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Ignaas Devisch

Ghent University, Health Sciences, Faculty Member

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I am a professor in philosophy of medicine, ethics and social philosophy. I'm specialized in contemporary continental philosophy, but my interests in philosophy are quite general.
Currently, I'm working on a project on autonomy and lifestyle, analyzed from out the work of Foucault and others, and on a project on sovereignty and community in a globalized world.
Address: www.ignaasdevisch.com

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University of Antwerp

Carole Estabrooks

University of Alberta

Renato Sabbatini

Cardiff University

University of Antwerpen

Imperial College London

David L. Albright

The University of Alabama

Gilang Dharmawan

State University of Medan

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Books by Ignaas Devisch

The Ivory Tower: in defence of tenacious philosophy

Ziek van gezondheid (sick of health)

Jean-Luc Nancy and the question of community

Re-treating Religion: Deconstructing Christianity With Jean-luc Nancy

One of the most complicated and ambiguous tendencies in contemporary western societies is the phe... more One of the most complicated and ambiguous tendencies in contemporary western societies is the phenomenon referred to as the turn to religion.In philosophy, one of the most original thinkers critically questioning this turnis Jean-Luc Nancy. Re-treating Religion is the first volume to analyze his long-term project The Deconstruction of Christianity, especially his major statement of it in Dis-Enclosure.Nancy conceives monotheistic religion and secularization not as opposite worldviews that succeed each other in time but rather as springing from the same history. This history consists in a paradoxical tendency to contest one's own foundations-whether God, truth, origin, humanity, or rationality-as well as to found itself on the void of this contestation. Nancy calls this unique combination of self-contestation and self-foundation the self-deconstructionof the Western world.The book includes discussion with Nancy himself, who contributes a substantial Preambleand a concluding dialogue with the volume editors. The contributions follow Nancy in tracing the complexities of Western culture back to the persistent legacy of monotheism, in order to illuminate the tensions and uncertainties we face in the twenty-first century

Ligt de waarheid in het midden?

Ligt de waarheid in het midden? Ignaas DevIscH 9 789054 879596 ISBN 978 90 5487 959 6

We. Jean-Luc Nancy and the question of community

Papers by Ignaas Devisch

Healthcare teams as complex adaptive systems: Focus on interpersonal interaction

by Peter Pype, Demi Krystallidou, Fien Mertens, and Ignaas Devisch

Objective: The aim of this study is to test the feasibility of a tool to objectify the functionin... more Objective: The aim of this study is to test the feasibility of a tool to objectify the functioning of healthcare teams operating in the complexity zone, and to evaluate its usefulness in identifying areas for team quality improvement. Methods: We distributed The Complex Adaptive Leadership (CAL TM) Organisational Capability Questionnaire (OCQ) to all members of one palliative care team (n = 15) and to palliative care physicians in Flanders, Belgium (n = 15). Group discussions were held on feasibility aspects and on the low scoring topics. Data was analysed calculating descriptive statistics (sum score, mean and standard deviation). The one sample T-Test was used to detect differences within each group. Results: Both groups of participants reached mean scores ranging from good to excellent. The one sample T test showed statistically significant differences between participants' sum scores within each group (p < 0,001). Group discussion led to suggestions for quality improvement e.g. enhanced feedback strategies between team members. Conclusion: The questionnaire used in our study shows to be a feasible and useful instrument for the evaluation of the palliative care teams' day-today operations and to identify areas for quality improvement. Practical implications: The CAL TM OCQ is a promising instrument to evaluate any healthcare team functioning. A group discussion on the questionnaire scores can serve as a starting point to identify targets for quality improvement initiatives.

'We hold these truths to be self-evident': Deconstructing 'evidence-based' medical practice

by Ignaas Devisch and Stuart J. Murray

Journal of Evaluation in Clinical Practice, 2009

The rationale, aims and objectives Evidence-based medicine (EBM) claims to be based on 'evidence'... more The rationale, aims and objectives Evidence-based medicine (EBM) claims to be based on 'evidence', rather than 'intuition'. However, EBM's fundamental distinction between quantitative 'evidence' and qualitative 'intuition' is not self-evident. The meaning of 'evidence' is unclear and no studies of quality exist to demonstrate the superiority of EBM in health care settings. This paper argues that, despite itself, EBM holds out only the illusion of conclusive scientific rigour for clinical decision making, and that EBM ultimately is unable to fulfil its own structural criteria for 'evidence'. Methods Our deconstructive analysis of EBM draws on the work of the French philosopher , Jacques Derrida. Deconstruction works in the name of justice to lay bare, to expose what has been hidden from view. In plain language, we deconstruct EBM's paradigm of 'evidence', the randomized controlled trial (RCT), to demonstrate that there cannot be incontrovertible evidence for EBM as such. We argue that EBM therefore 'auto-deconstructs' its own paradigm, and that medical practitioners, policymakers and patients alike ought to be aware of this failure within EBM itself. Results EBM's strict distinction between admissible evidence (based on RCTs) and other supposedly inadmissible evidence is not itself based on evidence, but rather, on intuition. In other words, according to EBM's own logic, there can be no 'evidentiary' basis for its distinction between admissible and inadmissible evidence. Ultimately, to uphold this fundamental distinction, EBM must seek recourse in (bio)political ideology and an epistemology akin to faith.

E-health beyond technology: analyzing the paradigm shift that lies beneath

by Tania Moerenhout, Ignaas Devisch, and Gustaaf Cornelis

Information and computer technology has come to play an increasingly important role in medicine, ... more Information and computer technology has come to play an increasingly important role in medicine, to the extent that e-health has been described as a disruptive innovation or revolution in healthcare. The attention is very much focused on the technology itself, and advances that have been made in genetics and biology. This leads to the question: What is changing in medicine today concerning e-health? To what degree could these changes be characterized as a ‘revolution’? We will apply the work of Thomas Kuhn, Larry Laudan, Michel Foucault and other philosophers—which offers an alternative understanding of progress and revolution in medicine to the classic discovery-oriented approach—to our analysis. Nowadays, the long-standing curative or reactive paradigm in medicine is facing a crisis due to an aging population, a significant increase in chronic diseases and the development of more expensive diagnostic tools and therapies. This promotes the evolution towards a new paradigm with an emphasis on preventive medicine. E-health constitutes an essential part of this new paradigm that seeks to solve the challenges presented by an aging population, skyrocketing costs and so forth. Our approach changes the focus from the technology itself toward the underlying paradigm shift in medicine. We will discuss the relevance of this approach by applying it to the surge in digital self-tracking through health apps and wearables: the recognition of the underlying paradigm shift leads to a more comprehensive understanding of self-tracking than a solely discovery-oriented or technology-focused view can provide.

The illusion and the paradox of being autonomous, experiences from persons with spinal cord injury in their transition period from hospital to home

by Geert Van Hove and Ignaas Devisch

Disability and …, Jan 1, 2011

To open a discourse on the concept of autonomy as a precursor for participation in individuals wi... more To open a discourse on the concept of autonomy as a precursor for participation in individuals with Spinal Cord Injury (SCI) by exploring the experiences about their perceived autonomy in their transition period from hospital to home. Method: Based on the 'grounded theory' approach; in-depth, semi structured interviews were conducted with 11 SCI-patients. A theoretical sampling strategy was used and the data was analysed according to the constant comparative method. Results: To capture this complexity of autonomy, the results have been structured in themes with regard to the self of the patient and his independency. The analysis showed four different typologies of how autonomy is perceived; (1) the active agent, (2) the active follower, (3) the passive follower and (4) the passive victim. Conclusion: Rehabilitation professionals can help individuals in disconnecting their internalised ideal of independency to avoid the illusion of being autonomous and can gain insight in the patients' typology and empower patients to avoid the paradox of being autonomous. If the ultimate goal of rehabilitation is participation; empowering the patient to achieve a 'sense of agency' instead of autonomy is the central goal for rehabilitation professionals. Empowerment and agency are key topics for the patient to gain mastery over his own life.

Lifestyle: Bioethics at a Critical Juncture

by Myriam Deveugele and Ignaas Devisch

Cambridge Quarterly of Healthcare Ethics, 2010

More than ever, the way we live our lives has become subject to our own decisionmaking. Our whole... more

Foucault at the bedside: a critical analysis of empowering a healthy lifestyle

Journal of evaluation in clinical practice, Jan 4, 2015

Since quite a few years, philosophy is heading towards the bedside of the patient: the practice o... more Since quite a few years, philosophy is heading towards the bedside of the patient: the practice of philosophy has stepped out of its ivory tower, it seems, to deal with empirical or practical questions. Apart from the advantages, we should keep in mind the importance of a critical analysis of medical or clinical practice as such. If ethics partakes the clinical stage, it runs the risk only to discuss the how question and to forget the more fundamental what or why questions: what are we doing exactly and why is it good for? Starting from the principle of the empowerment of the patient, we will demonstrate how the discourse on empowerment in health care seems to forget a profound reflection upon this principle as such. By rehearsing some basics from the governmentality theory of Michel Foucault and the actualization of it by Nicolas Rose, we will argue how philosophical investigation in medical-ethical evolutions such as empowerment of the patient is still needed to understand what is...

Do We Know What We Do not Know? A Response to Celine Bonnet

International journal of health policy and management, 2013

&amp;amp;quot;Food taxes increase prices of food or food ingredients in order to stimulate co... more &amp;amp;quot;Food taxes increase prices of food or food ingredients in order to stimulate consumers to change their eating behaviour and finally to level up population health. Their aim is to tackle the high rates of obesity and other lifestyle diseases. As Bonnet argues, often food taxes are set up out of an economic perspective (1). To change consumer behaviour is one thing, to level up people’s health is a complex matter. Evidently, to evaluate the most accurate measures, governments require rigorous consideration (2). People have to go along a process, through different stages and challenges (3–6).&amp;amp;quot;

Food taxes: how likely are likely effects?

International journal of health policy and management, 2013

&amp;amp;quot;I want to thank Block and Willett (1) for their comments on my paper (2). Their... more &amp;amp;quot;I want to thank Block and Willett (1) for their comments on my paper (2). Their remarks are substantial, thoughtful and they help us to discuss more profoundly one example of a food tax, the tax on Sugar-Sweetened Beverages (SSBs). Indeed, not all food taxes are created equal and next to a more general debate, we need to discuss into details every kind of attempt to tackle the increasing prevalence of obesity and diabetes. Though SSBs were not in particular what I had in mind, of course they are included in the debate. Let me reply to some of their arguments, given the limited word count of this format. I want to apologize for not being able to get into all of the arguments. The “strong evidence” Block and Willett relied upon, needs careful interpretation. Looking after evidence on the effects of taxes, it is almost exclusively based on simulation studies which only predict (‘likely effect’) and therefore inherently neglect the complexity of real life situations. As Hawkes has demonstrated (3), current evidence does not leave the uncertainty behind us. While we are talking about the complex cross-section of many areas and disciplines, the awareness of this complexity seems to be absent in their suggestions. They righteously stated that “no policy is viewed in isolation” but looking after arguments, they quoted many trials which did isolate the topic of SSBs to predict the effect.&amp;amp;quot;

Singularity and medicine: is there a place for heteronomy in medical ethics?

Journal of Evaluation in Clinical Practice, 2014

In medicine and in clinical practice, autonomy is opposed to heteronomy or paternalism. While aut... more In medicine and in clinical practice, autonomy is opposed to heteronomy or paternalism. While autonomy comes down to free choice, independence or self-fulfillment, heteronomy or paternalism are associated with restraints from outside, lack of free choice or dependence. Despite several mediating concepts such as relational autonomy, this opposition stands firm in medical discourse. Reflecting upon his own heart transplantation but also falling back upon the whole of his oeuvre, we want to analyze what the impact of Nancy&amp;amp;amp;amp;amp;amp;#39;s thought can be on the concept of autonomy in medicine. As in Nancy&amp;amp;amp;amp;amp;amp;#39;s theory, autonomy and heteronomy are intertwined, how then to understand the autonomous individual in a clinical context? Nancy developed in his book Corpus, the untranslatable French word &amp;amp;amp;amp;amp;amp;#39;expeausition&amp;amp;amp;amp;amp;amp;#39; to express the exposure of surfaces to one another - playing on the term &amp;amp;amp;amp;amp;amp;#39;exposition&amp;amp;amp;amp;amp;amp;#39;: &amp;amp;amp;amp;amp;amp;#39;peau&amp;amp;amp;amp;amp;amp;#39;, in French, means skin. Skin is literally exposed to contact with another skin or surface. Such exposure and such contact is &amp;amp;amp;amp;amp;amp;#39;world&amp;amp;amp;amp;amp;amp;#39; he argues, in the same way that a product exchange between two people is. Heteronomy therefore is constitutive for autonomy, not a restraint of it. Analyzed from the work of French philosopher Jean-Luc Nancy, there is no such thing as autonomy because every &amp;amp;amp;amp;amp;amp;#39;self&amp;amp;amp;amp;amp;amp;#39; or &amp;amp;amp;amp;amp;amp;#39;I&amp;amp;amp;amp;amp;amp;#39; is always already intruded by something from outside. There is no autonomy without heteronomy, he argues and he therefore prefers to speak of an individual as being exposed to the outer world.

De verleiding van de ethiek

by Ignaas Devisch and Gert Verschraegen

... Title, De verleiding van de ethiek. Publication Status, published. Research Field, Medicine a... more

A new era of medical consumption: medicalisation revisited

by Ignaas Devisch and Ine Van Hoyweghen

Aporia, Jan 1, 2011

JL Nancy and the metaphysics of freedom

by joeri schrijvers and Ignaas Devisch

In this article, a close study of Jean-Luc Nancy's The Experience of Freedom is offered. After pr... more In this article, a close study of Jean-Luc Nancy's The Experience of Freedom is offered. After presenting the book's main argument, i.e. a non-metaphysical thinking of freedom, we turn to the question of subjectivity and freedom in relation to the eventfulness of freedom itself. The article closes by questioning certain surprising tendencies in Nancy's work. So, for instance, one might note a return of the concept of destiny (and therefore of a certain form of metaphysics) in Nancy's debate with Heidegger. Throughout, this essay seeks to relate the theme of freedom to other works of Nancy, including his recent deconstruction of Christianity, and to the debate with Heidegger and Derrida that takes place around the question of the freedom of the human being.

Mental suffering and the DSM-5: a critical review

by Stijn Vanheule and Ignaas Devisch

The definition of mental disorder included in the Diagnostic and Statistical Manual of Mental Dis... more The definition of mental disorder included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), indicates that mental disorders are usually associated with significant distress. However, the handbook is vague with respect to whether distress is crucial to the diagnosis of mental disorders, and a conceptual framework on the precise nature of distress is lacking. As a result, it remains vague how the term 'distress' is to be taken into account in actual diagnostic situations: the DSM-5 provides no operational framework for diagnosing distress. The authors argue that the work of Georges Canguilhem, who focuses on the topic of abnormality and pathology, and Paul Ricoeur's philosophical reflections on the theme of mental suffering may provide a structure for conceptualizing and evaluating distress. Ricoeur's phenomenological model of mental suffering is discussed. Here, mental suffering can be thought of in terms of the relationship between self and other, and also in terms of the continuum made up by, what he terms, languishing and acting. Ricoeur suggests that distress is not a quantity that can be measured, but a characteristic that should be studied qualitatively in interpersonal and narrative contexts. Consequently, diagnosticians should describe and document how individuals experience subjective distress. On a practical level, this means that clinicians' ideas about patients' distress should be embedded in case formulations. A detailed evaluation of an individual's pathos-experience should be made before conclusions are drawn with regard to diagnosis. bs_bs_banner

Reliability in Psychiatric Diagnosis with the DSM: Old Wine in New Barrels

by Jochem Willemsen, Stijn Vanheule, and Ignaas Devisch

Letter to the Editor are questionable, and values ≤ 0.40 are poor. Considering these standards, t... more

The Ivory Tower: in defence of tenacious philosophy

Ziek van gezondheid (sick of health)

Jean-Luc Nancy and the question of community

Re-treating Religion: Deconstructing Christianity With Jean-luc Nancy

One of the most complicated and ambiguous tendencies in contemporary western societies is the phe... more One of the most complicated and ambiguous tendencies in contemporary western societies is the phenomenon referred to as the turn to religion.In philosophy, one of the most original thinkers critically questioning this turnis Jean-Luc Nancy. Re-treating Religion is the first volume to analyze his long-term project The Deconstruction of Christianity, especially his major statement of it in Dis-Enclosure.Nancy conceives monotheistic religion and secularization not as opposite worldviews that succeed each other in time but rather as springing from the same history. This history consists in a paradoxical tendency to contest one's own foundations-whether God, truth, origin, humanity, or rationality-as well as to found itself on the void of this contestation. Nancy calls this unique combination of self-contestation and self-foundation the self-deconstructionof the Western world.The book includes discussion with Nancy himself, who contributes a substantial Preambleand a concluding dialogue with the volume editors. The contributions follow Nancy in tracing the complexities of Western culture back to the persistent legacy of monotheism, in order to illuminate the tensions and uncertainties we face in the twenty-first century

Ligt de waarheid in het midden?

Ligt de waarheid in het midden? Ignaas DevIscH 9 789054 879596 ISBN 978 90 5487 959 6

We. Jean-Luc Nancy and the question of community

Healthcare teams as complex adaptive systems: Focus on interpersonal interaction

by Peter Pype, Demi Krystallidou, Fien Mertens, and Ignaas Devisch

Objective: The aim of this study is to test the feasibility of a tool to objectify the functionin... more Objective: The aim of this study is to test the feasibility of a tool to objectify the functioning of healthcare teams operating in the complexity zone, and to evaluate its usefulness in identifying areas for team quality improvement. Methods: We distributed The Complex Adaptive Leadership (CAL TM) Organisational Capability Questionnaire (OCQ) to all members of one palliative care team (n = 15) and to palliative care physicians in Flanders, Belgium (n = 15). Group discussions were held on feasibility aspects and on the low scoring topics. Data was analysed calculating descriptive statistics (sum score, mean and standard deviation). The one sample T-Test was used to detect differences within each group. Results: Both groups of participants reached mean scores ranging from good to excellent. The one sample T test showed statistically significant differences between participants' sum scores within each group (p < 0,001). Group discussion led to suggestions for quality improvement e.g. enhanced feedback strategies between team members. Conclusion: The questionnaire used in our study shows to be a feasible and useful instrument for the evaluation of the palliative care teams' day-today operations and to identify areas for quality improvement. Practical implications: The CAL TM OCQ is a promising instrument to evaluate any healthcare team functioning. A group discussion on the questionnaire scores can serve as a starting point to identify targets for quality improvement initiatives.

'We hold these truths to be self-evident': Deconstructing 'evidence-based' medical practice

by Ignaas Devisch and Stuart J. Murray

Journal of Evaluation in Clinical Practice, 2009

The rationale, aims and objectives Evidence-based medicine (EBM) claims to be based on 'evidence'... more The rationale, aims and objectives Evidence-based medicine (EBM) claims to be based on 'evidence', rather than 'intuition'. However, EBM's fundamental distinction between quantitative 'evidence' and qualitative 'intuition' is not self-evident. The meaning of 'evidence' is unclear and no studies of quality exist to demonstrate the superiority of EBM in health care settings. This paper argues that, despite itself, EBM holds out only the illusion of conclusive scientific rigour for clinical decision making, and that EBM ultimately is unable to fulfil its own structural criteria for 'evidence'. Methods Our deconstructive analysis of EBM draws on the work of the French philosopher , Jacques Derrida. Deconstruction works in the name of justice to lay bare, to expose what has been hidden from view. In plain language, we deconstruct EBM's paradigm of 'evidence', the randomized controlled trial (RCT), to demonstrate that there cannot be incontrovertible evidence for EBM as such. We argue that EBM therefore 'auto-deconstructs' its own paradigm, and that medical practitioners, policymakers and patients alike ought to be aware of this failure within EBM itself. Results EBM's strict distinction between admissible evidence (based on RCTs) and other supposedly inadmissible evidence is not itself based on evidence, but rather, on intuition. In other words, according to EBM's own logic, there can be no 'evidentiary' basis for its distinction between admissible and inadmissible evidence. Ultimately, to uphold this fundamental distinction, EBM must seek recourse in (bio)political ideology and an epistemology akin to faith.

E-health beyond technology: analyzing the paradigm shift that lies beneath

by Tania Moerenhout, Ignaas Devisch, and Gustaaf Cornelis

Information and computer technology has come to play an increasingly important role in medicine, ... more Information and computer technology has come to play an increasingly important role in medicine, to the extent that e-health has been described as a disruptive innovation or revolution in healthcare. The attention is very much focused on the technology itself, and advances that have been made in genetics and biology. This leads to the question: What is changing in medicine today concerning e-health? To what degree could these changes be characterized as a ‘revolution’? We will apply the work of Thomas Kuhn, Larry Laudan, Michel Foucault and other philosophers—which offers an alternative understanding of progress and revolution in medicine to the classic discovery-oriented approach—to our analysis. Nowadays, the long-standing curative or reactive paradigm in medicine is facing a crisis due to an aging population, a significant increase in chronic diseases and the development of more expensive diagnostic tools and therapies. This promotes the evolution towards a new paradigm with an emphasis on preventive medicine. E-health constitutes an essential part of this new paradigm that seeks to solve the challenges presented by an aging population, skyrocketing costs and so forth. Our approach changes the focus from the technology itself toward the underlying paradigm shift in medicine. We will discuss the relevance of this approach by applying it to the surge in digital self-tracking through health apps and wearables: the recognition of the underlying paradigm shift leads to a more comprehensive understanding of self-tracking than a solely discovery-oriented or technology-focused view can provide.

The illusion and the paradox of being autonomous, experiences from persons with spinal cord injury in their transition period from hospital to home

by Geert Van Hove and Ignaas Devisch

Disability and …, Jan 1, 2011

To open a discourse on the concept of autonomy as a precursor for participation in individuals wi... more To open a discourse on the concept of autonomy as a precursor for participation in individuals with Spinal Cord Injury (SCI) by exploring the experiences about their perceived autonomy in their transition period from hospital to home. Method: Based on the 'grounded theory' approach; in-depth, semi structured interviews were conducted with 11 SCI-patients. A theoretical sampling strategy was used and the data was analysed according to the constant comparative method. Results: To capture this complexity of autonomy, the results have been structured in themes with regard to the self of the patient and his independency. The analysis showed four different typologies of how autonomy is perceived; (1) the active agent, (2) the active follower, (3) the passive follower and (4) the passive victim. Conclusion: Rehabilitation professionals can help individuals in disconnecting their internalised ideal of independency to avoid the illusion of being autonomous and can gain insight in the patients' typology and empower patients to avoid the paradox of being autonomous. If the ultimate goal of rehabilitation is participation; empowering the patient to achieve a 'sense of agency' instead of autonomy is the central goal for rehabilitation professionals. Empowerment and agency are key topics for the patient to gain mastery over his own life.

Lifestyle: Bioethics at a Critical Juncture

by Myriam Deveugele and Ignaas Devisch

Cambridge Quarterly of Healthcare Ethics, 2010

More than ever, the way we live our lives has become subject to our own decisionmaking. Our whole... more

Foucault at the bedside: a critical analysis of empowering a healthy lifestyle

Journal of evaluation in clinical practice, Jan 4, 2015

Since quite a few years, philosophy is heading towards the bedside of the patient: the practice o... more Since quite a few years, philosophy is heading towards the bedside of the patient: the practice of philosophy has stepped out of its ivory tower, it seems, to deal with empirical or practical questions. Apart from the advantages, we should keep in mind the importance of a critical analysis of medical or clinical practice as such. If ethics partakes the clinical stage, it runs the risk only to discuss the how question and to forget the more fundamental what or why questions: what are we doing exactly and why is it good for? Starting from the principle of the empowerment of the patient, we will demonstrate how the discourse on empowerment in health care seems to forget a profound reflection upon this principle as such. By rehearsing some basics from the governmentality theory of Michel Foucault and the actualization of it by Nicolas Rose, we will argue how philosophical investigation in medical-ethical evolutions such as empowerment of the patient is still needed to understand what is...

Do We Know What We Do not Know? A Response to Celine Bonnet

International journal of health policy and management, 2013

&amp;amp;quot;Food taxes increase prices of food or food ingredients in order to stimulate co... more &amp;amp;quot;Food taxes increase prices of food or food ingredients in order to stimulate consumers to change their eating behaviour and finally to level up population health. Their aim is to tackle the high rates of obesity and other lifestyle diseases. As Bonnet argues, often food taxes are set up out of an economic perspective (1). To change consumer behaviour is one thing, to level up people’s health is a complex matter. Evidently, to evaluate the most accurate measures, governments require rigorous consideration (2). People have to go along a process, through different stages and challenges (3–6).&amp;amp;quot;

Food taxes: how likely are likely effects?

International journal of health policy and management, 2013

&amp;amp;quot;I want to thank Block and Willett (1) for their comments on my paper (2). Their... more &amp;amp;quot;I want to thank Block and Willett (1) for their comments on my paper (2). Their remarks are substantial, thoughtful and they help us to discuss more profoundly one example of a food tax, the tax on Sugar-Sweetened Beverages (SSBs). Indeed, not all food taxes are created equal and next to a more general debate, we need to discuss into details every kind of attempt to tackle the increasing prevalence of obesity and diabetes. Though SSBs were not in particular what I had in mind, of course they are included in the debate. Let me reply to some of their arguments, given the limited word count of this format. I want to apologize for not being able to get into all of the arguments. The “strong evidence” Block and Willett relied upon, needs careful interpretation. Looking after evidence on the effects of taxes, it is almost exclusively based on simulation studies which only predict (‘likely effect’) and therefore inherently neglect the complexity of real life situations. As Hawkes has demonstrated (3), current evidence does not leave the uncertainty behind us. While we are talking about the complex cross-section of many areas and disciplines, the awareness of this complexity seems to be absent in their suggestions. They righteously stated that “no policy is viewed in isolation” but looking after arguments, they quoted many trials which did isolate the topic of SSBs to predict the effect.&amp;amp;quot;

Singularity and medicine: is there a place for heteronomy in medical ethics?

Journal of Evaluation in Clinical Practice, 2014

In medicine and in clinical practice, autonomy is opposed to heteronomy or paternalism. While aut... more In medicine and in clinical practice, autonomy is opposed to heteronomy or paternalism. While autonomy comes down to free choice, independence or self-fulfillment, heteronomy or paternalism are associated with restraints from outside, lack of free choice or dependence. Despite several mediating concepts such as relational autonomy, this opposition stands firm in medical discourse. Reflecting upon his own heart transplantation but also falling back upon the whole of his oeuvre, we want to analyze what the impact of Nancy&amp;amp;amp;amp;amp;amp;#39;s thought can be on the concept of autonomy in medicine. As in Nancy&amp;amp;amp;amp;amp;amp;#39;s theory, autonomy and heteronomy are intertwined, how then to understand the autonomous individual in a clinical context? Nancy developed in his book Corpus, the untranslatable French word &amp;amp;amp;amp;amp;amp;#39;expeausition&amp;amp;amp;amp;amp;amp;#39; to express the exposure of surfaces to one another - playing on the term &amp;amp;amp;amp;amp;amp;#39;exposition&amp;amp;amp;amp;amp;amp;#39;: &amp;amp;amp;amp;amp;amp;#39;peau&amp;amp;amp;amp;amp;amp;#39;, in French, means skin. Skin is literally exposed to contact with another skin or surface. Such exposure and such contact is &amp;amp;amp;amp;amp;amp;#39;world&amp;amp;amp;amp;amp;amp;#39; he argues, in the same way that a product exchange between two people is. Heteronomy therefore is constitutive for autonomy, not a restraint of it. Analyzed from the work of French philosopher Jean-Luc Nancy, there is no such thing as autonomy because every &amp;amp;amp;amp;amp;amp;#39;self&amp;amp;amp;amp;amp;amp;#39; or &amp;amp;amp;amp;amp;amp;#39;I&amp;amp;amp;amp;amp;amp;#39; is always already intruded by something from outside. There is no autonomy without heteronomy, he argues and he therefore prefers to speak of an individual as being exposed to the outer world.

De verleiding van de ethiek

by Ignaas Devisch and Gert Verschraegen

... Title, De verleiding van de ethiek. Publication Status, published. Research Field, Medicine a... more

A new era of medical consumption: medicalisation revisited

by Ignaas Devisch and Ine Van Hoyweghen

Aporia, Jan 1, 2011

JL Nancy and the metaphysics of freedom

by joeri schrijvers and Ignaas Devisch

In this article, a close study of Jean-Luc Nancy's The Experience of Freedom is offered. After pr... more In this article, a close study of Jean-Luc Nancy's The Experience of Freedom is offered. After presenting the book's main argument, i.e. a non-metaphysical thinking of freedom, we turn to the question of subjectivity and freedom in relation to the eventfulness of freedom itself. The article closes by questioning certain surprising tendencies in Nancy's work. So, for instance, one might note a return of the concept of destiny (and therefore of a certain form of metaphysics) in Nancy's debate with Heidegger. Throughout, this essay seeks to relate the theme of freedom to other works of Nancy, including his recent deconstruction of Christianity, and to the debate with Heidegger and Derrida that takes place around the question of the freedom of the human being.

Mental suffering and the DSM-5: a critical review

by Stijn Vanheule and Ignaas Devisch

The definition of mental disorder included in the Diagnostic and Statistical Manual of Mental Dis... more The definition of mental disorder included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), indicates that mental disorders are usually associated with significant distress. However, the handbook is vague with respect to whether distress is crucial to the diagnosis of mental disorders, and a conceptual framework on the precise nature of distress is lacking. As a result, it remains vague how the term 'distress' is to be taken into account in actual diagnostic situations: the DSM-5 provides no operational framework for diagnosing distress. The authors argue that the work of Georges Canguilhem, who focuses on the topic of abnormality and pathology, and Paul Ricoeur's philosophical reflections on the theme of mental suffering may provide a structure for conceptualizing and evaluating distress. Ricoeur's phenomenological model of mental suffering is discussed. Here, mental suffering can be thought of in terms of the relationship between self and other, and also in terms of the continuum made up by, what he terms, languishing and acting. Ricoeur suggests that distress is not a quantity that can be measured, but a characteristic that should be studied qualitatively in interpersonal and narrative contexts. Consequently, diagnosticians should describe and document how individuals experience subjective distress. On a practical level, this means that clinicians' ideas about patients' distress should be embedded in case formulations. A detailed evaluation of an individual's pathos-experience should be made before conclusions are drawn with regard to diagnosis. bs_bs_banner

Reliability in Psychiatric Diagnosis with the DSM: Old Wine in New Barrels

by Jochem Willemsen, Stijn Vanheule, and Ignaas Devisch

Letter to the Editor are questionable, and values ≤ 0.40 are poor. Considering these standards, t... more

Solidariteit en het recht op gezondheidszorg. Een discoursanalyse van het Burgerlabo over de terugbetaling van behandelingen in de gezondheidszorg

by Benjamin De Cleen, Ignaas Devisch, Leen Van Brussel, Laura Calabrese, and François Romijn

Een discoursanalyse van het Burgerlabo over de terugbetaling van behandelingen in de gezondheidszorg

'Why 5+1 is not always 6'

The Ivory Tower. In defence of tenacious philosophy

HOW (NOT) TO PROPERLY ABANDON THE IMPROPER?

Nancian virtual doubts about ‘Leformal’ democracy: Or how to deal with contemporary political configuration in an uneasy way?

French philosopher Jean-Luc Nancy is acting uneasily when it comes to contemporary politics. Ther... more French philosopher Jean-Luc Nancy is acting uneasily when it comes to contemporary politics. There is a sort of agitation in his work in relation to this question. At several places we read an appeal to deal thoroughly with this question and 'qu'il y a un travail à faire', that there is still work to do. From the beginning of the 1980s with the 'Centre de Recherches Philosophiques sur le Politique' and the two books resulting out of that, until the many, rather short texts he published on this topic during the last years of the century, the question of politics crosses very clearly Nancy's work. He not only fulminates against the contemporary philosophical 'content' with democracy.

Co-Responsibility: a New Horizon for Today’s Health Care

Health Care Analysis

In this article, we focus at a key concept of today’s healthcare, namely responsibility. Personal... more In this article, we focus at a key concept of today’s healthcare, namely responsibility. Personal responsibility is so important today because it is obvious that the way society is organized, many people are facing a lot of difficulties to live their lives in a responsible way. We explicitly obtain an analysis of responsibility from a view which avoids the binary thinking which is so remarkably present in today’s health care discourse. The aim of this pilot study is therefore to open up the horizon of the use of responsibility in today’s healthcare. We develop the notion of ‘co-responsibility’ to understand how individuals, despite the fact they are responsible for their own agency, are always also affected by an ought which contaminates their efforts to fulfill their duties and obligations. We discuss co-responsibility not as conclusion or a magic formula to all problems, but as a new starting point of which we have to explore the opportunities for current and future health care dilemmas.

Ethics and social care

Sugar and society