Affiliation: Interdisciplinary Research Lab for Bioethics, Institute of Philosophy, Czech Academy of Sciences
Title: Embodied Social Imaginaries: Bioethical Considerations of Technological Interventions in Health Care
Abstract: In this paper I will examine ethical implications for the use of technology in health care. Recent theories of bioethics, the ethics of biological and medical research and medical practice, turn to phenomenology and argue that looking at patients’ embodied experiences has a significant impact on decisions concerning technological interventions in health care (Bayne and Levy 2005, Slatman 2012, Svenaeus 2017). More exactly, whether and to what extent bodies can and should be manipulated by medical technologies (prostheses, body reconstructions, surgery) is not only a question of physical health, as well as of applying ethical, cultural as well as legal norms (e.g. respect for body integrity), but also of the patient’s actual lived experience of his or her body (e.g. personal experience of body wholeness). Phenomenology, in the sense of the analysis of lived existence, therefore contributes to bioethics. In my paper I will take a position in recent phenomenology inspired bioethical discussions. Recent theories of bioethics often develop a phenomenological concept of narrative identity and argue that listening to patient’s stories can be a meaningful task for health care professionals, because it clarifies patients’ personal values that result from the specific corporal history of their bodies. The idea is that a person’s body identity, experiences and integrity are not one experience, but changes over time. It is a “body biography” (Slatman 2012, 294). I will further develop this idea of body biography by arguing that these biographies include not only personal, but also social values, which can passively influence a patient’s view on their body (e.g. beauty ideals), but which patients can also actively endorse, question or reject. In order to make my point, I will draw on theories of narrative identity and the social imaginary (e.g. Ricoeur 1992, 2007; Dawney 2011; Taylor 2020 (forthcoming)). My main argument will be that narrative identity, from a phenomenological perspective, relates to the social imaginary, being a community’s social values, norms and principles, since the values we endorse are not isolated entities. From a phenomenological perspective, a person’s body experience results from a dynamic interaction with the social imaginary, which allows taking a critical attitude to social norms (e.g. beauty ideals or values about body wholeness). Moral imagination is key for this kind of critique, in the sense that it allows us to perceive a different reality, with other ethical values then the socially dominant ones. A phenomenological conception of the social imaginary therefore offers a theoretical basis that explains why social values have an impact on patients’ decisions and autonomy in health care, as qualitative studies show (Gilbar and Balroy, 2018). A phenomenological concept of the social imaginary can moreover highlight the importance of awareness of the impact of social values in relations between patients and health care professionals. Empathically imagining a patient’s personal values within its social and cultural backgrounds aids in understanding a patient’s autonomy.
Roxana Baiasu, Alexandra de Herbay
Affiliation: Philosophy Faculty, Oxford University and Tutorial Fellow, Stanford University Center, Oxford; Psychiatre, Centre Hospitalier Universitaire Strasbourg; Psychiatre, Praticien Hospitalier Centre Hospitalier Universitaire Strasbourg
Title: Phenomenology of embodiment in illness: Can phenomenology and enactivism account for medically unexplained symptoms?
Abstract: In her paper, Roxana Baiasu is concerned with certain phenomenological contributions to person-centered practices in healthcare which can work in partnership with evidence-based approaches. She propose a meaning-centered phenomenological approach to embodiment in illness (which complements body-centered and feeling-centered accounts such as the ones proposed by Havi Carel and Matthew Ratcliffe, respectively). This approach is pursued in order to develop an understanding of illness as involving a breakdown or loss of meaning; however, it acknowledges that at the heart of illness lies the possibility of a reconstruction of meaning and certain related cognitive mechanisms which make it possible for the individual to find meaning in life. This phenomenological discussion is extended and pursued further by Alexandra de Herbay to approach the nature of certain symptoms in terms of their meaningfulness for the patients and, more specifically, to address the issue of medically unexplained symptoms in connection to the patients’ lived experience of their embodiment in illness. Unexplained or insufficiently medically explained symptoms constitute a major contemporary medical problem in terms of frequency, nosographic difficulties, therapeutic resolution, disabling repercussions for the patient, dissatisfaction for the caregiver and cost for society. An experiential phenomenological approach could allow us to distance ourselves from the search for aetiological objectification which embeds both the patient and the doctor in the unproductive body-mind and somatic- psychic dualisms. From an enactive perspective, we try to reconstruct the bio-psycho-social factors that predispose, precipitate, perpetuate symptomatology as situated ecological conditions that can open up to strategies of complex rationality responding to the patient's needs as an integral part of the environment.