Dualism and Its Discontents II: Philosophical Tinctures

Part II of II: This chapter explores philosophical responses to Cartesian dualism—notably Maurice Merleau-Ponty’s elaboration of phenomenology—and its relevance to medicine. With close reading of Merleau-Ponty’s Phenomenology of Perception, phenomenology’s attentiveness to lived experience and to embodiment is described. Next, discussion of the work of philosophers, clinicians, ethicists and patients—including Havi Carel, S. Kay Toombs, Richard Baron, Edmund Pellegrino, Richard Zaner, and Fredrik Svenaeus—demonstrates the influence of phenomenological perspectives in healthcare, addressing the dissociation and alienation often experienced by clinicians and patients alike. Counter-examples to the philosophical narrative presented here are then offered, demonstrating the rich complexity of philosophical enquiry. The chapter closes with a brief discussion of the poem “Soul” by David Ferry, which offers a means of approaching the age-old issue of the relationship between body, mind, and spirit. Thus the authors argue that philosophical understanding—particularly in combination with literature—offers particular insight into the challenges and possibilities of healthcare today.

Ethical Care of the Critically Ill Child: a conception of a ‘thick’ bioethics

In this article I argue for an interpretive approach to bioethics with critically ill children. I begin by highlighting the dominant Anglo-American bioethical framework that defines standards for ethical care in critically ill children and then outline a critique of this framework. Drawing predominantly on the ideas of Charles Taylor, Michael Walzer and Richard Zaner, I call for a reconception of bioethics and propose an interpretive ‘thick’ framework that is centred on culture and context. Finally, I illustrate this interpretive approach through a comparative study of two cases in pediatric intensive care: the narratives of Marc and Larry. These case studies reveal that ethical dilemmas in pediatric critical care can be traced to relational tensions over respect, trust and power rooted in the disparity of moral horizons among the persons involved.