Journal of evaluation in clinical practice
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Pain has proven to be a refractory problem in US healthcare. This paper argues that starting to address this requires viewing pain-assessment as a form of sense-making that occurs between patients and providers. ⋯ Finally, section four moves beyond Rorty by linking sense-making to philosophical health. Should this prove persuasive, I will have shown an area in biomedicine where philosophy is not an 'optional add on', but a vitally important part of what should be clinical practice.
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Morita therapy is one of the leading alternative psychotherapeutic approaches that has emerged from Japan and has adapted with notable success to the mores and demands of the Western medical establishment. Although still on the margin, Morita therapy has the potential to offer a viable option for those who seek therapeutic assistance for various neuroses and psychosomatic illnesses that culminate in psychiatric symptoms such as generalized anxiety disorder, obsessive-compulsive disorder, or posttraumatic stress disorder. Diverging considerably from conventional Western psychiatric approaches, Morita therapy has its own modes of conceiving mental illness and offers distinct curative methods that are in some ways akin to the techniques of meaning-centred psychotherapies, but in many other ways are rather different. In this paper, the meaning-formation and the building of a constant sense of purpose in Morita therapy is explored, with a special focus on how these relate to creating a stable psychological framework for the client.
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Bioethics seems preoccupied with establishing, debating, promoting and sometimes debunking principles. While these tasks trade on the status of the word 'principle' in our ordinary language, scant attention is paid to the way principles operate in language. In this paper, we explore how principles relate to rules and practices so as to better understand their logic. ⋯ While general principles can be, and are, establishable in abstraction from specific practices, as they are in principlist bioethics, such principles are impotent as moral guides to action. We show that the purchase any principle has as a moral guide to action emerges from its indexical properties as a principle which has sense in a specific practice. The meaning of any principle is internal to the practice and context in which it is invoked and, therefore, principles are not kinds of master rule which dictate moral judgement in new contexts but rather chameleon-like rules which change with the contexture in which they are invoked.
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In past years, physicians have, with a certain continuity, reported increasing numbers of burnout, depression and compassion fatigue in their daily practice. These problems were attributed, not only but also, to a loss of public trust and an increase in violent behaviour of patients and family members towards medical professionals in all walks of life. Recently, however, during the breakout of the coronavirus disease 2019 (COVID-19) pandemic in 2020, there were public expressions of appreciation and respect for health care workers that almost universally have been assessed as indications of a re-establishment of public trust in physicians and appreciation for the medical professions' commitments. In other words, shared experiences of what society was in need of: the experience of a 'common good'. Those responses during the COVID-19 pandemic increased positive feelings among practicing physicians, such as commitment, solidarity, competency, and experiences concerning obligations for the common good and a sense of belonging to one and the same community for all. Essentially, these responses of raised self-awareness of commitment and solidarity between (potential) patients and medical personal point towards the social importance and power of these values and virtues. This shared domain in ethical sources of behaviour seems to hold a promise of overcoming gaps between the different spheres of doctors and patients. That promise justifies stressing the relevance of this shared domain of Virtue Ethics in the training of physicians. ⋯ Applying the four-step model may contribute to strengthening the development of moral character in medical students and residents, and decrease the negative consequences of moral distress, burnout and compassion fatigue in health care personnel. In the future, this model should be empirically studied.