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11 Med., Health Care & Phil. 1 (2008)

handle is hein.journals/medhcph11 and id is 1 raw text is: Med Health Care and Philos (2008) 11:1 DOI 10.1007/s11019-007-9110-2 © Springer 2007 Editorial From clinical ethics to phenomenology Both in Europe and the US clinical ethics has developed substantially in the last few decades. A great diversity of models of clinical ethics consul- tation and approaches to moral deliberation have been developed. Moreover, different kinds of Hospital Ethics Committees have been established. As a result of the rapid practical development of clinical ethics, systematic research studies do now seem to lag behind somewhat. Against this back- drop, Stella Reiter-Theil and George Agich present a thematic section focusing on research in clinical ethics and consultation. The five studies of this section come from Europe and the USA and cover a broad range of topics relevant to clinical ethics consultation. The rest of this issue consists of four papers. Silke Schicktanz et al. focus on the concept of being affected (Betroffenheit) and its use in biomedical decision making processes in Germany. Actively involving people who are being affected in decision-making processes has become increasingly popular during the last few decades. However, this participation is also critically discussed. Against this backdrop the authors explore the significance and the argumentative role of the concept of being affected as it is used by affected and lay people themselves. Their analysis is founded on focus group discussions in which lay people, patients and relatives discuss their stance towards the biomedical practices of organ transplantation and postnatal genetic testing. Based on the results of this empir- ical research the authors further explore the moral significance of being affected. In the second paper, Mind the gap! Three approaches to scarcity in health care, Yvonne Denier presents an analysis of scarcity in health care. In her analysis, scarcity turns out to be a phenomenon that can be approached from an economic as well as a justice perspective. Denier, however, argues that both approaches are unsatis- factory because they cannot adequately deal with certain key issues pertaining to the problem of scarcity in health care. Therefore, she introduces a third approach, the finitude approach, thereby introducing a new and more encouraging assess- ment of the limits of human existence into the discussion. The last two papers in this issue are inspired by the phenomenological tradition. Wendy J. Austin et al. present a hermeneutic phenomeno- logical study of the lived experience of moral distress in psychiatric practice. Moral distress arises in situations where one is forced to act in such a way that it contradicts one's personal moral opinions. Not being able to act according to one's moral beliefs and values can be caused by both internal as well as external limitations. Austin et al. argue that psychiatrists' moral dis- tress is mainly triggered by competing demands from patients and society. The authors further characterize this phenomenon by identifying cer- tain situations that cause distress as well as analysing psychiatrists' attempts to deal with this distress. With their study they aim to help practitioners better recognize, understand and address situations of moral distress. Anna Luise Kirkengen's paper Inscriptions of violence: societal and medical neglect of child abuse - impact on life and health is grounded in the phenomenology of the body. Based on this understanding Kirkengen analyses the sickness history of Katherine Kaplan who has been violated since childhood. The lived body unites the material body and personal experiences, thus transcending the traditional distinction between body and mind. Hence, the history of sickness in the body cannot be properly understood disconnected from the history of the sick person. Hence, Kirkengen argues in favor of going beyond fragmenting and alienating medical research towards an integrative medical theoretical approach that does justice to the lived body. Bert Gordijn and Wim Dekkers Editors-in-chief

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