Journal of evaluation in clinical practice
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The emotional underpinnings that facilitate and complicate the practice of ethical principles like respect warrant sustained interdisciplinary attention. In this article, I suggest that shame is a requisite component of the emotional repertoire than makes respect for persons possible. ⋯ I suggest that through reflection made possible within mooded shame, physicians develop a sense of being both accountable to and alongside patients, and I explore the ties between this position and philosophical concepts of respect.
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ICD-11's diagnostic definition possesses conceptual lacunae and normative implications calling for further attention. ⋯ At least with present day medical and scientific knowledge, a complete characterization of the AN phenotype cannot be achieved without reference to psychological states of motivation. And more research, not only clinical, genetic and neurobiological but also conceptual and ethical, will be required to resolve the challenges presented by AN.
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This article returns to Goffman's early formulations of 'stigma' in outlining a critique of contemporary social scientific uses and abuses of the concept. We argue that whilst Goffman's discussion of stigma is not without its troubles, it has mostly been approached in a manner that treats the concept outside of an appreciation of stigma as a phenomenon of interaction order. ⋯ We analyse both social scientific and lay uses of the stigma concept in relation to care-experienced young children and self-harm to demonstrate the shared categorisational practices and logics that are often obscured through theoretical treatments of stigma. The recommendation is, then, that an attention to 'stigma' in care settings must begin with the conditions in and from which stigma might come to feature as a sense-making device for all parties.
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This article examines the processes that contribute to the stigmatization of a group of people typically identified as "children in care" or "looked after children." In particular, we will look at the ways that we (adults, professionals, and carers) interact with these children, based on their status as both children and members of a socially marginalized and disadvantaged group, and how these modes of interaction can inhibit dialogue-a dialogue that is needed if we are to base our conceptions regarding the needs of these children on a more accurate understanding of their experiences and perspective. The problem is particularly challenging because the very terminology we use in the care community to identify this group is a product of the damaging preconceptions that have affected our interactions with its members and, we argue, it serves to reinforce those preconceptions. Using Fricker's work on epistemic injustice, in conjunction with evidence regarding how accusations of abuse and neglect of these children have been addressed in numerous cases, we illustrate the problems we have in hearing the voices of members of this group and the harmful effects this has on their own ability to understand and articulate their experiences. ⋯ Currently, dialogue between these children and those of us charged to "look after" them is too often characterized by a lack of trust: not only in terms of the children feeling that their word is not taken seriously, that their claims are not likely to be believed, but also in their feeling that they cannot trust those to whom they might disclose abuse or neglect. The goals of the paper are modest in that we aim simply to open up the debate on how to meet this epistemic challenge, noting that there are specific problems that extend beyond those already identified for hearing the voices of other victims of epistemic injustice. Explicitly recognizing the nature and extent of the problem still leaves us a long way from its solution, but it is a crucial start.
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The aim of the present paper is to describe and discuss how recent theories about translation, bridging medical and humanistic understandings of knowledge translation, in the medical humanities can bring about a new understanding of health literacy in the context of patient education. We argue that knowledge translation must be understood as active engagement with contextual meaning, considering the understandings, interpretation, and expertise of both patient and health care provider (deconstruction of the distinction between biomedical and cultural knowledge). To illustrate our points, we will describe the case of Jim, a kidney transplant recipient who received standard patient education but lost the graft (the new kidney). ⋯ In this perspective, graft function is seen as a phenomenon that embraces translation between health as a biomedical phenomenon and healing as lived experience, and that opens for shared meaning-making processes between the patient and the health care provider. In Jim's case, this means that we need to rethink the approach to patient education in a way that encourages the patient's idiosyncratic way of thinking and experiencing, and to transform health information into a means for sustaining Jim's singular life - not biological life "in general." The patient education programme did not take into consideration the singularities of Jim's biographical temporality, with its changes in everyday life, priorities, attitudes, and values. Hence, we claim that health literacy should involve a simultaneous interrogation of the patients and the health professional's constructions of knowledge.