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3.
Eur J Philos ; 28(1): 199-213, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32421021

RESUMEN

We develop a broader, more fine-grained taxonomy of forms of transformative experience, inspired by the work of L. A. Paul. Our vulnerability to such experiences arises, we argue, due to the vulnerability, dependence, and affliction intrinsic to the human condition. We use this trio to distinguish a variety of positively, negatively, and ambivalently valenced forms of epistemically and/or personally transformative experiences. Moreover, we argue that many transformative experiences can arise gradually and cumulatively, unfolding over the course of longer periods of time.

5.
Lit Med ; 38(2): 248-250, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33518540
6.
Med Humanit ; 45(3): 294-303, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31371484

RESUMEN

Health research is often bounded by disciplinary expertise. While cross-disciplinary collaborations are often forged, the analysis of data which draws on more than one discipline at the same time is underexplored. Life of Breath, a 5-year project funded by the Wellcome Trust to understand the clinical, historical and cultural phenomenology of the breath and breathlessness, brings together an interdisciplinary team, including medical humanities scholars, respiratory clinicians, medical anthropologists, medical historians, cultural theorists, artists and philosophers. While individual members of the Life of Breath team come together to share ongoing work, collaborate and learn from each other's approach, we also had the ambition to explore the feasibility of integrating our approaches in a shared response to the same piece of textual data. In this article, we present our pluralistic, interdisciplinary analysis of an excerpt from a single cognitive interview transcript with a patient with chronic obstructive pulmonary disease. We discuss the variation in the responses and interpretations of the data, why research into breathlessness may particularly benefit from an interdisciplinary approach, and the wider implications of the findings for interdisciplinary research within health and medicine.


Asunto(s)
Investigación Biomédica/métodos , Disnea , Relaciones Interprofesionales , Conducta Cooperativa , Interpretación Estadística de Datos , Humanos , Comunicación Interdisciplinaria
7.
J Med Ethics ; 45(9): 592-593, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31311852

RESUMEN

In this short commentary, I reflect on the new definition of disease proposed by Powell and Scarffe. I suggest that the method they appeal to as objective, namely, rational justification, is open to several criticisms, which I outline and discuss.

8.
Eur Respir J ; 53(6)2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-31000673

RESUMEN

INTRODUCTION: Lymphangioleiomyomatosis (LAM) occurs either associated with tuberous sclerosis complex (TSC) or as sporadic disease (S-LAM). Risk factors for development of S-LAM are unknown. We hypothesised that DNA sequence variants outside of TSC2/TSC1 might be associated with susceptibility for S-LAM and performed a genome-wide association study (GWAS). METHODS: Genotyped and imputed data on 5 426 936 single nucleotide polymorphisms (SNPs) in 426 S-LAM subjects were compared, using conditional logistic regression, with similar data from 852 females from COPDGene in a matched case-control design. For replication studies, genotypes for 196 non-Hispanic White female S-LAM subjects were compared with three different sets of controls. RNA sequencing and immunohistochemistry analyses were also performed. RESULTS: Two noncoding genotyped SNPs met genome-wide significance: rs4544201 and rs2006950 (p=4.2×10-8 and 6.1×10-9, respectively), which are in the same 35 kb linkage disequilibrium block on chromosome 15q26.2. This association was replicated in an independent cohort. NR2F2 (nuclear receptor subfamily 2 group F member 2), a nuclear receptor and transcription factor, was the only nearby protein-coding gene. NR2F2 expression was higher by RNA sequencing in one abdominal LAM tumour and four kidney angiomyolipomas, a LAM-related tumour, compared with all cancers from The Cancer Genome Atlas. Immunohistochemistry showed strong nuclear expression in both LAM and angiomyolipoma tumours. CONCLUSIONS: SNPs on chromosome 15q26.2 are associated with S-LAM, and chromatin and expression data suggest that this association may occur through effects on NR2F2 expression, which potentially plays an important role in S-LAM development.


Asunto(s)
Factor de Transcripción COUP II/genética , Neoplasias Renales/genética , Neoplasias Pulmonares/genética , Linfangioleiomiomatosis/genética , Anciano , Anciano de 80 o más Años , Secuencia de Bases , Estudios de Casos y Controles , Femenino , Estudio de Asociación del Genoma Completo , Genotipo , Humanos , Internacionalidad , Modelos Logísticos , Masculino , Persona de Mediana Edad , Polimorfismo de Nucleótido Simple
12.
Theor Med Bioeth ; 38(4): 239-244, 2017 08.
Artículo en Inglés | MEDLINE | ID: mdl-28702734
13.
BJPsych Bull ; 41(2): 65-70, 2017 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-28400962

RESUMEN

It has been argued that those who suffer from medical conditions are more vulnerable to epistemic injustice (a harm done to a person in their capacity as an epistemic subject) than healthy people. This editorial claims that people with mental disorders are even more vulnerable to epistemic injustice than those with somatic illnesses. Two kinds of contributory factors are outlined, global and specific. Some suggestions are made to counteract the effects of these factors, for instance, we suggest that physicians should participate in groups where the subjective experience of patients is explored, and learn to become more aware of their own unconscious prejudices towards psychiatric patients.

14.
J Appl Philos ; 34(2): 172-190, 2017 02.
Artículo en Inglés | MEDLINE | ID: mdl-28303075

RESUMEN

This article analyses the phenomenon of epistemic injustice within contemporary healthcare. We begin by detailing the persistent complaints patients make about their testimonial frustration and hermeneutical marginalization, and the negative impact this has on their care. We offer an epistemic analysis of this problem using Miranda Fricker's account of epistemic injustice. We detail two types of epistemic injustice, testimonial and hermeneutical, and identify the negative stereotypes and structural features of modern healthcare practices that generate them. We claim that these stereotypes and structural features render ill persons especially vulnerable to these two types of epistemic injustice. We end by proposing five avenues for further work on epistemic injustice in healthcare.

15.
J Med Ethics ; 43(8): 549-557, 2017 08.
Artículo en Inglés | MEDLINE | ID: mdl-27920164

RESUMEN

Chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) remains a controversial illness category. This paper surveys the state of knowledge and attitudes about this illness and proposes that epistemic concerns about the testimonial credibility of patients can be articulated using Miranda Fricker's concept of epistemic injustice. While there is consensus within mainstream medical guidelines that there is no known cause of CFS/ME, there is continued debate about how best to conceive of CFS/ME, including disagreement about how to interpret clinical studies of treatments. Against this background, robust qualitative and quantitative research from a range of countries has found that many doctors (and medical students) display uncertainty about whether CFS/ME is real, which may result in delays in diagnosis and treatment for patients. Strikingly, qualitative research evinces that patients with CFS/ME often experience suspicion by healthcare professionals, and many patients vocally oppose the effectiveness, and the conceptualisation, of their illness as psychologically treatable. We address the intersection of these issues and healthcare ethics, and claim that this state of affairs can be explained as a case of epistemic injustice (2007). We find evidence that healthcare consultations are fora where patients with CFS/ME may be particularly vulnerable to epistemic injustice. We argue that the (often unintentional) marginalisation of many patients is a professional failure that may lead to further ethical and practical consequences both for progressive research into CFS/ME, and for ethical care and delivery of current treatments among individuals suffering from this debilitating illness.


Asunto(s)
Actitud del Personal de Salud , Atención a la Salud/ética , Síndrome de Fatiga Crónica/terapia , Conocimiento , Relaciones Médico-Paciente/ética , Médicos/ética , Justicia Social , Ética Médica , Humanos , Investigación Cualitativa , Trastornos Somatomorfos , Estereotipo , Incertidumbre
17.
Perspect Biol Med ; 58(1): 53-65, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26657681

RESUMEN

This essay recounts the author's experience of diagnosis of a rare respiratory condition in order to invite a broader reflection on the nature of diagnosis. Diagnosis is a pivotal moment in one's illness experience, and it can be viewed as both a closure of possibilities and an opening of new, unanticipated ones. The notion of anticipation is also important to the illness experience, in that anticipation and waiting characterize the illness experience generally--in waiting rooms, anticipating test results--as well as the change in one's attitude towards the future, which becomes fearsome in illness.


Asunto(s)
Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/psicología , Linfangioleiomiomatosis/diagnóstico , Linfangioleiomiomatosis/psicología , Adulto , Femenino , Trastornos del Espectro Alcohólico Fetal/diagnóstico , Trastornos del Espectro Alcohólico Fetal/psicología , Humanos , Medicina en la Literatura
20.
Med Health Care Philos ; 17(4): 529-40, 2014 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-24740808

RESUMEN

In this paper we argue that ill persons are particularly vulnerable to epistemic injustice in the sense articulated by Fricker (Epistemic injustice. Power and the ethics of knowing. Oxford University Press, Oxford, 2007). Ill persons are vulnerable to testimonial injustice through the presumptive attribution of characteristics like cognitive unreliability and emotional instability that downgrade the credibility of their testimonies. Ill persons are also vulnerable to hermeneutical injustice because many aspects of the experience of illness are difficult to understand and communicate and this often owes to gaps in collective hermeneutical resources. We then argue that epistemic injustice arises in part owing to the epistemic privilege enjoyed by the practitioners and institutions of contemporary healthcare services--the former owing to their training, expertise, and third-person psychology, and the latter owing to their implicit privileging of certain styles of articulating and evidencing testimonies in ways that marginalise ill persons. We suggest that a phenomenological toolkit may be part of an effort to ameliorate epistemic injustice.


Asunto(s)
Atención a la Salud/ética , Conocimiento , Filosofía Médica , Enfermedad/psicología , Humanos , Justicia Social/ética
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