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Suffering, justice, and the politics of becoming.

To suffer is to undergo, to bear, to endure. Suffering exists on the underside of agency; it is as important to ethics as agency. The experience of suffering is never entirely captured by the ethical, political, medical and spiritual categories in which it is represented. Perhaps an engagement with suffering can open up hidden connections between these domains. After examining John Caputo and Friedrich Nietzsche comparatively on the relation between suffering and ethics, this essay explores the relation of the "politics of becoming" to suffering. The politics of becoming is a paradoxical process by which a new cultural identity is drawn into being and yet is irreducible to the energies and motives that spurred its initiators to action. To exemplify and think the politics of becoming is to call into question the sufficiency of existing paradigms of morality. A critical examination of the Rawlsian model of justice brings out, for example, the insufficiency of justice to the politics of becoming. It suggests the need, first, to pursue an "ethics of engagement" between several parties drawing upon a variety of sources of ethical inspiration and, second, to cultivate "critical responsiveness" to new social movements that struggle to place new identities onto the cultural register. If the latter movements sometimes modify general understandings of suffering, identity, justice and medical practice they also indicate the role cultural thinkers can play in re-examining periodically established codes of interaction between these domains.

Altruism↗

Is medicine hermeneutics all the way down?

Several recent publications have suggested that hermeneutics, the method of literary criticism, might prove to be useful in medicine. In this essay I consider this thesis with particular attention to the claim that medicine "is hermeneutics all the way down". After examining an anti-positivist critique of positivist medicine and arguing that hermeneutic interpretation involves a more radical critique of modern medicine, I examine the supposed consequences of hermeneutical universalism: relativism, skepticism and antirealism which further evaluation reveals to be only potential consequences of hermeneutics. A brief discussion of phronesis and of the possible "texts" of medicine concludes the article.

Clinical Medicine↗

Authenticity as a foundational principle of medical ethics.

Increasingly, contemporary medical ethicists have become aware of the need to explicate a foundation for their various models of applied ethics. Many of these theories are inspired by the apparent incompatibility of patient autonomy and provider beneficence. The principle of patient autonomy derives its current primacy to a large extent from its legal origins. However, this principle seems at odds with the clinical reality. In the bioethical literature, the notion of authenticity has been proposed as an alternative foundational principle to autonomy. This article examines this proposal in reference to various existentialist philosophers (Heidegger, Sartre, Camus and Marcel). It is concluded that the principle of autonomy fails to do what it is commonly supposed to do: provide a criterion of distinction that can be invoked to settle moral controversies between patients and providers. The existentialist concept of authenticity is more promising in at least one crucial respect: It acknowledges that the essence of human life disappears from sight if life's temporal character is reduced to a series of present decisions and actions. This also implies that the very quest for a criterion that allows physicians to distinguish between sudden, unexpected decisions of their patients to be or not to be respected, without recourse to the patient's past or future, is erroneous.

Cultural Diversity↗