While stakeholders in hand transplantation (HTx) recognize the importance of assessing quality of life (QoL), QoL has historically been inadequately defined and measured in such assessment procedures. Current conversations related to QoL in HTx could be enhanced by a phenomenological account of the lived body-namely, by illuminating the ways in which humans develop a holistic QoL through meaningful orientation in their interactions with the world and others. This meaningful orientation involves many factors; this essay considers how QoL is shaped by temporality (how past and future inform present satisfaction), embodiment (habituated, generally unconscious, meaningful attunement to the world), and intersubjectivity (how our identity as selves is constructed through social relationships). Hands-on PhenomenologyStakeholders in vascularized composite allotransplantation-specifically, hand transplantation (HTx)-acknowledge that standard assessment of quality of life (QoL) and providing long-term enhancement of QoL to hand transplant recipients is essential for the future of HTx. 1,2 However, there is ongoing debate regarding how QoL is to be defined and measured in such assessment procedures and, furthermore, how assessments can be standardized across the unique circumstances of individual transplant recipients. 2,3 Concerns over how to assess QoL are magnified by the tendency among stakeholders and the media to overemphasize cases that have been particularly successful and without incident. 2,3 For example, the website for the Louisville program 4 provides links to the success stories of its 10 HTx patients but does not mention that one recipient completed suicide, 2 have had their hand transplants removed, or that another feels that his hand transplant is effectively useless. 2,3 Furthermore, current tools that are used to track the progress of HTx patients (Carroll; Disabilities of the Arm, Shoulder and Hand, or DASH; and Hand Transplantation Score System, or HTSS, which still needs validation 1,5 ) are primarily concerned with functionality of the hand and lack adequate metrics for evaluating QoL.Current QoL assessments of hand transplant recipients fail to appreciate how our habituated, multifaceted, and generally unconscious facilitation of our Citation
In a study in Brain (2014), Dr. Susan Harkema and her fellow researchers demonstrated that the input of an electronic epidural stimulator in the lower spinal cord of four completely paralyzed patients allowed them to regain voluntary movement in their toes, defying the longstanding scientific position regarding sensory and motor complete paralysis. Harkema herself admits that she thought this achievement was impossible at the outset, as she believed that the body is incapable of movement without receiving complex signals from the brain. Many cognitive neuroscientists continue to maintain this standpoint of Cartesian dualism. In response, I argue that the insights of Maurice Merleau-Ponty provide a possible explanation of the results of this new research. Merleau-Ponty insisted that I am my body and that the body has its own kind of knowledge about the world. This framework serves as the backdrop for recent phenomenological studies in cognitive neuroscience. In this vein, this essay will consider how Merleau-Ponty's account of embodiment provides an ample model for explaining the findings of Susan Harkema's current spinal cord research.Essays Philos (2016)17:69-93 |
What is the structure of an apology? What is an apology supposed to achieve, and how do we know when it has achieved its purpose? These questions seem pretty straightforward when we are speaking of an apology as it is traditionally conceived, which considers an explicit action that I have performed toward another individual. But how does one apologize for one's thrownness into systemic structures of inequality and violence-such as America's long history of racism toward people of color? I call this here a "political apology," which may take both national forms-such as Australia's National "I'm Sorry Day"-or personal acts-such as when a white person might apologize to a friend who is a person of color for the persistence of anti-Black racism in America. This essay will consider Emmanuel Levinas's work and how it relates to this notion of a political apology. In some respects, Levinas's thought is profoundly constructive and useful; however, his ahistorical, asymmetrical account of intersubjectivity is inadequate to explain what an apology seeks to achieve on a substantial political level. For this, I believe we must articulate a Levinasian-inspired account of the self-other relation that more adequately takes into account both parties as well as the concrete situation in which the need for apology arises.
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