Since its inception, phenomenological philosophy has engaged with empirical data of lived experiences. Recently, phenomenological philosophy itself has branched out into performing systematic qualitative research, resulting in a heterogeneous field of qualitative phenomenological philosophy. By introducing and outlining the research approach of 'Qualitative Critical Phenomenology' (QCP), this paper shows how one may conduct systemic qualitative research to lived experiences with an explicit phenomenological philosophical aim. In building on insights from various approaches within critical phenomenology, we not only give a stepwise explication of how to do QCP, we also discuss how we reflectively engage with lived experience as a research object and how key phenomenological themes - i.e. varieties of pre-/reflectivity and the phenomenological reduction - matter for designing and conducting a QCP inquiry. As such, we contribute to discussions on critical phenomenology - i.e. why it matters - but also to debates on how qualitative critical phenomenology may provide a critical lens to prevailing socio-cultural norms and their constitutive force in co-shaping perception and experience.

By drawing on Jean-Luc Nancys philosophy of ontological relationality, this article explores what it means to be a we in breast cancer. What are the characteristicsthe extent and diversityof couples relationally lived experiences of bodily changes in breast cancer? Through analyzing duo interviews with diagnosed women and their partners, four ways of sharing an embodied life are identified. (1) While being different together, partners have different, albeit connected kinds of experiences of breast cancer. (2) While being there for you, partners take care of each other in mutually dependent ways. (3) While being reconnected to you, partners (re-)relate to each other through intimacy and sexuality. (4) While being like you, partners synchronize their embodied daily lives to one another, sometimes up to the point that the self cannot be distinguished from the other anymore. These ways reveal that being a we involves complex affective, bodily encounters in which the many fault lines that both separate partners into individual selves and join them together as a unity are continuously reshaped and negotiated. Being a we may be understood as something we have to do. Therefore, in being true to the legacy of Nancy, we argue at the end of this article for a sensible praxis of sharing a life and body, particularly in breast cancer.

Conceptions of autonomy in western philosophy and ethics have often centred on self-governance and self-determination. However, a growing bulk of literature also questions such conceptions, including the understanding of the autonomous self as a self-governing independent individual that chooses, acts, and lives in accordance with her or his own values, norms, or sense of sell This article contributes to the critical interrogation of selfhood, autonomy, and autonomous decision making by combining a feminist focus on relational dimensions of selfhood and autonomy with phenomenological philosophy of the embodied self as being-in-the-world. It offers a philosophical investigation of different dimensions of bodily relational autonomy by turning to phenomenological accounts of the lived body as self-reflexive. When so doing, we hope to contribute to bridging the gap that sometimes exists between discussions of autonomy in analytic moral philosophy and of freedom and facticity in phenomenological philosophy. We see this gap as unfortunate, and hold that a nuanced understanding of autonomy and autonomous decision making can be reached if these strands of philosophy are brought into dialogue.

The 2014 film Still Alice depicts the prominent linguistics professor Alice Howland who at the age of 50 is diagnosed with early onset familial Alzheimer’s Disease (AD). The film follows Alice from her first experiences of disorientation and forgetting of words through the progression of her condition that eventually leaves her unable to care for herself. This chapter analyses the film Still Alice in order to discuss frameworks for conceptualising subjectivity in relation to dementia, and particularly AD. In one scene Alice wakes up in the middle of the night distressed that her phone is missing and in the next scene her husband finds it in the freezer in the kitchen. The viewer is under the illusion that the second scene, coming straight after the first, portrays the next morning, as Alice says “I was looking for that last night” but then John reveals that a month has passed.

While the value of early detection of dementia is largely agreed upon, population-based screening as a means of early detection is controversial. This controversial status means that such screening is not recommended in most national dementia plans. Some current practices, however, resemble screening but are labelled “case-finding” or “detection of cognitive impairment”. Labelled as such, they may avoid the ethical scrutiny that population-based screening may be subject to. This article examines conceptualizations of screening and case-finding. It shows how the definitions and delimitations of the concepts (the what of screening) are drawn into the ethical, political, and practical dimensions that screening assessment criteria or principles are intended to clarify and control (the how of screening, how it is and how it should be performed). As a result, different conceptualizations of screening provide the opportunity to rethink what ethical assessments should take place: the conceptualizations have different ethico-political implications. The article argues that population-based systematic screening, population-based opportunistic screening, and case-finding should be clearly distinguished.

This article examines a population-based opportunistic screening practice for cognitive impairment that takes place at a hospital in Sweden. At the hospital, there is a routine in place that stipulates that all patients over the age of 65 who are admitted to the ward will be offered testing for cognitive impairment, unless they have been tested within the last six months or have been diagnosed with any form of cognitive impairment. However, our analysis shows that this routine is not universally and mechanically applied. Rather, the health care professionals have developed and use an ethico-political judgment, concerning, for example, whom to test, when to offer the tests, and how to explain and perform them. This article explores the role and practice of this form of judgment, emphasising its political and ethical nature. The analysis is based on qualitative interviews with professionals and patients, and draws on the theories of Aristotle and Hannah Arendt.

In 2014, the first child in the world was born after live uterus transplantation and IVF (UTx-IVF). Before and after this event, ethical aspects of UTx-IVF have been discussed in the medical and bioethical debate as well as, with varying intensity, in Swedish media and political fora. This article examines what comes to be identified as important ethical problems and solu-tions in the media debate of UTx-IVF in Sweden, showing specifically how problems, target groups, goals, benefits, risks and stakes are delineated and positioned. It also demonstrates how specific assumptions, norms and values are expressed and used to underpin specific positions within this debate, and how certain subjects, desires and risks become shrouded or simply omitted from it. This approach—which we label the Ethics of the Societal Entrenchment-approach, inspired by Koch and Stemerding (1994)—allows us to discuss how the identification of something as the problem helps to shape what gets to be described as a solution, and how specific solutions provide frameworks within which problems can be stated and emphasised. We also offer a critical discussion of whether some of these articulations and formations should be seen as ethically troubling, and if so, why.

This article examines young women's experiences of telling others that they have no uterus and no, or a so-called small, vagina – a condition labelled ‘congenital absence of uterus and vagina’, which falls within the larger category of ‘atypical’ sex development. Our aim is to investigate how affective dissonances such as fear and frustration are expressed in young women's narratives about letting others know about their ‘atypical’ sex development, and how these women narrate desired steps to recognition. By drawing on feminist writings on the performativity of affects or emotions, we examine what affective dissonances accomplish within three identified narratives: how affective dissonances may contribute to the women's positioning of themselves vis-à-vis other individuals and how affective dissonances can imply a strengthening and/or questioning of norms about female embodiment and heterosexuality. This allows us to tease out how routes for questioning of these norms become available through the three narratives that together form a storyline of coming out about a congenital absence of a uterus and vagina in the Swedish context. Furthermore, by demonstrating how others' responses shape the women – their understandings of their own bodies, their envisaged future disclosures and their relations – our analysis highlights the multifaceted intersubjective and in other ways relational, affective and temporal dimensions of coming out about one's 'atypical' sex development.

Medical therapy, research and technology enable us to make our bodies, or parts of them, available to others in an increasing number of ways. This is the case in organ, tissue, egg and sperm donation as well as in surrogate motherhood and clinical research. Bringing together leading scholars working on the ethical, social and cultural aspects of such bodily exchanges, this cutting-edge book develops new ways of understanding them.

Bodily Exchanges, Bioethics and Border Crossing both probes the established giving and selling frameworks for conceptualising bodily exchanges in medicine, and seeks to develop and examine another, less familiar framework: that of sharing. A framework of sharing can capture practices that involve giving up and giving away part of one’s body, such as organ and tissue donation, and practices that do not, such as surrogacy and research participation. Sharing also recognizes the multiple relationalities that these exchanges can involve and invites inquiry into the context in which they occur. In addition, the book explores the multiple forms of border crossing that bodily exchanges in medicine involve, from the physical boundaries of the body to relational borders – as can happen in surrogacy – to national borders and the range of ethical issues that these various border-crossings can give rise to. 

Engaging with anthropology, sociology, philosophy, and feminist and postcolonical perspectives, this is an original and timely contribution to contemporary bioethics in a time of increasing globalization. It will be of use to students and researchers from a range of humanities and social science backgrounds as well as medical and other healthcare professionals with an interest in bioethics.

Objective Between 2016 and 2017, a population-based preconception expanded carrier screening (PECS) test was developed in the Netherlands during a pilot study. It was subsequently made possible in mid-2018 for couples to ask to have such a PECS test from specially trained general practitioners (GPs). Research has described GPs as crucial in offering PECS tests, but little is known about the GPs’ views on PECS and their experiences of providing this test. This article presents a thematic analysis of the PECS practice from the perspective of GPs and a bioethical discussion of the empirical results.

Design Empirical bioethics. A thematic analysis of qualitative semi-structured interviews was conducted, and is combined with an ethical/philosophical discussion.

Setting The Netherlands.

Participants 7 Dutch GPs in the Netherlands, interviewed in 2019–2020.

Results Two themes were identified in the thematic analysis: ‘Choice and its complexity’ and ‘PECS as prompting existential concerns’. The empirical bioethics discussion showed that the first theme highlights that several areas coshape the complexity of choice on PECS, and the need for shared relational autonomous decision-making on these areas within the couple. The second theme highlights that it is not possible to analyse the existential issues raised by PECS solely on the level of the couple or family. A societal level must be included, since these levels affect each other. We refer to this as ‘entangled existential genetics’.

Conclusion The empirical bioethical analysis leads us to present two practical implications. These are: (1) training of GPs who are to offer PECS should cover shared relational autonomous decision-making within the couple and (2) more attention should be given to existential issues evoked by genetic considerations, also during the education of GPs and in bioethical discussions around PECS.

Efter skandalen kring kirurgen på Karolinska Institutet som gjorde experimentella operationer, talas det om gråzoner i lagen. Men detta stämmer inte, utan är ett sätt att blanda bort korten, skriver en rad professorer från sex olika universitet gemensamt.

This article examines how people who are shorter than average make sense of their lived experience of embodiment. It offers a sociophenomenological analysis of 10 semistructured interviews conducted in the Netherlands, focusing on if, how, and why height matters to them. It draws theoretically on phenomenological discussions of lived and objective space, intercorporeality and norms about bodies. The analysis shows that height as a lived phenomenon (1) is active engagement in space, (2) coshapes habituated ways of behaving and (3) is shaped by gendered norms and beliefs about height. Based on this analysis, the article challenges what we label as the ‘problem-oriented approach’ to discussions about growth hormone treatment for children with idiopathic short stature. In this approach, possible psychosocial disadvantages or problems of short stature and quantifiable height become central to the ethical evaluation of growth hormone treatment at the expense of first-hand lived experiences of short stature and height as a lived phenomenon. Based on our sociophenomenological analysis, this paper argues that the rationale for giving growth hormone treatment should combine medical and psychological assessments with investigations of lived experiences of the child. Such an approach would allow considerations not only of possible risks or disadvantages of short stature but also of the actual ways in which the child makes sense of her or his height.

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Studies on surrogate motherhood have mostly explored paid arrangements through the lens of a contract model, as clinical work or as a maternal identity-building project. Turning to the under-examined case of unpaid, so-called altruistic surrogate motherhood and based on an analysis of interviews with women who had been unpaid surrogate mothers in a full gestational surrogacy with a friend or relative in Canada, the United States or Australia, this article explores altruistic surrogate motherhood as relational work. It argues that this form of surrogate motherhood within close interpersonal relations can be conceptualised through the relational work involved in hosting a child for the intended parents. The article explores how relational work in this context implies an embodied, asymmetrical and far-reaching sense of responsibility that surrogate mothers describe as characteristic of their surrogacy experience. In this way, the article sheds light on feminist concerns about surrogacy as an embodied and objectifying work of women while at the same time illuminating how surrogate mothers respond to the intended parents in light of their pre-surrogacy relationship, how meanings are negotiated by them and how relationships are managed during the pregnancy.

Although intra-familial egg donation has been practiced for more than 15 years in several countries, little is known about family relationships in this family type. Framed within the new kinship studies, this article focuses on the experiential dimension of kinship in sister-to-sister egg donation families: how is kinship unpacked and reconstructed in this specific family constellation? Qualitative data analysis of interviews with receiving parents, their donating sisters and the donor children revealed six themes: (1) being connected as an extended family; (2)disambiguating motherhood; (3) giving and receiving as structuring processes; (4) acknowledging and managing the special link between donor and child; (5)making sense of the union between father and donor; and (6) kinship constructions being challenged. This study showed the complex and continuous balancing of meanings related to the mother-child dyad, the donor-child dyad and the donor-father dyad. What stood out was the complexity of, on the one hand cherishing the genetic link with the child allowed by the sisters egg donation, while, on the other, managing the meanings related to this link, by, for instance, acknowledging, downsizing, symbolising, and differentiating it from the mother-child bond. (A Virtual Abstract of this paper can be accessed at: https://www.youtube.com/channel/UC_979cmCmR9rLrKuD7z0ycA))

Vad får vi egentligen veta när vi genomgår medicinsk screening? Hur upplever vi erbjudandet om testning eller att genomgå screening?

Det är några av frågorna som diskuteras i Screeningens mångsidighet. Texterna utgår från såväl människors erfarenheter av screening som forskning och vetenskapliga diskussioner. Skribenterna gör nedslag kring exempelvis nationella screeningprogram som mammografi och gynekologiskt cellprov, men också screening för prostatacancer, kognitiv svikt och covid–19. Även hälsoenkäter som screeningverktyg och screening av genetiska anlag som kan leda till sjukdom hos barn lyfts fram.

I sina studier belyser författarna existentiella, etiska och socio–kulturella aspekter av olika screeningpraktiker. De visar på utmaningar som oro, osäkerhet, hur risk skapas och vad den gör med en människa. Tankar kring screeningens tidsmässiga perspektiv och den väntan som uppstår blir viktiga.

Författarna är alla verksamma inom medicinsk humaniora som undersöker människors sjukdomserfarenheter och vardagliga möten med medicinska praktiker. I den här boken fokuserar de vad screening gör med oss som individer och vilka utmaningar vårt samhälle ställs inför i det sjukdomsförebyggande arbetet.

MedverkandeMartin GunnarsonBjørn HofmannEricka JohnsonLisa LindénSofia Morberg JämterudMarit SolbjørAnette WickströmKristin Zeiler

The Health Behavior in School-Aged Children (HBSC) survey contains scales intended to measure life satisfaction, mental health problems, and socioeconomic status. This article takes inspiration from science and technology studies (STS) and analyse the survey as performative. It also examines subjective meaning-making through an analysis of interviews with 15-year-old teenagers. It shows how the survey enacts the subject position of an accountable teenager and how teenagers experience the survey as sending a message about how one should live. While some teenagers experience this as positive, others narrate feelings of shame. This could be interpreted as a way for them to be accountable for themselves.

Transformation studies lean towards the more practical aspects of change processes and are not yet dealing adequately with their personal and political dimensions. They are arguably constrained in doing so in their current stances, either fixated on systems and how to control them or on individualistic values and behaviours. In this study we show the range of actually-occurring societal transformations that people face can be usefully approached through a combination of dialogical sense-making and critical phenomenology. While distinct, these approaches share a concern with experience and meaning-making, concerns which are often neglected when societal transformation becomes abstracted and alienated from people’s lives. The two approaches reveal how societal transformational change is situated, shared, embodied and laden with diverse meanings. Dialogical sense-making expands the theorisation of the experiential, personal and political dimensions of transformation and shows how the practical dimension of change is always personal and political. Critical phenomenology addresses how the experience of transformation help shape subjectivity, as a lived relation to the world, and sheds light on taken-forgranted, lived norms about bodies and transformative change. Drawing together the three spheres of transformation – the practical, personal, and political - allows a fuller grasp of the complexity in which new worlds may emerge. Through a discussion of insights from these approaches, we develop a language and framework to understand how people interact with change processes. This development allows new questions about transformative change, based on a reframing of transformations that brings them closer to people’s lives. Together these approaches broaden and deepen social-science and humanities contributions to transformation studies and sustainability science. 

Studies of transformative change have been making headway in understanding the complexity of societal transformation processes. Yet, we lack understanding of how people’s lived experiences of transformations both shape and are shaped by meaning-making processes. In addressing this gap, we make two assumptions: Firstly, change processes comprise interactions between social actors that shape the way they are made sense of and experienced by the people involved in such interactions. Secondly, such change processes involve transformative experiences, which can bring to light previously taken-for-granted dimensions of lived experience. To address this research gap, we describe two complementary tools for analysing transformations: dialogical sense-making and critical phenomenology. These approaches share a focus on the experiential and sense-making dimensions, yet ask distinctly different kinds of questions and use different methods. Dialogical sense-making explores how people create meanings around transformations through various social interactions. Critical phenomenology analyses subjectivity, lived experience and structures that make possible and help shape experience. When brought into dialogue with each other, they allow for richer analyses of how the sense or meaning of transformations is constituted in experience.

Objective

In obstetrical and gynaecological healthcare, patients often find themselves in a vulnerable position. Sensitive issues such as sexual and reproductive health are addressed and certain procedures can be experienced as abusive. According to research a lifetime prevalence of abuse in healthcare (AHC) can be assumed for 13–28% of female patients in the Nordic countries. In the present study we analyse the content of ethical documents for healthcare professionals within obstetrics and gynaecology in Sweden, in order to find out to what extent ethicalguidelines consider issues that have shown to be related to the occurrence of AHC.

Study design

We searched the literature to find empirical data on AHC. Guidelines for nurses, midwives and physicians were selected. After developing an analytical framework based on the empirical data the content of the ethicalguidelines was analysed.

Results

The various ethicalguidelines for staff working within obstetrics and gynaecology differ distinctively from each other regarding their content of issues that are related to AHC. Issues that were mostly disregarded were: considering the patient's perspective and the patients’ possible experience of violence, considering power imbalances within healthcare, sexual misconduct, how to deal with other professional's ethical misconduct and how professionals relate to each other. We found the ethicalguidelines of the International Federation of Gynecology and Obstetrics (FIGO) and of the International Confederation of Midwives to be those which contained most of the issues that have empirically shown to be important in regard to AHC.

Conclusion

While staff members from different professions may share responsibility for the same patient, their ethicalguidelines vary considerably. To become a possible resource for prevention of AHC, we suggest that ethicalguidelines in healthcare should be revised following empirical research on ethical conduct. As ethicalguidelines cannot be effective by their existence only, we would like to initiate a discussion on the function and use of ethicalguidelines in general and regarding AHC in particular. Being aware that ethicalguidelines are only a part of ethics in healthcare, however, we envision a broader approach to the aim of preventing AHC, where research is encouraged on how a virtue ethics approach could be applied.

Background: In Scandinavia 13–28% of gynecology patients have experienced abuse in health care in their life time, which contradicts the ethical obligations not to harm the patient and to protect the patient's dignity. Concerning learning to act ethically, scholars have emphasized the importance of combining theoretical and practical dimensions. This article explores Forum Play as a way of learning to act ethically in abusive situations in health care.

Method: Ten health-care workers participating in a Forum Play course took part in this study. To explore participants' experiences of Forum Play, semi-structured interviews were conducted and processed by using the grounded theory analysis techniques of coding and constant comparison.

Results: The analysis resulted in the core category “developing response–ability.” It encompasses the processes bringing about the ability to respond adequately to situations where abuse occurs and the conditions for these processes, as well as the participants' achieved understanding of the third person's potential to act in a situation with a power imbalance. Forum Play allows participants to reflect on both verbal and body language, and gives them time to enact and think through issues of moral agency.

Conclusion: The simulated reality of Forum Play offers a platform where learning to act ethically in abusive situations in health care is facilitated by providing a safe space, suspending constricting structural conditions such as hierarchies and lack of time, fostering moral imagination, allowing creativity in developing and trying out a variety of acting alternatives, and reflecting upon the observed and experienced situation.

The aim of this article is to explore nuances within the field of bodily self-awareness. My starting-point is phenomenological. I focus on how the subject experiences her or his body, i.e. how the body stands forth to the subject. I build on the phenomenologist Drew Leders distinction between bodily dis-appearance and dys-appearance. In bodily dis-appearance, I am only prereflectively aware of my body. My body is not a thematic object of my experience. Bodily dys-appearance takes place when the body appears to me as "ill" or "bad." This is often the case when I experience pain or illness. Here, I will examine three versions of bodily dys-appearance. Whereas many phenomenological studies have explored cases of bodily dys-appearance, few studies have focused on the opposite of bodily dys-appearance, i.e. on bodily modes of being where the body appears to the subject as something good, easy or well. This is done in this article. When the body stands forth as good, easy or well to the subject, I suggest that the body eu-appears to this person. The analysis of eu-appearance shows that the subject can attend to her or his body as something positive and that this attention need not result in discomfort or alienation. Eu-appearance can take place in physical exercise, in sexual pleasure and in some cases of wanted pregnancies. I also discuss, briefly, the case of masochism.

Recent years have seen a rise in the number of sociological, anthropological, and ethnological works on the gift metaphor in organ donation contexts, as well as in the number of philosophical and theological analyses of giving and generosity, which has been mirrored in the ethical debate on organ donation. In order to capture the breadth of this field, four frameworks for thinking about bodily exchanges in medicine have been distinguished: property rights, heroic gift-giving, sacrifice, and gift-giving as aporia. Unfortunately, they all run into difficulties in terms of both making sense of the relational dimensions of postmortem and live organ donations and being normatively adequate in the sense of shedding light and providing guidance on ethical concerns when body parts are donated. For this reason, this article presents a phenomenological framework of giving-through-sharing, based on Maurice Merleau-Pontys philosophy. This framework makes sense of relational dimensions of postmortem and live organ donation. It also sheds light on three highly debated concerns in organ donation ethics: indebtedness on the part of recipients, the fact that some live donors do not experience donation as a matter of choice, and the potentially painful experience of donors relatives, who need to make decisions about postmortem organ donation at a time of bereavement. It can indirectly support what may be called a normalization of bodily exchanges in medicine.

The article examines how some culturally shared and corporeally enacted beliefs and norms about sexed and racialized embodiment can form embodied agency, and this with the aid of the concepts of incorporation and excorporation. It discusses how the phenomenological concept of excorporation can help us examine painful experiences of how one's lived body breaks in the encounter with others. The article also examines how a continuous excorporation can result in bodily alienation, and what embodied resistance can mean when one has undergone or undergoes excorporation. Elaborating on the work of, among others, Maurice Merleau-Ponty, Martin Heidegger, Drew Leder, and Sarah Ahmed, I discuss incorporation and excorporation of beliefs and norms regarding sexual difference, such as beliefs and norms regarding female and male embodiment, through a reading of Jeffrey Eugenides' novel Middlesex. I also suggest that it is useful to understand the postcolonial scholar Frantz Fanon's narrative of how he could not but attend to his own skin color while living in France in the 1940s and 1950s, in terms of excorporation. Whereas these are different narratives in many ways, I regard them as helpful for clarifying what excorporation implies and what analytic work this concept can enable.

Since John Locke, regnant conceptions of personhood in Western philosophy have focused onindividual capabilities for complex forms of consciousness that involve cognition such as thecapability to remember past events and one’s own past actions, to think about and identify oneself asoneself, and/or to reason. Conceptions of personhood such as this one qualify as cognition-oriented,and they often fail to acknowledge the role of embodiment for personhood. This article offers analternative conception of personhood from within the tradition of phenomenology of the body. Thearticle presents a phenomenological analysis of joint musical activity in dementia care and outlines anintercorporeal conception of personhood based on this analysis. It also provides a philosophical basisfor the idea that others can hold us in personhood and it questions a strict one-body-one-person logicthat has pertained in much personhood debate.

According to the US National Institute on Aging and the Alzheimers Association (NIA-AA), Alzheimers disease (AD) should be understood as a biological construct. It can be diagnosed based on AD-characteristic biomarkers only, even if AD biomarkers can be present many years before a person experiences any symptoms of AD. The NIA-AAs conceptualisation of AD radically challenges past AD conceptualisations. This article offers ananalytic framework for the clarification and analysis of meanings and effects of conceptualisations of diseases such as that of AD. This framework consists of nine questions that allows us to determine how the conceptualisations of diseases, such as that of AD, link or decouple the following terms to/from each other: screening, diagnosis, pathology, disease (along the lines of what have been labelled as "biological-physiological" or "normative" conceptions of disease in philosophy of medicine), symptoms, and illness. It also includes questions regarding how specific decouplings open up for new categories through which people can understand themselves in new ways, and what spaces of possibilities specific conceptualisations (and their decouplings and linkages) open to. The article shows how specific decouplings/linkages can open up not only for the phenomena of pathologisation but also for a distinct, but related phenomenon here termed as diseasisation.

Virtue ethical approaches, with their foci on the character of the moral subject, on motivations, emotions and relationships, can enable ethics in medicine and provide fuller ethical examinations and more context-sensitive and creative solutions than can principle-based or consequentialist reasoning alone. Such reasoning can explain the persistent interest with moral virtues in medicine. Virtue ethics is seen as a valuable alternative to other ways of grappling with moral dilemmas in medicine, where a number of principles have been applied to particular cases with some considerations of possible consequences of different actions (see Pellegrino 2001, Bolsin et al . 2005, Gardiner 2003, Thomasma 2000, Tong 1998). Though the latter frameworks give valuable ethical insights, they have their limits in terms of how different principles should be valued and weighted against each other. Virtue ethical approaches are commonly concerned with the subject becoming virtuous. This requires time and continuous practice. It involves habituation. In this regard, the development of virtues shares features with the development of practical skills. In both cases, we learn by doing. Despite the fact that the learning of practical skills is an interest for phenomenologists such as Maurice Merleau-Ponty (2006), surprisingly little dialogue has taken place between virtue ethics and phenomenological traditions. Such a dialogue will arise in this text. A phenomenological analysis can deepen our understanding of how the practical know-how of virtues can feed into the subject ’ s embodied existence and perception. It can throw new light on the debated phenomenon of moral perception. And it can matter for medical ethics education. A few previous studies have elaborated a phenomenology of virtue that examines what it is like to be a virtuous person (Annas 2008) or out lined a phenomenology of skill-acquisition where acting ethically is seen as a skill (Dreyfus and Dreyfus 2004). Such studies have contributed with insights as regards the role of moral know-how in moral development. They have not, however, examined bodily dimension of learning to act ethically and becoming virtuous, in any detail. This will be done here. My aim is to examine, phenomenologically, the role of the body when becoming virtuous and what incorporation of virtues-as-skills would mean for perception . This can further explain the phenomenon of moral perception, contribute to the discussion of alternative approaches to medical ethics and particularly so to the discussion of ethical competence and the learning of ethics in medical education. The text consists of five parts. I start by briefly outlining a virtue ethical approach to medical practice along the lines of Alasdair MacIntyre (1981) and Edmund Pellegrino (1995, 2001). In this reasoning, medicine is seen as a moral practice and an activity through which certain goods, that are internal to the practice, are reached. Virtues are defined in relation to the practice, as learned qualities that promote the achievement of the internal goods of the practice. This enables a discussion of what virtues health care professionals preferably should develop in order for them to achieve the internal goods of medicine. It also opens up a discussion of moral perception in medicine, and the second part contains a short discussion of moral perception and the benefit of seeing virtues-as-skills. The third part turns to phenomenology of the body and presents some core concepts in this perspective. In the fourth part, I examine the role of the body when becoming virtuous and the fifth part examines what it would mean to say that virtues-as-skills should be incorporated, for moral perception.

With pre-implantation genetic diagnosis (PGD), genetic testing and selective transfer of embryos is possible. In the future, germ-line gene therapy (GLGT) applied to embryos before implantation, in order to introduce missing genes or replace mutant ones, may be possible. The objective of this dissertation is to analyse moral aspects of these technologies, as described by eighteen British, Italian and Swedish gynaecologists and geneticists. The objective is systematised into three parts: research interviews and qualitative analysis, philosophical analysis, and elaboration of a framework that supports the combination of analytic methods.

PGD was described as positive since it enabled some couples at risk for a genetic disease to have a child without the disease. PGD was described as in different senses ‘better’ than methods for prenatal diagnosis and selective termination of pregnancy. It was also described as positive since it provided couples at risk with one more option, even if it did not result in the birth of a healthy child. However, interviewees were concerned about the difficulty of defining and evaluating genetic disease. They were also concerned about patients’ choices, and about exaggerated use or misuse. Whereas PGD gave rise to ambivalence in terms of how to understand, describe and evaluate it, GLGT was often described as unrealistic or undesirable.

The results of the qualitative analysis are used in a philosophical analysis of the concepts of choice, autonomous choice, ambivalence, trust and ambivalence in trust relations. A set of distinct characteristics of each concept are elaborated. The results of the philosophical analysis are used in the discussion of the results of the qualitative analysis.

The study shows that the technologies imply both ‘new’ ways to perform ‘old’ medical practices and ‘new’ practices. Old moral questions are reformulated. New moral questions are added. Against the background of this, the concept of genetic identity is discussed.

Key words: empirical ethics, pre-implantation genetic diagnosis, germ-line gene therapy, qualitative research, philosophical analysis, medical progress, genetic disease, choice, autonomous choice, ambivalence, trust, genetic identity.

Studies have been made on attitudes to and experiences of women and men who have undergone pre-implantation genetic diagnosis (PGD), or who are regarded as potential users of this diagnostic method. Few studies have been conducted regarding the attitudes to and experiences of medical professionals as regards PGD. This paper reports on findings from such a qualitative study in which 18 semi-structured interviews were performed with geneticists and gynaecologists in Italy, Sweden and the UK. Interviewees emphasized, among other things, the importance of choice provision. Interviewees also told stories that indicated the many ways through which choice was feared to be hampered - or was hampered. A similar emphasis on the importance of PGD as one more alternative to choose between, for 'high-risk' couples, is not found in studies on the experiences, attitudes and views of potential, or actual, users of PGD.

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Death concept, death definition, death criterion and death test pluralism has been described by some as a problematic approach. Others have claimed it to be a promising way forward within modern pluralistic societies. This article describes the New Jersey Death Definition Law and the Japanese Transplantation Law. Both of these laws allow for more than one death concept within a single legal system. The article discusses a philosophical basis for these laws starting from John Rawls understanding of comprehensive doctrines, reasonable pluralism and overlapping consensus. It argues for the view that a certain legal pluralism in areas of disputed metaphysical, philosophical and/or religious questions should be allowed, as long as the disputed questions concern the individual and the resulting policy, law or acts based on the policy/law, do not harm the lives of other individuals to an intolerable extent. However, while this death concept, death definition, death criterion and death test pluralism solves some problems, it creates others.

The articles aim is to explore human hand allograft recipients postoperative experience of disownership and their gradual experience of their new hand as theirs, with the aid of the work of the French phenomenologist Maurice Merleau-Ponty. Many have used a Merleau-Pontinian perspective in the analysis of embodiment. Far fewer have used it in medico-ethical analysis. Drew Leders phenomenologically based ethics of organ donation and organ sale is an exception to this tendency. The articles second aim is to examine Leders phenomenologically based ethics of organ donation and organ sale. Though I find parts of Leders approach promising, I also elaborate a line of reasoning that draws on Merleau-Ponty, that does allow us to argue for certain kinds of organ donation and against organ sale-and that avoids some of the problems with Leders approach. This alternative route builds on the concept of the integrity of the body-subject.

This part briefly reviews the most important contributions made to the wide issue of Gender and Health in Europe and Latin America over the past 12 years. Particular attention is paid to historiographic production focused on the contemporary world, identifying the main research lines and taking account of the constant interactions and exchanges among different disciplines, notably sociology, anthropology and history. Relevant non-European literature in the English language has been included when new topics are developed, theoretical contributions are advanced or European and/or Latin American realities are addressed. The following types of studies are reviewed: those that incorporate feminist perspectives, specifically a gender approach, to the study of health, medicine and healthcare practices; those that study the ways in which medicine and science have explained the feminine body and the sexual difference; those that make women the subject of investigation, addressing their health, work and role in social-cultural systems of health; and those that investigate the part played by male- -female relationships in healthcare organization and in the production of ideas, norms and values related to health and disease. First, we summarize the concepts of gender and androcentrism and their interest for the history of medicine and health, proposing some methodological points for a gender approach. Second, we outline the main contributions and research lines on these issues. Finally, the results of research into gender and health are illustrated by 15 collaborations that gather documentary sources and case studies.

During the past three decades, several technologies have been developed that allow medical professionals to assess the physical status of the foetus during a woman’s pregnancy. On the one hand, it has been argued that use of these technologies can be reassuring for parents who worry that their child may have a certain genetic disease. They can receive knowledge on which to base decisions of whether to carry the pregnancy to term. It has also been argued that those who know that they are at risk of a certain genetic disease and who, therefore, dare not try for pregnancy may dare to do so thanks to the availability of these technologies. On the other hand, uses of the technologies have also been criticised for imposing psychological burdens (Hildt 2002), particularly on women (Lippman 1998). Today, technologies are not only available for assessment of the prenatal physical status of the foetus but also for the genetic diagnosis of the embryo.

Emotionally-related live organ donation is different from almost all other medical treatments in that a family member or, in some countries, a friend contributes with an organ or parts of an organ to the recipient. Furthermore, there is a long-acknowledged but not well-understood gender-imbalance in emotionally-related live kidney donation. This article argues for the benefit of the concept of just love as an analytic tool in the analysis of emotionally-related live organ donation where the potential donor(s) and the recipient are engaged in a love relation. The concept of just love is helpful in the analysis of these live organ donations even if no statistical gender-imbalance prevails. It is particularly helpful, however, in the analysis of the gender-imbalance in live kidney donations if these donations are seen as a specific kind of care-work, if care-work is experienced as a labour one should perform out of love and if women still experience stronger pressures to engage in care-work than do men. The aim of the article is to present arguments for the need of just love as an analytic tool in the analysis of emotionally-related live organ donation where the potential donor(s) and the recipient are engaged in a love relation. The aim is also to elaborate two criteria that need to be met in order for love to qualify as just and to highlight certain clinical implications.

Hur ser vetenskapen på människan 150 år efter Darwins Om arternas ursprung?Är hon fortfarande skapelsens krona, eller bara ett djur som styrs av själviska gener?Och hur är det med hennes förnuft? Är det dags att nedgradera dess betydelse?Slår evolutionsläran undan benen för all form av gudstro eller finns det en möjlighet till fredlig samexistens mellan religion och darwinism? Kan idén om det "naturliga urvalet" hjälpa oss att förstå förändringsprocesser i samhället lika väl som i naturen? Går det att förena en humanistisk och en biologistisk syn på människan?I boken, som är en del i det samtal mellan olika positioner som blir allt viktigare, hävdas att evolutionsläran åtminstone är glasklar på enpunkt: den ger inget utrymme för rasistiska spekulationer om olika etniska gruppers olika värde.Möt den mångfasetterade människan, sedd genom ett antal olika vetenskapliga prismor.Människan sedd genom olika vetenskapliga prismor

Two ethical frameworks have dominated the discussion of organ donation for long: that of property rights and that of gift-giving. However, recent years have seen a drastic rise in the number of philosophical analyses of the meaning of giving and generosity, which has been mirrored in ethical debates on organ donation and in critical sociological, anthropological and ethnological work on the gift metaphor in this context. In order to capture the flourishing of this field, this article distinguishes between four frameworks for thinking about bodily exchanges in medicine: those of property rights, heroic gift-giving, sacrifice, and gift-giving as aporia. These frameworks represent four different ways of making sense of donation of organs as well as tissue, gametes and blood, draw on different conceptions of the relations between the self and the other, and bring out different ethical issues as core ones. The article presents these frameworks, argues that all of them run into difficulties when trying to make sense of reciprocity and relational interdependence in donation, and shows how the three gift-giving frameworks (of heroism, sacrifice and aporia) hang together in a critical discussion about what is at stake in organ donation. It also presents and argues in favour of an alternative intercorporeal framework of giving-through-sharing that more thoroughly explicates the gift metaphor in the context of donation, and offers tools for making sense of relational dimensions of live and post mortem donations.

This chapter brings phenomenological philosophy to bioethics debates about decision-making in transplantation medicine in general and parental live kidney donation in specific. It clarifies why both discussions of parental live kidney donation in terms of coercion (Kärrfelt et al 2004) and as “indicative” of parents’ autonomy (if it expresses what they want or who they want to be, see Crouch and Elliot 1999) fail to make sense of the complexity of the situation. Noting that the rich literature that explores relational aspects of subjectivity and conceptualises autonomous individuals as making decisions situated within and dependent on particular social contexts (see Freeman 2011; Donchin 2001; Mackenzie and Stoljars 2000; Christman 1998; Friedman 1997) still rarely addresses the role of the body, the chapter also addresses the role of embodiment for perception and choice. It argues for the need to think-through what may be labelled as the autós of autonomy and, more precisely, the focus on one’s own, the same/sameness, oneself or one’s self that has come to characterise much autonomy discussions, via phenomenological philosophy.

The chapter is divided into three parts. First, I make use of the phenomenological understanding of the intercorporeal self as being-in-the-world, in a discussion of how pain, fear or bodily symptoms of ESRD that unfolds in the shared space of child and parent can shape both of them in relation to each other (c.f. Käll 2013; Zeiler 2014a), feed into their bodily style of being-together, and help form parents’ perception of actions ‘within’ reach for them. Second, I shift the focus from the parent–child dyad to the larger semiotic–material context of haemodialysis and kidney transplantation in Sweden. This allows for an examination of embodied and enacted normativities, through an engagement with what Martin Gunnarson (2016: 128) has identified as a ‘dominant […] orientation towards transplantation’ in Sweden and Latvia. This second part also combines the discussion of an orientation towards transplantation with that of how norms about parenthood may be incorporated and excorporated into parents’ lived bodies,4 thereby making it possible to show why the no-choice theme in previous empirical work is understandable but more disconcerting than may first be assumed. Third, I argue that the acknowledgement of intercorporeal dimensions of bodily existence (argued for in Part I) and the role of orientation (argued for in Part II) demonstrates the need for a thinking-through of the autós of autonomous decision making, i.e. the understanding of the ‘ownness’ of this decision making, in ways other than those argued for in much of the bioethical autonomy and relational autonomy literature.

Enhancement of autonomous choice may be considered as an important reason for facilitating the use of genetic tests such as preimplantation genetic diagnosis. The principle of respect for autonomy is a crucial component not only of Western liberal traditions but also of Western bioethics. This is especially so in bioethical discussions and analyses of clinical encounters within medicine. On the basis of an analysis of qualitative research interviews performed with British, Italian and Swedish geneticists and gynaecologists on ethical aspects of preimplantation genetic diagnosis, the plausibility of the notion of autonomy within reproductive medicine is discussed. The analysis of interviews indicates not only that there is a gap between theoretical discussions and concrete practice, but also that an increase in choice--paradoxically--can hamper couples' choice.