Heart and Soul

The lead article in this January‐February 2021 issue—the first of the Hastings Center Report's fiftieth year of publication—does not set out to change medicine. It tries instead to understand it. In “A Heart without Life: Artificial Organs and the Lived Body,” Mary Jean Walker draws on work in phenomenology and on empirical research with people who have received artificial heart devices to argue that such devices may have two very different effects on how a patient experiences the body and the self. Several other pieces in this issue address the ongoing slew of patient care and health policy problems surrounding the Covid‐19 pandemic, and a special report titled Democracy in Crisis: Civic Learning and the Reconstruction of Common Purpose considers the requirements for public involvement in policy‐making about bioethical issues.     

ADHD and Temporality: A Desynchronized Way of Being in the World

ADHD is, I argue, an impairment in sense of time and a matter of difference in rhythm; it can be understood as a certain being in the world, or more specifically, as a disruption in the experience of time and a state of desynchronization and arrhythmia. Through excerpts of interviews with adults diagnosed with ADHD and observations, I illustrate how impairment in time is manifested in an embodied experience of being out of sync. I suggest that the experience of ADHD is characterized as 1) an inner restlessness and bodily arrhythmia; 2) an intersubjective desynchronization between the individual and its surroundings; and 3) a feeling of lagging behind socially due to difficulties in social skills. In closing, I argue that an increasingly accelerating society is augmenting the experience of being out of sync rather than eliminating it.     

Deception,Pain, and Placebo: Applying the Brummett-Salter Deception Framework

In this commentary, I explore the usefulness of the framework Abram Brummett and Erica K. Salter present in their article “Mapping the Moral Terrain of Clinical Deception.” Deception cases are divisive because they nearly always evoke the metadilemma of clinical ethics: a clash between duties (in these cases, truth telling) and consequences (whatever good might come of the lie). Here, I describe a patient case in which the clinical team considered deceiving a patient about his pain-medicine dosage in exchange for his allowing the clinicians to properly care for his percutaneous endoscopic gastrostomy tube stoma, so as to prevent infection. Applying the framework that Brummett and Salter have developed helped our clinical team parse the numerous complex issues involved. The nuances of our case also illustrated additional ways in which the ethics of deception needs to be further refined.     

Your Father's a Fighter; Your Daughter's a Vegetable: A Critical Analysis of the Use of Metaphor in Clinical Practice

There are two widespread beliefs about the use of metaphors in clinical medicine. The first is that military metaphors are harmful to patients and should be discouraged in medical practice. The second is that the metaphors of clinical practice can be judged by and standardized in reference to neutral criteria. In this article, I evaluate both these beliefs, exposing their shared flawed logic. This logic underwrites the false empiricist assumptions that metaphorical language and literal language are fundamentally distinct, play separate roles in communication, and therefore can be independently analyzed, systematized, and prescribed. Next, using the resources of ordinary language philosophy, I lay out a theoretical view of medical metaphors that is grounded in metaphor use within clinician-patient relationships. Finally, drawing on the work of philosopher Max Black, I diagram a practical conceptual framework for clinicians to use when they consider whether a metaphor is appropriate for a specific patient encounter.     

Neuromodulation Technologies and the Regulation of Forms of Life: Exploring,Treating, Enhancing

ABSTRACT

Deep brain stimulation (DBS) is one of the most innovative treatments for a range of neurological and psychiatric conditions. As the practice spreads worldwide, this invasive neurosurgical technology has become the subject of major social, scientific, and ethical concerns about its regulation. In this article, I describe its implementation in a French neuroscience ward and the different forms of practice that structure and promote the development and circulation of this neuromodulation technology. I explore how alternative experimental uses of DBS and deviations from its original therapeutic objectives both interfere with and promote its dissemination. At first, it appeared that neuroscientists could use DBS as a powerful tool to create reproducible experimental human models of emotional or behavioral symptoms so as to explore the functions of the human brain in vivo. In parallel, implanted patients influenced the care program by viewing DBS as a potential technology of self-enhancement for a wide range of personal situations. These alternative uses of DBS have challenged its modes of regulation and standardization and have raised new medical, scientific, and moral controversies. These concern not only ethical and methodological norms of medical and scientific practices but also the anthropological tensions raised by the forms of life that are emerging from neuroscience and experimental practices.