[Engaged caregivers: an empirical-ethical analysis of dignity in palliative care]. / Geëngageerde hulpverleners.

The concept of dignity is often used in palliative care, and, in particular, as a concept to illustrate what is important to those involved. However, philosophers, ethicists and laypersons cannot agree on what dignity actually is. In this paper, we analyse what caregivers told us about situations in which they thought dignity was at stake. From two focus group meeting of health care professionals concerning the end of life, we learned that dignity could mean different things, but that there were also shared themes. Dignity was at stake where the situation of the patient threatened the deeply felt values of the caregivers. The caregiver engages him or herself to support the dignity of their patient while simultaneously honouring their own sense of dignity. We recommend that care organisations support caregivers' engagement with dignity by creating time and space for its analysis.

The particularity of dignity: relational engagement in care at the end of life.

This paper articulates dignity as relational engagement in concrete care situations. Dignity is often understood as an abstract principle that represents inherent worth of all human beings. In actual care practices, this principle has to be substantiated in order to gain meaning and inform care activities. We describe three exemplary substantiations of the principle of dignity in care: as a state or characteristic of a situation; as a way to differentiate between socio-cultural positions; or as personal meaning. We continue our analysis by presenting cases on dignity in care related to us in focus groups with medical professionals. Our empirical ethical lens is in this paper is to analyse, not the meaning of dignity, but the way in which it emerges in practices where it is pursued, within relationships between people, technologies, places, regulations, and the values cherished by or embedded in them. We show that professional caregivers recognize in the dignity of the person they care for their own dignity; giving up on the one implies no less than giving up on the other. This 'mirrored experience' of dignity expresses itself in professional's engagement with the situation. The value of this engagement, we argue, lies not primarily in realizing the particular content of the values at stake. We point to the importance of engagement itself, even if the values engaged with cannot be realized to the full, and even if competing versions of dignity are at stake simultaneously. In this way the caregivers provide us with interesting examples of moral actorship in situations of conflicting values.

Knowledge of shadows: the introduction of X-ray images in medicine.

Ever since the discovery of X-rays in 1895, X-ray imaging has played a large role in the cognitive and practical organization of medicine. This article analyses the way X-ray images were introduced and made sense of in medical thinking and acting around the turn of the century. The implicit assumption in many histories of radiology is that the specific (diagnostic) message of the X-ray images resided inside them from the beginning, and that it is obscured either by technological or epistemological problems. These being solved, it would then be no problem to see directly what information the image contains. In this article this assumption is contested. It is argued that the specific content of the images was shaped by the activities of X-ray workers within the context of medical developments of the time. This shaping, as it is historically reconstructed here, consisted of four methods. X-ray workers (be they physicians, technicians or scientists) experimented with the technology, the images, the photographic materials and the objects that were X-rayed. They used X-ray images of dead bodies to compare them with radiographs of living patients. Radiologists tried to'translate'diagnostic information acquired with other methods into the shadows of the X-ray images. And finally they compared images with images. The process of shaping the content and use of X-ray images, of making them represent reality, took place within specific institutions, and it took a different form in different countries, but also for different parts of the body. Developments of institutionalisation and professionalisation of radiology in England and the Netherlands are presented to provide a small part of the background of this shaping of knowledge of shadows.