Ignaas Devisch

Ghent University | UGhent · www.ignaasdevisch.com

Exome-based testing for genetic diseases can reveal unsolicited findings (UFs), i.e. predispositions for diseases that exceed the diagnostic question. Knowledge of patients’ interpretation of possible UFs and of motives for (not) wanting to know UFs is still limited. This lacking knowledge may impede effective counselling that meets patients’ needs...

Patient access to electronic health records gives rise to ethical questions related to the patient-doctor-computer relationship. Our study aims to examine patients’ moral attitudes toward a shared EHR, with a focus on autonomy, information access, and responsibility. A de novo self-administered questionnaire containing three vignettes and 15 statem...

Background: The collection, storage and exchange of medical information are becoming increasingly complex. More parties are involved in this process, and the data are expected to serve many different purposes beside patient care. This raises several ethical questions regarding privacy, data ownership, security and confidentiality. It is vital to c...

Introduction: Effective doctor-patient communication in oncology settings can be challenging due to the complexity of the cancer disease trajectory. The challenges can become greater when doctors and patients do not share a common language and need to rely on language mediators. The aim of this study is to provide evidence-based recommendations for...

Use of electronic health records (EHR) within clinical encounters is increasingly pervasive. The digital record allows for data storage and sharing to facilitate patient care, billing, research, patient communication and quality-of-care improvement—all at once. However, this multifunctionality is also one of the main reasons care providers struggle...

Background: Incidental findings (IFs) and secondary findings (SFs), being results that are unrelated to the diagnostic question, are the subject of an important debate in the practice of clinical genomic medicine. Arguments for reporting these results or not doing so typically relate to the principles of autonomy, non-maleficence and beneficence....

Objective: The aim of this study is to explore whether specific ethical questions arise with the use of a shared electronic health record (EHR) system, based on the daily experience of primary care physicians (PCPs). Methods: In this qualitative research project, we conducted 14 in-depth semistructured interviews with PCPs in a tertiary hospital...

Background: Incidental and secondary findings (IFs and SFs) are subject to ongoing discussion as potential consequences of clinical exome sequencing (ES). International policy documents vary on the reporting of these findings. Discussion points include the practice of unintentionally identified IFs versus deliberately pursued SFs, patient opt-out...

Depression in the media: A qualitative pilotstudy on the experience of former patients regarding media coverage on depression. Depression is one of the most prevalent mental disorders worldwide; in Belgium, one out of three is at risk for encountering this condition. Only a minority finds adjusted help, making further emphasis on awareness, preven...

Incidental or secondary findings (ISFs) in whole exome or whole genome sequencing have been widely debated in recent literature. The American College of Medical Genetics and Genomics’ recommendations on diagnostic ISFs have strongly catalyzed the discussion, resulting in worldwide reactions and a variety of international guidelines. This article wi...

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: Wha...

With concepts like ‘governmentality’, ‘pastoral power’ or ‘population’, in his later lectures on biopolitics, Michel Foucault attempted to conceive the question how the care for public health became indeed a central task and for politics and for all of us. Health is not only on the political agenda of many governments (governmentality), it’s presen...

Background: Palliative day-care centers are a marginal service within the palliative care landscape. Relevant research on the potential and added value of this service model is lacking, and it may therefore be underappreciated. Aim: To examine how representatives of Belgian palliative day-care centers perceive their strengths and added value, as...

Victims of disaster suffer, not only at the very moment of the disaster, but also years after the disaster has taken place, they are still in an emotional journey. While many moral perspectives focus on the moment of the disaster itself, a lot of work is to be done years after the disaster. How do people go through their suffering and how can we ta...

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™) Organisational Capability Questionnaire (OCQ) to all...

High-quality doctor-patient communication in end-of-life care results in better quality of life for patients. In linguistically and culturally diverse societies, language discordant consultations become daily practice, leading to difficulties in eliciting patient preferences toward end-of-life care. Although family members invariably act as informa...

Confronted with numerous scandals, sports organizations are turning to the adoption of ethical codes to attain more ethical behavior. However, the effectiveness of an ethical code as a means to increase ethical behavior remains debated; furthermore the particular characteristics of a sports context have not yet been taken into account. Neither have...

Background: In general, vulnerable populations experience more problems in accessing health care. This also applies to the Roma-population. In the City of Ghent, Belgium, a relativly large group of Roma resides more or less permanently. The aim of this study is to explore the barriers this population encounters in their search for care. Methods:...

Purpose To explore the perspectives of male clients in a neurological rehabilitation setting with regard to the occupational therapy they have received and the client-centred approach. Method This study involved a qualitative research design based on the grounded theory tradition. Individual in-depth interviews were used to collect data. Data were...

More than four years ago, Anders Breivik launched his apocalyptic raid in Norway. His killing raid was not an action standing on its own but a statement to invite people to read his manifesto called 2083. A European Declaration of Independence. The highly despicable and disgusting mission of Anders Breivik addresses us whether we like it or not. Ma...

This article examines what is called the 'caring organization' out of the work of French philosopher Jean-Luc Nancy. Starting from two tales from Kafka and Borges, it analyzes Nancy's concept of community and singularity and their potential relevance for the area of social sciences. Thinking an organization from the perspective of singularity means...

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 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...

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...

Given the ongoing political turbulence worldwide, it is more than necessary for us to reconsider the question of democracy. This question has been posed by French philosopher Claude Lefort for many years, but it has assumed a renewed urgency. Although in Iraq the first danger of democracy, totalitarian dictatorship, was tackled, the liberators clea...

In a footnote to The Inoperative Community French philosopher Jean-Luc Nancy wonders how to escape Hegelian dialectics. Because Nancy in his later work often returns to this attempt of a ‘disclosure of our metaphysical horizon’, we not only consider this note as a crucial one in his attempt to ‘disclose’ our metaphysical horizon; on top of that, we...

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...

Today, the improper is not only a philosophical issue; it is also a political question. In particular, striving to abandon the improper is central to the contemporary political agenda in many Western countries. Given the risks of a political agenda abandoning the improper in a proper way and realizing a “closed community,” contemporary philosophers...

In an effort to reduce the growing prevalence of overweight and obesity, food taxes have been introduced in several European countries, the so-called 'obesitax'. As yet little evidence is at hand, policy measures are being taken to counterweight the consumption of unhealthy food or the increasing diet-related diseases. Several questions need to be...

Recently, a court in Belgium awarded a sum of 400 000 euros to the parents of a child with disability who at that point had already died of Sanfilippo syndrome. Their charge was not that the baby was born with disability, but that the child was born. The charge was brought in the child's name, and so effectively, the child had sued against its own...

Background: Shared decision making (SDM) reduces the asymmetrical power between the therapist and the patient. Patient involvement improves patient satisfaction, adherence, and health outcomes and is a prerequisite for good clinical practice. The opportunities for using SDM in physical therapy have been previously considered. Objective: The obje...

This paper reflects upon the conditions how 'nudging' can change individual health choices without being paternalistic and therefore can be defined as an instrument of social justice? So many problems we are facing in today's nursing are situated at the intersection of autonomy and heteronomy, i.e. why well informed and autonomous people make unhea...

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. Based on the 'grounded theory' approach; in-depth, semi structured interviews were conducted with 11 SCI-patients....

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 "turn" is Jean-Luc Nancy. Re-treating Religion is the first volume to analyze his long-term project "The Deconstruction of Christ...

The Low Countries (Belgium and the Netherlands) have their own traditions when it comes down to sports. Sports such as football, cycling (Belgium) or skating (the Netherlands) take center stage with the sports-minded public, and are a central element in popular culture, somewhat similar to the way cricket is part of the British culture. Since many...

The purpose of this paper is to explore the sti- mulating factors and the obstacles experienced by nurses in community health centres in their work with prevention and health promotion. We conducted the qualitative research design con- sisting of fifteen nurses in five community health centres in Ghent. There was also a focus group and participant...

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 ‘Ce...

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-metaphysicalthinking of freedom, we turn to the question of subjectivity and freedom in relation to the eventfulness of freedom itself. The article closes by questioningcertain surprising tendencies in Nancy...

In this article, I argue that we need a new perspective in the debate on autonomy in medicine, to understand many of the problems we face today - dilemmas that are situated at the intersection of autonomy and heteronomy, such as why well informed and autonomous people make unhealthy lifestyle choices. If people do not choose what they want, this is...

When Ivan Illich launched his critique on the medical establishment, medicalisation became synonym for a perverted evolution in western health care. Since then, it has been most of the time used as a critique to the oppression by the health establishment of which the subjects suffer, culminating in the call for resistance against this system. The w...

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 av...

The nineteenth century saw the rise of Darwinism as a new paradigm for the study of nature and man mans an integral part thereof. Many scholars were intent on removing the abstract principles and universal truths of early modern philosophy in favour of understanding man's nature through more scientifically-based methods. Walter Bagehot (1826–1877)...

Jean-Luc Nancy has not written a single work dedicated entirely to the problem of justice or related themes, but nevertheless, topics such as right, justice, judgement or law appear in various places in Nancy’s work. Besides ‘Lapsus judicii’ and ‘Dies irae’, the theme of justice particularly comes up and in two small texts: ‘Cosmos Basileus’ and ‘H...

Although at first glance current debates on health seem to be infected by a gap between ‘two cultures’, focusing on them would hinder us from seeing the real deadlock at a more fundamental level. Both ‘cultures’ presuppose heteronomy as a bad thing that should be avoided. Although we agree upon autonomy as a desirable objective, heteronomy is not o...

In one of his latest books, La pensée dérobée (2001), Jean-Luc Nancy continues writing about the major themes of his work up until now: community, sense, being as being with, or singular plural being. These themes come together in a witnessing of the world “as such”: that is to say,the world here and now in which we are living in common. The sense...

For years now, autonomy has been discussed as one of the central values in health care. Understood as self-realization, it is opposed to paternalism which is conceived as an intolerable occurrence of heteronomy. Although different concepts have been developed to nuance this opposition, when it comes to health care discourse, heteronomy is still the...

More than ever, the way we live our lives has become subject to our own decisionmaking. Our whole way of living, in particular what we do to our body, has become the expression of personal lifestyle choices. Because we can make changes to our body according to our own individual preferences, every aspect of our life begins to be seen as the result...

It has been taken for granted that in western modernity we are dealing with a secularised world, an atheistic world where religion is no longer reigning the public sphere. In other words: a world where sense lies outside the world towards a world where sense is situated within it. If we follow the line of thought French philosopher Jean-Luc Nancy s...

In a footnote of The Inoperative Community French philosopher Jean-Luc Nancy wonders how to escape Hegelian dialectics. Because Nancy in his later work often returns to this attempt of a ‘disclosure of our metaphysical horizon’, we not only consider this note as a crucial one in his attempt to ‘disclose’ our metaphysical horizon; on top of that, we...

In many countries a healthy lifestyle is expected to become a criterion in obtaining healthcare services. If we understand lifestyle as a merely individual matter, what would be the consequences for health care if individual responsibility were a key principle in allocating health care services? Our attempt is to ‘enrich’ the debate on healthcare r...

Ethics in sports has become more popular. When it comes down to ethics of sports, it is ethics’ explicit ambition to evaluate sports in a critical way and to ask for what ought to be. One could ask, with Nietzsche, what it means for ethics to reflect upon sports and what its pro’s and con’s are? Not only this question deals with what ethics has to...

Although much research has been dedicated to describing the ethical and communicative conditions of the encounter between a health care professional and a patient, in fact we know very little of the encounter itself, nor of the concept of the identity of the subjects they implicitly fall back upon. By contrast, in this paper we want to start from t...

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 i...

Despite innumerable campaigns, highly-explicit warnings on packages, references to death and cancer, many people still continue to persist obstinately in their smoking behaviour. Therefore, the following general conclusion would seem to be justified: smokers are idiots! However, it is possible to ask what is actually meant in such circumstances by...

Traditionally, the average code of conduct within Western health care starts from the autonomy of the patient. In addition, medicine today is ‘evidence based’ and the patient is an ‘informed consent’. Yet, the individual autonomy of the patient in health care is not simply enhancing today. Quite a few fundamental changes have and are currently at w...