Aims and Objectives
To explore the notion of Being‐with and authentic discourse for people making decisions about major amputation.
Background
Chronic limb‐threatening ischaemia is a devastating ...disease with a high burden of pain and complex wounds. Patients may deteriorate suddenly after multiple revascularisation procedures and, amputation is offered when further reperfusion is considered futile. Delayed decisions about amputation have negative consequences for patients, families and health systems, yet little attention is given to training clinicians for the sophisticated communication required. Clinicians need to engage in authentic discourse about amputation to create shared meaning and facilitate decision‐making.
Design
Qualitative study using hermeneutic Heideggerian phenomenology.
Methods
Twelve patients offered major amputation, and 13 family participants from three vascular units in Australia engaged in 42 semi‐structured interviews, representing 19 cases of chronic limb‐threatening ischaemia. Hermeneutic phenomenology using the Heideggerian tenet of Being‐with as an analytic framework, a philosophically based understanding of Being‐with and Discourse related to treatment discussions and decisions was derived. The research was reported in accordance with the COREQ checklist.
Findings
Effective discourse between the person and family was hampered by changed circumstances of Being‐with, characterised by guilt, and a retreat from discourse through deficient discourse and filtering information. Clinician Being‐with was hampered by discourse that was deficient, poorly delivered, discordant and disconnected through a lack of empathetic listening. There were also examples of enhanced clinician Being‐with that made room for more constructive discourse and more timely decisions about amputation.
Conclusions
Heidegger's construct of Being‐with provides a useful framework to reveal the role of authentic discourse in improving patient and family experience and decisions about treatment.
No Patient or Public Contribution
This study did not engage consumers other than as patient and carer participants.
Relevance to Clinical Practice
Decisions about amputation are often difficult for patients or family members who may be substitute decision‐makers. A better understanding of the experience may assist clinicians in their interactions with patients and families.
Fairtrade operates its global system through a homogenising but marketable set of standards. Combined with issues around how to include producers in governance, this has led to feelings of ...disconnection and disenfranchisement for the latter, which are impacting on Fairtrade’s effectiveness and legitimacy. Through a focus on the South African wine industry, this paper argues that the Fairtrade community needs to be reinvigorated through dialogical communication, impactful participation and cultural synthesis to better enact responsibility across its systemic geographical and cultural distances. “Being‐with” its multiple stakeholders makes space for a more responsive, contextual and connected system. Drawing on the ideas of Paulo Freire, the paper concludes that a Fairtrade built on solidarity through a participatory and decentralised system would allow for discussions of the ideals and practices that are essential to negotiating, and not swallowing up, the shifting “we” of Fairtrade and more effectively balancing its local and global responsibilities.
Introduction
Despite existentialism positing that existential concerns are universal, research into the existential issues related to addiction remains scarce. An existential model of addiction is ...lacking.
Objectives
This research aims to develop an existential model of addiction, conceptualising the development of addiction through to authenticity.
Methods
A scoping literature review was carried out using PUBMED, reference lists and internet websites.
Results
Psychopathology, from an existential point of view, occurs as a result of the avoidance of the existential givens which are death, freedom, existential isolation and meaninglessness. In this model, addiction is positioned as a coping mechanism to deal with the existential or neurotic anxiety which arises from facing or avoiding the existential givens. Addiction is defined as being-with-drug; a state in which our inherent relation to others is replaced by a relation with a substance. This state is understood from the ontological, axiological, ethical and praxeological levels, shedding light on the phenomenological experience of addiction. The existential dilemmas around meaning, loneliness, death, freedom, guilt and control while living with addiction are discussed. Finally, existential crises, boundary situations and secondary suffering are seen as the main motivators to overcome addiction.
Conclusions
Phenomenological and existential research support the fact that existential issues are relevant to addiction. This model explains the relationships between existential concepts and addiction, while providing a framework for clinicians to explore and address these issues with patients.
This article explores the complexity of contemporary Christian chaplaincy within the British Army, where Christian (with other faiths and representatives of secular philosophies) serve an ostensibly ...secular institution. and sometimes conflicted context, especially focused on the concept of 'being with', central to the thought of the scholar and priest Samuel Wells. Outlining the history of Chaplaincy within the British Army, showing how the Department has changed to serve a changing Army, it then outlines some of the contemporary challenges. Looking at how the role is worked out within the contemporary British Army, there remains an important incarnational role for the Chaplain to 'be with' the Army and it's people.
After a brief review of different definitions and types of loneliness I offer an analysis of the concept of existential loneliness and its philosophical background. In contrast to the interpersonal ...aspects of other types of loneliness, existential loneliness has been characterized as an intrapersonal default state of incommunicability or profound aloneness, part of or based on a fundamental ontological or transcendental structure in human existence. There are both conceptual and practical issues with the notion of existential loneliness, with implications for psychotherapy. I offer a critical approach, and argue that there is no good philosophical basis for this conception of existential loneliness, and that although loneliness can be existential in some respect, it typically manifests itself in interpersonal contexts, and should not be considered a fundamental ontological structure of human existence.
PDF
