Journal of evaluation in clinical practice
-
Charters and Heitman have recently argued that epidemic status is lost once the disease becomes 'accepted into people's daily lives and routines, becoming endemic-domesticated-and accepted'. This is a normativist, subjectivist approach to epidemic classification; that is, it is both value-laden, and dependent on the attitudes of the population. In this article, we argue for an alternative approach: a value-dependent realist account of epidemic-status. ⋯ To frame the argument we draw from complexity theory, arguing that human populations can be viewed as complex systems, and epidemic-status as an emergent property of a complex system. We propose aggregating the normative standards relevant to labeling a disease as an epidemic, and use this as our indicator for both the beginning, and the end of epidemics. An epidemic ends, we argue, once the burden of disease drops below an objective but distinctly normative 'epidemic threshold'.
-
Case Reports
The role of the lived body during the integration of the traumatic experience of the sternotomy scar: A case study.
Open heart surgery is a potentially traumatic experience for patients, thus posing a real risk to both the patient's physical and mental health as well as bodily integrity. All of these can greatly affect the emotional relationship to the sternotomy scar, the physical aspect of self-representation. Sternotomy scars mark patients for life, yet our knowledge of patients' subjective experiences is unknown. ⋯ Based on our study, it seems that the corporeal dimension of posttraumatic growth may develop after the traumatic experience of heart surgery, in which bodily intimacy with oneself and Significant Others plays a major role. In this case study, the objective reality of the heart as "sick" flesh and the "broken, pierced" bone (Körper), as well as the dissociation-and then its integration-of the lived, living body experience (Leib) are outlined. Our case study was analysed in the theoretical framework of phenomenology and psychoanalysis.
-
The evidentiary standards and epistemic models of clinical care, especially those of evidence-based medicine, are dissimilar to those used in philosophy and examination of how the two systems intersect may help clinicians make more informed treatment decisions. ⋯ We find that the medical establishment should embrace ethical evaluation as intrinsic to medical practice and that medical training and treatment guidelines should reflect this reality. Patients deserve clarity and transparency about how physicians make determinations about their treatment, and physicians should be prepared to offer explanations for those decisions.
-
Since non-directed (altruistic) kidney donors do not stand to benefit from the lengthening and strengthening of a relationship that they intrinsically value, their donations are considered to constitute the most altruistic variety of living kidney donation. ⋯ Accordingly, the expected value of becoming a living kidney donor is likely to be positive, meaning the act of doing so may be considered akin to the taking out of an insurance policy. In the context of non-directed (altruistic) kidney donation, this may diminish the extent to which such a donation is considered altruistic.
-
Despite the at least decades long record of philosophical recognition and interest, the intricacy of the deceptively familiar appearing concepts of 'disease', 'disorder', 'disability', and so forth, has only recently begun showing itself with clarity in the popular discourse wherein its newly emerging prominence stems from the liberties and restrictions contingent upon it. Whether a person is deemed to be afflicted by a disease or a disorder governs their ability to access health care, be it free at the point of use or provided by an insurer; it also influences the treatment of individuals by the judicial system and employers; it even affects one's own perception of self. ⋯ Using a series of presently contentious cases illustrate the power of the proposed framework which is capable of providing actionable and humane solutions to problems that leave the current theories confounded.