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Papers by Isabelle Wienand

Background: Care for palliative care patients is often provided by unpaid caregivers (eg, family ... more Background: Care for palliative care patients is often provided by unpaid caregivers (eg, family members) who take care of the patient's daily needs (eg, bathing, dressing). Family members of palliative care patients are involved in numerous ways. These tasks and responsibilities can make them feel burdened and even overburdened. Aim: We specifically looked at patients' medical records to determine what is being reported about burden and overburden and who seems to be mostly affected. Burden was understood as a weight or task that is difficult to accept or carry, whereas overburden indicates that this weight or task cannot be carried anymore. Methods: We looked at 300 medical records of palliative care patients written by health-care professionals. Written notes were analyzed using latent content analysis as it helps to analyze large amounts of textual data qualitatively and to understand the underlying concepts of what was said. Results: Most (73.5%) patients had a cancer diagnosis. Mean age was 67.6 years (range, 22-98 years). Burden and overburden were identified as main categories and further divided into the following subcategories: for patients and families. According to the written notes, patients often felt burdened by their disease, financial problems, situation at home, and families' reactions to their disease. By and large, patients felt overburdened by their own disease. Families often felt burdened because of issues related to patients' medical condition, providing home care, or financial and social aspects. Families mentioned home care and the decision-making process as being overburdening. Conclusion: Findings in the palliative care patients' medical records are inasmuch important, as they point at the health-care staff's awareness of possible weights and tasks that might be burdensome for patients and their families. Attention should be drawn to the documentation of medical records in order to identify recurrent difficulties and to help discuss these.

Cadernos Nietzsche, 2012

O artigo procura responder à questão se a ideia de reconciliação encontra-se articulada no pensam... more O artigo procura responder à questão se a ideia de reconciliação encontra-se articulada no pensamento de Nietzsche. Esta abordagem é feita em três passos. A primeira parte apresenta a crítica de Nietzsche à motivação e aos objetivos da reconciliação (ou autorreconciliação) presentes em concepções religiosas, sociais e filosóficas. A segunda parte defende que Nietzsche desenvolve uma forma alternativa de reconciliação: a autossuperação. A terceira e última parte discute em que medida a insistência de Nietzsche no eu na autossuperação pode subtrair a figura do outro e assim borrar a linha entre autossuperação e auto-ilusão.

International Journal of Philosophical Studies, 2009

The Latin edition of the Meditationes (1641) was followed by Sets of Objections and by Descartes&... more The Latin edition of the Meditationes (1641) was followed by Sets of Objections and by Descartes' Sets of Replies. One of the recurring objections concerned the Cartesian claim which states that mind and body are both really distinct and unified substances. Arnauld (Fourth Set of Objections) and Gassendi (Fifth Set of Objections) made Descartes aware of the incoherence of these two claims made in Meditation II and VI. In these public disputes, Descartes uses certain arguments as well as rhetorical devices to defend his views. In a less public context such as the correspondence with Princess Elisabeth of Bohemia, which starts in May 1643, Descartes continues to maintain his paradoxical theses. What one finds in these letters is that Descartes changes not only the tone, but also the content, of his arguments (e.g. the argument of the "three kinds of primitive ideas or notions"). The paper proceeds in four parts: (1) reconstructing the main arguments of the distinction an...

In the history of ideas, "suicide" refers in general to the voluntary act of selfdestruction (Min... more In the history of ideas, "suicide" refers in general to the voluntary act of selfdestruction (Minois 1995). By contrast, the word "suicide" is hardly used alone in contemporary medical ethics, as patients' requests to end their lives refers to specific ethical and legal issues (Beauchamp 1993). For instance, "physician-assisted suicide" raises the question about the justified conditions under which physicians may be involved in the request of patients to die. The fundamental condition is that the decision-making of the patient be unambiguously autonomous. A further use of the word "suicide" in medical ethics is within the context of "suicide prevention". It refers to the medical-social right to intervene in order to prevent patients who are mentally ill, or clinically depressed, from not acting autonomously (Beauchamp and Childress 2009). This paper focuses upon the philosophical arguments on assisted suicide, which the German thinker Friedrich Nietzsche (1844-1900) developed in his early writings. We argue that Nietzsche-who is often perceived as defending the legitimacy of suicide as the expression of individual autonomy (Hecht 2013)remains, however, cautious and undecided concerning the possibility of identifying for certain whether a patient is indeed acting autonomously when s/he requests to put an end to his/her life. We underline the hermeneutic challenges that health-care professionals face when a patient formulates a suicide request. In this paper, we ask whether it should be desirable that health-care professionals suspend their personal view regarding assisted suicide. The paper focuses on Nietzsche's ideas about suicide, which he formulated at the end of the 1870s, mainly in Human, all too Human (HTH). In this contribution, we shall take a closer look at §185 of The Wanderer and His Shadow and suggest, in contrast to a widespread view, that Nietzsche is not an active and straightforward defender of the cause of suicide. Our suspicion is that Nietzsche was aiming at something else than at simply endorsing a pro-suicide attitude. When Nietzsche took up the case of suicide, it was mainly to criticize philosophical rejections of suicide, in particular Schopenhauer's view (Jacquette 2000), the religious prohibition, and the moral condemnation of suicide. The issue of suicide was an opportunity for Nietzsche to distance himself from normative stances. By criticizing the philosophical, moral, and religious condemnation of suicide, Nietzsche did not, however, plead for a legitimation of suicide. The suggestion made here is that Nietzsche's disagreement with the moral

... Reviewed by. Isabelle Wienand University of Nijmegen/Université de Fribourg isabelle.wienand@... more ... Reviewed by. Isabelle Wienand University of Nijmegen/Université de Fribourg isabelle.wienand@ unifr.ch. Nuno Nabais. Nietzsche and the Metaphysics of the Tragic. Trans. from Portuguese by Martin Earl. ... Nuno Nabais teaches philosophy at the University of Lisbon. ...

Conflict and Contest in Nietzsche’s Philosophy

Philosophische Bibliothek

Journal of bioethical inquiry, Jan 16, 2018

This paper explores the importance of hope as a determining factor for patients to participate in... more This paper explores the importance of hope as a determining factor for patients to participate in first-in-human trials for synthetic biology therapies. This paper focuses on different aspects of hope in the context of human health and well-being and explores the varieties of hope expressed by patients. The research findings are based on interview data collected from stable gout and diabetes patients. Three concepts of hope have emerged from the interviews: hope as certainty (H1); hope as reflective uncertainty (H2); hope as self-therapy (H3). The purpose of the paper is twofold. First, it aims to underline the significance of hope in patients' medical decision-making, as well as the beneficence of hope for patients' well-being, and for progress in research. Second, it shows how philosophical investigations-in particular Descartes-explore the phenomenon of hope and provide medical empirical research with profitable insights and tools.

Science and engineering ethics, Apr 2, 2016

We analyzed stable patients' views regarding synthetic biology in general, the medical applic... more We analyzed stable patients' views regarding synthetic biology in general, the medical application of synthetic biology, and their potential participation in trials of synthetic biology in particular. The aim of the study was to find out whether patients' views and preferences change after receiving more detailed information about synthetic biology and its clinical applications. The qualitative study was carried out with a purposive sample of 36 stable patients, who suffered from diabetes or gout. Interviews were transcribed verbatim, translated and fully anonymized. Thematic analysis was applied in order to examine stable patients' attitudes towards synthetic biology, its medical application, and their participation in trials. When patients were asked about synthetic biology in general, most of them were anxious that something uncontrollable could be created. After a concrete example of possible future treatment options, patients started to see synthetic biology in a mo...

Background: Care for palliative care patients is often provided by unpaid caregivers (eg, family ... more Background: Care for palliative care patients is often provided by unpaid caregivers (eg, family members) who take care of the patient's daily needs (eg, bathing, dressing). Family members of palliative care patients are involved in numerous ways. These tasks and responsibilities can make them feel burdened and even overburdened. Aim: We specifically looked at patients' medical records to determine what is being reported about burden and overburden and who seems to be mostly affected. Burden was understood as a weight or task that is difficult to accept or carry, whereas overburden indicates that this weight or task cannot be carried anymore. Methods: We looked at 300 medical records of palliative care patients written by health-care professionals. Written notes were analyzed using latent content analysis as it helps to analyze large amounts of textual data qualitatively and to understand the underlying concepts of what was said. Results: Most (73.5%) patients had a cancer diagnosis. Mean age was 67.6 years (range, 22-98 years). Burden and overburden were identified as main categories and further divided into the following subcategories: for patients and families. According to the written notes, patients often felt burdened by their disease, financial problems, situation at home, and families' reactions to their disease. By and large, patients felt overburdened by their own disease. Families often felt burdened because of issues related to patients' medical condition, providing home care, or financial and social aspects. Families mentioned home care and the decision-making process as being overburdening. Conclusion: Findings in the palliative care patients' medical records are inasmuch important, as they point at the health-care staff's awareness of possible weights and tasks that might be burdensome for patients and their families. Attention should be drawn to the documentation of medical records in order to identify recurrent difficulties and to help discuss these.

Cadernos Nietzsche, 2012

O artigo procura responder à questão se a ideia de reconciliação encontra-se articulada no pensam... more O artigo procura responder à questão se a ideia de reconciliação encontra-se articulada no pensamento de Nietzsche. Esta abordagem é feita em três passos. A primeira parte apresenta a crítica de Nietzsche à motivação e aos objetivos da reconciliação (ou autorreconciliação) presentes em concepções religiosas, sociais e filosóficas. A segunda parte defende que Nietzsche desenvolve uma forma alternativa de reconciliação: a autossuperação. A terceira e última parte discute em que medida a insistência de Nietzsche no eu na autossuperação pode subtrair a figura do outro e assim borrar a linha entre autossuperação e auto-ilusão.

International Journal of Philosophical Studies, 2009

The Latin edition of the Meditationes (1641) was followed by Sets of Objections and by Descartes&... more The Latin edition of the Meditationes (1641) was followed by Sets of Objections and by Descartes' Sets of Replies. One of the recurring objections concerned the Cartesian claim which states that mind and body are both really distinct and unified substances. Arnauld (Fourth Set of Objections) and Gassendi (Fifth Set of Objections) made Descartes aware of the incoherence of these two claims made in Meditation II and VI. In these public disputes, Descartes uses certain arguments as well as rhetorical devices to defend his views. In a less public context such as the correspondence with Princess Elisabeth of Bohemia, which starts in May 1643, Descartes continues to maintain his paradoxical theses. What one finds in these letters is that Descartes changes not only the tone, but also the content, of his arguments (e.g. the argument of the "three kinds of primitive ideas or notions"). The paper proceeds in four parts: (1) reconstructing the main arguments of the distinction an...

In the history of ideas, "suicide" refers in general to the voluntary act of selfdestruction (Min... more In the history of ideas, "suicide" refers in general to the voluntary act of selfdestruction (Minois 1995). By contrast, the word "suicide" is hardly used alone in contemporary medical ethics, as patients' requests to end their lives refers to specific ethical and legal issues (Beauchamp 1993). For instance, "physician-assisted suicide" raises the question about the justified conditions under which physicians may be involved in the request of patients to die. The fundamental condition is that the decision-making of the patient be unambiguously autonomous. A further use of the word "suicide" in medical ethics is within the context of "suicide prevention". It refers to the medical-social right to intervene in order to prevent patients who are mentally ill, or clinically depressed, from not acting autonomously (Beauchamp and Childress 2009). This paper focuses upon the philosophical arguments on assisted suicide, which the German thinker Friedrich Nietzsche (1844-1900) developed in his early writings. We argue that Nietzsche-who is often perceived as defending the legitimacy of suicide as the expression of individual autonomy (Hecht 2013)remains, however, cautious and undecided concerning the possibility of identifying for certain whether a patient is indeed acting autonomously when s/he requests to put an end to his/her life. We underline the hermeneutic challenges that health-care professionals face when a patient formulates a suicide request. In this paper, we ask whether it should be desirable that health-care professionals suspend their personal view regarding assisted suicide. The paper focuses on Nietzsche's ideas about suicide, which he formulated at the end of the 1870s, mainly in Human, all too Human (HTH). In this contribution, we shall take a closer look at §185 of The Wanderer and His Shadow and suggest, in contrast to a widespread view, that Nietzsche is not an active and straightforward defender of the cause of suicide. Our suspicion is that Nietzsche was aiming at something else than at simply endorsing a pro-suicide attitude. When Nietzsche took up the case of suicide, it was mainly to criticize philosophical rejections of suicide, in particular Schopenhauer's view (Jacquette 2000), the religious prohibition, and the moral condemnation of suicide. The issue of suicide was an opportunity for Nietzsche to distance himself from normative stances. By criticizing the philosophical, moral, and religious condemnation of suicide, Nietzsche did not, however, plead for a legitimation of suicide. The suggestion made here is that Nietzsche's disagreement with the moral

... Reviewed by. Isabelle Wienand University of Nijmegen/Université de Fribourg isabelle.wienand@... more ... Reviewed by. Isabelle Wienand University of Nijmegen/Université de Fribourg isabelle.wienand@ unifr.ch. Nuno Nabais. Nietzsche and the Metaphysics of the Tragic. Trans. from Portuguese by Martin Earl. ... Nuno Nabais teaches philosophy at the University of Lisbon. ...

Conflict and Contest in Nietzsche’s Philosophy

Philosophische Bibliothek

Journal of bioethical inquiry, Jan 16, 2018

This paper explores the importance of hope as a determining factor for patients to participate in... more This paper explores the importance of hope as a determining factor for patients to participate in first-in-human trials for synthetic biology therapies. This paper focuses on different aspects of hope in the context of human health and well-being and explores the varieties of hope expressed by patients. The research findings are based on interview data collected from stable gout and diabetes patients. Three concepts of hope have emerged from the interviews: hope as certainty (H1); hope as reflective uncertainty (H2); hope as self-therapy (H3). The purpose of the paper is twofold. First, it aims to underline the significance of hope in patients' medical decision-making, as well as the beneficence of hope for patients' well-being, and for progress in research. Second, it shows how philosophical investigations-in particular Descartes-explore the phenomenon of hope and provide medical empirical research with profitable insights and tools.

Science and engineering ethics, Apr 2, 2016

We analyzed stable patients' views regarding synthetic biology in general, the medical applic... more We analyzed stable patients' views regarding synthetic biology in general, the medical application of synthetic biology, and their potential participation in trials of synthetic biology in particular. The aim of the study was to find out whether patients' views and preferences change after receiving more detailed information about synthetic biology and its clinical applications. The qualitative study was carried out with a purposive sample of 36 stable patients, who suffered from diabetes or gout. Interviews were transcribed verbatim, translated and fully anonymized. Thematic analysis was applied in order to examine stable patients' attitudes towards synthetic biology, its medical application, and their participation in trials. When patients were asked about synthetic biology in general, most of them were anxious that something uncontrollable could be created. After a concrete example of possible future treatment options, patients started to see synthetic biology in a mo...

The Journal of Nietzsche Studies, 2009

... Reviewed by. Isabelle Wienand University of Nijmegen/Université de Fribourg isabelle.wienand@... more ... Reviewed by. Isabelle Wienand University of Nijmegen/Université de Fribourg isabelle.wienand@ unifr.ch. Nuno Nabais. Nietzsche and the Metaphysics of the Tragic. Trans. from Portuguese by Martin Earl. ... Nuno Nabais teaches philosophy at the University of Lisbon. ...