Author: Françoise Monnoyeur

Saying What We Mean [SWWM] provides a collection of selected philosophical writings by Eugene Gendlin (1926-2017) edited by editors Edward S. Casey and Donata M. Schoeller. As Schoeller notes this volume is intended to “excite an appetite for the extraordinary thinking of Eugene Gendlin and for the effects of his concepts as well as his practices that, in paraphrasing Adorno, ‘open up’ the phenomena they make thinkable.” [xv] SWWM is the first collection of Gendlin’s specifically philosophical writings, and is Gendlin’s final publication, appearing several months after his passing. It presents a final explication of Gendlin’s personal philosophy of experience, in which he explored the contours of the relation between implicit and explicit knowing, and the generation of language and conceptual meaning from the ground of our embodied senses. At the same time this “farewell letter” invites the reader to carry forward this exploration in her own personal way. The publication of SWWM reminds us that, as Gendlin himself insisted, his professional identity was first and foremost that of a philosopher. Gendlin’s intellectual roots extend deeply into Continental, Analytic philosophy as well as American pragmatism. His intellectual influences include among others: Dilthey, Husserl, Heidegger, Merleau-Ponty, Wittgenstein, Whitehead, and McKeon – the latter with whom Gendlin studied at the University of Chicago, and had a great influence on shaping Gendlin’s philosophical outlook. Gendlin was a prolific author, and his philosophical writings have been published in numerous essays and several books.[1]

Despite Gendlin’s prolific philosophical output, the publication of SWWM serves as a needful reminder of Gendlin’s philosophical ideas. Other than as a philosopher, Gendlin is most popularly remembered as the founder of the practical experiential method called Focusing, which provides a structured methodology to bring open, non-judging attention to embodied, experiential internal knowing – often referred to as the “felt sense” – prior to its conceptualization in language.[2]  Focusing is most widely used as an aid for psychotherapy, although it is accessible to everyone interested in a practical methodology for personal transformation. Focusing developed out of Gendlin’s research at the University of Chicago with humanistic psychologist Carl Rogers into the phenomenological-process-oriented theory of experience and its transformation. Gendlin’s original research revealed that the way in which a client related to his or her personal experience during psychotherapy sessions, irrespective of the particular psychotherapeutic approach, provided a single significant predictor of the therapy’s success. As a process oriented methodology with deep roots in phenomenological philosophy, Focusing can be applied to enhance any particular psychotherapeutic approach, or can occur as a stand-alone methodology to enhance human potential. The essays in SWWM attest that Gendlin’s practical method of Focusing would be unthinkable without its underlying philosophical foundation. At the same time, the practical and the theoretical aspects of Gendlin’s lifework cannot and should not be artificially separated. The practice of Focusing provided Gendlin with material for philosophical reflection, as much as philosophical reflection provided the conceptual apparatus for the development of Focusing’s methodology. The core insight animating all of the essays in SWWM is the unceasing bidirectional relation between experience and rational conceptualization.

Gendlin’s focus on process means that he is not limited to espousing a particular philosophical school; but rather provides a process model approach that can ground different forms of philosophical conceptualization. Gendlin’s emphasis on the processes of thinking rather than on the final forms themselves is no doubt inspired in large part by Edmund Husserl’s phenomenological critique of psychology and the natural sciences. Gendlin’s philosophical feat has been to radically personalize philosophy, countering the age-old tendency towards universalization in philosophical reflection, while at the same time respecting structures of explicit rationality and cognition. This personalized perspective – both in terms of personal philosophical meaning, as well as in terms of self-healing– has deep roots in Gendlin’s personal history. In a German language interview with Lore Kolbei (1994), Gendlin described how his childhood experience fleeing Nazi occupied Vienna with his family, shaped his future life and single-minded intellectual focus. In determining how to escape the clutches of the Nazis together with his family, Gendlin’s father relied on following his internal feelings in deciding which individuals they encountered could be trusted in their escape. Gendlin’s later life was dedicated to deciphering the meaning of these internal feelings, both through psychotherapeutic processes and philosophical reflection. I feel it important to mention this biographical history, since it is of central importance in shaping Gendlin’s personalized philosophy. It is of interest that Gendlin does not refer to such cultural and biographical influences in his philosophical writings, as if wanting to emphasize the universal nature of pre-conceptual sensations in giving rise to language and explicit cognition.

SWWM provides in single volume some of Gendlin’s most influential essays. As such, this volume makes Gendlin’s philosophical reflections accessible to a wider audience in a concentrated form, and may be important in bringing Gendlin’s intellectual work to the attention of philosophers who have not yet come across his work, or have glossed over its importance providing a structured methodology to analyze pre-conceptual cognition in relation to explicit forms of knowing. (It is also worth mentioning the collection of critical studies on Gendlin’s work in the philosophy of language entitled Language beyond Postmodernism [LBM] (1997),  published more than two decades ago and which like SWWM served as a kind of introductory volume for Gendlin’s philosophical ideas.)  The essays in SWWM are primarily philosophical, though they speak equally to Gendlin’s practice of Focusing, and the later application of Focusing to analyze professional knowing called Thinking at the Edge (TAE). TAE is a practical methodology for applying the “intricate precision” immanent in our experiential knowing to professional, scientific and private contexts. [xix] For example, a clinician reflecting on aspects of a clinical case, could apply TAE to investigate the boundaries of intuition and explicit knowing. Perhaps the most important function of SWWM is to provide a general framework for Gendlin’s conceptual evolution. Unfortunately, chronological details of each essay are not provided, which would give information about the progressive development of Gendlin’s thinking.

The edited volume is divided into four parts:

Part 1. Phenomenology of the Implicit;

Part 2. A Process Model;

Part 3. On the Edges of Plato, Heidegger, Kant, and Wittgenstein, and

Part 4. Thinking with the Implicit.

Part 1 provides different approaches of Gendlin towards developing a conceptual methodology and language to differentiate different layers of implicit experience. Phenomenology provides the major philosophical ground for this engagement with implicit experience; though Gendlin uses his phenomenological approach to interrogate different philosophical schools and methodologies, especially linguistic analysis and philosophy of language. Phenomenology too, is not spared Gendlin’s critical gaze, as depicted in his brilliant essay, “Two Phenomenologists Do Not Disagree,” in which he analyzes the situation whereby two committed phenomenologists disagree over a single observed phenomenon. As opposed to following a particular phenomenological school or individual philosopher, Gendlin proposes to ‘study the formulating process itself,’ as well as the ‘roles of experience in it’ in order to determine how experience can ‘ground different formulations differently,’ including different phenomenological statements or perspectives. [8] Even though a particular statement may be differentiated as phenomenological from a non-phenomenological statement by following a well demarcated phenomenological methodology or “noticeable signposts,, for example Husserl’s proposed methodology of bracketing, in order to enable a primordial experience of a particular object of inquiry, Gendlin observes that phenomenological statements may possess many unintended logical implications.[8] These hidden intentions or meanings are amenable to being uncovered or elicited through further processes of concentrated focusing or introspection.

Gendlin’s essays depict his intellectual debt to the tradition of phenomenology; and at the same time develops his own philosophy of the implicit in new directions, navigating between age-old dichotomies, such as reductionism and idealism. An important aspect of the collection of philosophical essays in SWWM lies in providing a means of tracing and analyzing the influence of various phenomenological traditions on Gendlin’s thinking, including that of Husserl, Heideger, and Merleau-Ponty, and how Gendlin carries this tradition forward in his personalized philosophical   way.

In his critical essay response to Gendlin’s philosophy entitled, “Experience and Meaning,” J.N. Mohanty (1997) provides key insights regarding Gendlin’s relation to Edmund Husserl’s phenomenology, which are still relevant in relation to Gendlin’s collection of philosophical essays in SWWM. In his analysis of the relation between experience and meaning in Gendlin’s philosophical theory, Mohanty discerns four levels of meaning:

1. Experiencing with implicit, incomplete felt meanings;

2. Explicit, felt but prelinguistic (though still symbolized) meanings, inwardly attended to;

3. Experiential concepts (arising out of the interaction of felt meanings with language);

4. Logical concepts. [184]

The core tension animating each of the essays in SWWM is the inherent relation between each of these four levels of meaning. While not participating in logical inference, the “most basic level,” i.e., the implicit background has its own precise kind of order, which functions in the formation of new and ever more precise scientific concepts. Thus, Gendlin posits a pre-conceptual rational order, that is not the same as explicit logic, but which grounds the possibility for explicit rationality. In Part 2. “A Process Model,” which refers to Gendlin’s magnum opus of the same name, Gendlin articulates further this pre-conceptual rational order, or what he now refers to as the ‘conditions of possibility’ for the ‘implicit precision of experience.’ [xvii] Implicit precision refers to the embodied process generated through interaction between the conscious organism and its environment. While logical precision is explicitly rational and depends on defined units, the process of implied precision ‘generates and regenerates the background objects and their relationships, including logical scientific units.’ [111] Implicit precision articulates Gendlin’s basic insight that there is a direct reference between preconceptual and explicit cognition. Moreover, as the name implicit precision implies, this level of organismic consciousness possesses a rational structure, even if it is not ordered according to explicit logical principles. Movement between these two forms of precision can occur in either direction. Indeed, scientific logic is unthinkable without this foundational level of embodied knowing.

Mohanty claims that Gendlin requires a mediating concept, a “Zwischenglied” between implicit experience and logical concept. Gendlin’s concept of direct reference provides this Zwischenglied. In SWWM Gendlin refers to this direct relationality between felt sense and logical concept using the terminology of ‘direct experience’ and ‘direct referent.’ In my own imagination, this Zwischenglied of direct reference is analogous to the sensation in holding two opposing poles of a magnet in close proximity. One feels the invisible magnetic force between the two poles of experience and logic. However, maintaining this force is a slippery undertaking that gives rise to a perplexing sensation. Trying to elicit the connection and opposition between these different levels is key to getting a sense of Gendlin’s philosophical task. As Gendlin writes, saying exactly how ‘direct experience can function as a ground in each step of formulating’ ‘opens up a whole new field of enquiry.’ [7]

Names such as “implicit precision” and “carrying forward,” referring to the infinite possibility for bodily implying beyond explicit concepts, are terms that Gendlin provides in the Process Model for conceptual structures arising from and referring to his process methodology. This process of naming felt-sensations as they emerge into language is an integral part of the Focusing process. Gendlin would undoubtedly invite readers of his philosophical writings to extend his philosophical practice by developing their own names for universal processes of meaning-making. One can debate the precise relation between Husserl’s use of act and intentionality in relation to Gendlin’s process model. For example, Mohanty notes that Gendlin did not regard Husserl’s conception of act and intentionality as including data of awareness, but rather as principles presupposed by such data. [183] Similarly, Gendlin held that Husserl did not include felt experiencing as part of the datum given in meaningful awareness. [ECM, p. 276] However, Gendlin’s views on Husserl appear to have shifted, since he notes in his essay, “Two Phenomenologists Do Not Disagree,” that Husserl did not begin his phenomenological explorations with analyzing the relations between feelings, situations, and language. Yet, through his contact with direct experience, he encountered these interrelations in that experience. [54] However, even if felt experiencing can be traced back to Husserl’s conception of act and intentionality, Gendlin’s expansion and delineation of the methodology to track the relation between experience and meaning moves beyond its phenomenological foundations. Moreover, the process of giving provisional name to conceptual structures emerging from reflection on one’s felt experience, such as “implicit precision” and “carrying forward,” blending personal experience with rational conceptualization is a unique philosophical contribution of Gendlin’s.

Any reader of SWWM must necessarily be divided into two groups. Those with a first-hand familiarity of the process of Focusing, and those who approach the text as a purely philosophical text to be understood conceptually. In a sense, it is not possible to approach these texts purely intellectually, since Gendlin’s method explicitly aims to bridge the mind-body dichotomy. In her introduction, Schoeller writes that, ‘Gendlin’s thinking and practices move across the body-mind split, expanding the field of experience and thinking beyond so-called subjective or objective approaches in order to cultivate an awareness of the preciseness of what he calls a “responsive order.”’ [xiv] Gendlin peppers his essays with practical examples, exhortations to his readers to engage practically with his methodology. For example, in his essay “The New Phenomenology of Carrying Forward,” Gendlin notes how in writing a poem one’s body has a precise sense of what needs to be said. [84] The process of Focusing is similar in many ways to the poet’s attending to her felt sensations in the process of writing a poem. Grappling with Gendlin’s conceptual ideas necessitates an induction into the process of Focusing. Yet, Gendlin would argue that any meaning-making process incorporates this kind of embodied sense-making, formalized in a structured process, or not. Readers who do not concretely explore Gendlin’s practical examples through deep introspection, and who merely try to understand his conceptual arguments from a disembodied perspective, must necessarily fail to comprehend the tenor of his argument.

The “Process Model” emphasizes the embodied nature of Gendlin’s philosophical project. (As a Feldenkrais Method Somatic Education Practitioner I am particularly receptive to the centrality of the body in Gendlin’s philosophy of the implicit. The Feldenkrais Method is similiar to Focusing in providing a practical methodology to explore the relation between one’s felt sense and cognition; however, the Feldenkrais Method introduces the added dimension of movement exploration.) In his essay “The Derivation of Space,” Gendlin notes that, ‘… the clarity which an analytic layout brings lies not only in the layout before us. It has an effect in the body. It brings an implicit whole bodied understanding. “Aha!” we say.’ [156] Following Stuart, in the essay on “Implicit Precision,” Gendlin refers to a perceptual concept called enkinaesthesia, i.e., ‘the sentient half of a behavior sequence and the sentience of patterned interactions which is the sequence of bodily shifts I call versioning.’  [121] Taking the cue from Gendlin’s terminology, an embodied adaptation of Focusing, called Whole-Bodied Focusing, developed by Kevin McEvenue [2015], integrates Focusing with somatic experiential techniques from the Alexander Method. Nonetheless, even though Gendlin’s philosophy of the implicit does provide a means of overcoming mind-body dualism, the body is emphasized only tangentially, in the sense that real attention to the body requires an embodied practice, as in Whole Body Focusing, other somatic education practices, such as Feldenkrais Method. The complete intellectual grasping of Gendlin’s ideas requires an embodied practice in conjunction with attention to the embodied basis of our logical conceptualization.

Part 3. “On the Edges of Plato, Heidegger, Kant and Wittgenstein presents” Gendlin’s philosophical thinking in relation to major philosophers in the Western tradition. Gendlin’s philosophy does indeed present a methodology to reengage and reinvigorate the Western philosophical canon. His philosophical ambitions are simultaneously grand and modest, in the sense that Gendlin has enough confidence in his insights to re-read ancient philosophers, such as Plato and Aristotle; yet does this, not by contesting their philosophical claims and arguments, but by “lifting out” the most basic experiential sensations elicited through engaging with the textual ideas. In other words, through his process model, Gendlin finds a means of re-engaging with ancient philosophical texts and ideas, to provide fresh insights and meanings, without attempting to disprove any particular philosophical approach.

This process of “lifting out” also has relation to phenomenology, though not Husserl’s transcendental phenomenology, but Martin Heidegger’s phenomenology of Being, and particularly his concept of Befindlichkeit. As Francesca Brencio (2019) notes in her recent review of Befindlichkeit in relation to psychopathology:

Befindlichkeit stresses the basic state of Dasein in its being situated: finding ourselves already in situatedness, means finding ourselves gathered to a “there” (being-there, in German Dasein). The situatedness is strictly related to the existence’s facticity and it becomes manifest to us through our own moods and affectivity. [344]

Our moods and affective states provide the grounds of our pre-conceptual experience, and the means of becoming attuned to the external world. There is, therefore, a strong affinity between Heidegger’s concept of Befindlichkeit and Gendlin’s philosophy of the implicit. In his essay, “Befindlichkeit: Heidegger and the Philosophy of Psychology,” Gendlin observes that, ‘Heidegger’s concept denotes how we sense ourselves in situations. Whereas feeling is usually thought of as something inward, Heidegger’s concept refers to something both inward and outward, but before a split between inside and outside has been made.’ [195]

In referring to psychological affective states and moods, Befindlichkeit has obvious clinical importance for clinical psychology and theories of psychopathology, and resonates strongly with Gendlin’s philosophical project and practical methodology of Focusing. However it is in providing the phenomenological possibility of original disclosing that provides the strongest link between Gendlin and Heidegger. Gendlin quotes the following paragraph from Heidegger’s magnum opus, Being and Time:

Befindlichkeit is a basic existential way in which Dasein (being-here) is its here. It not only characterizes Dasein ontologically, but because of its disclosing, it is at the same time of basic methodological significance for the existential analytic. Like any ontological interpretation whatsoever this analytic can only, so to speak, “listen in” to the previously disclosed being of something that is… Phenomenological interpretation must give Dasein the possibility of original disclosing, to raise the phenomenal content of this disclosing into concepts. [178-79]

For Heidegger it is the disclosing of Befindlichkeit which renders a statement phenomenological, from a state of free-floatingness. [216] Gendlin claims to extend Heidegger’s concept of Befindlichkeit in his own practical philosophy through adding the bodily dimension; which Gendlin claims is missing in Heidegger’s philosophy. Additionally, Befindlichkeit provides a means of explaining Gendlin’s process methodology in Focusing, through getting in touch with and “lifting out” implicit felt meanings for conceptualization. As mentioned, for Gendlin, this lifting out process, while phenomenological, is not limited to any particular philosophical formulation, including that of Heidegger’s analysis of Being. The deep relation between Befindlichkeit and Gendlin’s philosophy of the implicit means that even though Gendlin’s philosophy is greatly indebted to the Husserlian phenomenological tradition, in his heart of hearts Gendlin appears more aligned with Heidegger’s philosophy of Being-in-the-world, though this relationship is not without its personal ambivalence. In his sole biographical observation in all of the essays in SWWM, Gendlin notes his indirect indebtedness to Heidegger, who he only came to read later in life once he overcame his personal antipathy to Heidegger:

My own work for many years preceded my reading Heidegger. I came to him quite late. Both the personality change mentioned above, and the philosophical work I will now mention, were written before I read Heidegger. But I had read those philosophers that most influenced Heidegger, and so I emerged from the same sources, at least to some extent. I had also read Sartre, Buber, and Merleau-Ponty, who were greatly and crucially following Heidegger. Hence my own work continues from Heidegger, and stands under his influence, although I did not recognize that until later….  [223]

Gendlin’s attraction towards Heidegger’s concept of Befindlichkeit can also be explained because of its inherent potential for developing a psychological or psychopathological theory. Since moods and affective feelings ground our experience of reality, psychopathological conditions such as anxiety are characterized by a breakdown or collapse of our affective experiential foundations.[3] It is not by chance that the practice of Focusing tends to emphasize uncomfortable physical and mental felt sensations, as the core of its therapeutic work.[4] Gendlin is attracted to and reworks Heidegger’s concept of Befindlichkeit because of his own deep therapeutic concern that informs both the practice of Focusing and his philosophical theorizing about the implicit. In “Befindlichkeit: Heidegger and the Philosophy of Psychology,” Gendlin observes that the essence of psychotherapy is phenomenological in the therapeutic process through the Heideggerian concept of lifting out. Thus, Gendlin notes that ‘any statements and interprerations are effective only when they lift something from the directly senses and preverbally “understood” felt complexity. Even very sophisticated statements by patients and therapists alter nothing in the patient’s living, unless there is the distinct effect of lifting something out.’ [218] This sentence encapsulates Gendlin’s life-work in interweaving philosophical conceptualization with lived experience in general, and psychotherapy in particular.

The final section of SWWM, Part 4. “Thinking with the Implicit,” presents an introduction to the practice of Thinking at the Edge (TAE), the extension of the practice of focusing to scientific and professional contexts. In Gendlin’s words, ‘TAE is a systematic way to articulate in new terms something which needs to be said but is at first only an inchoate “bodily sense.”’ [282] It seems to me (without having personally experienced its practice) that TAE applies the Focusing methodology in a specific structured context, as opposed for example, simply trying to assess one’s felt bodily sense, in order to elicit new logical analytical formulations and creative theorization. In other words, TAE is concerned with developing explicit logical concepts relating to specific spheres of interest or expertize out of the grounds of implicit knowing. Gendlin has an explicit political awareness around TAE, considering that it provides a tool for people from all social strata and intellectual backgrounds to articulate their experiences, and to develop new patterns of thought. Through TAE, Gendlin claims, the capacity to develop novel philosophical ideas and logical and scientific concepts is no longer limited to an intellectual elite, but is open to all.

TAE is of especial personal interest to me in terms of its potential applications to medicine and clinical reasoning. I have an abiding interest in the philosophy of the implicit, having conducted analogous research into the tacit foundations of clinical reasoning.[5] This work was not fundamentally informed by Gendlin’s writings, but rather was influenced by other phenomenologists, such as Edmund Husserl, Maurice Merleau-Ponty and Emmanuel Levinas, as well Michael Polanyi’s philosophy of tacit knowing. Similar to Gendlin, my focus on the role of intuition in clinical reasoning has also brought me to conceptualize a kind of rationality in clinical reasoning that is not modelled on explicit knowing; but rather envisages clinical reasoning as a kind of embodied practical wisdom modelled on the Aristotelian conception of phronesis. Reading SWWM with this background context in mind, suggests that Gendlin’s delineation of a responsive order to pre-conceptual reflection does provide an important intellectual resource for re-conceptualizing the role of practical wisdom in clinical reasoning, especially through the application of practical techniques from Focusing and TAE. Theoretically, TAE might be of real value in expanding understanding of the tacit foundations of various forms of clinical reasoning, including the intuitive component of clinical judgement, and developing ideas from bench to bedside in translational medicine. Arguably, applying TAE to the clinical context could re-invigorate contemporary epistemology of medical knowledge.[6] As of yet, the application of TAE to the medical clinical context does not yet appear to have been formally developed. The collection of Gendlin’s selected philosophical essays in SWWM invites the reader to continue engaging with Gendlin’s philosophical ideas, and to continue the path that he forged finding one’s own personalized meanings as a means of individual and intellectual renewal.

References:

Brencio, Francesca. 2019. “Befindlichkeit: Disposition.” In The Oxford Handbook of Phenomenological Psychopathology, edited by Giovanni Stanghellini, et al.  Oxford. Oxford University Press: 345-353.

Heidegger, Martin. 1962. Being and Time. Translated by John Macquarrie and Edward Robinson. London: SCM.

Mohanty, Jitendra Nath. 1997. “Experience and Meaning.” In Language beyond Postmodernism: Saying and Thinking in Gendlin’s Philosophy, edited by David Michael Levin. Evanston, IL. Northwestern University Press: 176-190.

Levin, David Michael (Ed.). 1997. Language beyond Postmodernism: Saying and Thinking in Gendlin’s Philosophy. Evanston, IL. Northwestern University Press.

Korbei, L. 1994. Eugen(e) Gend(e)lin. In O. Frischenschlager (Hg.), Wien, wo sonst! Die Entstehung der Psychoanalyse und ihrer Schulen. Wien/Köln/Weimar: Böhlau: 174-181. From http://www.focusing.org/gendlin/docs/gol_2181.html

McEvenue, Kevin. 2015. Wholebody Focusing: Life Lived in the Moment. Copyright Whole Body Focusing.

[1] See most notably, Gendlin, Eugene. 1962. Experiencing and the Creation of Meaning (ECM). Glencoe, IL. Free Press, Evanston; 2017. A Process Model. Evanston, IL. Northwestern University Press.

[2] See, for example, Cornell, Ann Weiser and McGavin, Barbara. 2002. The Focusing Student’s and Companion’s Manual. 1. Berkeley, CA. Calluna Press.

[3] See, Brencio, Francesca. 2019. “Befindlichkeit: Disposition.” In The Oxford Handbook of Phenomenological Psychopathology, edited by Giovanni Stanghellini, et al.  Oxford. Oxford University Press: 345-353.

[4] See, for example, Gendlin, Eugene. 1984. “The Client’s Client: The Edge of Awareness.” In Client-Centered Therapy and the Person-Centered Approach: New Directions in Theory, Research and Practice, edited by Ronald Levant & John Shlien. New York. Praeger: 76-107.

[5] See, Braude, Hillel. 2012. Intuition in Medicine: A Philosophical Defense of Clinical Reasoning. Chicago. The University of Chicago Press; 2016. “Clinical Reasoning and Knowing.” In Companion to Contemporary Philosophy of Medicine, edited by James Marcum, Bloomsbury Press: 323-342; 2013. “Human All Too Human Reasoning: Comparing Clinical and Phenomenological Intuition,” The Journal of Medicine and Philosophy. 38(2): 173-189; 2016. “Skilled Know-How, Virtuosity and Expertise in Clinical Practice.” In Handbook of the Philosophy of Medicine, edited by Thomas Schramme and Steven Edwards, Springer Press: 699-716.

[6] See, Braude, Hillel. 2016. “Review of Miriam Solomon’s Making Medical Knowledge.” Theoretical Medicine & Bioethics, 37(5): 433-436.