This article explores an example of person-centred care: the work of so-called renal care coordinators. The empirical basis of the article consists of qualitative interviews with renal care coordinators, alongside participant observations of their patient interactions. During the analyses of the empirical material, I found that one of the coordinators’ most fundamental ambitions is to get to know who the patient is. This is also a central tenet of person-centred care. The aim of the article is not only to argue for the plausibility of this tenet, but also, and more importantly, to highlight and explore its implications in the context of healthcare, through the example of renal care coordination. By drawing on the philosophy of Hannah Arendt, the article shows that the disclosure of who the patient is that takes place in person-centred care requires speech and action, which are modes of human activity that initiate processes characterized by unpredictability, uncertainty, and irreversibility. This unpredictability, uncertainty, and irreversibility, found to be inherent in person-centred care, is then discussed in relation to the pursuit of certainty characterizing contemporary evidence-based medicine. At the end of the article the conclusion is drawn that, if healthcare is to be person-centred, it must find ways of accommodating the contradictory pursuits of certainty and uncertainty found in evidence-based medicine and person-centred care respectively.

While the value of early detection of dementia is largely agreed upon, populationbased screening as a means of early detection is controversial. This controversial status means that such screening is not recommended in most national dementia plans. Some current practices, however, resemble screening but are labelled “casefinding” or “detection of cognitive impairment”. Labelled as such, they may avoid the ethical scrutiny that population-based screening may be subject to. This article examines conceptualizations of screening and case-finding. It shows how the definitions and delimitations of the concepts (the what of screening) are drawn into the ethical, political, and practical dimensions that screening assessment criteria or principles are intended to clarify and control (the how of screening, how it is and how it should be performed). As a result, different conceptualizations of screening provide the opportunity to rethink what ethical assessments should take place: the conceptualizations have different ethico-political implications. The article argues that population- based systematic screening, population-based opportunistic screening, and case-finding should be clearly distinguished.

In this article we explore how diagnostic and therapeutic technologies shape the lived experiences of illness for patients. By analysing a wide range of examples, we identify six ways that technology can (trans)form the experience of illness (and health). First, technology may create awareness of disease by revealing asymptomatic signs or markers (imaging techniques, blood tests). Second, the technology can reveal risk factors for developing diseases (e.g., high blood pressure or genetic tests that reveal risks of falling ill in the future). Third, the technology can affect and change an already present illness experience (e.g., the way blood sugar measurement affects the perceived symptoms of diabetes). Fourth, therapeutic technologies may redefine our experiences of a certain condition as diseased rather than unfortunate (e.g. assisted reproductive technologies or symptom based diagnoses in psychiatry). Fifth, technology influences illness experiences through altering social-cultural norms and values regarding various diagnoses. Sixth, technology influences and changes our experiences of being healthy in contrast and relation to being diseased and ill. This typology of how technology forms illness and related conditions calls for reflection regarding the phenomenology of technology and health. How are medical technologies and their outcomes perceived and understood by patients? The phenomenological way of approaching illness as a lived, bodily being-in-the-world is an important approach for better understanding and evaluating the effects that medical technologies may have on our health, not only in defining, diagnosing, or treating diseases, but also in making us feel more vulnerable and less healthy in different regards.

A large slice of contemporary phenomenology of medicine has been devoted to developing an account of health and illness that proceeds from the first-person perspective when attempting to understand the ill person in contrast and connection to the third-person perspective on his/her diseased body. A proof that this phenomenological account of health and illness, represented by philosophers, such as Drew Leder, Kay Toombs, Havi Carel, Hans-Georg Gadamer, Kevin Aho, and Fredrik Svenaeus, is becoming increasingly influential in philosophy of medicine and medical ethics is the criticism of it that has been voiced in some recent studies. In this article, two such critical contributions, proceeding from radically different premises and backgrounds, are discussed: Jonathan Sholl's naturalistic critique and Talia Welsh's Nietzschean critique. The aim is to defend the phenomenological account and clear up misunderstandings about what it amounts to and what we should be able to expect from it.

In “Dying Bodies and Dead Bodies: A Phenomenological Analysis of Dementia, Coma, and Brain Death,” Fredrik Svenaeus investigates how we should look upon the death of persons and their bodies, especially in cases in which they appear to split ways. The chapter makes use of the work of Martin Heidegger, Hans Jonas and other phenomenologists to argue that although life and death are to be understood on a bodily level, the ontological and ethical analyses of dying need to be complemented by a phenomenology of how persons may gradually disappear in power of being constituted by bodily processes that are breaking down. In this analysis, a continuous scale of different levels of personhood is introduced and compared to some influential views on the essence of human being and death in contemporary medicine and bioethics.

In On the Problem of Empathy Edith Stein claims empathy to be a three-step process in which the experiences of the other person (1.) emerge to me as meaningful in my perception of her, I then (2.) fulfil an explication of these experiences by following them through in an imaginative account guided by her, in order to (3.) return to a more comprehensive understanding of the experiences of the other person. Stein obviously intends the phenomenon of empathy to be importantly related to (A.) the project of getting to know more about the experiential world of the other person, as well as (B.) the project of developing an ethics centred around the notion of spirit (Geist) and personhood. Although it is debatable whether Stein actually succeeds in fully realizing either of these aims in her book, in this chapterI intend to explore how the Steinian theory of empathy could serve both as an experientially based anchoring point of medical epistemology and as a founding ground for medical ethics. Empathy is an apt starting point for medical ethics in that it acknowledges that moral reflection begins in experiencing the suffering of a person, who is in need of help, a starting point that also connects to the question of which capabilities (virtues) a good doctor (health care professional) needs to embody. 

In this paper I aim to show with the aid of philosophers Edith Stein and Peter Goldie, how empathy and other social feelings are instantiated and developed in real life versus on the Internet. The examples of on-line communication show both how important the embodied aspects of empathy are and how empathy may be possible also in the cases of encountering personal stories rather than personal bodies. Since video meetings, social media, online gaming and other forms of interaction via digital technologies are taking up an increasing part of our time, it is important to understand how such forms of social intercourse are different from in real life (IRL) meetings and why they can accordingly foster not only new communal bonds but also hatred and misunderstanding.

In this paper I explore health and illness through the lens of enactivism, which is understood and developed as a bodily-based worldly-engaged phenomenology. Various health theories - biomedical, ability-based, biopsychosocial - are introduced and scrutinized from the point of view of enactivism and phenomenology. Health is ultimately argued to consist in a central world-disclosing aspect of what is called existential feelings, experienced by way of transparency and ease in carrying out important life projects. Health, in such a phenomenologically enacted understanding, is an important and in many cases necessary part of leading a good life. Illness, on the other hand, by such a phenomenological view, consist in finding oneself at mercy of unhomelike existential feelings, such as bodily pains, nausea, extreme unmotivated tiredness, depression, chronic anxiety and delusion, which make it harder and, in some cases, impossible to flourish. In illness suffering the lived body hurts, resists, or, in other ways, alienates the activities of the ill person.

In standard philosophical classifications of feelings, bodily pain is not considered an emotion, since it does not contain any beliefs or judgments about the world in the way that emotions do (Goldie 2000). I am mad, sad, afraid, or happy about something (not) being the case, but when I find myself in pain this intentional structure is not present. Pain is therefore classified as a pre-intentional feeling, which makes (a part of) the body appear in a specific (painful) way, which does not, however, have a proper meaning content. Bodily sensations can be of the negative sort—pains, itches, feelings of being too hot or cold—or of the positive sort—tickles, feelings of bodily comfort or orgasms—but they do not carry any cognitive content beyond this perceived painfulness or pleasantness of the body (parts).

Phenomenology has the potential of improving upon such narrow conceptions of pain by showing how it is a peculiar and many-faced form of embodied experience. To be in pain is not only to perceive parts of one’s body in a certain way but also to feel how the perceived world changes in structure and content. Accordingly, pain can be explored and understood as an embodied mood; a way of finding oneself in the world that typically leads to certain emotions of the negative type: frustration, irritation, anger, fear, sadness, self-pity or even loss of hope and trust in others (Kusch and Ratcliffe forthcoming; Svenaeus 2015, 2017, chapter 2). Such emotions, that typically occur if pain is intense and long lasting, display beliefs about the situation of the pain sufferer that are nurtured by the bodily affliction. 

In this article, a phenomenological ontology concerning in vitro embryos is developed and defended, exploring the practical implications for reproductive medical technologies. This phenomenological alternative, in comparison with other positions in bioethics, firmly takes on-board the dangers of reification of human life by advancements of medical science. The in vitro embryo is clearly not a human person, but neither is it a lump of human cells, merely. The phenomenologist should consider the embryo to be a potential human person, but also acknowledge the changes in basic ontology brought about by medical technologies when producing embryos in the laboratory. In vitro embryos, however they are made, still have a significant symbolic standing that demands respect on the strength of their biological potentiality. Such a standing could be reflected in practice by limiting the use of IVF embryos to fields of research that seek cures for severe human diseases and which cannot be pursued by other means, and by forbidding the buying and selling of human embryos. Regarding the future possibilities of not only selecting but also manipulating the genes of embryos in IVF by way of CRISPR/Cas and other technologies, the phenomenological view stresses that such interventions should not move beyond de-selecting or deleting genes that carry severe risks for developing painful and debilitating diseases. Abstaining from choosing the characteristics of children-to-be beyond the measures taken to save them from considerable, unnecessary suffering is ultimately a matter of avoiding to instrumentalize the practice of procreation. In contrast to an order-and-delivery service, the relationship between parents and their children should be thought of as an empathic and dialogic relation. At stake in this relation is not only the understanding and avoidance of unnecessary suffering but also the possibilities of human ourishing. Child-rearing should respond to the personal characteristics that a child, from birth onwards, already embodies and expresses, and continually support and guide the child’s possibilities to develop these characteristics in a successful way.

In this article I investigate the ways in which phenomenology could guide our views on the rights and/or wrongs of abortion. To my knowledge very few phenomenologists have directed their attention toward this issue, although quite a few have strived to better understand and articulate the strongly related themes of pregnancy and birth, most often in the context of feminist philosophy. After introducing the ethical and political contemporary debate concerning abortion, I introduce phenomenology in the context of medicine and the way phenomenologists have understood the human body to be lived and experienced by its owner. I then turn to the issue of pregnancy and discuss how the embryo or foetus could appear for us, particularly from the perspective of the pregnant woman, and what such showing up may mean from an ethical perspective. The way medical technology has changed the experience of pregnancy-for the pregnant woman as well as for the father and/or other close ones-is discussed, particularly the implementation of early obstetric ultra-sound screening and blood tests (NIPT) for Down's syndrome and other medical defects. I conclude the article by suggesting that phenomenology can help us to negotiate an upper time limit for legal abortion and, also, provide ways to determine what embryo-foetus defects to look for and in which cases these should be looked upon as good reasons for performing an abortion.

This is the first monograph to deal with medicine as a form of hermeneutics, now in a thoroughly revised and updated edition, including a whole new chapter on medical ethics. The book offers a comprehensive philosophical argument why good medical practice cannot be curtailed to scientific investigations of the body but is a form of clinical hermeneutics performed by health-care professionals in dialogue with their patients. Medical hermeneutics is rooted in a phenomenology of illness which acknowledges and proceeds from the ill party’s bodily feelings, everyday life-world circumstances and self-understanding in aiming to restore health.

The author shows how the works of classical phenomenologists and hermeneuticians – Martin Heidegger, Maurice Merleau-Ponty, Hans-Georg Gadamer and Paul Ricoeur – may be employed to understand how medical diagnosis is enveloped by professional empathy and clinical judgement and developed by scientific investigations of the patient’s bodily condition. Health and illness are ultimately considered to be ways of feeling at home or not at home in the world, and such experiences are the starting point of medical hermeneutics when aiming to make best use of scientific knowledge. The book is aimed at researchers and teachers in philosophy of medicine and medical ethics, and at physicians, nurses and other health-care professionals meeting with patients in ethically complex and challenging situations. Phenomenology and hermeneutics, most often considered as methods belonging to the humanities, are shown to be of vital importance for the understanding of medical practice and ethical dilemmas of health care.

Objectification is a real problem in medicine that can lead to bad medical practice or, in the worst case, dehumanization of the patient. Nevertheless, objectification also plays a major and necessary role in medicine: the patient's body should be viewed as a biological organism in order to find diseases and be able to cure them. Listening to the patient's illness story should not be replaced, but, indeed, developed by the physical examination of his body searching for the causes of his complaints. Whereas phenomenologists have so far mainly been identifying the back sides of objectification in medicine, in this paper the aim is to analyze differences between detrimental objectifications and objectifications that do not deprive the patient of his subjectivity but, rather, at least in some cases, may lead the patient to feel more at home with his body.

The paper presents an account of suffering as a multi-level phenomenon based on concepts such as mood, being-in-the-world and core life value. This phenomenological account will better allow us to evaluate the hardships associated with dying and thereby assist health care professionals in helping persons to die in the best possible manner. Suffering consists not only in physical pain but in being unable to do basic things that are considered to bestow meaning on one's life. The suffering can also be related to no longer being able to be the person one wants to be in the eyes of others, to losing one's dignity and identity. These three types of suffering become articulated by a narrative that holds together and bestows meaning on the whole life and identity of the dying person. In the encounter with the patient, the health-care professional attempts to understand the suffering-experience of the patient in an empathic and dialogic manner, in addition to exploring what has gone wrong in the patient's body. Matters of physician assisted suicide and/or euthanasia-if it should be legalized and if so under which conditions-need to be addressed by understanding the different levels of human suffering and its positive counterpart, human flourishing, rather than stressing the respect for patient autonomy and no-harm principles, only. In this phenomenological analysis the notions of vulnerability and togetherness, ultimately connecting to the political-philosophical issues of how we live together and take care of each other in a community, need to be scrutinized.

Alltför ofta har känslorna genom historien betraktats som en förvrängning av filosofins och vetenskapens objektiva beskrivning av verkligheten. Känslorna blir då något som vi bör sträva efter att befria oss ifrån i stället för det som utgör hjärtat av vår existens. Men det är fel. Verkligheten får i själva verket sin struktur och mening genom känslor som öppnar upp en värld som vi kan dela med andra människor. Det är känslornas skapande kraft som skiljer oss från maskiner och som gör att vi kan erövra kunskap om världen i kontrast till att bearbeta information och göra beräkningar. Boken tar sig an känslornas natur genom att kombinera filosofisk analys med empirisk forskning från biologi, psykologi och antropologi. Resonemangen illustreras med hjälp av erfarenheter av känslors makt och betydelse från vardagen och samtiden. Känslans mellanmänskliga funktion får stort utrymme, alltifrån den känsla av empati och samvaro som är avgörande för ett gott liv, till de mer problematiska gruppkänslor som växer sig starka genom massan och som kan exploateras inom politiken. Vägen går från de allra första till de allra sista känslorna från födelsen till döden och på vägen passeras de viktigaste typerna av känslor i livet, inte minst sådana som är förknippade med kärlek och lycka eller lidande och sjukdom.

One way to examine the enigmatic meaningfulness of human life is to ask under which conditions persons ask in earnest for assistance to die, either through euthanasia or physician assisted suicide. The counterpart of intolerable suffering must consist in some form of, however minimal, flourishing that makes people want to go on with their lives, disregarding other reasons to reject assisted dying that have more to do with religious prohibitions. To learn more about why persons want to hasten death during the last days, weeks or months of their lives, what kinds of suffering they fear and what they hold to be the main reasons to carry on or not carry on living, the paper offers some examples from a book written by the physician Uwe-Christian Arnold. He has helped hundreds of persons in Germany to die with the aid of sedative drugs the last 25 years, despite the professional societies and codes in Germany that prohibit such actions. The paper discusses various examples from Arnold’s book and makes use of them to better understand not only why people sometimes want to die but what made their lives meaningful before they reached this final decision.

The aim of this paper is to provide a phenomenology of uncanniness which shows that although Martin Heidegger in his path breaking analysis of existential anxiety and human finitude puts his finger on some key elements of what in German is known as “das Unheimliche”, this analysis falls short of displaying what it means to have a truly uncanny experience for reasons of neglecting the constitutive powers of embodiment and intersubjectivity. To understand the true nature of the uncanny, we should turn to experiences of automata, corpses, ghosts and doubles found in horror stories and to the lives of persons afflicted by certain mental disorders, such as Cotard syndrome and Capgras delusion. To feel and perceive oneself to be dead (Cotard syndrome) or family members to have been replaced by impostors (Capgras delusion) are not only more profoundly uncanny experiences than facing the general meaninglessness of life, targeted by Heidegger; they are in many ways experiences that can teach us more about the phenomenology of being-in-the-world than Heidegger’s account of existential anxiety is able to do. The experiences reported by persons suffering from such mental disorders force us to acknowledge how all pervasive and powerful so called existential feelings can be in affording – and denying – structure and content to our perceptions and thoughts when we inhabit a world.

Since 2017, opportunistic screening for cognitive impairment takes place at the geriatric ward of a local hospital in Sweden. Persons above the age of 65 who are admitted to the ward, who have not been tested for cognitive impairment during the last six months nor have a previously known cognitive impairment, are offered the Mini-Mental State Examination and the Clock-Drawing Test. This article analyses what the opportunistic screening practice means for patients and healthcare professionals. It combines a phenomenologically-oriented focus on subjectivity and sense-making with a focus that is inspired by science and technology studies on what the tests become within the specific context in which they are used, which allows a dual focus on subjectivity and performativity. The article shows how the tests become several different, not infrequently seemingly contradictory, things: an offer, an important tool for knowledge-production, something unproblematic yet also emotionally troubling, something one can fail and an indicator that one belongs to a risk group and needs to be tested. Further, the article shows how the practice is shaped by the sociocultural context. It examines the role of the affective responses to the test for subjectivity - particularly patient subjectivity - and offers a set of recommendations, if this practice were to expand to other hospitals.