Stuart J. Murray

On the constitution and status of ‘evidence’ in the health sciences

Abstract Drawing on the philosophy of Michel Foucault and Gilles Deleuze, this paper interrogates the constitution of ‘evidence’ that defines the evidence-based movement in the health sciences. What are the current social and political conditions under which scientific knowledge appears to be ‘true’? Foucault describes these conditions as state ‘science’, a regime that privileges economic modes of governance and efficiency. Today, the Cochrane taxonomy and research database is increasingly endorsed by government and public health policy makers. Although this ‘evidence-based’ paradigm ostensibly promotes the noble ideal of ‘true knowledge’ free from political bias, in reality, this apparent neutrality is dangerous because it masks the methods by which power silently operates to inscribe rigid norms and to ensure political dominance. Through the practice of critique, this paper begins to expose and to politicise the workings of this power, ultimately suggesting that scholars are in a privileged position to oppose such regimes and foremost have the duty to politicise what hides behind the distortion and misrepresentation of ‘evidence’.

Phenomenology, ethics, and the crisis of the lived‐body

mind or abstract body? And how might this understanding figure in the transformation of ethical care? Husserl claims that the life-world (Lebenswelt) and the lived-body (Leib) have been ‘forgotten’, ‘surreptitiously substituted’ (p. 48) by the historical sedimentations of technoculture and tradition, ‘fashionable prejudices and their phraseologies’ (p. 289). If the forgotten life-world and lived-body are themselves foundational, i.e. historically and ontologically prior to the fashionable prejudices and appearances that surreptitiously take their place – such as institutionalized biomedicine and bioethics – Husserl nevertheless acknowledges that a direct return to origins would be too onerous, if not impossible, to carry out (p. 363). We cannot simply reclaim the lived-body and the life-world. Der Traum is ausgeträumt – the dream of origins is over, dreamed-up, dreamed-out (p. 389). So, while he calls for us to ‘re-activate’ and ‘re-vitalise’ these origins, this activity can only occur in medias res, ‘a praxis in which those imperfectly determining thing-representations make up the material’ (p. 345). Husserl takes as his representative example geometry, which figures largely in The Crisis and in its famous appendix, ‘The Origin of Geometry’; this text has been the subject of numerous commentaries, including Derrida’s (1989). Husserl’s guiding question is: ‘how does geometrical ideality (just like that of all sciences) proceed from its primary intrapersonal origin, where it is a structure within the conscious space of the first inventor’s soul, to its ideal objectivity [ideale Gegenständlichkeit]?’ (pp. 357–358). In other words, how is the original ‘intrapersonal’ idea transmitted historically, how does it become ‘objective’ for us, and furthermore, how can we locate this epistemic ‘object’ as it has become increasingly abstract and disembodied across the course of history – much as ‘crisis’ itself has lost its body? Husserl argues that it is the duty of the community of scientists to carry out this task, reflectively, philosophically. While Husserl does not use the term, I would call this a rhetorical and ethical appropriation of the tradition, resisting the blind application of ready-made rules, concepts, and theorems that are transmitted through the ‘seduction of language’ (p. 362). This is a properly rhetorical endeavour because it is in the midst of linguistic representations that the ideal objectivities are to be found: ‘it belongs to their objective being that they be linguistically expressed and can be expressed again and again; or, more precisely, they have their objectivity, their existence-foreveryone, only as signification, as the meaning of speech’ (p. 357n).And it is rhetorical because we must attend to how meaning is transmitted through speech, ‘in the “how” of the manners of givenness and in the onta themselves, not straightforwardly but rather as objects in respect to their “how” . . . throughout the alteration of relative validities, subjective appearances, and opinions’ (p. 144). The ‘how’ is the work of Phenomenology, Ethics, and Crisis 291

Experiencing Seclusion in a Forensic Psychiatric Setting: A Phenomenological Study.

ABSTRACT In hospital settings, and especially in forensic psychiatric ones, restlessness, aggression, and even violence are familiar issues to healthcare workers. Under these circumstances, the need for restrictive measures (seclusion, mechanical/chemical restraints) is sometimes needed. Although such measures should be considered as exceptional interventions, they continue to be widespread in general, psychiatric, and forensic psychiatric settings. Although there is a great deal of literature on a myriad of issues associated with the use of seclusion, very little research has focused on the lived experience of the seclusion room in forensic psychiatric settings, whether from the patient’s perspective or from the perspective of nursing staff responsible for these patients. Such an examination could help ameliorate the experience of secluded forensic psychiatric patients while informing nursing staff about the impacts of seclusion. This article reports the results of a federally funded qualitative, phenomenological research study conducted in a Canadian forensic psychiatric environment. Our results show that the “structure of place” matters for both patients who experience seclusion and nursing staff who work therapeutically in these settings. “Place” is irreducible to the physical “space” in which bodies find themselves; this study of place took into consideration the ways the lived body experiences seclusion and interrelates with others. Although there can be no doubt that many patients who experience seclusion are oftentimes objectively at risk, with a heightened potential to self-harm and to harm other inpatients and nursing staff as well, as our study participants attested, the bodies secluded in this space are not “objects.”

HIV, Viral Suppression and New Technologies of Surveillance and Control

The global response to managing the spread of HIV has recently undergone a significant shift with the advent of ‘treatment as prevention’, a strategy which presumes that scaling-up testing and treatment for people living with HIV will produce a broader preventative benefit. Treatment as prevention includes an array of diagnostic, technological and policy developments that are creating new understandings of how HIV circulates in bodies and spaces. Drawing on the work of Michel Foucault, we contextualize these developments by linking them to systems of governance and discursive subjectivation. The goal of this article is to problematize the growing importance of viral suppression in the management of HIV and the use of related surveillance technologies. For people living with HIV, we demonstrate how treatment-as-prevention’s emphasis on individual and collective viral load is transforming the performative dimensions of embodied risk, affect, subjectivity and sex.

An extrapolation of Foucault’s Technologies of the Self to effect positive transformation in the intensivist as teacher and mentor

In critical care medicine, teaching and mentoring practices are extremely important in regard to attracting and retaining young trainees and faculty in this important subspecialty that has a scarcity of needed personnel in the USA. To this end, we argue that Foucault’s Technologies of the Self is critical background reading when endeavoring to effect the positive transformation of faculty into effective teachers and mentors.

Cutting Both Ways: On the Ethical Entanglements of Human Rights, Rites, and Genital Mutilation

Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content.

Affirming the Human? The Question of Biopolitics

This article stages a rhetorical encounter between Heidegger and Foucault, positing the topos of care to critique the recent turn to “affirmative” biopolitics. For both thinkers, “the question of the human” redounds upon a subject whose being is constituted tropologically, yet “affirmative” biopoliticians misunderstand the rhetoricity of the human question and are caught within a neoliberal ethic. Reading Heidegger’s use of a first-century CE fable in Being of Time alongside Foucault’s final lectures on the fabled death of Socrates and the care of the self, this article explores their rhetorical strategies of self-constitution as a relation of chresis and care.

Seclusive Space: Crisis Confinement and Behavior Modification in Canadian Forensic Psychiatric Settings

This essay offers a theoretical reflection emerging from the a u thors’ qualitative empirical studies examining ethical practice and mental health care in Canadian forensic psychiatric settings. Forensic psychiatry is a specialized area of psychiatry LUI!Ling the fields of mental health, law, and criminology. Forensic psychiatry implies the use of (para)medical psychiatric knowledge or ‘opinion’ concerning patients who have legal issues. According to the American Academy of PsychiaLry and the Law, forensic psychiatry involves ‘’civil, criminal, correctional, regulatory or legislative matters, and ... specialized clinical consultations in areas such as risk assessment or employmenL’ (AAPL 2005). While Lhe AAPL’s eLhics guidelines acknowledge the ‘special hazards’ and ‘potential for unintended bias’ in the practice of forensic psychiatry—particularly in the courtroom — the Academy urges its members Lo ‘minimize such hazards’ and to ‘strive’ to reach an ‘objective opinion’ (AAPL 2005). Our research focuses on the clinical use of forensic psychiatry within correctional facilities, where it is applied to a cap Live population of inmaLes who have been diagnosed with a mental disorder linked, in some respects, to their incarceration.

Allegories of the Bioethical: Reading J.M. Coetzee’s Diary of a Bad Year

This essay reads J.M. Coetzee’s novel, Diary of a Bad Year, as an occasion to problematize contemporary bioethical (and neoliberal) paradigms. Coetzee’s rhetorical strategies are analyzed to better understand the “scene of address” within which ethical claims can be voiced. Drawing on Foucault’s Socratic understanding of ethics as the self’s relation to itself, self-relation is explored through the rhetorical figure of catachresis. The essay ultimately argues that the ethical voice emerges when the terms—terms by which I relate to myself, to others, to my own body, and to the bodies of others—are themselves subject to catachrestic refiguration.

Mort d’Ashley Smith : entre bio-politique carcérale et souveraineté judiciaire

Cet article constitue une relecture critique des circonstances entourant la mort d’Ashley Smith, une jeune femme decedee des causes d’asphyxie par auto-strangulation alors qu’elle avait ete placee en isolement administratif par le Service correctionnel du Canada (SCC). La mort de Smith a ete qualifiee d’« homicide » par un jury a la suite de l’enquete du coroner pour ensuite etre qualifiee de « suicide » par le Service correctionnel du Canada (SCC) dans sa reponse aux conclusions de l’enquete. La confusion qui regne au sujet de la cause precise de la mort d’Ashley Smith seme le doute sur la ou les personnes responsables de la mort de Smith dont le deces ne peut etre que le resultat d’une action directe, d’une part, ou un drame attribuable a une negligence systemique, d’autre part. En s’appuyant sur la distinction theorique-historique, proposee par Michel Foucault, entre pouvoir souverain et biopolitique, notre analyse montre que la mort de Smith est un effet de pratiques biopolitiques ayant cours au sein des etablissements correctionnels. Nous estimons par ailleurs que la reponse du Service correctionnel du Canada aux conclusions de l’enquete montre de maniere flagrante comment le SCC esquive ses responsabilites : il invoque une prerogative juridique (et souveraine) sur les personnes dont il a la garde, et ce dans le but de masquer ses implications bio-politiques.