Philosophy and the clinic: Stigma, respect and shame

Abstract

Since its foundation in 2010, the annual philosophy thematic edition of this journal has been a forum for authors from a wide range of disciplines and backgrounds, enabling contributors to raise questions of an urgent and fundamental nature regarding the most pressing problems facing the delivery and organization of healthcare. Authors have successfully exposed and challenged underlying assumptions that framed professional and policy discourse in diverse areas, generating productive and insightful dialogue regarding the relationship between evidence, value, clinical research and practice. These lively debates continue in this thematic edition, which includes a special section on stigma, shame and respect in healthcare. Authors address the problems with identifying and overcoming stigma in the clinic, interactional, structural and phenomenological accounts of stigma and the ‘stigma‐shame nexus’. Papers examine the lived experience of discreditation, discrimination and degradation in a range of contexts, from the labour room to mental healthcare and the treatment of ‘deviancy’ and ‘looked‐after children’. Authors raise challenging questions about the development of our uses of language in the context of care, and the relationship between stigma, disrespect and important analyses of power asymmetry and epistemic injustice. The relationship between respect, autonomy and personhood is explored with reference to contributions from an important conference series, which includes analyses of shame in the context of medically unexplained illness, humour, humiliation and obstetric violence.

Person‐specific evidence has the ability to mobilize relational capacity: A four‐step grounded theory developed in people with long‐term health conditions

“…Person‐specific evidence in a supportive relationship with an HCP indicates the importance of having a secure relationship with an HCP with advanced communication skills with whom people can share their new discoveries for the first time (Mullen, 1985). Shame, guilt, and fear of stigma (Hamann et al, 2017; Loughlin et al, 2022) may play major roles in the relationship between the person with an LTHC and the HCP, and these apparently diminish during steps one and two of cocreating person‐specific evidence and step four of making life changes. For HCPs, the ability to distinguish critically between unverified assumptions about a person and person‐specific evidence verified by the person it concerns seems central to their readiness to share the evidence with the interdisciplinary team.…”

Editorial for the 2023 philosophy thematic edition: Treating the whole person: Philosophical health

“…As recent special editions of this journal make very clear, the idea that we need to focus on the ‘whole person’, if we are to understand and better promote human health, has very much regained currency in contemporary healthcare debates 1–8 . This ‘whole‐person’ approach, dating back to the ancients, 9 requires not only understanding a person's biology, but also seeing that person as a social being whose needs, well‐being and flourishing are essentially relational in nature.…”

“…Cox's systematic analysis of patient understanding in medical decision‐making provides criteria to help practitioners in both assessing and assisting a patient's capacity to make autonomous decisions regarding their care 32 . Her article is followed by three articles that address the concerns raised in the previous health philosophy thematic edition of this journal 1 …”

“…As recent special editions of this journal make very clear, the idea that we need to focus on the 'whole person', if we are to understand and better promote human health, has very much regained currency in contemporary healthcare debates. [1][2][3][4][5][6][7][8] This 'whole-person' approach, dating back to the ancients, 9 requires not only understanding a person's biology, but also seeing that person as a social being whose needs, well-being and flourishing are essentially relational in nature. To live a human life is to be engaged with one's 'environment' in the broadest sense of this term, concerning one's interactions with other people, animals, the natural objects and the human constructions that constitute one's world.…”

“…32 Her article is followed by three articles that address the concerns raised in the previous health philosophy thematic edition of this journal. 1 In a discussion of the relationship between emotion, ethics and epistemology, Penelope Lusk's work illustrates how shaming practices in medical education can propagate epistemic injustice. 33 Maryam Golafshani develops critical phenomenologies of shame and empathy, applying them to an analysis of practitioner and patient behaviour in the context of Covid-19 vaccinations.…”