Your Father's a Fighter; Your Daughter's a Vegetable: OHSU
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Your Father’s a Fighter;
Your Daughter’s a Vegetable:
A Critical Analysis of the
Use of Metaphor in Clinical Practice
by TYLER TAT E
Military metaphors are often thought to be harmful to patients, and some writers have
proposed that empirical research could determine whether a metaphor is fit or ill for health care. But the
“best” metaphor for a patient encounter can be known only from within the patient-clinician relationship. A
conceptual framework can, however, give clinicians preliminary guidance for evaluating metaphors.
No word can be judged as to whether it is good or self to be rational and value neutral.5 Trope skepticism
bad, correct or incorrect, beautiful or ugly, or anything runs deep in health care.
else that matters . . . in isolation. Yet while many of biomedicine’s metaphors have
—I. A. Richards been maligned, no class of metaphors has been de-
nounced as much as those of war. In bioethics, for in-
S
ome metaphors are widely thought to be prob- stance, Jing-Bao Nie and colleagues have recently made
lematic for medical practice. George Annas argues a series of strong claims on this subject. In their 2016
that military and market metaphors are inappro- article “Healing without Waging War: Beyond Military
priate for health care and recommends the ecology Metaphors in Medicine and HIV Cure Research,”6 the
metaphor instead.1 Marlaine Smith rejects the meta- authors argue that military metaphors are inherently
phor of “human being as machine” in favor of “human harmful to patients and research subjects. They assert
being as organism.”2 Daniel Shalev also criticizes ma- that “by silencing patients’ voices through erasing their
chine metaphors, but he endorses journey metaphors.3 experiences and narratives of illness, the use of military
Susan Sontag, even more suspicious of medical tropes, metaphors can hinder . . . caring for people suffering
famously denounces the use of all metaphors in medi- from the increasing incidence of chronic health con-
cal discourse—especially metaphors used to illustrate ditions.”7 The authors allege that “military metaphors
the experience of having cancer.4 Laurence J. Kirmayer can inadvertently further stigmatize patients, and en-
seems to agree with Sontag and worries that rhetoric dorse the legitimacy of war and violence in social and
employs metaphor to influence biomedical discourse political life.”8 Nie and colleagues ask why it is “that
clandestinely, even though this discourse proclaims it- healers, clinical doctors, and researchers committed to
improving health continue to utilize violent metaphors
when doing so runs the risk of devaluing human life?”9
Tyler Tate, “Your Father’s a Fighter; Your Daughter’s a Vegetable: A These critiques suggest that military metaphors are
Critical Analysis of the Use of Metaphor in Clinical Practice,” Hastings
Center Report 50, no. 5 (2020): 20-29. DOI: 10.1002/hast.1182 uniquely dangerous, disparaging, and harmful.
20 HASTINGS C E N T E R R E P ORT September-October 2020This survey of opinions raises a problem with this thinking is that it First, then, what exactly is a meta-
number of questions. What exactly rests on the false empiricist assump- phor? The answer is not straightfor-
makes a metaphor a good metaphor, tion that metaphorical language and ward. The Greek root of metaphor is
and what kind of evidence could sup- literal language are fundamentally metaphora, literally meaning “trans-
port such a claim? How can war met- distinct—in other words, that these fer”: meta (“trans”) + pherein (“to car-
aphors, considered so pejoratively by kinds of language play separate roles ry”).16 For Aristotle, one of the first to
scholars, be so helpful and seemingly in communication and can be ana- comment on the subject, metaphor is
natural in many clinical encounters? lyzed, systematized, and prescribed defined as “giving something a name
Can a metaphor cause harm simply independently of each other.15 Even that belongs to something else.”17
because of its topic? Should whole if there were a sound rationale for Aristotle’s definition is a weak version
domains of language be banned from making this conceptual distinction, of a “substitution” view of metaphor,18
medical speech? And if so, by what in clinical practice, the distinction the idea that one word borrows from
criterion should they be appraised? breaks down. another and therefore “carries no new
In a recent Journal of the American These two widespread beliefs— information, since the absent term
Medical Association perspective,10 Brit that military metaphors are harmful (if one exists) can be brought back
Trogen attempts to answer some of to patients and should be discour- in.”19 The strongest version of the
these questions. She contends that aged in medical practice and that the substitution view—which holds that
there are good and bad metaphors
and that medical language must strive While many of biomedicine’s metaphors have
to be more “evidence based” and sci-
entifically grounded. Trogen notes been maligned, no class of metaphors has
that medical practitioners “strive to
make conscious, empirical decisions been denounced as much as those of war.
on everything from drug dosing and
treatment modalities to medical edu- metaphors of clinical practice can be metaphors are entirely superfluous
cation and health policy.”11 And so, judged by, and standardized in refer- (and even deceptive)—was a prod-
she would add, why not language? ence to, neutral criteria—rest on a uct of Enlightenment thinking.20 For
As she sees it, the scientific logic shared but deeply flawed logic. In this example, Thomas Hobbes expressed
needed in pharmacology extends to article, I will examine these beliefs, the strong substitution view in 1651
the process by which humans make expose their flawed logic, and then lay when he claimed, “The Light of hu-
meaning out of words. In medicine, out a theoretical view of medical met- mane minds is Perspicuous Words,
she concludes, “[w]e should be just as aphors as grounded in use within cli- but by exact definitions first snuffed,
rigorous with our words”12 as we are nician-patient relationships. Drawing and purged from ambiguity; Reason is
with any other therapy, procedure, from philosopher Max Black’s analy- the pace; Encrease of Science the way;
or policy. Trogen is not alone in this sis of metaphorical qualities, which and the benefit of man-kind the end.
view; a number of social scientists I discuss in terms of indispensability And on the contrary, Metaphors, and
have advocated for more sophisti- versus replaceability and fixedness ver- sensless and ambiguous words, are
cated empirical research on the meta- sus variability, I will diagram a con- like ignes fatui; and reasoning upon
phors of health care. Their aims are, ceptual tool for clinicians to use when them, is wandering among innumer-
among other things, to bring the “use they consider whether a metaphor is able absurdities; and their end, con-
of metaphors into the domain of ev- appropriate for a specific patient en- tention, and sedition, or contempt
idence-based practice”13 and “assure counter. This tool maps metaphors [sic].”21John Locke was equally suspi-
that metaphorical language does not onto a qualitative grid and gives cli- cious of tropes and decried the “figu-
undermine public health or research nicians a method to understand how rative application of words,” which
efforts.”14 These scholars appear to be metaphors work in communication does nothing but “insinuate wrong
advocating for the protocolization of and to determine which metaphors ideas, move the passions, and there-
metaphorical language in a way that might be felicitous within a particular by mislead the judgement.”22 This
mirrors the protocolization of treat- context and relationship. strong view eventually crested with
ment for asthma, meningitis, or lung the logical empiricists who discred-
cancer. The Purpose of Metaphors ited metaphor due to its lack of veri-
While the spirit of these efforts fication conditions (for example, you
is laudable, multiple problems at-
tend the idea that empirical research A short history of metaphor is in-
structive. It can highlight several
of the conceptual blunders commit-
cannot prove or disprove that “man is
a wolf ” as you can prove or disprove
can either determine psychologi- that “the cat is on the mat”).23
cal valence or establish norms for ted by some writers on metaphor. In the later twentieth century, de-
medicine’s metaphors. The chief flationary accounts of metaphor were
September-October 2020 H AS TI N GS C EN TE R REPO RT 21increasingly criticized. In contrast metaphors are viewed as emergent critically as law. This is especially true
to a substitution view, literary critic representations of deeper and more for health care, as an examination of
I. A. Richards, Black, and others ar- fundamental cognitive-physical re- both the sundry metaphors of clini-
gued that metaphor is essential to the lationships. Under this theory, lin- cal practice and the diverse mean-
growth of human knowledge. Black guistic metaphors are not arbitrary ings metaphors can have for patients,
contended, for instance, that meta- or accidental; they are expressions clinicians, and family members will
phors both create and disclose real- constrained by the physical structure confirm.
ity.24 Metaphors create reality when and natural orientation of the mate-
they help forge novel cognitive link- rial universe. Metaphor, Metaphor
ages (i.e., new perspectives25) for un- However, while the conceptual Everywhere
derstanding and engaging the world. metaphor theory is taken for granted
Metaphors disclose reality when, like
a good model (such as the computer
by many social scientists working in
health care,33 it is not problem-free.
M etaphor pervades medical lan-
guage, and the use of meta-
phor by both patients and clinicians
as a model for the brain), good meta- Janet Martin Soskice has character- is effortless and unconscious. For
phors serve as cognitive devices for ized the theory as part of a question- example, metaphorical language is
“showing” how things actually are.26 able genus of ideas that promotes customary when discussing the body
According to this “constitutive”27 what she terms the “metaphor-as- (“your heart is a pump”; “the liver
view of metaphor, there is no objec- myth” thesis, a thesis that posits that cleans the blood of impurities”; “your
tive vantage point for human beings, “man . . . deceives himself when he brain is a computer”; “psychotherapy
no disembodied perspective, for the regards his own linguistic [read: met- reprograms your thinking”; “antide-
“world is necessarily a world under aphorical] constructs as embodying pressants restore balance to the mind”;
a certain description.”28 A powerful some trans-anthropological truth.”34 “your body is a machine—you have to
metaphor can redescribe the nature According to the metaphor-as-myth keep it oiled, don’t let it overheat, give
of the world and our place in it; in thesis, metaphors merely reveal as- it good fuel”), disease (“seizures are a
other words, metaphors can shape pects of human thought; reality itself short circuit in the brain”; “cancer is a
what is real to us and shape us in the remains inaccessible, for “man, like battle”; “Alzheimer’s disease is a long
process.29 the spider, spins out of himself the goodbye”; “asthma is a roller coaster”;
More recently, questions around world which he inhabits.”35 “your cholesterol is high”; “the in-
metaphor have ramified beyond phi- Yet this “mythology” is unsatis- fection can seed other parts of your
losophy and literary studies. Since the fying; when a speaker claims that body—we are worried the bacteria
publication of Metaphors We Live By “Hitler was a monster” or “cancer is will swim through the bloodstream
(1980), by George Lakoff and Mark a battle,” they are not making state- and then set up shop in your brain”),
Johnson, their conceptual metaphor ments completely unaccountable to a making decisions (“making the de-
theory30 has dominated academic reality external to the speaker’s mind. cision to stop treatment feels like
research on metaphor, especially in Instead, the speaker is to some extent turning a barge around”; “chemo is a
the social and biomedical sciences.31 discussing objective facts about real- full-time job”; “tracheostomy is a run-
The theory postulates that human ity, about the way things are (even if away train”; “use your mom anten-
concepts are intrinsically metaphori- these facts are invariably nested in a nae, and if you sense anything wrong,
cal and embodied. According to the particular culture and historical mo- come back and see me”; “whichever
conceptual metaphor theory, meta- ment). Another problem for the con- choice we make, it will be a gam-
phors are conceptual templates32 ceptual metaphor theory, then, is that ble—we will have to go all in; we will
that structure human cognition and it comes dangerously close to “con- have to really double down”), and
emerge necessarily from physical facts fusing word derivation with word end-of-life care (“brain death”; “she
about human existence: for instance, meaning.”36 In other words, the theo- has reached the end of the road”; “the
humans grow from small babies into ry can be taken to imply that speakers patient is circling the drain”; “is my
larger adults, are spatially oriented are always used by metaphors (in the daughter going to be a vegetable?”)37
with fronts and backs, and share the sense that there is a primitive struc- Metaphor is ubiquitous in medi-
same basic anatomy, physiology, and ture, disclosed in every metaphori- cine. In fact, clinicians and patients
lifecycle with other humans across cal utterance, that subconsciously seem incapable of speaking at all with-
history and geography. Hence, for determines what they can or cannot out recourse to metaphor. Certainly,
the conceptual metaphor theory, ab- think) instead of using metaphors to there are disconcerting features of
stract ideas such as argument is war, say what they mean. metaphorical language. Metaphors
love is a journey, or time is money are Regardless of these debates, the may objectify and dehumanize (as
physically and culturally determined important moral to extract from this with “body as machine” and “body
ways that human beings understand discussion is that no single theory as battleground”). Metaphors may
and navigate reality, and linguistic of metaphor should be accepted un-
22 HASTINGS C E N T E R R E P ORT September-October 2020confuse, deceive, and offend. Yet distinction between these two cat- cancer as an enemy, they become less
metaphors also open up valuable new egories? A first step toward evaluating likely to imagine undertaking disease-
perspectives for patients and clini- this position is to examine medicine’s preventative lifestyle choices?47
cians and allow them and patients’ military metaphors. I will analyze the latter possibili-
families to talk about abstract ideas Trogen notes that there is “signifi- ties first. Two empirical studies often
and negotiate emotionally freighted cant research suggesting that certain cited as support against the use of war
situations. Metaphor is an indispens- mental frameworks can contribute to metaphors in the medical encounter48
able mode of discourse. worsened patient outcomes.”39 As ev- find an association between cancer pa-
Furthermore, as many of these idence, she points to the deleterious tients who used attack language (such
examples demonstrate, drawing a effects that the use of “militaristic” as “punishment” and “enemy”) to
line between metaphorical and lit- metaphors can have on cancer pa- describe the meaning of their illness
eral language is often difficult.38 tients’ quality of life.40 To justify the experience and a higher prevalence
Metaphors are frequently indistin- common criticism that metaphors of anxiety, depression, or poor cop-
guishable from nonfigurative words of violence and war are inappropri- ing.49 The worry is that the milieu of
(as with “high blood pressure,” “brain ate for the field of medicine, most war language produces these effects.
death,” and “turning a corner”), and writers who endorse this view either However, at best, these data support
it is language (whether metaphori- cite empirical data taken to prove a a correlation rather than a causal con-
cal or not) and other signs—such as connection between war language nection. In other words, it is just as
pictures, diagrams, symbols, models, and a poor health outcome, or they likely that patients who are most de-
sign language, gestures, and body
language—that provides the content Among the few studies that actually
of patient-clinician communication.
These various forms of communica- examine patients’ own metaphors, war
tion cannot be disentangled without
disabling communication and trans- metaphors abound and are often viewed as
forming patient-clinician interac-
tions into something strange and positive and constructive.
alien. Moreover, once the ubiquity
and depth of metaphor within medi- expound a normative rationale. Both pressed and anxious feel attacked and
cine is recognized, it begins to seem these efforts fail. punished and consequently use this
odd to advocate that metaphors be- To see why, one must first attempt language and these felt categories of
come “evidence based.” What could to discover what exactly is the in- meaning to understand and articulate
that even really mean? Pragmatically, trinsic negative property contained their cancer experience as it is that
to “rigorously” standardize medical in metaphors of war. Judging by the clinicians cause depression or anxiety
metaphors would require a rigorous harshest critics, the property appears by using attack language. These stud-
standardization not just of metaphors to be the distinct capacity to harm. ies do not illuminate reasons that war
but of language and ultimately all But what does it mean to be harmed metaphors are harmful or the nature
communicative acts performed with- by a military metaphor? The options of the harm, nor do they provide nor-
in the context of clinical care. The are diverse. Harm could be hav- mative guidance for what metaphor
result would be, somewhat ironically, ing your narrative commandeered a clinician should or should not use.
a thoroughly dehumanized (albeit by a story of war41 or being viewed The third empirical study,50 which
limpid, rational, and evidence-based) by your physician as the space for a was performed on volunteers who did
system of medical communication in battle against a disease, rather than as not identify as cancer patients, found
which clinicians communicate from a person with a disease.42 Harm could that after a person read descriptions
preformulated scripts or machines occur when a patient inappropriately of cancer that employed enemy meta-
read off new diagnoses and describe believes that she still needs to fight phors, they were less likely to list
treatment protocols as objectively when she is receiving only palliative prevention behaviors when asked
and rigorously as possible. This alter- care43 or has a chronic illness that what they would do to lessen their
native seems highly undesirable. cannot be defeated.44 Conversely, are chances of developing cancer in the
patients harmed, as some empirical future. These findings are intriguing.
Wars and Rumors of Wars data is thought to suggest, if, by con- But while they may be useful for pro-
ceiving of their disease as an enemy, grams or clinicians doing preventa-
T he practical difficulties of sepa-
rating metaphorical and literal
language aside, what about the view
they tend to have higher levels of de-
pression and anxiety45 or report more
tive screening (although they reveal
little about real-world behaviors or
pain and lower coping scores?46 Or why preventative choices are auto-
that there is a relevant philosophical are patients harmed if, by envisioning matically superior to other kinds of
September-October 2020 H AS TI N GS C EN TE R REPO RT 23life choices51), they offer no insight for language use in medicine that, sible to assess any individual violence
into how war metaphors could be for example, teach medical and nurs- metaphor without understanding its
uniquely and essentially harmful. ing students to generally avoid using context and function (of which there
The remaining critiques of mili- military metaphors in their future were numerous, some deemed posi-
tary metaphor can be distilled into practice would silence the voices of tive and some negative) in the life of
one dominant, theoretical claim some patients and prescribe a subtle the patient. This versatility has been
whose logic seems to be this: war tyranny of the majority. Yet I doubt demonstrated in other qualitative
always kills and destroys human be- that they are the majority. For ex- analyses of violence metaphors.56
ings, and killing and destruction are ample, as Tod Chambers personally Finally, in one of the first analyses of
equivalent to harm. Therefore, via a notes52—and as is the case with the the metaphors of non-English-speak-
category substitution, war language vast majority of patients I treat—it ing patients, Dalia Magaña inspected
also must be equivalent to harm (or can be extremely helpful to imagine the breast cancer narratives of fifty-
must necessarily harm). Accordingly, fighting off an illness; after all, being one Latina and Spanish women57 and
war metaphors are essentially damag- sick or in pain often feels as if you are found that violence metaphors were
ing. They paint the human body as a threatened and under attack. the most commonly used metaphors
battleground (so the story goes), and Among the few studies that ac- and that patients used these positively
they needlessly impose bloodshed, tually examine patients’ own meta- (for instance, to construe cancer as a
carnage, and the atrocities of war on phors, war metaphors abound, and “malevolent enemy” and themselves
an already sick and fearful patient. these metaphors are often viewed as “warriors”58). She concludes that
There is something different about as positive and constructive. In one “the functions of violence metaphors
them. By dragging the patient’s nar- study, patients with cancer used include expressing concerns and
rative into the plot of war, they cause violence metaphors more than any fears, offering wisdom about their
the patient to suffer, as the person’s other class of metaphor when de- [the metaphor users’] experiences,
soul is dealt some sort of searing spiri- scribing their illness experience in empowering people by creating a
tual or existential injury. online writing, about 1.5 times per sense of optimism, and urging others
But do war metaphors actually one thousand words.53 The authors not to give up.”59 For these women,
cause this kind of spiritual or exis- found that patients use both violence violence metaphors served as a key
tential harm? I am not convinced and journey metaphors and that both source of resilience and hope.
that they do. For one, the language types can be used either to empower Perhaps, in fact, patients’ and cli-
of warfare is the ordinary language of oneself or to reinforce negative feel- nicians’ attraction to military meta-
many patients, and they seem none ings. Comparing violence metaphors phors is the result of something
the worse for it. For numerous pa- with (the more in-vogue) journey deeper, something woven into the
tients in the Veterans Affairs hospitals metaphors, the authors forcefully very fabric of human thinking. This
across the country, including many conclude, “A blanket rejection of hypothesis is supported by insights
whom I cared for as a palliative care Violence metaphors and an uncriti- from Lakoff and Johnson’s concep-
fellow at a VA hospital, bootcamp, cal promotion of Journey metaphors tual metaphor theory. Under this
invasions, airstrikes, generals, orders, would deprive patients of the positive theory, it is possible that human un-
and target practice are formative parts functions of the former and ignore derstanding and expression of illness
of both their lives and their natural the potential pitfalls of the latter. is inextricably tied to—even neces-
language. The fact that I have not Instead, greater awareness of the func- sarily generated from—a metaphori-
fought in battle or that I think that tion (empowering or disempowering) cal, embodied template of war.60 The
war is fundamentally vile is not rea- of patients’ metaphor use can lead to thought pattern is this: I am my body,
son to deny this language to them. more effective communication about my body is me, and I will not sit pas-
For many people, the military is the the experience of cancer.”54 sively by when facing my own annihila-
noblest of callings and fills their life Other published data corroborate tion. I will fight, and if I’m lucky, I will
with value, dignity, and meaning. To this position. For example, in the be victorious in the end. In my own
deprive them of this language would largest survey of patients’ metaphors experience, at least, that’s how most
be unjust and border on a hegemonic performed to date—an analysis of a patients respond to the existential
censoring of their voices and stories. collection of patient, caregiver, and threat of serious illness.
The seeming lack of concern for clinician interviews and online fo- Where do these reflections leave
the many patients that find great rums focused on end-of-life care55 us? They reveal why, contrary to what
strength, courage, and resolve from —patients employed a great number Trogen and others have suggested,
this kind of language is deeply trou- and large variety of violence meta- empirical research cannot determine
bling. In addition, even if most phors to describe their illness experi- clinical practice norms for metaphor
patients did prefer nonviolent meta- ences. The authors concluded that, use. Empirical research cannot reveal
phors, to encourage broad policies based on their research, it is impos- what these norms ought to be because
24 HASTINGS C E N T E R R E P ORT September-October 2020it cannot “discover” which metaphors themselves into the future hangs to- and talk about our lives may in some
are good or bad or which fail to work gether as a life.64 How should I live? sense actually be our lives. Metaphors
in actual practice. Trogen claims that What should I do? What does this are the contact points of shared hu-
“[p]atients’ responses to clinical in- pain mean for my life (well, what did man reality. Metaphors are the tools
terventions, whether pharmacologic it mean last time?)? This just is what it that we humans have at our dispos-
or linguistic, are necessarily variable, is like to exist as a human being.65 But al to create a shared story in which
and understanding this variability why is this important for metaphors words like “love,” “justice,” “illness,”
will be important to investigate.”61 and the medical encounter? Because, “dying,” “god,” “hope,” and “forgive-
Though more investigation may be at the point of patient-clinician con- ness” mean anything at all.
informative, the underlying analogy tact, two stories collide. And at that Yet any individual metaphor is
between pharmacology and language moment, it becomes critical for the always part of a network of words
is mistaken. Responses to pharmaco- patient and clinician to learn to un- and meanings. No word—metaphor
logic interventions and responses to derstand each other. Metaphor plays or otherwise—can stand alone. No
metaphors involve significantly dif- a vital role in this process. meaning is sacrosanct. Rather, words
ferent kinds of variability. If I give one As Lakoff and Johnson have dem- gain their sense publicly and in a
hundred patients 300 milligrams of onstrated, metaphor is an indispens- community of speakers by being jux-
intravenous hydromorphone, a pow- able medium through which human taposed against a whole host of other
erful opioid, the breathing of all will
slow down or stop. However, if I tell Empirical research cannot “discover” which
one hundred newly diagnosed can-
cer patients, “You’ve got a real battle metaphors are good or bad or which fail
ahead,” I do not know a priori how
they will understand and respond to work in actual practice.
to this sentence, and no number of
experiments can predict that for me beings both organize and express words and meanings. In this network,
with certainty. Human language, their experiences and understand the words and meanings exist together as
meaning, and understanding do experiences of other people. But not a story, and it is in the telling, hear-
not operate under the same rules as any metaphor will do justice to a hu- ing, and interrogating of the story
physics, chemistry, and physiology.62 man experience. The right metaphor that individuals learn to understand
Contrary to what empiricists over is the one that can accurately articu- each other. It follows that the mean-
the years have claimed, there is no late a felt, lived experience. Charles ing and appropriateness of any word
law for how language works, no logi- Taylor identifies these kind of experi- emerges only from within the linguis-
cal formula that “nails”63 language to ence-organizing, rootlike metaphors tic practices of talking and listening.
the observable and measurable “facts” as “template metaphors” for living.66 Meaning and appropriateness cannot
of reality. How, then, does human These templates will be, at least par- be prescribed by committee or fiat.
meaning-making and understanding tially, unique to each individual. It Toril Moi extends this idea in
occur, particularly within a patient may be that, for one person, a journey her recent book The Revolution of
encounter? metaphor captures the occasionally the Ordinary. Moi, a literary theo-
trudging, occasionally roller-coaster rist and philosopher, presents a
Our Lives in Language experience of illness; for another Wittgensteinian vision of language
person, only a battle metaphor can that is grounded in use.67 According
M eaning-making and under-
standing can occur between
patients and clinicians because both
accurately express the feeling of hav-
ing to fight to survive against cancer,
to Moi, it is an error to presume that
anything outside of the two people
diabetes, or a bloodstream infection. actually talking could determine
parties are imbedded in stories. By Of course, these different templates what a word means or does, for only
this I mean that the subjective human will be “given,” in the sense that the in use do words live. Within this
experience of being a body moving narrative background against which “ordinary” vision of language, any
through space and time is rendered we can understand anything is given prescriptions or grand theories are
intelligible insofar as it is envisaged (whether by our culture, laws, or doc- illegitimate, especially those claim-
as a narrative, or story. Occurrences tors). However, this only heightens ing scientific authority. Moi quotes
become meaningful events for a sub- the importance of our template meta- Wittgenstein scholar P. M. S. Hacker,
ject when they are knit together in a phors, especially if we are convinced who laments that we now “live in a
narrative arc, and it is only against the that there is nothing under, or more culture dominated by science and
backdrop of a meaning-rich narrative foundational than, these templates. technology. We are prone to think
that a subject’s constant interpreta- Put another way, the metaphors we that all serious questions can be an-
tion of occurrences and projection of use to conceptualize, understand, swered by the natural sciences.”68
September-October 2020 H AS TI N GS C EN TE R REPO RT 25Moi affirms Hacker’s concern, noting utterance.”73 Metaphor, like the rest is critical for a speaker to convey a cer-
that today “even humanists appear to of language and other signs, is sim- tain idea, meaning, or feeling; hence,
have embarked on a quest to substi- ply a means through which humans an indispensable metaphor is difficult
tute measurement for judgement in can both understand the world and to paraphrase, and when a paraphrase
every human practice.”69 Moi may express to each other the embodied is attempted, important meanings are
as well be speaking to Trogen when experience of being alive. lost. A metaphor is fixed if it holds
Trogen appeals to a standard of “best” Finally, if the right metaphor for its meaning across multiple hearers.
care, as if what is “best” for a patient a patient encounter can be known The opposite of indispensable is re-
exists prior to their own hopes, fears, only from within the discourse of the placeable, and the opposite of fixed is
emotional life, and story. patient-clinician relationship rath- variable. So, any metaphor could, in
But the best metaphor cannot be er than from outside it, the onus is theory, be mapped onto a grid, with
identified before a patient is met, wit- placed on individual clinicians to ac- the x axis indicating its degree of in-
nessed, and spoken to. Patients are tually listen to and understand their dispensability versus replaceability,
not interchangeable, like carburetors, patients’ stories. Since, ultimately, all and the y axis showing its degree of
or even like their own hearts and kid- language can both harm people and fixedness versus variability.
neys. Communication is not simply confuse, deceive, and conceal the A metaphor’s indispensability
a transfer of information, the moving truth, it becomes the responsibility is connected to its uniqueness. In-
of a computer file between two fold- of clinicians to practice and grow in dispensability is a property of the ten-
ers on a desktop, and it cannot be the wisdom and discernment that is sion between the metaphor itself and
reduced to a formula. Rather, com- required to intuit the right words for the idea or object it is being used to
munication is the activity of com- the right times—rather than thinking describe. This property manifests as
muning or (etymologically speaking) that they can have easy recourse to a a metaphor’s ability to open up new
sharing something, and communi- set list of words or phrases fashioned horizons of understanding for speaker
cation is an active and cooperative from a one-size-fits-all algorithm. and hearer and to shed new light on a
process that requires reciprocity and situation. Often, the indispensability
work.70 Crucially, though, this work Guidance for Choosing of a metaphor will be recognized and
can be done well only within the con- Metaphors felt only after the metaphor is spoken
fines of a relationship, for the capacity and considered. Indispensability is
to relate a story depends on there be-
ing a relationship in which that story
A relationally driven approach to
metaphor use raises a practical
concern: if the meaning of a meta-
about work; what work does a meta-
phor do for us here, now?
can be received, praised, challenged, phor is determined by use, then its Fixedness is determined to a great-
and responded to.71 Only in relation- meaning is ad hoc, and therefore, er extent by context and convention.
ship can the meanings of signs arc clinicians are permitted no guidance Compared to indispensability, fixed-
together and converge into genuine regarding what metaphors they gen- ness is more of a hearer issue; fixed-
conversation. Whether that sign is a erally should or should not employ. ness is therefore more amenable to
word, a sentence, an x-ray image, a Consequently, a relationally driven empirical investigation, since local
new lab value, a metaphor, a shrug, approach appears both unfruitful for linguistic conventions and practices
a high five, or even a door slammed clinicians, who long for guidance, can be studied (as in Magaña’s re-
in the clinician’s face, it is only in re- and incorrect, as some metaphors search).
lationship and through the joint con- seem patently superior to others. Indispensability and fixedness are
struction of a shared and meaningful A framework for clinicians to use features of conversation in relation-
story72 that talking with (as opposed when conceptualizing metaphors ship, that is, when speaker and hearer
to talking past) can actually occur. may help circumvent this concern, are, at least partially, embedded in
Once we see the priority of lan- and in what remains, I will attempt the same network of rules that de-
guage use over and above dictionary to outline such a framework. I envi- termine which linguistic “moves” are
definitions or prejudged determi- sion this framework as a heuristic, or intelligible and which are not. This
nations of meaning, the separation shortcut, that clinicians can turn to framework is not intended to be used
between metaphor and the rest of when considering the best metaphor in situations where a clinician knows
language collapses. The meaning of for a situation. It is not intended to nothing about their patient, or their
a metaphor in a patient encounter be authoritative, conclusive, or static. patient knows nothing about them.
is how the metaphor is understood Deploying a modified version of Generally, the “safest” metaphors
and used in that encounter. As Moi an analysis advanced by Black,74 we are highly fixed. An example of a
explains, “To understand a metaphor can consider two aspects of every highly fixed metaphor is “your heart
is not to translate it back to its ‘literal’ metaphor: indispensability and fixed- is a pump.” “Your heart is a pump”
meaning, but to understand the work ness. A metaphor is indispensable if it is fixed insofar as it is unlikely to
this image does here, in this specific be misunderstood, at least among
26 HASTINGS C E N T E R R E P ORT September-October 2020English-speaking patients acclimated than “whichever choice we make, it understanding. These features make
to Western medicine.75 This is a de- will be a gamble.” them a good choice. Metaphors that
sirable trait for clinical communica- The problematic metaphor “your are highly fixed but only slightly in-
tion. In addition, the “your heart is a daughter is a vegetable” is harder to dispensable can be useful, especially
pump” metaphor is moderately indis- categorize. The “vegetable” metaphor when describing discrete objects or
pensable, as there are few other ways appears to be replaceable because it organs (as in “lungs are balloons” or
for clinicians to say what they mean. has, especially within American med- “the brain is the body’s command
At the other end of the spectrum icine, an easily paraphrased meaning: center”). For similar but opposite rea-
lies a metaphor like “your daughter is a patient is a vegetable if they have sons, replaceable and variable meta-
a plant” (or “tree,” “fruit,” or “toma- lost nonvegetative functions like lan- phors should be avoided. Metaphors
to”). Perhaps this phrase is silly, but guage and cognition. But, of course, that are indispensable but variable,
one can at least imagine a clinician in the medical context, “vegetable” like many war metaphors, are best
using it in a nervous attempt to tell a has another meaning. For some clini- employed within a developed and
parent that their child is in a vegeta- cians, to say that a patient is a veg- knowing clinician-patient relation-
tive state (while resisting the urge to etable is to mean that, because the ship; within such a relationship, mis-
say “your daughter is a vegetable” due patient lacks certain abilities, they understanding is less likely to occur,
to that metaphor’s derogatory status)
or, in a different situation, to remind The best metaphor cannot be identified
a new parent that they must feed their
newborn on a regular schedule. Here, before a patient is met, witnessed, and
the metaphor is both highly replace-
able (there are better ways to say what spoken to. Patients are not interchangeable,
the clinician means) and highly vari-
able (the entailments of the metaphor like carburetors, or even like their own hearts.
are unpredictable). This metaphor
would be a poor choice in nearly any do not deserve medical care or life- and the power of the metaphor can
clinical context. sustaining treatments. In this second, be appreciated and even exploited.
Conversely, “whichever choice we derogatory sense, the metaphor is This heuristic is meant to be a use-
make, it will be a gamble” is indis- actually quite indispensable (in my ful tool for clinicians. But, as with
pensable but variable. It is indispens- sense of the word) and even expedi- any tool, if it does not work for a
able because it gives the clinician the ent.76 Relatedly, its location on the particular job, it should be discarded,
distinct ability to describe the risk, op- fixed-variable spectrum is indetermi- modified, or exchanged for some-
timism, uncertainty, and arbitrariness nate due to the numerous offensive thing more apt. Moreover, because
of many medical therapies (especially and disparaging interpretations and this heuristic is conditioned by the
regarding intensive care and clinical entailments that have grown up and speaker’s intended meaning and the
trials). It is variable because of how are growing up around the metaphor. hearer’s interpretation, it necessarily
it can be openly interpreted; people Finally, a highly replaceable and depends on context. It cannot be ap-
have highly unpredictable reactions highly fixed metaphor may be some- plied to bare “text” or “textual data,”
to gambling generally, and patients thing like “asthma is a roller coaster” as if words disclose their meanings
may find hope or fear at the idea of or “bacteria swim through the blood- independent of the speakers and lis-
“rolling the dice” with their own life. stream,” as there are other suitable teners, or writers and readers, who
War metaphors can be similarly cat- options (“asthma is a wild ride” or, bring them to life. Only human be-
egorized, though they are more indis- more prosaically, “asthma is challeng- ings can perform such a miraculous,
pensable (insofar as they possess the ing” and “bacteria travel through the life-giving act.
sui generis power to accurately repre- bloodstream”) and a lower likelihood The conclusion that all language
sent a predominant genre of the lived that the metaphors will be questioned gains meaning through use and that,
experience of illness) and less variable. or misunderstood by the hearer. to grasp how another person under-
For instance, when I say, “Your father So what combination of meta- stands a metaphor, sentence, or medi-
is a fighter” (perhaps in reference to a phorical aspects should be prioritized? cal explanation, you actually have to
man who has survived the Vietnam As a rule of thumb, indispensable and spend time listening and talking to
War and is now battling pneumonia fixed metaphors are both descriptive- them may seem banal. Anyone who
in the intensive care unit), the meta- ly powerful and maintain a durable has spent time as a patient, caretaker,
phor is both more essential for good meaning across speakers and contexts. or clinician, however, knows that this
communication (indispensable) and Due to their fixedness, they are also is not the case. Sitting with the suf-
less openly interpretable (more fixed) less reliant on the presence of a strong fering of another person, engaging
relationship for successful uptake and them in conversation and absorbing
September-October 2020 H AS TI N GS C EN TE R REPO RT 27some of their pain in the process, is 8. Ibid., 9. 29. R. E. Malone, “Policy as Product:
not an easy activity. Furthermore, lis- 9. Ibid., 3. Morality and Metaphor in Health Policy
10. B. Trogen, “The Evidence-Based Discourse,” Hastings Center Report 29, no.
tening and talking to people well is Metaphor,” Journal of the American Medical 3 (1999): 16-22, at 16-17.
no longer something our health care Association 317 (2017): 1411-12. 30. G. Lakoff and M. Johnson, Metaphors
system prioritizes, with its top-down 11. Ibid., 1412. We Live By (Chicago: University of Chicago
emphasis on efficiency, productivity, 12. Ibid., 1412. Press, 1980).
and cost saving. Efficiency, however, 13. D. J. Hauser and N. 31. For a book length treatment of the
Schwarz, “Medical Metaphors Matter: social sciences and the conceptual meta-
will not make medicine more hu- Experiments Can Determine the Impact of phor theory, see M. J. Landau, M. D.
mane or create a space for patient’s Metaphors on Bioethical Issues,” American Robinson, and B. P. Meier, eds., The Power
stories to be witnessed and respond- Journal of Bioethics 16, no. 10 (2016): 18- of Metaphor: Examining Its Influence on
ed to. Only good and caring people 19, at 19. Social Life (Washington, DC: American
can accomplish that daunting task, 14. D. J. Hauser, R. M. Nesse, and N. Psychological Association, 2014).
Schwarz, “Lay Theories and Metaphors of 32. This is Charles Taylor’s rendering
for, ultimately, it is good people who Health and Illness,” in The Science of Lay of Lakoff and Johnson (C. Taylor, The
speak good words, not the other way Theories, ed. C. Zedelius, B. Müller, and J. Language Animal: The Full Shape of the
around. Indeed, as medicine reimag- Schooler (New York: Springer, 1997), 341- Human Linguistic Capacity [Cambridge,
ines itself for the future, it is crucial 54, at 351. MA: Harvard University Press, 2016], 146).
for the field to refocus on the patient- 15. A related way to describe this prob- 33. See, for example, E. Semino, Z.
lem is that it commits a “conceptual er- Demjéng, and J. Demmen, “An Integrated
clinician relationship, which forms ror,” as claimed by Benjamin Frush and Approach to Metaphor and Framing in
the bedrock of good and ethical clini- John Brewer Eberly Jr. in a direct reply to Cognition, Discourse, and Practice, with
cal care. Trogen (B. Frush and J. Eberly Jr., “Risks an Application to Metaphors for Cancer,”
of Medical Metaphors,” Journal of the Applied Linguistics 339, no. 5 (2018):
Acknowledgments American Medical Association 318, no. 5 625-45; J. Demmen et al., “A Computer-
I would like to thank Mark Clark, [2017]: 482-83). Assisted Study of the Use of Violence
16. J. M. Soskice, Metaphor and Religious Metaphors for Cancer and End of Life
who read and commented on an early Language (Oxford: Clarendon Press, 1985), by Patients, Family Carers and Health
version of this manuscript as part of 1. Professionals,” International Journal of
the American Society for Bioethics 17. Aristotle, Poetics (Oxford: Clarendon Corpus Linguistics 20, no. 2 (2015): 205-31;
and Humanities Early Career Advisor Press, 1968), 1457. R. W. Gibbs Jr. and H. Franks, “Embodied
Program, and Doug Diekema, Jeremy 18. Soskice, Metaphor and Religious Metaphor in Women’s Narratives about
Millington, and David Tate for their Language, 24-26. Their Experiences with Cancer,” Health
constructive feedback on multiple 19. P. Ricoeur, The Rule of Metaphor, Communication 14, no. 2 (2002): 139-65;
drafts. I would also like to thank the trans. R. Czerny (Abingdon, England: or A. W. Gustafsson, C. Hommerberg, and
Hastings Center Report reviewers for Routledge, 2003), 21. A. Sandgren, “Coping by Metaphors: The
their incisive comments. 20. Soskice, Metaphor and Religious Versatile Function of Metaphors in Blogs
Language, 10-14. about Living with Advanced Cancer,”
Notes 21. T. Hobbes, Leviathan (London: Medical Humanities 46 (2019): 267-77.
Penguin, 1968), 116-17. 34. Soskice, Metaphor and Religious
1. G. J. Annas, “Reframing the Debate 22. J. Locke, An Essay Concerning Human Language, 80.
on Health Care Reform by Replacing Understanding (Indianapolis: Hackett, 35. Ibid.
Our Metaphors,” New England Journal of 1996), 214. 36. Ibid, 81.
Medicine 332 (1995): 744-48. 23. M. Reimer and E. Camp, 37. These metaphors were collected from
2. M. C. Smith, “Metaphor in Nursing “Metaphor,” in The Oxford Handbook of both my own experience caring for patients
Theory,” Nursing Quarterly 5, no. 2 (1992): Philosophy of Language, ed. E. Lepore and as well as through email exchanges with
48-49, at 48. B. C. Smith (New York: Oxford University residents and alumni of the University of
3. D. Shalev, “The Machine Days Press, 2014), 845-63, at 847. Washington–Seattle Children’s Hospital
Are Over: Medicine Metaphors and the 24. M. Black, “More about Metaphor,” Pediatric Residency Program.
Psychiatric Resident,” Academic Psychiatry in Metaphor and Thought, ed. A. Ortony 38. I. A. Richards seems to agree when
42, no. 2 (2018): 255-57. (Cambridge: Cambridge University Press, he says that the “worst assumption” about
4. S. Sontag, “Illness as Metaphor” and 1979), 19-43. metaphor one can make is “that metaphor
“AIDS and Its Metaphors” (New York: 25. E. Camp, “Metaphor and That is something special and exceptional in the
Anchor, 1990). Certain ‘Je Ne Sais Quoi,’” Philosophical use of language, a deviation from its nor-
5. L. J. Kirmayer, “Mind and Body Studies 129, no.1 (2006): 1-25. mal mode of working” (The Philosophy of
as Metaphors: Hidden Values in 26. See Soskice, Metaphor and Religious Rhetoric, 90).
Biomedicine,” in Biomedicine Examined, Language, 97-117, and R. Boyd, “Metaphor 39. B. Trogen, “Risks of Medical
ed. M. Lock and D. R. Gorden (Dordrecht, and Theory Change: What Is ‘Metaphor’ a Metaphors—Reply,” Journal of the American
The Netherlands: Kluwer, 1988), 57-93, at Metaphor For?,” in Metaphor and Thought, Medical Association 318 (2017): 482-83, at
57. ed. A. Ortony (Cambridge: Cambridge 482.
6. J.-B. Nie et al., “Healing without University Press, 1979), 356-408. 40. Trogen, “The Evidence-Based
Waging War: Beyond Military Metaphors 27. I. A. Richards, The Philosophy of Metaphor,” 1411.
in Medicine and HIV Cure Research,” Rhetoric (Oxford: Oxford University Press, 41. Nie et al., “Healing without Waging
American Journal of Bioethics 16, no. 10 1936), 90. War.”
(2016): 3-11. 28. Black, “More about Metaphor,” 31. 42. See A. Fuks, “The Military Metaphors
7. Ibid., 5-6. of Modern Medicine,” in The Meaning
28 HASTINGS C E N T E R R E P ORT September-October 2020Management Challenge: Making Sense of 55. Demmen et al., “A Computer- 67. T. Moi, Revolution of the Ordinary:
Health, Illness, and Disease, ed. Z. Li and T. Assisted Study of the Use of Violence Literary Studies after Wittgenstein, Austin,
L. Long (Oxford: Inter-Disciplinary Press, Metaphors.” and Cavell (Chicago: University of Chicago
2009), 57-68, and P. Hodgkin, “Medicine 56. See A. Byrne et al., “Patients’ Press, 2017).
Is War: And Other Medical Metaphors,” Experience of Cancer: Evidence of the 68. Ibid., 2.
British Medical Journal 291 (1985): 1820- Role of ‘Fighting’ in Collusive Clinical 69. Ibid., 2.
21. Communication,” Patient Education 70. Janet Bavelas and colleagues showed
43. M. Trachsel, “Killing the Pain and and Counseling 48, no. 1 (2002): 15- that a person’s ability to coherently tell a sto-
Battling the Lethargy: Misleading Military 21; C. Skott, “Expressive Metaphors in ry depends in part on the degree of engage-
Metaphors in Palliative Care,” American Cancer Narratives,” Cancer Nursing 25, ment and participation of the listener (J.
Journal of Bioethics 16, no. 10 (2016): 24- no. 3 (2002): 230-35; Gibbs and Franks, Bavelas et al., “Listeners as Co-narrators,”
25. “Embodied Metaphor”; and Gustafsson, Journal of Personality and Social Psychology,
44. See L. M. Ellis and C. D. Blanke, Hommerberg, and Sandgren, “Coping by 79 no. 6 [2000]: 941-52). For a discus-
“Losing ‘Losing the Battle with Cancer,’” Metaphors.” sion of the significance of Bavelas’s work
JAMA Oncology 1, no. 1 (2015): 13-14, 57. D. Magaña, “Praying to Win This on the patient-clinician relationship, see D.
and D. R. George, E. R. Whitehouse, and Battle: Cancer Metaphors in Latina and Ofri, What Patients Say, What Doctors Hear
P. J. Whitehouse, “Asking More of Our Spanish Women’s Narratives,” Health (Boston: Beacon Press, 2017), 110-16.
Metaphors: Narrative Strategies to End Communication 35, no. 5 (2020): 649-57. 71. R. Carson, “The Hyphenated
the ‘War on Alzheimer’s’ and Humanize 58. Ibid., 655. Space: Liminality in the Doctor-Patient
Cognitive Aging,” American Journal of 59. Ibid. Relationship,” in Stories Matter: The Role of
Bioethics 16, no. 10 (2016): 22-24. 60. Bob Pearlman and I explore this idea Narrative in Medical Ethics, ed. R. Charon
45. L. F. Degner et al., “A New Approach in greater detail elsewhere: T. P. Tate and and M. Montello (New York: Routledge,
to Eliciting Meaning in the Context of R. A. Pearlman, “Military Metaphors in 2002), 171-82, at 175.
Breast Cancer,” Cancer Nursing 26, no. 3 Health Care: Who Are We Actually Trying 72. H. Brody, “‘My Story Is Broken,
(2003): 169-78. to Help?,” American Journal of Bioethics 16, Can You Help Me Fix It?’ Medical Ethics
46. D. P. Barkwell, “Ascribed Meaning: no. 10 (2016): 15-17. and the Joint Construction of Narrative,”
A Critical Factor in Coping and Pain 61. Trogen, “Risks of Medical Literature and Medicine 13, no. 1 (1994):
Attenuation in Patients with Cancer- Metaphors.” 79-92.
Related Pain,” Journal of Palliative Care 7, 62. Nor can they be explained in any 73. Moi, Revolution of the Ordinary, 247,
no. 3 (1991): 5-14. predictably rigorous or lawlike fashion note 27.
47. D. J. Hauser and N. Schwarz, “The by looking to the social sciences, as the 74. Black, “More about Metaphor,” 25-
War on Prevention: Bellicose Cancer social sciences do not follow “laws” ei- 27.
Metaphors Hurt (Some) Prevention ther. See A. MacIntyre, After Virtue: A 75. In my clinical experience, it can also
Intentions,” Personality and Social Psychology Study in Moral Philosophy, 3rd ed. (Notre be understood by non-English speakers,
Bulletin 41, no. 1 (2015): 66-77. Dame, IN: University of Notre Dame especially when a clinician is working with
48. For examples of articles citing Press, 2012), 88-108; C. Taylor, Human a good medical interpreter. In these situa-
these studies as support, see Trogen, “The Agency and Language: Philosophical Papers tions, within the palliative care context, I
Evidence-Based Metaphor,” 1411, and D. 1 (Cambridge: Cambridge University find metaphors to be particularly useful
Khullar, “The Trouble with Medicine’s Press, 1999), 15-76; J. Blakely, Alasdair when discussing complex and esoteric topics
Metaphors,” Atlantic, August 7, 2014. MacIntyre, Charles Taylor, and the Demise of with patients and families, and I generally
49. Degner et al., “A New Approach to Naturalism (Notre Dame, IN: University of try to select metaphors that fall in this “safe”
Eliciting Meaning”; Barkwell, “Ascribed Notre Dame Press, 2016); and A. W. Frank, category. For a helpful and related discus-
Meaning.” “Can We Research Suffering?,” Qualitative sion around the general usefulness of meta-
50. Hauser and Schwarz, “The War on Health Research 11, no. 3 (2001): 353-62, phor (focused on English-speaking patients
Prevention.” at 355-59. but modifiable for patients that are not), see
51. Here I’m reminded of the hon- 63. G. E. M. Anscombe, An Introduction D. Hui, D. S. Zhukovsky, and E. Bruera,
est lines of Maggie Smith’s poem “Good to Wittgenstein’s Tractatus: Themes in the “Serious Illness Conversations: Paving the
Bones”: “Life is short, though I keep this Philosophy of Wittgenstein (South Bend, IN: Road with Metaphors,” Oncologist 23, no.
from my children. / Life is short, and I’ve St. Augustine’s Press, 1971), 50. 6 (2018): 730-33. Thanks to a Hastings
shortened mine / in a thousand delicious, / 64. MacIntyre, After Virtue, 204- Center Report reviewer for reminding me of
ill-advised ways, / a thousand deliciously ill- 25; A. MacIntyre, Ethics in the Conflicts this important topic and alerting me to this
advised ways / I’ll keep from my children” of Modernity (Cambridge: Cambridge publication.
(in M. Smith, Good Bones [North Adams, University Press, 2017), 26-27, 231-42. 76. In this sense, the metaphor “veg-
MA: Tupelo Press, 2017], 75). 65. J. Bruner, “The Narrative etable” can work like a slur, in that it can
52. T. Chambers, “Metaphors as Construction of Reality,” Critical Inquiry invite or even underwrite a certain mor-
Equipment for Living,” American Journal of 18, no. 1 (1991): 1-21. This empirical ally objectionable perspective (namely, that
Bioethics 16, no. 10 (2016): 12-13. claim about the narrative structure of the there is a tight relationship between neu-
53. D. Semino et al., “The Online Use life of “a human being” may not apply to rologic function and moral value). When
of Violence and Journey Metaphors by people with profound intellectual disability it does so, the perspective becomes a live
Patients with Cancer, as Compared with or cognitive impairment (such as dementia) and operative lens for clinicians to adopt
Health Professionals: A Mixed Methods and therefore does not actually refer to “the” or even hide behind (by saying something
Study,” BMJ Supportive and Palliative Care human life but merely “a type” of human prejudicial without really “saying” it). For a
7, no. 1 (2017): 60-66. life, albeit the type that most, if not all, germane discussion, see E. Camp, “Slurring
54. Ibid, 60. readers of this essay experience. Perspectives,” Analytic Philosophy 54, no. 3
66. Taylor, The Language Animal, 146- (2013): 330-49.
64.
September-October 2020 H AS TI N GS C EN TE R REPO RT 29You can also read
