Based on newly discovered texts, this book explores the barely known but tremendously influential thought of the Tibetan Buddhist teacher, Mabja Jangchub Tsöndrü.This Tibetan Buddhist master exercised significant influence on the interpretation of Madhyamaka thinking in Tibet during the formative phase of Tibetan Buddhism and plays a key role in the religious thought of his day and beyond. The book studies the framework of Mabja’s philosophical project, holding it up against the works of both his own Madhyamaka teachers as well (...) as those of central authors of the later "classical period". The emerging account of the evolution of Madhyamaka in Tibet reveals a striking pattern of transformative appropriations. This, in turn, affords us insights into the nature and function of tradition in Tibetan religious culture and Mahāyāna Buddhism at large. Innovation is demanded for both the advancement and consolidation of tradition. This ground-breaking book is an invaluable contribution to the study of Tibetan philosophy. It is of great interest to Buddhist practitioners, specialists in Buddhist philosophy and Tibetan Buddhism. (shrink)

This chapter suggests that Sellars' account of subjectivity as socially constructed, and hence conceptual at its illusory roots, presents a crisp and compelling perspective on cognitive life that captures Buddhist conceptions of transformative non-duality.

As a Madhyamaka philosopher, Taktsang Lotsawa Sherab Rinchen 1 is perhaps most widely known for his claim to have identified eighteen major contradictions in the thought of Tsongkhapa Losang Drakpa, a polemic discussion that appears in the Madhyamaka chapter of his encyclopedic Freedom from Extremes through Comprehensive Knowledge of Philosophy.2 In this article we will not pursue this critique, both renowned and infamous, but instead focus on Taktsang Lotsawa's own pragmatic hermeneutics of emptiness in context. Taktsang Lotsawa argues that *Svātantrika (...) 3 Mādhyamikas, in their drive to furnish the two... (shrink)

In an analysis of recent work on nudging we distinguish three positions on the relationship between nudging founded in libertarian paternalism and the protection of personal autonomy through informed consent. We argue that all three positions fail to provide adequate protection of personal autonomy in the clinical context. Acknowledging that nudging may be beneficial, we suggest a fourth position according to which nudging and informed consent are valuable in different domains of interaction.

"De ente et essentia" from Thomas Aquinas. Thomas Aquinas (1225-1274), sanctus, doctor Ecclesiae catholicae, theologus italianus et philosophus mediaevalis.

Available from UMI in association with The British Library. ;This thesis traces endeavours in the twentieth century to provide the 'intellectual' foundations for general medical practice as an independent, autonomous clinical discipline. The empirical focus of the study is upon the application of psychological and 'person-centred' approaches to general practice; above all, in the work of Michael Balint, and the Royal College of General Practitioners in the post-war period. The thesis is guided by two predominant theoretical concerns. First, to highlight (...) the complex strategies and the wide range of means and resources that have been required to give substance to the claim that general practice is 'by nature' a person-centred endeavour. Second, to consider--and to question--certain influential approaches to medical power in general, and to the social consequences of 'emancipatory'--person-centred--forms of medicine in particular. Specifically, the 'power/knowledge' approach to medical sociology is contested both with regard to its empirical findings and in relation to its basis in the work of Michel Foucault . ;The study which follows is intended neither as a narrative history of general practice nor as a history of ideas about general practice. Its empirical concern is more specific than either of these. Focusing upon the twentieth century and above all the post-war period, it seeks to analyse some of the ways in which general practitioners have sought to autonomise their discipline by giving it an 'intellectual' basis. If the 'general practitioner' has long existed as a professional label then nevertheless notions of what unifies the general practitioner's activities have undergone a degree of mutation. It is these 'models' of general practice--physiological, epidemiological, psychological--which will be investigated here. As such, the purpose behind the study is partly of a 'methodological' order. The study seeks to show that what counts in evolving a coherent model of general practice is not just the provision of a 'representation' of the general practitioner's activities but a construction on several levels. (shrink)

When an individual facing intractable pain is given an estimate of a few months to live, does hastening death become a viable and legitimate alternative for willing patients? Has the time come for physicians to do away with the traditional notion of healthcare as maintaining or improving physical and mental health, and instead accept their own limitations by facilitating death when requested? The Universities of Oxford and Cambridge held the 2013 Varsity Medical Debate on the motion “This House Would Legalise (...) Assisted Dying”. This article summarises the key arguments developed over the course of the debate. We will explore how assisted dying can affect both the patient and doctor; the nature of consent and limits of autonomy; the effects on society; the viability of a proposed model; and, perhaps most importantly, the potential need for the practice within our current medico-legal framework. (shrink)

This essay analyzes two types of patient‐experience data to broaden and deepen understanding of trust in health care. Analysis of patients’ open‐ended comments shows a close connection between patients’ feelings of trust and their intent to recommend providers and provider organizations—a global measure to evaluate patients’ perceptions of care experiences. Patients’ comments also reveal the bidirectional building of trust between the patient and the caregiver. Trust gets built when patients perceive their caregivers to trust their knowledge of their bodies as (...) well as when caregivers demonstrate caring behaviors that earn the patients’ trust. Patients’ ratings of a closed‐ended survey item on “confidence in provider” create the greatest differentiation for the global measure of patient experience—whether patients did or did not recommend a practice or provider. The essay also discusses related findings on pre‐visit friction and the use of humor by the caregiver to expand understanding of trust. (shrink)

The invention of psychopathology -- Malingering -- Doctoring -- Inculpating -- Sheltering -- Cheating -- Lying -- The burden of responsibility.

This issue includes a number of papers on reproductive ethics, broadly construed. In a recent book, Anja Karnein proposed that embryos created in vitro should be offered up for adoption before being discarded or used in research;1 here Timothy Murphy offers a critical response . Elsewhere, Tak Chan and Stark & Delatycki debate the role of medical professionals in providing parentage determination. Chan argues that doctors are obliged to provide parentage tests when this is requested by parents, provided there is (...) a low risk that the child will be abandoned . Stark & Delatycki discuss some difficulties raised by the ‘risk of abandonment’ condition . Finally, papers by Kate Greasley and David Lang discuss the controversy surrounding the criminal prosecution of abortion doctor Kermit Gosnell. Greasley criticises the way in which some commentators capitalised on horror at Gosnell's extreme practices to advance more general anti-abortion objectives . Lang argues, against Greasley, that the dominant pro-life response to the case was neither self-contradictory nor intellectually dishonest .The issue is dominated, however, by discussions of ‘bioenhancement’ – the use of biomedical technologies to augment human capacities. A common criticism of bioenhancements is that they are anti-social: though they may benefit the user, they will have a negative effect on society-at-large. Such concerns are perhaps well placed in relation to the most obvious contemporary examples of bioenhancement: doping in sport, aesthetic medicine, and the use of stimulants to enhance examination performance. However, two varieties of bioenhancement discussed in this issue might be thought to have more positive social effects.David Shaw discusses the possible use of cognitive enhancing drugs to improve health outcomes in disadvantaged segments of society . Such enhancements might be thought to have desirable social …. (shrink)

Who is speaking in the history of social thought? The question of the authentic voice of social thought is typically posed in terms that tend to be either ambitiously theoretical or carefully methodological. Thus histories of social thought frequently offer either a résumé of general ideas about society (say from Montesquieu to Parsons) or a survey which gets bogged down in a rather tedious, nit-picking debate about empirical methodology. This paper is something of a preview of a pro jected attempt (...) on the part of the authors to capture the voice of social thought in rather different terms. Our three theses are: (1) that those who speak 'in the name of society' have just as frequently been doctors and bureaucrats as opposed to 'social philosophers' or professional sociologists; correlatively, (2) that the creative voice of social thought has more often been technical, problem-centred and tied up with par ticular rationalities of government as opposed to being either exclu sively theoretical or merely responsive to 'objective problems' in society; and, (3) that if sociology today struggles for a voice in which to speak this may be in some part due to the ways in which the past history of social thought has typically been conceived. (shrink)

In his slim and punchy little book, Acedia and its Discontents: Metaphysics of Desire in an Age of Boredom, R.J. Snell suggests that the common experience of the loss of meaning in the modern world can be attributed to the vice of acedia. Relying on Evagrius of Pontus, as well as the Angelic Doctor, St Thomas Aquinas, Snell defines acedia as a rejection of life itself and an antipathy with one’s place in the world. It is the unhappy rejection (...) of one’s supernatural end, union with the Triune God. (shrink)

Wolf Haas' Detective Brenner series has become wildly popular around the world for a reason: They're timely, edgy stories told in a wry, quirky voice that's often hilarious, and with a protagonist it's hard not to love. In this episode, Brenner-forced out of the police force-tries to get away from detective work by taking a job as the personal chauffeur for two-year-old Helena, the daughter of a Munich construction giant and a Viennese abortion doctor. One day, while Brenner's attention is (...) turned to picking out a chocolate bar for Helena at a gas station, Helena gets snatched from the car. Abruptly out of a job, Brenner decides to investigate her disappearance on his own. With both parents in the public eye, there's no scarcity of leads-the father's latest development project has spurred public protest, and the mother's clinic has been targeted by the zealous leader of an anti-abortion group. Brenner and God is told with a dark humor that leaves no character, including Brenner, unscathed. Haas tells the story of a fallible hero who can be indecisive and world-weary, baffled and disillusioned by what he finds, but who presses forward nonetheless out of a stubborn sense of decency-a two-year-old is kidnapped, so you find her, because that's just what you do. (shrink)

There is no arguing the impact of Inoue Tetsujirō on the development of philosophy in Japan from the Meiji Restoration through the end of the Pacific War. He was the first Japanese to receive a doctorate in philosophy from Germany and the first native-born chair of the philosophy department at Tokyo Imperial University, the training center for almost all the major Japanese philosophers who graduated before 1915. Inoue was instrumental in making German idealism the Western philosophy of choice for Japan, (...) but he also appreciated Asian traditions as well, having no qualms about claiming there was true philosophy in India, China, and premodern Japan. He set the foundation for academic philosophy in Japan not so much through his own rather simplistic personal philosophy, but especially through his contributions to the organization of the field. This article focuses mainly on Inoue’s troubled relation with Confucianism. On one hand, in seeking a premodern philosophy to serve as the bedrock for modern Japan, Inoue looked to the Edo-period Confucian traditions originating in China. He divided them into Shushigaku, Yōmeigaku, and what he named Kogaku, the school focusing on classical texts preceding neo-Confucian developments and interpretations. In many respects, like so many others of his generation, Inoue was by training and personal preference a Confucian. That is not the whole story, however. Inoue understood Confucianism’s primary purpose as cultivating the social values and order that would ensure an efficient society of human flourishing, stability, and harmony. Yet, he also likely suspected that the people of the new Japan, with its modernization and plethora of Western ideas, would not unquestioningly accept the authority of the Confucian classics, nor be willing to undertake the rigors of textual study that are the hallmark of the Confucian scholar. In Edo-period Japan, that study had been the responsibility of the samurai class, but in their democratization program, the Meiji reformers had abolished the old class system. Education of the young would now shift from the Confucian academies to the new public school system. Always cooperative with the government to the point of being obsequious, Inoue took a leading role in the National Morality program and its installment in the nationwide school curriculum. That curriculum combined a Shinto-based reverence for the sacred nature of the emperor in the kokutai ideology along with practical moralistic values that could be loosely called Confucian. Yet, if schooling for most was limited to the elementary level and if there was no longer a samurai class to oversee the moral behavior of the society, who could nurture and enforce the moral order? Through a set of fortuitous events, Inoue “discovered” bushidō, the Way of the warrior. If there were no longer a samurai warrior class, perhaps all Japanese could become de facto samurai—at least in their mindset. Most may no longer have the scholarly skills and time to glean their spiritual and moral insights from Confucian texts. Yet, they could find the virtues of loyalty, sincerity, filiality, and compliance with seniority within the distinctively mindful heart and spirit of ancient Japan carried within the Japanese bloodline. What happened to the Confucianism of Inoue Tetsujirō? Some of its values were absorbed into bushidō and National Morality, but the praxis of the Confucian scholar and the ideal of the kunshi seem to have been lost, much to Japan’s detriment. (shrink)

Gilbert Simondon, one of the most influential contemporary French philosophers, published only three works: L'individu et sa genèse physico-biologique and L'individuation psychique et collective, both drawn from his doctoral thesis, and _Du mode d'existence des objets techniques_. It is this last work that brought Simondon into the public eye; as a consequence, he has been considered a "thinker of technics" and cited often in pedagogical reports on teaching technology. Yet Simondon was a philosopher whose ambitions lay in an in-depth renewal (...) of ontology as a process of individuation--that is, how individuals come into being, persist, and transform. In this accessible yet rigorous introduction to Simondon's work, Muriel Combes helps to bridge the gap between Simondon's account of technics and his philosophy of individuation. Some thinkers have found inspiration in Simondon's philosophy of individuation, notably Gilles Deleuze and Félix Guattari. Combes's account, first published in French in 1999, is one of the only studies of Simondon to appear in English. Combes breaks new ground, exploring an ethics and politics adequate to Simondon's hypothesis of preindividual being, considering through the lens of transindividual philosophy what form a nonservile relation to technology might take today. Her book is essential reading for anyone who wants to understand Simondon's work. (shrink)

John Duns Scotus (1265/66-1308) was one of the most important and influential philosophertheologians of the High Middle Ages. His brilliantly complex and nuanced thought, which earned him the nickname "the Subtle Doctor," left a mark on discussions of such disparate topics as the semantics of religious language, the problem of universals, divine illumination, and the nature of human freedom. This essay first lays out what is known about Scotus's life and the dating of his works. It then offers an overview (...) of some of his key positions in four main areas of philosophy: natural theology, metaphysics, the theory of knowledge, and ethics and moral psychology. (shrink)

Originally presented as the author's thesis (doctoral)--Basel, 1994.

In this paper I convey a recurring problem and possible solution that arose during my doctoral research on the topic of cross-cultural Holocaust curriculum development for Latvian schools. Specifically, as I devised the methodology for my research, I experienced a number of frustrations concerning the issue of transferability and the limitations of both reader generalizability and grounded theory. Ultimately, I found a more appropriate goal for the external applicability of this and other highly contextual research studies in the form of (...) "grounded understandings," which are tentative apprehensions of the importance or significance of phenomena and conceptualizations that hold meaning and explanatory power, but are only embryonic in their potential to generate theory. (shrink)

Antipsychiatry : alternative psychiatry -- The doctor of irresponsibility -- The trickster and the tricked -- Antipsychiatry and anti-art -- Antipsychiatry abroad.

"De unitate intellectus contra Averroistas" from Thomas Aquinas. Thomas Aquinas (1225-1274), sanctus, doctor Ecclesiae catholicae, theologus italianus et philosophus mediaevalis.

Thomas L. Shaffer argues that the morals of modern American lawyers and doctors have been corrupted by misguided professionalism and weak philosophy.

It is often argued by health professionals working within the field of palliative care that palliative care and euthanasia/assisted suicide are incompatible. Across the literature, this claim is grounded on the three claims that (1) palliative care and euthanasia/assisted suicide have different aims, (2) euthanasia/assisted suicide is at odds with the doctor’s fundamental role as a healer, and (3) euthanasia/assisted suicide constitutes patient abandonment. Furthermore, even if palliative care and euthanasia/assisted suicide are compatible, it is often argued that the availability (...) of palliative care renders euthanasia/assisted suicide redundant. This depends on two claims that (1) palliative care is always available and effective, and (2) palliative care is always preferable to euthanasia/assisted suicide. This article argues that all of these claims are false, ultimately aiming to establish that palliative care and euthanasia/assisted suicide are complementary rather than mutually exclusive. (shrink)

This paper aims to elucidate some dysfunctional aspects of health care utilisation by combining concepts from modern systems theory and from psychoanalysis. Contemporary health care in industrialised countries can be conceived as a social system in terms of modern systems theory. According to this theory, social systems are operating on the basis of a ‘guiding difference,’ which in the case of health care is the distinction between ‘healthy’ and ‘ill.’ Its rigidity in adhering to the healthy-ill dichotomy exposes health care (...) to being collusively entangled in the interpersonal defence arrangements of patients. In the psychoanalytic view, individual conflicts can be warded off from consciousness not only by intrapsychic defence, but also by interpersonal defence mechanisms. These mechanisms involve the patients’ close social environment, often including doctors and hospitals. The functioning and the motivational structure of health care itself shows features of neurotic defence: Not only its representatives, but health care as a whole act in a rigid, obsessive manner in order to separate the healthy from the ill and to battle against (presumed) diseases. This obsession sometimes results in excessive diagnostic activism and in inconsiderate application of aggressive medical treatments. Both are inappropriate with regard to the salient problem of modern medicine: the increase of chronic nonfatal diseases like depression and chronic pain. The described defence mechanisms are unconscious not only to patients but also to health care professionals (let alone health politicians), and are contributing to dysfunctional health care overuse. (shrink)

No Child Left Behind and the Illusion of Reform highlights the scholarship of eight doctoral students in curriculum and their professor, who took on the legal, political, philosophical, social, cultural, economic, and curricular assumptions of the No Child Left Behind Act . This book, the manifestation of their work, is a critical examination of the impact of the NCLB on the lives of children, families, and teachers.

In “Avoiding a Death Panel Redux,” Nicole Piemonte and Laura Hermer make the argument that the advance care planning consultation provision during the health care reform debate collapsed both because the language in the provision was deliberately misread and because some features of the language could in fact be misleading. We agree on both counts. We add that the cost‐effectiveness provisions of the bill make us face difficult decisions we as a nation would rather avoid, but can and must face (...) squarely and together. It is time for an honest national conversation about at least two issues concerning medical care near the end of life. First, talking about or planning a good death with your doctor or nurse will not make death happen sooner. The data show that better planning for a well‐managed terminal illness leads to longer life as well as better symptom control and less distress. Second, we need to quickly and directly confront the cost of end of life care in the United State, recognize the political consequences, and work with the broad middle to advance the common good. (shrink)

In 2014, American doctor Ian Crozier chose to travel to Sierra Leone to help fight the West African Ebola epidemic. He contracted Ebola himself and was evacuated to the US, where he received hospital treatment for 40 days. Crozier knowingly chose to expose himself to a risk of contracting Ebola, and thus appears to be at least somewhat morally responsible for his infection. Did this responsibility weaken his justice-based claim to publicly funded treatment? On one influential view—luck egalitarianism—the answer is (...) ‘yes’. Or so Albertsen and Thaysen suggest in this issue.1 According to luck egalitarianism, justice requires the elimination of inequalities between people, but only when the relative harm borne by those on the wrong end of the inequality is a matter of luck. Albertsen and Thaysen understand luck egalitarianism to entail that, when one is responsible for befalling a harm, one has no claim in justice to the mitigation of that harm. On this view, they suggest, Crozier’s claim to treatment would be similar to that of a reckless Alpine skier who is injured in a skiing accident, and would be weaker than that of those with a normal claim to treatment—those who bear no responsibility for their illness. Both of these implications seem implausible, however. Intuitively, Crozier’s claim to treatment is no weaker than those with normal claims, and certainly stronger than the reckless skier’s. Can luck egalitarianism be ‘adjusted or interpreted’ so as to avoid these implausible implications? The authors suggest that it can. Their innovation is to distinguish heroic doctors like Crozier from reckless skiers by invoking a distinction between being responsible for creating harm and for incurring harm. Their thought is that one creates harm when one brings harm on oneself without also preventing at least as much harm to others. Thus, the harm that …. (shrink)

The Jubilee Centre’s new report, Virtuous Medical Practice, examines the place of character and values in the medical profession in Britain today. Its findings are drawn from a UK-focused multi-methods study of 549 doctors and aspiring doctors at three career stages, first and final year students and experienced doctors.

T. S. Eliot left Harvard during his third year of study in the department of philosophy and went to England. Forty-six years later he authorized the publication of his doctoral dissertation. Here we have a reprint of his sympathetic but not entirely uncritical study of the English idealist philosopher F. H. Bradley.

The graduate teaching assistant prepares to enter a classroom for the first time as its instructor beset by feelings of incompetence: indeed, learning to successfully display a professional identity is often a terrifying experience, such that promising novices may abandon it prematurely. This hermeneutic phenomenological study asks one female doctoral candidate the following question: What is the experience of feelings of competence and incompetence in the process of becoming a professor? The core finding of this interview-based study is the thematic (...) demarcation of sequential stages in the participant’s experience of the process of becoming “member enough”. In the presentation of the findings, the identification of the central themes is validated with excerpts from the interview data, and their implications for the study of competence, the sociocultural study of identity development, and the mentoring of pre-service college faculty discussed. Indo-Pacific Journal of Phenomenology , May 2010, Volume 10, Edition 1. (shrink)

As etiologic concepts of diseases gradually changed from humoral to microbial in the 19th century, syphilis presented particularly great challenges to doctors and scientists. Was “syphilis” merely a synonym for “venereal disease,” and did all manifestations attributed to it have the same cause? The discovery in 1879 of the gonococcus by Albert L. Neisser , and of the cause of chancroid, or soft chancre, in 1890 by Augusto Ducrey , established that venereal disease and syphilis were not synonymous, but syphilis (...) continued to mystify investigators. Symptoms could disappear for years and then—in most but not all persons—reappear with entirely different “tertiary” manifestations. .. (shrink)

Using Hofstede's culture theory (1980, 2001 Culture's Consequences: Comparing Values, Behaviours, Institutions, and Organizations Across Nation. Sage, NewYork), the current study incorporates the moral development (e.g. Thorne, 2000; Thorne and Magnan, 2000; Thorne et al., 2003) and multidimensional ethics scale (e.g. Cohen et al., 1993; Cohen et al., 1996b; Cohen et al., 2001; Flory et al., 1992) approaches to compare the ethical reasoning and decisions of Canadian and Mainland Chinese final year undergraduate accounting students. The results indicate that Canadian accounting (...) students' formulation of an intention to act on a particular ethical dilemma (deliberative reasoning) as measured by the moral development approach (Thorne, 2000) was higher than Mainland Chinese accounting students. The current study proposes that the five factors identified by the multidimensional ethics scale (MES), as being relevant to ethical decision making can be placed into the three levels of ethical reasoning identified by Kohlberg's (1958, The Development of Modes of Moral Thinking and Choice in the Years Ten to Sixteen. University of Chicago, Doctoral dissertation) theory of cognitive moral development. Canadian accounting students used post-conventional MES factors (moral equity, contractualism, and utilitarianism) more frequently and made more ethical audit decisions than Chinese accounting students. (shrink)

Virtue ethics has long provided fruitful resources for the study of issues in medical ethics. In particular, study of the moral virtues of the good doctor—like kindness, fairness and good judgement—have provided insights into the nature of medical professionalism and the ethical demands on the medical practitioner as a moral person. Today, a substantial literature exists exploring the virtues in medical practice and many commentators advocate an emphasis on the inculcation of the virtues of good medical practice in medical education (...) and throughout the medical career. However, until very recently, no empirical studies have attempted to investigate which virtues, in particular, medical doctors and medical students tend to have or not to have, nor how these virtues influence how they think about or practise medicine. The question of what virtuous medical practice is, is vast and, as we have written elsewhere, the question of how to study doctors’ moral character is fraught with difficulty. In this paper, we report the results of a first-of-a-kind study that attempted to explore these issues at three medical schools in the United Kingdom. We identify which character traits are important in the good doctor in the opinion of medical students and doctors and identify which virtues they say of themselves they possess and do not possess. Moreover, we identify how thinking about the virtues contributes to doctors’ and medical students’ thinking about common moral dilemmas in medicine. In ending, we remark on the implications for medical education. (shrink)

In this article we examine the figure of the doctor in animated debates around public sector medicine in contemporary South Africa. The loss of health professionals from the South African public system is a key contributor to the present healthcare crisis. South African medical schools have revised curricula to engage trainee doctors with a broader set of social concerns, but the disjunctures between training, health systems failures, and a high disease burden call into question whether junior doctors are adequately prepared (...) or whether conditions of care extend beyond medical training. A concern with 'resilience' suggests a correct ethical relation to a putative obligation to provide care in a struggling system. By examining the ways in which trainee doctors are expected to 'cope' with the demands of medical practice, to adopt the correct moral posture in relation to the urgency of care, and to enact a desirable ethical relation to the broader social and political context of medical practice, we examine the picture of humanist concern that animates the subjectivities and techniques of the self called for by this training, and advocate for endurance as an alternative framework for understanding the political and ethical relations between doctors, patients and health systems. (shrink)

Antimicrobial resistance (AMR) is a global public health disaster driven largely by antibiotic use in human health care. Doctors considering whether to prescribe antibiotics face an ethical conflict between upholding individual patient health and advancing public health aims. Existing literature mainly examines whether patients awaiting consultations desire or expect to receive antibiotic prescriptions, but does not report views of the wider public regarding conditions under which doctors should prescribe antibiotics. It also does not explore the ethical significance of public views (...) or their sensitivity to awareness of AMR risks or the standpoint (self-interested or impartial) taken by participants. Methods: An online survey was conducted with a sample of the U.S. public (n = 158). Participants were asked to indicate what relative priority should be given to individual patients and society-at-large from various standpoints and in various contexts, including antibiotic prescription. Results: Of the participants, 50.3% thought that doctors should generally prioritize individual patients over society, whereas 32.0% prioritized society over individual patients. When asked in the context of AMR, 39.2% prioritized individuals whereas 45.5% prioritized society. Participants were significantly less willing to prioritize society over individuals when they themselves were the patient, both in general (p = .001) and in relation to AMR specifically (p = .006). Conclusions: Participants’ attitudes were more oriented to society and sensitive to collective responsibility when informed about the social costs of antibiotic use and when considered from a third-person rather than first-person perspective. That is, as participants came closer to taking the perspective of an informed and impartial “ideal observer,” their support for prioritizing society increased. Our findings suggest that, insofar as antibiotic policies and practices should be informed by attitudes that are impartial and well-informed, there is significant support for prioritizing society. (shrink)

New Institutional Theory is used to explain the context for argumentation in modern practice. The illustration of Direct to Consumer Drug advertising is deployed to show how communicative argument between a doctor and patient is influenced by force exogenous to the practice of medicine. The essay shows how strategic maneuvering shifts the burden of proof within institutional relations.

Informed consent is the legal instrument that purports to protect an individual's autonomy and defends against medical arbitrariness. Informed Consent and Health highlights that possession of complete information about all relevant aspects of a proposed treatment is integral to the ability of a patient to make an informed choice. With patient choice at both legislative and judicial levels rising to greater levels of prominence, this timely book examines how the tensions between the rights of patients to make choices and the (...) duties of doctors to provide health care are managed.This illuminating book investigates our evolving understanding of informed consent from a range of comparative and international perspectives, demonstrating the diversity of its interpretations around the world. Chapters offer a nuanced analysis of the problems that impede the understanding and implementation of the concept of informed consent and explore the contemporary challenges that continue to hinder both the patient and the medical community.Containing an in-depth discussion on this fundamental right, this thought-provoking book will be of value to academics and practitioners alike. Providing fascinating insight into new solutions and interpretations, this book will also prove a key resource for clinicians and health care workers. (shrink)

Although the traditional physician ethic sees nothing objectionable about the doctor's influence over patients, superficial conceptions of the patient's right to self-determination imply that this influence may be manipulative. On the contrary, there are several different lines of argument which can reconcile self-determination with the physician's influence. Nevertheless, drawing the boundaries between legitimate methods of persuasion, and manipulation or coercion sometimes proves difficult.

The Watchman's bed is not ‘supervised’ by dreams; instead, fear ‘stands in attendance’. The images are medical. He is ill; dream-filled sleep would be a good doctor, but the bad doctor fear is already on the job, preventing him from sleeping well.