 2013; 19:415-21. [PMID: 23692221 DOI: 10.1111/jep.12060] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2013] [Indexed: 01/30/2023]
Affiliation(s)
| | - Robyn Bluhm
- Department of Philosophy and Religious Studies; Old Dominion University; Norfolk Virginia USA
| | - Drozdstoj S. Stoyanov
- Department of Psychiatry and Medical Psychology; MUP & Vice Chair Philosophy SIG; Royal College of Psychiatrists; London UK
- Center for Philosophy of Science; University of Pittsburgh; Pittsburgh Pennsylvania USA
| | - Stephen Buetow
- Department of General Practice; University of Auckland; Auckland New Zealand
| | - Ross E. G. Upshur
- University of Toronto Joint Centre for Bioethics; Toronto Ontario Canada
| | - Kirstin Borgerson
- Department of Philosophy; Dalhousie University; Halifax Nova Scotia Canada
| | | | - Elselijn Kingma
- King's College Centre for Humanities and Health; Department of Philosophy; King's College London; London UK
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Loughlin M, Bluhm R, Buetow S, Upshur REG, Goldenberg MJ, Borgerson K, Entwistle V, Kingma E. Reason and value: making reasoning fit for practice. J Eval Clin Pract 2012; 18:929-37. [PMID: 22994987 DOI: 10.1111/j.1365-2753.2012.01896.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Michael Loughlin
- Department of Interdisciplinary Studies; MMU Cheshire; Crewe; UK
| | - Robyn Bluhm
- Department of Philosophy and Religious Studies; Old Dominion University; Norfolk; VA; USA
| | - Stephen Buetow
- Department of General Practice; University of Auckland; Auckland; New Zealand
| | - Ross E. G. Upshur
- University of Toronto Joint Centre for Bioethics; Toronto; ON; Canada
| | | | | | - Vikki Entwistle
- Social Dimensions of Health Institute; University of Dundee; Dundee; UK
| | - Elselijn Kingma
- King's College Centre for Humanities and Health/Department of Philosophy; King's College London; London; UK
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Kingma E, McCabe MM. Interdisciplinary workshop report: methodology and 'Personhood and Identity in Medicine'. J Eval Clin Pract 2012; 18:1057-63. [PMID: 22995008 DOI: 10.1111/j.1365-2753.2012.01917.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Elselijn Kingma
- Department of Philosophy, King's College London, London, UK.
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Loughlin M, Lewith G, Falkenberg T. Science, Practice and Mythology: A Definition and Examination of the Implications of Scientism in Medicine. HEALTH CARE ANALYSIS 2012; 21:130-45. [DOI: 10.1007/s10728-012-0211-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
There are strong arguments in favour of the need for more 'empirically informed philosophy'. Using papers in the current issue of JECP as case studies, I raise fundamental and unresolved methodological questions about the proper relationship between philosophy and empirical research, in particular concerning the relationship between 'data' in empirical research and the 'responses' people give in to questions in the process of philosophical dialogue. There are tensions between the role of data in empirical research and the critical stance required for philosophy that need to be addressed, if empirically informed philosophy is to make a serious and substantial contribution to our thinking about the matters of great import it addresses.
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Affiliation(s)
- Michael Loughlin
- Department of Interdisciplinary Studies, MMU Cheshire, Crewe, UK
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Loughlin M, Bluhm R, Buetow S, Upshur REG, Goldenberg MJ, Borgerson K, Entwistle V. Virtue, progress and practice. J Eval Clin Pract 2011; 17:839-46. [PMID: 21951924 DOI: 10.1111/j.1365-2753.2011.01748.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Medicine is predicated on a view of human nature that is highly positivist and atomistic. This is apparent in the way in which its students are taught, clinical consultations are structured and medical evidence is generated. The field of medical humanities originally emerged as a challenge to this overly narrow view, but it has rarely progressed beyond tinkering around the edges of medical education. This is partly because its practitioners have largely been working from within a pervasive medical culture from which it is difficult to break free, and partly because the field has been insufficiently armed with scholarly thinking from the humanities. This is beginning to change and there is a sign that research in medical humanities has the potential to mount a persuasive challenge to medicine's ways of teaching, working and finding out. This article problematizes medicine's narrow viewpoint, grounding its critique in philosophical ideas from phenomenology and pragmatism. I will reflect upon the historical context within which medical humanities has emerged and briefly examine specific examples of how its interdisciplinary approach, involving humanities scholars with clinicians and medical scientists, may develop new research directions in medicine.
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Affiliation(s)
- Jane Macnaughton
- Centre for Medical Humanities, Durham University, Trevelyan College, Durham, UK.
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Kingma E, Chisnall B, McCabe MM. Interdisciplinary workshop on concepts of health and disease: report. J Eval Clin Pract 2011; 17:1018-22. [PMID: 21951939 DOI: 10.1111/j.1365-2753.2011.01745.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Elselijn Kingma
- King's College Centre for Humanities and Health/Department of Philosophy, King's College London, London, UK
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