Stuart Murray

Human enhancement technologies raise serious ethical questions about health practices no longer content simply to treat disease, but which now also propose to “optimize” human beings’ physical, cognitive and psychological abilities. These technologies call for a reassessment of our relationship to health, the human body and the body's organic, identity and social functions. In nursing, such considerations are in their infancy. In this paper, we argue for the relevance of critical phenomenology as a way to better understand the ethical issues related to human enhancement technologies (HET). In so doing, we seek to problematize HET and assess their influence on the future development of nursing science and practice. It is difficult to anticipate the concrete effects of HET, we suggest, because these practices reconfigure the meaning of normativity and disorient our conventional ethical landscape. In this context, we argue that the later work of Martin Heidegger and Michel Foucault invites a critical perspective into how techno‐scientific discourses modify our relationship to care, to health and to our own social and corporeal identities. Despite the traditional philosophical opposition between phenomenology and critical theory, we maintain that a hybrid critical phenomenological approach opens new ways to assess the integration of technology and practice. Our analysis understands HET as a process of “hybridization” between technological objects and human subjects. Critical phenomenology thus effectively questions anthropocentric definitions of technology, challenges the dichotomy between curative treatment and enhancement and, finally, prompts valuable reflection on the implications of HET for nursing theory and practice.

In his six 1983 lectures published under the title, Fearless Speech (2001), Michel Foucault developed the theme of free speech and its relation to frankness, truth-telling, criticism, and duty. Derived from the ancient Greek word parrhesia, Foucault's analysis of free speech is relevant to the mentoring of medical students. This is especially true given the educational and social need to transform future physicians into able citizens who practice a fearless freedom of expression on behalf of their patients, the public, the medical profession, and themselves in the public and political arena. In this paper, we argue that Foucault's understanding of free speech, or parrhesia, should be read as an ethical response to the American Medical Association's recent educational effort, Initiative to Transform Medical Education (ITME): Recommendations for change in the system of medical education (2007). In this document, the American Medical Association identifies gaps in medical education, emphasizing the need to enhance health system safety and quality, to improve education in training institutions, and to address the inadequacy of physician preparedness in new content areas. These gaps, and their relationship to the ITME goal of promoting excellence in patient care by implementing reform in the US system of medical education, call for a serious consideration and use of Foucault's parrhesia in the way that medical students are trained and mentored.

The Force of Truth is the author’s own significantly revised and expanded translation of La Force du vrai, which was published in French in 2017. The French text bears the subtitle, De Foucault à Austin (from Foucault to Austin), reflecting the book’s engagement with performative speech act theory. The American subtitle—Critique, Genealogy, and Truth-Telling in Michel Foucault—gestures instead to new material, including most substantively a final summative chapter, “Critique and Possibilizing Genealogy” (chap. 5), as well as a brief conclusion, “Rethinking Critique.” It is worth emphasizing that six years had elapsed from the publication of La Force du vrai to The Force of Truth. I would note as well that the... Read More.

Beginning with a focus on the ethical foundations of caregiving in health and expanding towards problems of ethics and justice implicated in a range of issues, this book develops and expands the notion of care itself and its connection to practice. Organised around the themes of culture as a restraint on caregiving in different social contexts and situations, innovative methods in healthcare, and the way in which culture works to position care as part of a rhetorical approach to dependency, responsibility, and justice, The Ethics of Carepresents case studies examining institutional responses to end-of-life issues, the notion of informed consent, biomedicine, indigenous rights and postcolonialism in care and theoretical approaches to the concept of care. Offering discussions from a variety of disciplinary approaches, including sociology, communication, and social theory, as well as hermeneutics, phenomenology, and deconstruction, this book will appeal to scholars across the social sciences with interests in healthcare, medicine, justice and the question of how we think about care as a notion and social form, and how this is related to practice.

The view from inside : gendered embodiment and the medical representation of sex / Shelley Wall -- The politics of medico-legal recognition : the terms of gendered subjectivity in the UK Gender Recognition Act / Sarah Burgess -- Journeys of choice? : abortion, travel, and women's autonomy / Christabelle Sethna and Marion Doull -- The code of ethics in medicine : intertextuality and meaning in Plato's Sophist and Hippocrates' oath / Twyla Gibson -- Sleeping ethics : gene, episteme, and the body politic / Deborah Lynn Steinberg -- The last temptation of Marion Woodman : the anorexic remainder in bone : dying into life / David L. Clark.

In the introduction to his recent book outlining a "deep rhetoric" that can affirm rhetoric's "philosophical foundations," James Crosswhite celebrates a remark made by the late Henry Johnstone, the founding and long-time editor of Philosophy and Rhetoric. Johnstone, claims Crosswhite, "once suggested that rhetoric was an attempt to be 'philosophy without tears'". The passage to which Crosswhite refers appears in Johnstone's foreword to the book Rhetoric and Philosophy, a collection of essays edited by Richard Cherwitz. There, in a bungled bid to praise rhetoric's "increased interest in philosophy during the past few decades," Johnstone attributes the "belief that [rhetoric] is 'philosophy without tears'"...

Each is for the other the middle term, through which each mediates itself with itself and unites with itself; and each is for itself, and for the other, an immediate being on its own account, which at the same time is such only through this mediation. They recognize themselves as mutually recognizing one another. Scholars seeking an account of recognition will be familiar with the seminal section on lordship and bondage in Hegel’s Phenomenology of Spirit. In these passages we learn that the dialectic of mutual recognition is the key to actualized self-consciousness, that moment in which the “I” transcends its immanence in the life process to become a self-reflective subject, actively superseding the..

The global response to managing the spread of HIV has recently undergone a significant shift with the advent of ‘treatment as prevention’, a strategy which presumes that scaling-up testing and treatment for people living with HIV will produce a broader preventative benefit. Treatment as prevention includes an array of diagnostic, technological and policy developments that are creating new understandings of how HIV circulates in bodies and spaces. Drawing on the work of Michel Foucault, we contextualize these developments by linking them to systems of governance and discursive subjectivation. The goal of this article is to problematize the growing importance of viral suppression in the management of HIV and the use of related surveillance technologies. For people living with HIV, we demonstrate how treatment-as-prevention’s emphasis on individual and collective viral load is transforming the performative dimensions of embodied risk, affect, subjectivity and sex.

Background There has been growing interest in the use of incentives to increase the uptake of health-related behaviours and achieve desired health outcomes at the individual and population level. However, the use of incentives remains controversial for ethical reasons. An area in which incentives have been not only proposed but used is HIV prevention, testing, treatment and care—each one representing an interconnecting step in the "HIV Cascade." Methods The main objective of this qualitative case study was to document the experiences of health care and service providers tasked with administrating incentivized HIV testing, treatment, and care in British Columbia, Canada. A second objective was to explore the ethical and professional tensions that arise from the use of incentives as well as strategies used by providers to mitigate them. We conducted interviews with 25 providers and 6 key informants, which were analyzed using applied thematic analysis. We also collected documents and took field notes. Results Our findings suggest that incentives target populations believed to pose the most risk to public health. As such, incentives are primarily used to close the gaps in the HIV Cascade by getting the "right populations" to test, start treatment, stay on treatment, and, most importantly, achieve viral suppression. Participants considered that incentives work because they "bring people through the door." However, they believed the effectiveness of incentives to be superficial, short-lived and one-dimensional—thus, failing to address underlying structural barriers to care and structural determinants of health. They also raised concerns about the unintended consequences of incentives and the strains they may put on the therapeutic relationship. They had developed strategies to mitigate the ensuing ethical and professional tensions and to make their work feel relational rather than transactional. Conclusions We identify an urgent need to problematize the use of incentives as a part of the "HIV Cascade" agenda and interrogate the ethics of engaging in this practice from the perspective of health care and service providers. More broadly, we question the introduction of market logic into the realm of health care—an area of life previously not subject to monetary exchanges.

ABSTRACT Written in late March 2020 in the early days of the U.S. coronavirus outbreak, this essay represents a contingent reflection on the American pandemic response, mourning in anticipation of what would soon surely unfold. I argue that the State's long-standing sacrificial economies have in this moment culminated in a suicidal State. The term is Foucault's, appearing in a controversial lecture on biopolitics, Nazism, and “biological racism.” Despite Foucault's problematic treatment of racism, I suggest that some aspects of this discourse might nevertheless be apropos in our context. The U.S. pandemic response is racism's suicidal State legacy writ large: an extension and retooling of historically racist infrastructures deployed (once again, again) in racialized domains (as more recent reports evidence), but in this moment also across biosocial inequities and vulnerabilities marked by differential fungibilities other than race.

This paper opens with first‐hand accounts of critical care medical interventions in which detainees, in the custody of U.S. Immigration and Customs Enforcement (ICE), are brought to the emergency department for treatment. This case dramatizes the extent to which the provision of ethical and acceptable nursing care is jeopardized by federal law enforcement paradigms. Drawing on the scholarship of Michel Foucault and Giorgio Agamben, this paper offers a theoretical account of the power dynamics that inform the health care of patients who find themselves caught in the custodial scaffolding of a vast immigration and detention apparatus. It offers an analysis of the display of sovereign and biopolitical power over the lives (and deaths) of detainees (Foucault), as well as the ways these individuals are reduced to “bare life” under the political pretext of an emergency or “state of exception” (Agamben). Our purpose here is both theoretical and practical: to better understand the often hidden agency or impersonal “will” exercised by the immigrant detention system, but also to equip clinicians in these and cognate facilities (e.g., prisons) with the critical tools by which they might better navigate incommensurable paradigms (i.e., care vs. custody) in order to deliver the best care while upholding their ethical duties as a care provider. This is all the more pressing because hospitals are not sanctuaries and given the incursion of federal law enforcement agents, nurses may find themselves conscripted as de facto agents of the state.

In this paper, we extend Michel Foucault’s final works on the ‘care of the self’ to an empirical examination of research practice in community-based research (CBR). We use Foucault’s ‘morality of behaviors’ to analyze interview data from a national sample of Canadian CBR practitioners working with communities affected by HIV. Despite claims in the literature that ethics review is overly burdensome for non-traditional forms of research, our findings suggest that many researchers using CBR have an ambivalent but ultimately productive relationship with institutional research ethics review requirements. They understand and use prescribed codes, but adapt them in practice to account for the needs of participating community members, members of their research teams and the larger communities with whom they work. Complying with ethics protocols was seen as only the beginning, a minimum standard; our research suggests that the real ethical work happens in the field, where CBR practitioners encounter community members in diverse public roles and must forge ethical consensus across communities. CBR represents an ethical terrain in which practitioners challenge themselves to work differently, and as a result they care for themselves—and others—in ways that often resist the propensity for domination through public health research.‘…there are different ways to “conduct oneself” morally, different ways for the acting individual to operate, not just as an agent, but as an ethical subject of action.’ (Foucault, 1985: 26)

◆ Writing is per se already violence: the rupture there is in each fragment, the break, the splitting, the tearing of the shred—acute singularity, steely point. And yet this combat is, for patience, debate. The name wears away [s'use], the fragment fragments, erodes.There is much talk today but little speech, or rather, little speech that could be received and responded to absent the vows of the unavowable community of its speakers. There is combat but debate is foreclosed by the absence of asignifying absence. To avow that a community is unavowable—when the name wears away—is not to say that it has been disavowed, subjected, though in many cases this is so, for often the name names sovereignly....

Human enhancement technologies raise serious ethical questions about health practices no longer content simply to treat disease, but which now also propose to “optimize” human beings’ physical, cognitive and psychological abilities. These technologies call for a reassessment of our relationship to health, the human body and the body's organic, identity and social functions. In nursing, such considerations are in their infancy. In this paper, we argue for the relevance of critical phenomenology as a way to better understand the ethical issues related to human enhancement technologies (HET). In so doing, we seek to problematize HET and assess their influence on the future development of nursing science and practice. It is difficult to anticipate the concrete effects of HET, we suggest, because these practices reconfigure the meaning of normativity and disorient our conventional ethical landscape. In this context, we argue that the later work of Martin Heidegger and Michel Foucault invites a critical perspective into how techno‐scientific discourses modify our relationship to care, to health and to our own social and corporeal identities. Despite the traditional philosophical opposition between phenomenology and critical theory, we maintain that a hybrid critical phenomenological approach opens new ways to assess the integration of technology and practice. Our analysis understands HET as a process of “hybridization” between technological objects and human subjects. Critical phenomenology thus effectively questions anthropocentric definitions of technology, challenges the dichotomy between curative treatment and enhancement and, finally, prompts valuable reflection on the implications of HET for nursing theory and practice.

Rationale, aims and objectives : Evidence-based medicine (EBM) claims to be based on 'evidence', rather than 'intuition'. However, EBM's fundamental distinction between quantitative 'evidence' and qualitative 'intuition' is not self-evident. The meaning of 'evidence' is unclear and no studies of quality exist to demonstrate the superiority of EBM in health care settings. This paper argues that, despite itself, EBM holds out only the illusion of conclusive scientific rigour for clinical decision making, and that EBM ultimately is unable to fulfil its own structural criteria for 'evidence'. Methods : Our deconstructive analysis of EBM draws on the work of the French philosopher, Jacques Derrida. Deconstruction works in the name of justice to lay bare, to expose what has been hidden from view. In plain language, we deconstruct EBM's paradigm of 'evidence', the randomized controlled trial (RCT), to demonstrate that there cannot be incontrovertible evidence for EBM as such. We argue that EBM therefore 'auto-deconstructs' its own paradigm, and that medical practitioners, policymakers and patients alike ought to be aware of this failure within EBM itself. Results : EBM's strict distinction between admissible evidence (based on RCTs) and other supposedly inadmissible evidence is not itself based on evidence, but rather, on intuition. In other words, according to EBM's own logic, there can be no 'evidentiary' basis for its distinction between admissible and inadmissible evidence. Ultimately, to uphold this fundamental distinction, EBM must seek recourse in (bio)political ideology and an epistemology akin to faith.

In his six 1983 lectures published under the title, Fearless Speech (2001), Michel Foucault developed the theme of free speech and its relation to frankness, truth-telling, criticism, and duty. Derived from the ancient Greek word parrhesia, Foucault's analysis of free speech is relevant to the mentoring of medical students. This is especially true given the educational and social need to transform future physicians into able citizens who practice a fearless freedom of expression on behalf of their patients, the public, the medical profession, and themselves in the public and political arena. In this paper, we argue that Foucault's understanding of free speech, or parrhesia, should be read as an ethical response to the American Medical Association's recent educational effort, Initiative to Transform Medical Education (ITME): Recommendations for change in the system of medical education (2007). In this document, the American Medical Association identifies gaps in medical education, emphasizing the need to enhance health system safety and quality, to improve education in training institutions, and to address the inadequacy of physician preparedness in new content areas. These gaps, and their relationship to the ITME goal of promoting excellence in patient care by implementing reform in the US system of medical education, call for a serious consideration and use of Foucault's parrhesia in the way that medical students are trained and mentored

Abstract: In this paper it is proposed that the traditional view of diplomacy is an archaic vision of the ‘engine room of international relations.’ This rhetoric, it is argued, is parochial and does not match the realities of the modern, twenty-first century diplomatic environment where plural, peaceful and polylateral networks of diplomacy are thriving. In the modern diplomatic environment, the activity of diplomacy should be viewed as the business of multi-actor peace, not only as the handmaiden of the occasionally belligerent state. New, radical and innovative views on diplomacy are flooding the diplomacy studies field. This paper will summarise these views into three distinct Schools of diplomatic thought - Traditional, Nascent and Innovative - which allude to this positive growth in scholarship. This paper will argue - centrally - that an enhanced understanding of diplomacy is the best chance society has to replace the norm of conflict with that of stability and peace achieved through diplomatic functions

This article is a critical methodological reflection on the use of interpretive phenomenological analysis (IPA) initiated in the context of a qualitative research project on the experience of seclusion in a psychiatric setting. It addresses an explicit gap in the IPA literature to explore the ways that Merleau-Ponty’s phenomenology can extend the remit of IPA for noncognitivist qualitative research projects beyond the field of health psychology. In particular, the article develops Merleau-Ponty’s understanding of the lived-body, language, and embodied speech, with specific attention to the ethical implications of body and place. It concludes with a discussion on phenomenological reflexivity and prompts a reconsideration of phenomenological methods across a wide range of qualitative research projects concerned with subjectivity and ethical practice, including critical health studies, critical bioethics, and cultural studies that employ a qualitative empirical research design

The central aim of this thesis is to deconstruct and reconstruct the dominant theoretical perceptions of diplomacy, by reworking radically existing theories of diplomacy. This thesis achieves reconceptualisation of diplomatic theory by critiquing the thoughts and ideas of theorists postulating on modern diplomacy. Consequently, this thesis is concerned (largely) with the theoretical terrain of diplomacy studies. The purpose of this intended deconstruction and reconstruction is to introduce and construct three lucid types of diplomatic theory. These three types or categories introduced in this thesis are Traditional, Nascent and Innovative Diplomatic Theory. By categorising these three distinct types of theories, it is hoped that the diplomatic scholar will have a choice of lenses through which to interpret the complexities of the modern diplomatic environment. Ultimately, this thesis aims to strengthen Traditional Diplomatic Theory (TDT) and introduce/construct two alternate forms of diplomatic theory, Nascent Diplomatic Theory (NDT) and Innovative Diplomatic Theory (IDT)

In this paper, we extend Michel Foucault’s final works on the ‘care of the self’ to an empirical examination of research practice in community-based research (CBR). We use Foucault’s ‘morality of behaviors’ to analyze interview data from a national sample of Canadian CBR practitioners working with communities affected by HIV. Despite claims in the literature that ethics review is overly burdensome for non-traditional forms of research, our findings suggest that many researchers using CBR have an ambivalent but ultimately productive relationship with institutional research ethics review requirements. They understand and use prescribed codes, but adapt them in practice to account for the needs of participating community members, members of their research teams and the larger communities with whom they work. Complying with ethics protocols was seen as only the beginning, a minimum standard; our research suggests that the real ethical work happens in the field, where CBR practitioners encounter community members in diverse public roles and must forge ethical consensus across communities. CBR represents an ethical terrain in which practitioners challenge themselves to work differently, and as a result they care for themselves—and others—in ways that often resist the propensity for domination through public health research.‘…there are different ways to “conduct oneself” morally, different ways for the acting individual to operate, not just as an agent, but as an ethical subject of action.’ (Foucault, 1985: 26)

Since the end of the Cold War, the scope and study of diplomacy has expanded. In the modern diplomatic environment, novel terms such as pipeline diplomacy, coercive diplomacy, diplomacy by sanction and citizen diplomacy are common, alongside the more traditional view of diplomacy as state-to-state activity, monopolized by professional, official diplomats. With such a broad range of views, the scholar can become confused as to what actually constitutes modern diplomacy? In this article, it is argued that the disparity of views in the diplomacy studies field must be classified and consolidated before the enhanced role of diplomacy in the twenty-first century can be better understood. In this article, three different classifications or schools of diplomatic thought are introduced and constructed: the Traditional School, the Nascent School, and the Innovative School