"The communication and support from the health professional is incredibly important": A qualitative study exploring the processes and practices that support parental decision-making about postmortem examination

Background Consent rates for postmortem (PM) examination in the perinatal and paediatric setting have dropped significantly in the United Kingdom, the United States, and the Western Europe. We explored the factors that act as facilitators or barriers to consent and identified processes and practices that support parental decision‐making. Methods A qualitative study conducted with bereaved parents, parent advocates, and health care professionals in the United Kingdom. Analysis was conducted on 439 free‐tect comments within a cross‐sectional survey, interviews with a subset of 20 survey respondents and 25 health professionals, and a focus group with five parent advocates. Results Three broad parental decision‐making groups were identified: 1, “Not open to postmortem examination”; 2, “Consent regardless of concerns”; and 3, “Initially undecided.” Decisional drivers that were particularly important for this “undecided” group were “the initial approach,” “adjustment and deliberation,” “detailed discussion about the procedure,” and “formal consent.” The way in which these were managed by health care staff significantly impacted whether those parents' consented to PM, particularly for those who are ambivalent about the procedure. Conclusions We propose a set of recommendations to improve the way PM counselling and consent is managed. Adopting such measures is likely to lead to improved family experience and more consistent and high‐quality discussion regarding PM

On approaching schizophrenia via Wittgenstein

Louis Sass disputes that schizophrenia can be understood successfully according to the hitherto dominant models--for much of what schizophrenics say and do is neither regressive (as psychoanalysis claims) nor just faulty reasoning (as "cognitivists" claim). Sass argues instead that schizophrenics frequently exhibit hyper-rationality, much as philosophers do. He holds that schizophrenic language can after all be interpreted--if we hear it as Wittgenstein hears solipsistic language. I counter first that broadly Winchian considerations undermine both the hermeneutic conception of interpreting other humans in general and Sass's hope of interpreting schizophrenics in particular. I then go on to argue that even if these Winchian considerations are not accepted, Sass in any case doesn't take sufficiently seriously Wittgenstein's use of nonsense as a term of criticism. Solipsism is not something we can understand so as to be able to understand analogically the schizophrenic's "world"--for there is no such thing as understanding it. Solipsism is nonsense, is nothing--there is no "world" there, in solipsists (as I show by reference to Cora Diamond's reading of Wittgenstein). Nor in any actually analogous cases of schizophrenia. Their "alienness" is the alienness of nothingness; roughly, of the fantasy of "logically alien thought"