Competence in chronic mental illness: the relevance of practical wisdom

Widdershoven, Guy; Ruissen, A.M.; Balkom, A.J.L.M. van; Meynen, Gerben

doi:10.1136/medethics-2014-102575

Cited by 16 publications

(12 citation statements)

References 8 publications

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“…Each consultation and interaction with Maddie will seek meaning that is contextual, specific and derived from multiple sources. A wise practitioner will attend to the scientific and clinical evidence-base, a patient's and/or carer's experience, individual preferences and perceptions and consideration of the past, present and future (Widdershoven et al, 2017).…”

Section: Ways Of Seeing Knowing and Beingmentioning

confidence: 99%

“…Wisdom, however, will elevate that analysis. It does so by recognising that choices are made in a context of uncertainty, by engaging with those who have different perspectives on Maddie's situation, by considering and testing the ways in which contrasting conclusions may be reached on identical facts, by attending to the interpretative nature of the task and by acknowledging the discomforting and maybe even painful emotions (Leget, 2004) and the strength of intuitions whilst seeking a balance (Widdershoven et al, 2017). A wise analytic response is an iterative process whereby those who seek meaning recognise that it may need to be revisited and are sufficiently flexible, humble and open to adapt to new or changing circumstances.…”

Section: Analysis and Wisdommentioning

confidence: 99%

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Wisdom and Ethico-Legal Practice

Bowman¹

2019

Practice Wisdom

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Ways of Seeing and Ways of Being ON WISDOM: WHY "WAYS OF SEEING, KNOWING AND BEING"? This chapter considers how different ways of seeing, knowing and being might inform how clinicians and practitioners make judgements, particularly in relation to the ethico-legal questions and considerations that arise in their work. What is meant by "ways of seeing, knowing and being" and why are these useful when thinking about the nature of wisdom? Since Foucault (1976) conceptualised the medical "gaze" that characterised work in the clinic, the lens of healthcare work has been a preoccupation of philosophers, anthropologists and sociologists. The way in which a healthcare professional is trained to see is detached, expert and powerful, yet there are other ways of seeing that, it is argued, inform wise practice. Ways of knowing describes the different types of knowledge and discernment that are required when practising medicine and engaging with its ethico-legal dimensions. Ways of being refers to the characteristics, behaviours and qualities that inform how someone responds when managing different types of knowledge in a context where uncertainty, emotion, complexity and pressure are common. Both ways of knowing and ways of being in practice are often implicit and underconsidered yet are fundamental to practice, choice and, specifically, the nature of wisdom. This chapter discusses that relationship between wisdom, ways of seeing, knowing and being, and the ethico-legal questions, considerations and challenges of medical practice. I argue, drawing on Havi Carel's (Carel, 2013, 2016; Carel & Kidd, 2014, 2016) work on epistemic justice in healthcare, that wisdom, when understood as shaped by ways of seeing, knowing and being, serves as a valuable force in healthcare: as a counter to inherent imbalances of power, as a guide for education and development, as protection against burnout and compassion fatigue and as a reminder of the essence of what it is to be an individual clinician and an individual patient in a demanding, resource-constrained system. WHAT IS WISDOM? Wisdom has been a feature of virtue ethics since Ancient times; from the scepticism of Socrates about the possibility and limits of knowledge (Miller & Platter, 2010; Plato, c. 400 BC/2010) to Aristotle's distinction between theoretical and practical wisdom (Aristotle, 349 BC/2004; Dowie, 2000). The nature of wisdom has preoccupied philosophers for centuries with the focus being predominantly, although not exclusively, on the personal rather than the systemic.

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Section: Ways Of Seeing Knowing and Beingmentioning

confidence: 99%

Section: Analysis and Wisdommentioning

confidence: 99%

Wisdom and Ethico-Legal Practice

Bowman¹

2019

Practice Wisdom

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“…However, competence should be understood from the perspective of the capabilities approach, which encompasses more than mere cognitive abilities. One possibility is to also emphasise the role of emotions and values in competence, as do Widdershoven et al 11 in their model of practical wisdom. As an absolute negative right freedom of thought cannot require that others actively help a person realise this right.…”

Section: Nussbaum’s Capabilities Approach and Freedom Of Thoughtmentioning

confidence: 99%

Promoting the freedom of thought of mental health service users: Nussbaum’s capabilities approach meets values-based practice

Stenlund

2017

J Med Ethics

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This article clarifies how the freedom of thought as a human right can be understood and promoted as a right of mental health service users, especially people with psychotic disorder, by using Martha Nussbaum's capabilities approach and Fulford's and Fulford 's values-based practice. According to Nussbaum, freedom of thought seems to primarily protect the capability to think, believe and feel. This capability can be promoted in the context of mental health services by values-based practice. The article points out that both Nussbaum's approach and values-based practice recognise that people's values differ. The idea of involving different actors and service users in mental healthcare is also common in both Nussbaum's approach and values-based practice. However, there are also differences in that values-based practice relies on a 'good process' in decision-making, whereas the capabilities approach is oriented towards a 'right outcome'. However, since process and outcome are linked with each other, these two approaches do not necessarily conflict despite this difference. The article suggests that absolute rights are possible within the two approaches. It also recognises that the capabilities approach, values-based practice and human rights approach lean on liberal values and thus can be combined at least in liberal societies.

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“…In these situations, they have not sufficient decision-making capacity and, hence, suicide is not a voluntary and deliberate choice of death over life. Decision-making capacity is a gradual concept that indicates whether someone is at a given moment able to make a specific decision in a voluntary and deliberate way (Widdershoven et al 2017).…”

Section: Ethical View On Suicidementioning

confidence: 99%

Christian Ethical Boundaries of Suicide Prevention

Liégeois

Schrijver

2018

Religions

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Abstract:In Western countries the general rule is that caregivers do everything possible to prevent suicide. The aim of this essay is to critically reflect on that position along three questions: is there an unconditional obligation to live, how far does the duty reach to safeguard life, and how does one deal with the tension between suicide prevention and euthanasia? The study material consists of Christian theological and ethical literature and relevant legislation, while the method is a religious ethical reflection, clarified by means of a case study. We consider suicide as an expression of an existential search for meaning and interwoven with psychiatric problems. After discussing the three ethical arguments against suicide, we conclude that the inviolability of life is a generally recognized and fundamental value, but that there is no unconditional obligation to live. Nevertheless, there is a legal duty to safeguard life. In practice however, restriction of freedom and coercion are counterproductive in the search for meaning and require a proportional assessment between inviolability of life and autonomy. Finally, the legal possibility of euthanasia in mental suffering or medically assisted suicide brings caregivers in a confusing situation. Good companionship of the euthanasia request may help finding a new life perspective and hence may contribute to suicide prevention.

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Competence in chronic mental illness: the relevance of practical wisdom

Cited by 16 publications

References 8 publications

Wisdom and Ethico-Legal Practice

Wisdom and Ethico-Legal Practice

Promoting the freedom of thought of mental health service users: Nussbaum’s capabilities approach meets values-based practice

Christian Ethical Boundaries of Suicide Prevention

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