Context Professionalism remains a challenging part of the medical curriculum to define, teach and evaluate. We suggest that one way to meet these challenges is to clarify the definition of professionalism and distinguish this from medical ethics. Methods Our analysis is two staged. First, we reviewed influential definitions of professionalism and separated elements relating to (a) ethico-legal competencies, (b) clinical competence and (c) professionalism. In reference to professionalism, we then distinguished between aspirational virtues/values and specific behaviours. From these, we develop (...) a working definition of medical professional behaviour consisting of six domains of behaviour: responsibility; relationships with and respect for patients; probity and honesty; self awareness and capacity for reflection; collaboration and team work; and care of colleagues. Second, we tested this working definition against empirical data concerning disciplinary action against practising doctors using (a) sources in the literature and (b) an original analysis of complaints received by the Medical Board of South Australia. Conclusion Our empirical analysis supports the relevance of four of the six potential domains: responsibility; relationships with and respect for patients; probity and honesty; self awareness and capacity for reflection. There are additional reasons for retaining ‘collaboration and team work’ in the medical professional behaviour curriculum but ‘care of colleagues’ may be better addressed in the ethico-legal curriculum. Our definition of professional behaviour is consistent with the theoretical literature, captures behaviours that predict future complaints against practitioners and is consistent with current complaints about professionalism in South Australian practitioners. This definition can further the teaching and assessing of professional behaviour in medical schools. (shrink)
Innovative surgery raises four kinds of ethical challenges: potential harms to patients; compromised informed consent; unfair allocation of healthcare resources; and conflicts of interest. Lack of adequate data on innovations and lack of regulatory oversight contribute to these ethical challenges. In this paper these issues and the extent to which problems may be resolved by better evidence-gathering and more comprehensive regulation are explored. It is suggested that some ethical issues will be more resistant to resolution than others, owing to special (...) features of both surgery and innovation. (shrink)
Since the 1990s, glycated haemoglobin (HbA1C) has been the gold standard for monitoring glycaemic control in people diagnosed as having either type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM). Discussions are underway about diagnosing diabetes mellitus on the basis of HbA1C titres and using HbA1C tests to screen for T2DM. These discussions have focused on the relative benefits for individual patients, with some attention directed towards reduced costs to healthcare systems and benefits to society. We argue that (...) there are strong ethical reasons for adopting HbA1C-based diagnosis and T2DM screening that have not yet been articulated. The rationale includes the differential impact of HbA1C-based diabetic testing on disadvantaged groups, and what we are beginning to learn about HbA1C vis-à-vis population health. Although it is arguable that screening must primarily benefit the individual, using HbA1C to diagnose and screen for T2DM may promote a more just distribution of health resources and lead to advances in investigating, monitoring and tackling the social determinants of health. (shrink)
Molecular dynamics (MD) simulations were performed of the structural changes occurring through the liquid?glass transition in Cu?Zr alloys. The total scattering functions (TSF), and their associated primary diffuse scattering peak positions (K p), heights (K h) and full-widths at half maximum (K FWHM) were used as metrics to compare the simulations to high-energy X-ray scattering data. The residuals of difference between the model and experimental TSFs are ?0.03 for the liquids and about 0.07 for the glasses. Over the compositional range (...) studied, Zr1? x Cu x (0.1 ≤ x ≤ 0.9), K p, K h and K FWHM show a strong dependence on composition and temperature. The simulation and experimental data correlate well between each other. MD simulation revealed that the Cu?Zr bonds undergo the largest changes during cooling of the liquid, whereas the Cu?Cu bonds change the least. Changes in the partial-pair correlations are more readily seen in the second and third shells. The Voronoi polyhedra (VP) in glasses are dominated by only a few select types that are compositionally dependent. The relative concentrations of the dominant VPs rapidly change in their relative proportion in the deeply undercooled liquid. The experimentally determined region of best glass formability, x Cu ? 65%, shows the largest temperature dependent changes for the deeply undercooled liquid in the MD simulation. This region also exhibits very strong temperature dependence for the diffusivity and the total energy of the system. These data point to a strong topological change in the best glass-forming alloys and a concurrent change in the VP chemistry in the deeply undercooled liquid. (shrink)
OBJECTIVES: To study and report the attitudes of patients and general practitioners (GPs) concerning the obligation of doctors to act for the good of their patients, and to provide a practical account of beneficence in general practice. DESIGN: Semi-structured interviews administered to GPs and patients. SETTING AND SAMPLE: Participants randomly recruited from an age and gender stratified list of GPs in a geographically defined region of South Australia. The sample comprised twenty-one general practitioners and seventeen patients recruited by participating GPs. (...) RESULTS: In practice, acting for the good of the patient not only accommodates the views of patients and GPs on expertise and knowing best, but also responds to the particular details of the clinical situation. Patients had a complex understanding of the expertise necessary for medical practice, describing a contextual domain in which they were expert, and which complemented the scientific expertise of their GPs. General practitioners identified multiple sources for their expertise, of which experience was the most significant. The role of the GP included responding to individual patients and particular clinical problems and ranged from the assumption of responsibility through to the proffering of medical advice. CONCLUSION: This study found that GPs acting for the good of their patients covered a variety of GP actions and patient preferences. Beneficence was not justified by presumed patient vulnerability or the inability of patients to understand medical problems, but furthered through a recognition of the different areas of expertise contributed by both parties to the consultation. (shrink)
There has been a heated debate within psychotherapeutic counseling of the role that can be afforded to spirituality within the counseling setting. If one single factor can be accorded primacy, then it might be reckoned the late Carl Rogers turned to spirituality in the last decade of his life. The following examines this debate in relation to the supposed, and, it might be argued, demonstrated, ineffable nature of alterity in relation to intersubjectivity in general. Many of the protagonists in (...) this debate have highlighted the inadequacy of discursive language in conveying the essential moment of connectedness in Rogerian therapy between two individuals. This gap, perceived or real, has been filled by rendering the relationship between therapist and client as spiritual. It is argued that this move has already been rehearsed in at least two classical texts, G. W. F. Hegel's Phenomenology of Spirit and Dostoyevsky's Crime and Punishment. Both authors at quite crucial junctures in these texts turn to spirituality within the context of a very specific self—other relation. There is very little discernible difference between these described relationships, in either substance or form, and those described by Rogers and others as being their most successful therapeutic encounters. All of them can be regarded as a therapeutic relationship between two specific individuals that derives benefits for both irreducible to, and irreplaceable by, the psycho-social benefits of wider group membership. (shrink)
A response to a critique by Roger W. Hunt of my views on the eventual likely need to use age as a standard for the allocation of expensive, high-technology, life-extending medical care for the elderly. The response encompasses three elements: 1. that while the elderly have a substantial claim to publicly-provided health care, it cannot be an unlimited claim; 2. that a health care system which provided a decent, coherent set of medical and social services for the elderly would be (...) sufficient, even if some limits had to be set; and 3. allocation and rationing decisions should not be made by individual doctors at the bedside but by regional or national policy. (shrink)
What is the proper relation between the scientific worldview and other parts or aspects of human knowledge and experience? Can any science aim at "complete coverage" of the world, and if it does, will it undermine--in principle or by tendency--other attempts to describe or understand the world? Should morality, theology and other areas resist or be protected from scientific treatment? Questions of this sort have been of pressing philosophical concern since antiquity. The Proper Ambition of Science presents ten particular case (...) studies written by prominent philosophers, looking at how this problem has been approached from the ancient world right up to the present day. Contributors: Bob Sharples, M.W.F. Stone, G.A.J. Rogers, J.R. Milton, Aaron Ridley, Christopher Hookway, Dermot Moran, Thomas E. Uebel, David Papineau, and Nancy Cartwright. (shrink)
Political theorists have argued for and against the propriety of a civic ethics of "public reason" that would set normative bounds on the expression of religious views in the public discourse of government officials and, to a lesser degree, citizens. This essay explores whether critics of ethical restraints on religious discourse have grounds to criticize the religious rhetoric of President George W. Bush. Quantitative and qualitative studies show that Bush has used a distinctive "prophetic" mode of religious expression more often (...) than any modern predecessor. This sort of religious discourse is argued to be ethically dubious from the standpoints of most public reason advocates and most of their critics. Even as it champions democracy and adherence to the plans of divine providence, it discourages and de-legitimates democratic dissent and fails to provide the religious guidance it promises. (shrink)
In contrast to many of his contemporaries, A. J. Ayer was an analytic philosopher who had sustained throughout his career some interest in developments in the work of his ‘continental’ peers. Ayer, who spoke French, held friendships with some important Parisian intellectuals, such as Camus, Bataille, Wahl and Merleau-Ponty. This paper examines the circumstances of a meeting between Ayer, Merleau-Ponty, Wahl, Ambrosino and Bataille, which took place in 1951 at some Parisian bar. The question under discussion during this meeting was (...) whether the sun existed before humans did, over which the various philosophers disagreed. This disagreement is tangled with a variety of issues, such as Ayer’s critique of Heidegger and Sartre (inherited from Carnap), Ayer’s response to Merleau-Ponty’s critique of empiricism, and Bataille’s response to Sartre’s critique of his notion of ‘unknowing’, which uncannily resembles Ayer’s critique of Sartre. 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I reply to critical discussion of my work by Copthorne Macdonald, Steve Fuller, John Stewart, Joseph Agassi, Margaret Boden, Donald Gillies, Mathew Iredale, David Hodgson, Karl Rogers, and Leemon McHenry.
Rogers, C. R. and Skinner, B. F. Some issues concerning the control of human behavior.--Broudy, H. S. Didactics, heuristics, and philetics.--Craig, R. An analysis of the psychology of moral development of Lawrence Kohlberg.--Scudder, J. R., Jr. Freedom with authority: a Buber model for teaching.--Hook, S. Some educational attitudes and poses.--Strike, K. A. Freedom, autonomy, and teaching.--Elkind, D. Piaget and Montessori.--Raywid, M. A. Irrationalism and the new reformism.--Doll, W. E., Jr. A methodology of experience: the process of inquiry.--Neff, F. C. (...) Competency-based teaching and trained fleas.--Brown, A. "What could be bad?" Some reflections on the accountability movement. (shrink)
The approach to critical realism, by D. Drake.--Pragmatism versus the pragmatist, by A. O. Lovejoy.--Critical realism and the possibility of knowledge, by J. B. Pratt.--The problem of error, by A. K. Rogers.--Three proofs of realism, by G. Santayana.--Knowledge and its categories, by R. W. Sellars.--On the nature of the datum, by C. A. Strong.
General semantics and the cold war mentality, by S. I. Hayakawa.--The talking tribes, by W. Johnson.--On a certain sort of disagreement, by I. J. Lee.--Serial communication of information in organizations, by W. V. Haney.--The cultural roots of bragmatics, by C. M. Babcock.--Images of the consumer's mind on and off Madison Avenue, by M. Rokeach.--Semantics and sexuality, by S. I. Hayakawa.--The magic word in Nazi persuasion, by H. A. Bosmajian.--Freedom and commitment, by C. R. Rogers.--Bibliography (p. 63).
Ethical self-management; an introduction to systematic personality psychology, by M. C. Katz.--Four axiological proofs of the infinite value of man, by R. S. Hartman.--Some thoughts regarding the current philosophy of the behavioral sciences, by C. R. Rogers.--Autonomy and community, by D. Lee.--Synergy in the society and in the individual, by A. H. Maslow.--Human nature: its cause and effect; a theoretical framework for understanding human motivation, by M. C. Katz.--Mental health; a generic attitude, by G. W. Allport.--Love feelings in courtship (...) couples; an analysis, by R. P. Hattis.--Economic policies and human well-being, by W. A. Weisskopf.--The great transformation, by H. F. W. Perk.--Contingencies of reinforcement in the design of a culture, by B. F. Skinner.--For further reading (p. 238-240). (shrink)