Stephen Pattison

Medical Humanities: a vision and some cautionary notes

This article aims to engender discussion about the nature and future of medical humanities. First, a normative personal vision of medical humanities as an inclusive movement is outlined. Some of the problems that may emerge if medical humanities conceives itself too narrowly are then discussed. The case of the rise of the medical ethics movement is used to show what can happen to a movement that restricts itself too quickly and then the stages of the “death course of a discipline” are described and assayed. The article concludes with a plea for medical humanities to remain a “broad church”, exploratory, pluralistic movement rather than aiming to become a paramedical academic discipline.

Need humanities be so useless? Justifying the place and role of humanities as a critical resource for performance and practice

Justifying the existence, position, and relevance of academic humanities scholarship may be difficult in the face of chronic practical needs in health care. Such scholarship may seem parasitic on human activity and performance that directly contributes to human wellbeing and health care. Here, a possible and partial justification for the importance of scholarship in the humanities as a critical resource for practice and performance is undertaken by two humanities scholars. Human identity and emotion are reflected and defined by performances, both in the traditional disciplines of the humanities, such as art and literature, and in the sciences and medicine. The critical attitude that such performances might inadvertently undermine is sustained by the humanities. The humanities disciplines ask the question: “What is it to be human?” Uncritical emotion and expression, arising, for example, from understanding developments in medicine and science, which might exclude or corrupt much that is of value in the healthcare sector and other areas of practical performance, can be constrained by this.

Theological Reflection for the Real World: Time to Think Again

Abstract This article provides an account of part of the preliminary activity undertaken in connection within a project entitled, Theological Reflection for the Real World. Using a loose, reflective empirical methodology, the authors review the reactions and responses of a small group of recently ordained clergy in the Church of England engaged in initial ministerial development to the idea of exploring methods of theological reflection. In the face of a basically negative response to the idea and practice of formal theological reflective methods, the authors consider the implications for theological education. While theological educators put formal theological reflection at the centre of practical theology, it seems possible that many students would give it a very different place. The inference from this is that perhaps methods and practices of theological reflection offered in theological education may need to be radically reconsidered.

An ethical analysis of the policies of British community and hospital care for mentally ill people.

Scant consideration has been given to the ethical implications of the policy of closing down psychiatric hospitals in favour of community care. The recent adherents of this policy in government have been enthusiastic in encouraging its implementation. This paper has three sections: a brief resumé of the history and principles of community care for the mentally ill; a discussion on the merits and de-merits of psychiatric care in the hospital and in the community; and an outline of some preliminary categories for ethical analysis.

The problem with integrity [Editorial]

In times of rapid organizational, technological and professional change, it is not surprising that words like ‘integrity’ become important. It is part of professional competence to manage multidimensional complexity, whether in terms of technical procedures or of relationships (or, more likely, both). In this context, professionals want to have some sense of personal value, probity and continuity of action and thought that guides them through confusion and moral ambiguities. They may thus seize upon the word ‘integrity’ as some kind of guarantor of appropriate behaviour. In ambiguous circumstances, personal and professional integrity forms the bulwark that will protect the beleaguered healthcare worker from the temptation to do that which is less than morally desirable, or spur him or her to do what is right. It is integrity that will reassure colleagues, patients, and members of the public that they are right to repose their trust in the conscientious groups and individuals that make up the various healthcare professions and organizations. The papers in this special edition of Nursing Philosophy emerged from a short colloquium about changing roles and relationships in health care organized by the British reflective network Think About Health in September 2009 (http://www. thinkabouthealth.com). Integrity was a key word in all the papers and discussions. These wrestled with the need to both fit in to social and organizational norms and priorities, and also to maintain a sense of personal judgment and moral direction for the sake of sanity, survival, conscience, and satisfaction. The picture of integrity that emerged is, however, far from simple and clear. Like many other important, popular concepts and usages in health care – e.g. respect – integrity itself can be conceptually, morally and practically ambiguous. Beneath quotidian, commonsensical usage lies considerable and important divergence in the understandings and practices associated with integrity. Critically understanding the range and implications of a diversity of meanings and practices is, then, important if the concept is to retain its proper value, particularly in relation to issues like conscientious objection and organizational conformity. Thus, the articles herein reveal many of the different ways in which integrity is, or might be, used, formal and informal. The first article, by Sanders, Pattison, and Hurwitz, focuses concretely on the problems confronted by the nurse in charge of an emergency department. A fundamental tension is identified between the demands that might be considered to be integral to nursing practice (and thus the appropriate care of the particular patient), and managerial imperative to meet certain targets. The issue here is not merely that the meeting of targets might compromise what the professional may judge to be good care, but more importantly that the managerial target culture undermines the professional’s sense of autonomy with shaming and humiliation. As with many concepts in morality, what ‘integrity’ means is made clearer precisely when we experience its absence. While the subsequent contributions to this volume may offer different theoretical insights and analyses, perhaps the immediacy of the experience of shame suffered by the nurse in charge will usefully pervade the reading of those papers.Edgar and Pattison may be seen to confront integrity as something demanded in morally complex and compromising situations, of which the emergency department may well be paradigmatic. They argue that integrity has a range of meanings, and they identify two main understandings and practices of integrity. Either one sees integrity as an integral and largely unchanging property of the individual, as an internal response to conscience, or one sees it in terms of social accountability and dialogue. In the latter interpretation, integrity is a process of self-reflection and learning. Exemplifying their argument particularly in relation to conscientious objection, Edgar and Pattison conclude that it is not at all clear that persons of integrity are necessarily those who have the most clear and unambiguous moral convictions. Integrity may lie in the professional’s capacity to discover the least-worst course of action,and thus at times to compromise, but always to bear witness to the value conflicts that threaten any enduring sense of purpose and autonomy. Edorial

Absent friends in medical humanities

Several humanities disciplines, including the study of modern languages and of religion and theology, can greatly enhance discussions of humane healthcare and should be encouraged to contribute more.

Reflecting on Reflection: Problems and Prospects for Theological Reflection

Summary This article is a reflective report on a symposium held in 2004 organised by Cardiff University and St Michaels College, Llandaff, and sponsored by the British and Irish Association for Practical Theology, which addressed problems and prospects in Theological Reflection. The article identifies the main themes and issues considered at the symposium by a group of around 20 British and Irish practical theologians and considers the present state of play and possible opportunities for developing reflective theological methods and theories. It contains a select bibliography of works relevant to theological reflection drawn from the membership of the symposium and details of the place where preparatory papers can be read on the web.

Counselling goes to church: Aspects of the ‘pastoral’ in John McLeod's narrative constructionist counselling and psychotherapy

Abstract A discussion is offered of the recent work of John McLeod, which explores the notion of therapy as a social process. Points of similarity between McLeods approach and notions of pastoral care are noted, such as an awareness of the relational nature of human well-being, the significance of narrative in therapeutic practice and the liminal role of carers within institutions. Points of difference are also noted, and critical questions are raised concerning McLeods understanding of how human communities can be nurtured and the possibility of McLeods model unintentionally becoming another form of therapeutic expertise. A case is made for the practical value of an on-going dialogue between McLeod and those with an interest in pastoral care.

Cause for concern: the absence of consideration of public and ethical interest in British public policy

In the UK, many fundamentally important policy decisions that are likely to affect the relationship between citizens and care services are now made at the sublegislative level and without adequate ethical consideration and scrutiny. This is well exemplified in the proposed guidance on the disclosure of information on children. A recent consultation paper by the UK government on the subject proposes an approach that seeks a simple technical solution to a complex problem, emphasising control and surveillance. This reflects pressure to be seen to act. The document fails with regard to ethical reflection appropriate to the complexity of the issue, an appreciation of complex relationships of trust, and a proper sense of the richness and complexity of the public interest. Such policies would, if implemented, fundamentally change the relationships between citizens and their carers, and among carers and the law and the state. This and similar proposals require far more ethical scrutiny and consideration of the public interest in the widest sense.

The Shadow Side of Jesus

a definite and very wide distinction between the life, teaching and theology of the man Jesus and the subsequent life, teaching and theology of the church which came after him and claims to derive its inspiration from him.~ Awareness of the supposed ’sins’ and ’corruption’ of the church and the christian tradition historically, as well as of various types of historical critical methods, has led to the attempt to distinguish the human Jesus from the community called church. In one way, the effort to save what we know of the historical