This article explores affectivity, temporality, and their interrelation in patients who contracted COVID-19 during the first wave of the pandemic in Sweden and with symptoms indicative of post-COVID-19 Condition (PCC) that remained one year after the infection. It offers a qualitative phenomenological philosophy analysis, showing how being ill with acute COVID-19 and with symptoms indicative of PCC can entail a radically altered self-world relation. We identify two examples of pre-intentional (existential) feelings: that of listlessness and that of not being able to sense what is real and not real, both of which, in different ways, imply a changed self-world relation. We offer an analysis of intentional feelings: how the fear of not “returning” to one’s previous self and the hope of such a return weave together the present and the absent, as well as the past and the future, in ways that make the future appear as constricted, disquieting, or lost. We argue that a phenomenological differentiation among experiences of living with symptoms indicative of PCC—through attention to the way intentional affectivity and pre-intentional affectivity help shape the embodied self’s attunement to the world—is apt to yield a better understanding of the variations within these experiences and contribute to clinical practice.

Background At the onset of the Covid-19 pandemic, it became clear that some individuals experienced lingering symptoms after the infection. This condition, known as post Covid-19 condition (or long Covid), is defined by WHO as persistent or new symptoms 3 months after the initial infection, lasting for at least 2 months, and not attributable to another diagnosis. Hence, the definition is very broad. Aim This study aims to examine how post Covid-19 condition as a diagnosis is viewed and interpreted by Swedish stakeholders, showing how these understandings carry a range of epistemological tensions. The study also seeks to understand the implications of these epistemological tensions for treatment and care organisation. Methods Qualitative interviews with 36 experts and key individuals in Sweden have been conducted. Result Experts agree that post Covid-19 condition is a complex syndrome and that persons who suffer are in need of care. However, several tensions in post Covid-19 condition as a diagnosis can be discerned. Most experts agreed on the gender and racial disparity where white women with Swedish background were a majority of post Covid-19 sufferers, while migrant patients and the elderly are largely absent. In relation to social categories, the question if children can have post Covid-19 condition is here a highly contested question. There is also disagreement on the aetiology of post Covid-19 condition, with some experts viewing it as a new, unique condition requiring specialised treatment, while others see it as similar to other post-viral conditions, treatable in primary care. Conclusion The article concludes that experts are divided in their understanding and that this affects Swedish policy on post Covid-19 care and treatment, showing that post Covid-19 condition is not only a medical issue but also a political battleground where science, expert opinion and patient experience shape policy. Patient and Public Contribution The article focuses on studying stakeholders' perspectives as these are key for informing public opinion and policy. In this article, all main organisations and authorities involved in post Covid-19 care are represented. We also see patients as crucial stakeholders and representatives of patient organisations, as well as representatives of some migrant communities, who have been interviewed. The latter were included to gain insights from groups that were largely absent in post Covid-19 care.

Several of the most debilitating symptoms in medi-cine, such as fatigue and pain, are highly non-specific and both difficult for the patient to describe and for the caregiver to interpret. The underlying factors con-tributing to such symptoms are often complex and multiple. Our purpose is to develop a cross-analysis methodology, developed from within an enactive in-terpretation of the biopsychosocial model that allows for a focus on neuroscientific, physiological, and expe-riential aspects of the person as a living being in their sociocultural world, and to do so in order to achieve a more holistic and clinically clarifying way of understan-ding complex conditions, such as post-COVID fatigue. Traditionally conceived, the biopsychosocial model of disease acknowledges this complexity, but does not as such suggest how to capture it for clinical or re-search purposes. In this paper, we propose a radically interdisciplinary approach, where experts from basic medical science, clinical medicine, psychology, pheno-menology, and ethics collaborate, each with their spe-cific perspectives and methods. We then combine and enrich the obtained results through a cross-analysis. We suggest that an enactively modernized biopsycho-social framework is especially suitable for this collabo-ration, as it acknowledges the close interrelation bet-ween mind, body, and environment, and can facilitate cross-analyses of data in this project.

Through identifying “carrier status,” preconception expanded carrier screening aims to provide prospective parents with information about their reproductive likelihood of conceiving a child with a genetic condition. This article presents an empirical ethics analysis of this form of screening, hence combining qualitative interviews with a critical ethical analysis, with the aim of examining ethical aspects of “carriership.” The thematic analysis of the qualitative interviews showed a relationship between responsibility and carriership, and three aspects were identified in what is here called preconceptual reproductive carrier responsibility: a view of the self as genetically at risk, a normative claim about the responsibility to engage with the screening technique in order to prevent suffering, and responsibility as being future-oriented. The article is contextualized against the theory of biomedicalization and feminist ethical perspectives on responsibility as part of a social and cultural practice. It is claimed that responsibility can function regulatively, where socially constructed norms of what counts as responsible action can limit what a couple understands as being required of them. This calls for further reflection on individual autonomy within this screening practice, acknowledging that genetic technology shapes and changes social attitudes to responsibility in relation to reproduction and that couples’ choices are situated within such contexts.

Jag ser bilder flimra förbi av liminal spaces, liminala utrymmen, som bilden av ett tomt väntrum där ett starkt lysrör utgör den enda ljuskällan. Det kalla ljuset över de orangea plaststolar och den slitna plastmattan skapar en ödesmättad känsla. Bilderna på liminala utrymmen präglas ofta av en tomhet, något öde, en plats där frånvaron av det mänskliga blir stark påträngande. Liminala utrymmen kan ses som ett slags mellanrum. Ett väntrum är ett bra exempel då det ska leda in till ett annat rum där något viktigt ska ske, kanske en läkarundersökning, ja själva orsaken till att man uppehöll sig i väntrummet. Men i sig självt är det liminala utrymmet, mellanrummet, sällan något som ses som centralt i sig självt. “Liminalitet” som begrepp fäster vår blick på just mellanrummet, men i en bredare bemärkelse än som fysisk plats. Ursprungligen användes det inom antropologisk forskning om övergångsriter där den liminala fasen är det stadium då en person befinner sig på väg från en position och status till en annan. Tankegången som framfördes var att övergångsriten hade tre delar. Personen som genomgår riten lämnar symboliskt den status man socialt var förankrad i, går in den liminala fasen – det mellanrum, den övergång där personens status eller roll socialt sett är oklar – för att slutligen accepteras i sin nya sociala roll. När idén vidareutvecklades beskrevs den liminala fasen som ett sårbart stadium och situationen kan på många sätt liknas vid ett socio-kulturellt limbo, personen är inte kvar i sin gamla position och har ännu inte intagit sin nya, allt som finns är själva övergången. Det är också från det latinska ordet för övergång, limen, som ordet har sitt ursprung. Med hjälp av tidigare forskning som analyserar graviditet och missfall via teorier om liminalitet utforskar jag i det här kapitlet sorgen efter missfall som en ”mellanrummets sorg”.

Preconception expanded carrier screening (PECS) informs prospective parents about the risk of conceiving a child with a heritable genetic condition. PECS will also, for many, become an important screening test, and websites will likely play a vital role in providing information on this practice. The aim of this article is to examine rationalities in the information on PECS on Dutch websites. The method used is multimodal critical discourse analysis. This method allows an examination of norms and assumptions in the descriptions, as well as of the positions that are discursively made available. The data consist of publicly available material on websites from two genetics departments in the Netherlands. In the results, we present the three main discourses and subject positions that were identified: risk and the couple as possible mediators of severe conditions; the focus on scientific facts and rational conceivers; and severity of the conditions and the responsible couple. In this study, we highlight the importance of acknowledging the interrelation between epistemology and ethics in the discourse on PECS. Finally, it is claimed that the focus on scientific facts in information on PECS risks making existential and ethical dilemmas and choices invisible.

Patients in need of palliative care are often described as vulnerable. Being vulnerable can sometimes be interpreted as the opposite of being autonomous, if an autonomous person is seen as an independent, self-sufficient person who forms decisions independently of others. Such a dichotomous view can create a situation where one has experiences of vulnerability that cannot be reconciled with the central ethical principle of autonomy. The article presents a feminist ethical perspective on the conceptualisation of vulnerability in the context of palliative care. It does so through the lens of the concepts of inherent and pathogenic vulnerability from the taxonomy on vulnerability suggested by Mackenzie et al. To differentiate between forms of vulnerability, is important since even though vulnerability can be regarded as a shared life condition it can be the product of practices creating harm to the patient. The article also presents an analysis of how vulnerability can be included in the interpretation of the ethical principle of autonomy, in order to be relevant in palliative care where vulnerability is salient, namely, as relational autonomy. Furthermore, two practical implications for nursing practice are suggested. Firstly, to acknowledge vulnerability as a shared life condition one needs training in order to neither be overwhelmed by ones own vulnerability, nor become invulnerable when facing vulnerability in others. Secondly, to foster relational autonomy includes navigating between the patient exercising their autonomy within a framework of relations, and shielding the patient from paternalistic practices. Nurses could be particularly suited for this role, which includes creating an environment which is open and supportive; navigating between patient, family and staff; seeing and acknowledging the complex situation in which patient autonomy is actually played out; and promoting patient autonomy.