Abstract
This article aims to provide a philosophical reading of palliative care between certainty and uncertainty. Indeed, palliative care is a medical discipline. In this, its practice must be supported by knowledge and techniques which need to be developed on an on-going basis. However, the dimension of uncertainty is also present and discussed regarding the question of death, as proposed in the theory of the French philosopher Vladimir Jankélévitch. Thus, addressing the paradox of death and the variability of relationships to death, the place and meaning of uncertainty in palliative care will be discussed. Such an idea allows the reinforcement, from a philosophical point of view, of the idea of the singular approach of the patient at the end of life.
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Notes
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Those two terms are the titles of three of his essays (Jankélévitch 1957): “La Manière et l’occasion”, “La méconnaissance et le malentendu” and “La volonté de vouloir”.
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https://cliniquedelincertitude.fr/ Accessed 16 February 2020.
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AFSOS (Association Francophone des Soins Oncologiques [French-speaking Association for Supportive Oncological Care]), SFAP (Société Française d’Accompagnement et de soins Palliatifs [French Society for Palliative Care]), SFETD (Société Française d’Étude et de Traitement de la Douleur [French Society for the Study and Treatment of Pain]); SFPO (Société Française er Francophone de Psycho-Oncologie [French Society of Psycho-Oncology]).
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Death is the destruction of brain cells that leads to the cessation of cardiac and respiratory functions, or the reverse process, taking into account the solidarity of these functions, the cessation of the three major vital functions subsequently leading to the destruction of the body’s tissues.” (Lecourt 2004, 752; author’s translation)
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I would like to precis something here. Vincent Morel insists on the specialized approach of palliative care to enhance the fact that we need to resist too much medicalization of palliative care. “The contribution of the human sciences is fundamental because they allow us to find with each patient, a healing response, by offering us a view of the sick person.” The integration of volunteers to support patients at the end of life, for example, shows that the palliative approach cannot only belong to a strictly biomedical approach. “This specificity of palliative care and the integration of volunteers is a major challenge to take the palliative approach out of a purely medical approach that must respond only to diagnostic and therapeutic approaches validated by evidence-based medicine criteria” (Morel 2014, 1141–1142).
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Vincent Morel insists on the necessity of pursuing the development of this medical discipline. Indeed, if we analyse practice, publications, research and recommendations, Morel says that research needs to develop in order to clarify the boundaries of such a discipline. Moreover, the specificity of this discipline implies that one must develop one’s “own tools” in order to best support the uncertainty which is linked to this period of life.
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These authors point out that research in the field of palliative care is quite difficult. Indeed, research is linked to evidence-based medicine. Consequently, the uncertainty implied by palliative care is a challenge. They say that the objective of evidence-based medicine is linked mainly to the will to disseminate recommendations to practitioners. They wonder about the place of uncertainty here for medicine in general. “The subjective integration of the relativity of the scientific approach is partly shunted by this use to external recommendations” (Delpierre et al. 2014, 1174).
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Camier-Lemoine, E. (2022). Palliative Care Between Certainty and Uncertainty. Which Philosophy of Death at the End of Life?. In: Seidlein, AH., Salloch, S. (eds) Ethical Challenges for Healthcare Practices at the End of Life: Interdisciplinary Perspectives. Philosophy and Medicine, vol 141. Springer, Cham. https://doi.org/10.1007/978-3-030-83186-8_2
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