Medicine and the Time Structure of the Good Life

DFG FOR 5022

The research group "Medicine and the time structure of the good life" investigates ethical questions of the time structure of the good life with regard to new medical possibilities. Concepts of the good life are relevant for many research fields in medicine, ethics, social and cultural studies. The research group addresses these often little reflected background assumptions in a systematic and interdisciplinary way. It investigates (1) the relationships between medical concepts, technologies and practices on one hand and practical approaches and normative ideas about the temporal structures of human life on the other, (2) how the connection between medicine and life-time is presented and negotiated in scientific and (popular) cultural narratives, and (3) how the involved temporal aspects of the good life are to be understood and evaluated ethically. The investigation of this innovative questions is based on three exemplary fields of medical practice in different phases in the life course: (a) the problematisation of biographical phases and transitions in the treatment of chronically ill people in young and middle adulthood, (b) the temporal planning, control and optimization efforts in middle age in the context of reproductive medicine, and (c) the (re)negotiation of ageing in the healthcare of older people. The relevant moral experiences, attitudes and convictions regarding the temporality of the good life are examined in close interdisciplinary cooperation between practical philosophy, medical ethics, medicine, modern German literature and media studies, and sociology/social psychology. The results are brought together in the perspective of an empirically and hermeneutically informed ethics of the good life in time, which seeks to take into account the socio-cultural conditions and contexts of application in their diversity and variability. The aim is to develop an ethically reflected understanding of the temporal conditions of the good life in time within the horizon of medical possibilities, based on concrete case studies. The group will provide innovative research services in three respects: On one hand, it will analyse interdisciplinary temporal structures of the good life from the perspective of socially and culturally diverse actors. Secondly, it will diachronically and synoptically examine the phases of life and age groups that have been treated separately in medicine up to now. Thirdly, it accomplishes this on the basis of a methodically innovative synthesis of philosophical-ethical, social-empirical and hermeneutical terms and concepts of the good life in time.


Subproject 1 (Philosophy): Temporality and Good Life

PI Prof. Dr. Holmer Steinfath

The sub-project constitutes a philosophical reflection on the basic concepts of the FOR. It is aimed at gaining general insights into the time structure of human life and the temporal conditions of leading an individually good life. These insights shall enable a better understanding of the consequences that medical innovations have for how individuals deal with their lifetimes. At the same time, these insights shall also benefit from observing the three medical scenarios that the FOR engages with, by being sharpened, modified and possibly revised.

Systematically, the sub-project pursues three ends: First, to articulate – by drawing on a fruitful exchange with the other sub-projects – a philosophical understanding of the good life which is both on a level with the philosophical literature and can be tailored to suit the topics of the other sub-projects. Unlike in the literature on questions of the good life, reflections on temporal dimensions of human life shall here be included from the start. Second, the sub-project aims at laying out these temporal dimensions in a nuanced way, showing their interconnectedness. The thesis motivating this is that we do not only lead our lives within time, but that leading a life has its very own time structure. Third, the sub-project proposes an understanding of the time structure of a good life. This will be done by formulating theses concerning felicitous ways of dealing with the time in one’s life. The empirical plausibility of these theses will be tested in discussions with the other sub-projects and with respect to new medical possibilities. The proposed understanding of the time structure of a good life is oriented towards the idea of temporal sovereignty in the sense of a productive appropriation of the time in one’s own life.

Being in constant exchange with the other more empirically oriented sub-projects is important for the philosophical sub-project because, due to their unavoidable generality, philosophical conceptions tend to carry implicit assumptions of normality which can prove dubious in the light of far-reaching medical innovations and processes of social change. The fragility of conceptions of normality, especially of temporal ones, is right now dramatically brought to the fore by the Corona-Pandemic.

Subproject 2 (Movie / Television): Popular narratives of a good life. Interrelationships between medicine and temporality on German television

PI: Prof. Dr. Claudia Stockinger, Dr. Christian Hißnauer

The subproject analyses the (mass) media representation and negotiation of temporal conceptions of the good life in the context of medicine from the perspective of a modern German literature and media studies oriented towards television studies. How are changing conceptions of time considering current medical developments and individual reorientations in relation to a successful life perceived and televisualized by German linear television and non-linear streaming services? The aforementioned mass media offer themselves as objects of interest for the analysis of temporal orientation patterns, because the question of the conditions and (ethical) justifications of a good life is a central, explicit and implicit component of all their formats. Above all, however, they are ascribed the function of conveying a “Medienmedizin”  ("media medicine") (Wulff 2001, 247, 258) in moral-discursive terms. In addition, they document and archive the changed handling of one's own lifetime, which is newly questioned by diseases, experiences of aging or by medical developments; they contribute both to the interdiscursive popularization of knowledge and to the normalization of conceptions of life and society, whereby they make 'popularity' and 'normality' simultaneously observable as effects of media processes; and sometimes, due to their immersive potential, they have relieving therapeutic functions, but can also be disorientating. It is precisely in the case study narratives of such media medicine (narrativization) that the interrelation between medical and social change not only becomes particularly clear; rather, it is also negotiated and culturally effective there because of the mass addressing of broad sections of the population. The relationship between medicine and life time addressed in the leading thesis of the research unit will thus be discussed and differentiated, if necessary even corrected, with regard to its public perception on German television. Aligned with the guiding concept of time sovereignty, the subproject analyses all three application scenarios relevant to the research unit by asking how they are represented as a form of popular medicine (ethics). It is therefore in close exchange with SP 4 (sociology/social psychology) and SP 5 (ethics of reproductive medicine) as well as with SP 6 (general practice) and SP 7 (ethics of geriatric medicine). By focusing on (disease) narratives, the subproject is directly linked to SP 3 (psychocardiology). In a fundamental, theoretically founded respect – i.e. with regard to questions of temporality and the good life – it is dependent on a continuous cooperation with SP 1 (philosophy).

Subproject 3 (Psychocardiology): Untimely heart disease. Time Structures of the Good Life in Psychocardiology

PI: Prof. Dr. Christoph Herrmann-Lingen

The subproject examines changes in the perception and design of a good life for persons aThe subproject examines changes in the perception and design of a good life for persons affected by premature and thus subjectively often "untimely" heart disease. The project will investigate, on and with these persons and a group of close relatives, (i) how heart disease influences the experience and organization of time (for example aspects of time sovereignty, intergenerational relationships and the view of the past, present and future), (ii) whether and how the altered experience of time contributes to the increased incidence of psychosocial problems and mental disorders typically observed in these persons, (iii) whether in turn the experience of time is influenced by those psychosocial problems, and (iv) how the quality of life of those affected, which is increasingly accepted as a central goal of medical therapy, can be understood as a holistic concept of good life, placed in a time perspective. For this purpose, after an interdisciplinary refinement of the underlying terms and concepts, a cross-sectional, predominantly qualitative empirical study will be designed and carried out. By means of interviews based on phenomenological psychopathology and operationalised psychodynamic diagnostics, among other approaches, the study will provide a multi-dimensional picture of ideas of good life in time for these persons, show deficits of established instruments for measuring quality of life in medicine as well as insufficiently covered support and treatment needs of affected persons and outline perspectives for the further development of quality oif life assessment tools and targeted interventions. In the first phase, dedicated to the theoretical foundation, the subproject will closely coordinate with SP 1 (Philosophy), to which it will subsequently provide empirical material to test its theoretical assumptions. The targeted consideration of gender effects, for example in the area of family planning of young women and men with heart disease, will provide links to the focus on reproductive medicine in SP 4 (Sociology / social psychology) and SP 5 (Ethics in reproductive medicine). The video interviews with their scenic material and narratives will be evaluated in cooperation with SP 2 (movies / television). Video interviews will also be analyzed by text analytic methods, harnessing the methodological competence available in SP 4 (Sociology / social psychology) and SP 6 (General practice). The perception of premature old age by people suffering from heart disease in young or middle age, which is expected from clinical observations, raises questions that can be addressed with the help of the conceptual tools of SP 7 (Ethics in the medicine of aging) and in comparison with the empirical findings of SP 6 (General practice).

Subproject 4 (Sociology / Social Psychology): Reproductive Timing. Normative and practical orientations in the context of reproductive medicine

PI: Prof. Dr. Vera King

This subproject investigates normative and practical orientations with regard to the timing – the planning and realisation – of motherhood against the background of reproduction technologies. On the one hand, medical possibilities of reproduction are considered to have an impact on the temporal standardisation of the life course. On the other hand, – and in the sense of an interaction – these possibilities are also considered to be increasingly used and reassessed in order to cope with lifetime challenges such as conflicts of conciliation, optimisation and time concerning work and family, which are linked to fertility and becoming a parent.

Accordingly, the key questions of this subproject are: 1. How is reproduction in the course of life or the individual biography linked – in a normative manner – to temporality and to ideas of a good life in the course of time? 2. What role does the use or perception of offers and possibilities of reproductive medicine play? 3. How are relations or potential contradictions between heteronomy and autonomy, success and failure, adaptation to social norms and obstinacy, aspiration (or pressure) to optimise and serenity in lifestyle expressed or managed? For this purpose, interviews with women and medical professionals (of gynaecology and reproductive medicine) on the subject of reproductive timing are conducted and analysed. Regarding the underlying terms and concepts as well as the methodology this subproject cooperates with the other subprojects, especially with the ZIP and the subprojects 1 (Philosophy), 3 (Psychocardiology), 2 (movie/television) and 5 (Ethics of Reproductive Medicine).

Subproject 5 (Ethics of Reproductive Medicine): Planning, controlling and optimizing reproduction in the horizon of the good life

PI: Prof. Dr. Claudia Wiesemann

For many, having children and starting a family is an essential aspect of the good life. While, for centuries, the temporal limitation of reproduction in middle age was taken for granted, at least for women, this phase of life seems to become an object of planning, control and optimization by the help of modern medical innovations and especially those by reproductive medicine. The proverbial "biological clock", so the promise goes, could be stopped, reproduction could be made more dynamic in time. Reproductive medicine offers a wide range of techniques such as in-vitro fertilization, especially reproduction by means of sperm and egg donation, the cryopreservation of gametes, pre-conceptual, pre-implantation and prenatal diagnostics, and last but not least abortion and contraception. These techniques make it possible to intervene in the timing of human reproduction, rendering reproduction more predictable and controllable, and thus accessible to temporal optimisation. Underlying are implicit or explicit normative concepts of the good life and appropriate temporality, which, so far, have received comparatively little reflection in medical ethical debates. Based on the methodology of empirically informed ethics and in close exchange with the other subprojects, especially SP 3 (Psychocardiology) and SP 4 (Sociology/Social Psychology), the research project will examine the sometimes dramatic temporal distortions and shifts in the life course on one hand and the planning and optimization efforts on the other hand, with their respective effects on common notions of the good life, and evaluate them from an ethical perspective.

Subproject 6 (General Medicine): Medicine in old age – perception and assessment of ageing processes by older people and medical and nursing professionals

PI: Prof. Dr. Eva Hummers, Dr. Evelyn Kleinert

Given the advanced possibilities in medical treatment in contemporary medicine, subproject (SP) 6 aims to explore healthcare preferences of older persons as well as the healthcare priorities of healthcare professionals who treat older patients. We assume that the preference for or rejection of medical treatment is influenced by individual and social age patterns as well as by the awareness of the finiteness of life.

Just like older people themselves, the ideas of healthcare professionals are also shaped by social images of old age and the associated ideas of age-appropriate health. These concepts are constantly changing. What was considered to be a 'normal' symptom of old age 100 years ago is now treated medically as a disease. Based on this assumption, SP 6 uses focus group discussions and supplementary individual interviews with older people and medical and nursing professionals to investigate how ageing processes are perceived. In addition, we will investigate how such processes are evaluated (i.e. the conflict between "trivialisation" and "pathologisation"). We will also investigate the care preferences and priorities of the three groups.

The interdisciplinary orientation of the overall project allows analytical terms and theoretical concepts from SP 1 (philosophy) and SP 7 (ethics of geriatric medicine) to be taken into account for data collection. In addition, we also integrate the effects of social norms emerging from the narratives in film and television from SP 2. Further, the results of focus group discussions and individual interviews will deliver empirical data that support the ethical debates.

Zentral- und Integrationsprojekt (ZIP): Medicine and the temporal structure of the good life – theory and method of an empirically and hermeneutically informed ethics

PI: Prof. Dr. Claudia Wiesemann, Prof. Dr. Markus Schweda)

The FOR’s focus on interrelations between medicine and the temporal structure of the good life requires a systematic combination of philosophical-bioethical and empirical-hemeneutical research perspectives. Only this multi-perspective approach reveals overarching connections between seemingly disparate questions of dealing with chronic diseases, planning reproduction, and healthcare provision in old age that are usually considered in completely different medical and biographical contexts. A fundamental theoretical and methodological discussion of disciplinary approaches, questions, and methods, including the perspectives of relevant social actors, is crucial for the development of a comprehensive and detailed understanding of temporal conditions of the good life in the context of modern medicine.

Against this backdrop, the Zentral- und Integrationsprojekt (ZIP) pursues three main objectives. First, it outlines conceptual connections between philosophical perspectives on the good life and similar conceptions in medicine, the health sciences, and social and cultural research. Secondly, it aims for a diachronic synthesis of the different biographical phases and medical specialities in view of the life course as a whole. Thirdly, it contributes to a theoretically and methodologically reflected combination of philosophical and bioethical discussions on the temporality of the good life and corresponding empirical social and cultural analyses of everyday life orientations and media narratives in order to make them productive for the different disciplines and for medicine in particular. The synopsis of the respective medical and biographical contexts of psychocardiology, reproductive medicine, and geriatric care will provide comprehensive conceptual, theoretical, and methodological perspectives on the temporal structure of the good life in the context of modern medicine. The reflection of the ongoing research process will also help to identify theoretical-methodological requirements of this kind of interdisciplinary cooperation at the intersection of ethics and social, cultural and health research. Finally, the ZIP also promotes public deliberation on the temporal conditions of a good life in the context of medical options and possibilities.

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