Pain is undertreated in the American health-care system at all levels: physician offices, hospitals, long-term care facilities. The result is needless suffering for patients, complications that cause further injury or death, and added costs in treatment overall. The health-care system's failure to respond to patient pain needs corrective action. Excuses for such shortcomings are simply not acceptable any longer.Physicians have long been accused of poor pain management for their patient. The term “opiophobia” has been coined to describe this remarkable clinical (...) aversion to the proper use of opioids to control pain. If the professional mandate of the health-care professional is to relieve suffering, then physicians are falling far short of their obligations by accepting myths about the use of opioids in the face of evidence to the contrary. (shrink)

The physician–patient relationship is anchored in trust. Historically the relationship has been a paternalistic one, with the patient expected to trust the physician's training and skills in doing what is “best” for the patient. But medical knowledge has expanded, as have treatment options and knowledge of the risks of treatment. The physician must now possess volumes of specialized knowledge about procedures and treatments, side effects and alternatives, drugs and their contraindications. Information has become a companion to trust. The patient, while (...) still dependent on the physician's expertise, now wants information about choices and hazards in treatment. Expanded choice has made the patient a consumer of healthcare and its risks rather than a passive recipient of treatment from the professional. (shrink)

Physicians and institutional providers face expanding liability exposure today, in spite of state tort reform legislation and public awareness of the costs of malpractice for providers. Standards of practice are evolving rapidly; new medical technologies are being introduced at a rapid rate; information is proliferating as to treatment efficacy, patient risk, and diseases generally. Tort standards mirror this change. As medical standards of care evolve, they provide a benchmark against which to measure provider failure. The liability exposure of physicians is (...) affected by the generation of data, including outcomes data usable to profile physician practice, and statistical data that allows for predictions as to treatment efficacy, and patient prognosis; obligations to inform patients and third parties of risk created by contagious disease and other sources of harm; obligations of physicians to disclose risks that the provider creates for the patient; obligations to disclose conflicts of interest arising out of the practice setting; and duties arising from new epidemiological knowledge. (shrink)

Medicine is still largely a pre-Darwin, pre-Newton enterprise…. We do not yet understand the underlying mechanisms of the major illnesses which plague humanity, and therefore much of what is done in the treatment of illness must still be empirical, trial and error therapy. We are compelled by our limitations to resort to shoring things up, applying halfway technology, trying to fix things after the fact.

We live in an anxious world, riddled with unpredictable threats to our safety and unexpected hatreds directed toward us. It is easy to obsess on the terrors around us, about which we can do little, and lose perspective on the real and sometimes devastating risks that we encounter in our daily lives. These everyday risks need to be regularly revisited — to remind ourselves that they can be reduced with the application of sharp minds, careful scholarship, and political will.Medical errors (...) in the American health-care system are just such a problem. The risk of death or serious injury at the hands of the American health-care system is not trivial, as we have learned over the past few years as the health-care establishment has acknowledged the level of iatrogenic injury in the system. If, as the Institute of Medicine reported in To Err Is Human, as many as 100,000 people every year are dying in hospitals, clinics, and doctors’ offices as the result of actions or omissions that could have been avoided, then this is a social problem of great magnitude and one that the law must try to correct. (shrink)

We live in an anxious world, riddled with unpredictable threats to our safety and unexpected hatreds directed toward us. It is easy to obsess on the terrors around us, about which we can do little, and lose perspective on the real and sometimes devastating risks that we encounter in our daily lives. These everyday risks need to be regularly revisited — to remind ourselves that they can be reduced with the application of sharp minds, careful scholarship, and political will.Medical errors (...) in the American health-care system are just such a problem. The risk of death or serious injury at the hands of the American health-care system is not trivial, as we have learned over the past few years as the health-care establishment has acknowledged the level of iatrogenic injury in the system. If, as the Institute of Medicine reported in To Err Is Human, as many as 100,000 people every year are dying in hospitals, clinics, and doctors’ offices as the result of actions or omissions that could have been avoided, then this is a social problem of great magnitude and one that the law must try to correct. (shrink)

Health-care provider liability has again taken center stage in American political debate, but with an ironic twist. In the seventies, physicians wanted tort reform, but they measured such reform solely by a reduction in both the risk of being sued and the size of any judgment a plaintiff could win. Malpractice reforms in many states in the seventies therefore capped damages, reduced contingency awards to lawyers, and restricted other tort rules to limit plaintiff success. Today physicians are conflicted. They want (...) an increase in liability exposure — not for themselves, but for managed care plans. We have therefore ended up with a series of overlapping debates, with the same debaters taking contradictory positions. Should managed care organizations—until now protected by ERISA preemption from liability—be liable? Physicians say yes. But should physicians be protected from the threat of suit, which they argue acts as an in terrorem device that drives disclosure of medical errors into hiding? (shrink)

Health-care provider liability has again taken center stage in American political debate, but with an ironic twist. In the seventies, physicians wanted tort reform, but they measured such reform solely by a reduction in both the risk of being sued and the size of any judgment a plaintiff could win. Malpractice reforms in many states in the seventies therefore capped damages, reduced contingency awards to lawyers, and restricted other tort rules to limit plaintiff success. Today physicians are conflicted. They want (...) an increase in liability exposure — not for themselves, but for managed care plans. We have therefore ended up with a series of overlapping debates, with the same debaters taking contradictory positions. Should managed care organizations—until now protected by ERISA preemption from liability—be liable? Physicians say yes. But should physicians be protected from the threat of suit, which they argue acts as an in terrorem device that drives disclosure of medical errors into hiding? (shrink)

theories. What was Freud thinking, when, and why and what were the major influences which shaped his ideas? We follow the inner movement of his theory construction, its meaning and coherence, as well as his conceptual logic and personal directions concerning his evolving views of the reciprocal interactions between mind and body, the motivational force of instinctual drives, and the dominant role of sexuality rooted in evolutionary biology in human development, behaviour, and the creation of neurotic disturbances. We follow Freud's (...) construction and sequential reconstructions of his theoretical models concerning the nature, dynamics, and principles of unconscious mental functioning, including his changing concepts on the nature and purpose of dreams. We trace his changing views on the role of deferred action of early childhood experiences and the determining role of unconscious fantasy, psychic reality, in the formation of adult character structure and neuroses. Through such historical analysis this book provides grounding for a meaningful understanding of Freud's familiar concepts: id, ego, superego, and the Oedipus complex. We explore what these concepts meant to Freud, why he conceived them, and what functions they served in his theory of mind. This is the perfect book for students and trainees wanting to learn more about the development of Freud's ideas, as well as for established psychoanalysts and psychotherapists interested in expanding their knowledge of Freud's theories. (shrink)

We are often told that we are morally obligated to produce equal opportunity for all. Therefore, it seems we should examine what power we have to produce that desirable state. For it would be nonsense to say we are required to provide what is beyond our power to provide. When we examine this question, we find our power limited by two sets of constraints. One set comprises formal constraints upon the idea itself of equal opportunity. We cannot do the logically (...) impossible. The other set comprises limits upon our ability to produce the directed socio-economic change, getting known outputs for known inputs. I illustrate the formal constraints by outlining the work of Douglas Rae. The constraints upon our abilities I illustrate with evidence from sociology and politics. At the end, we shall discover that our power to make opportunities equal is sharply though not unbearably limited. A critical but unbaised survey will reveal that in the past fifty years we have gone remarkably far towards doing all that we are presently capable of doing to equalize opportunities. Perhaps we shall go even farther when we learn how. The word ‘real’ in the title is opposed to ‘ideal’ or even ‘chimerical'. It may seem an interesting question what equality of opportunity should consist in were we able to produce directed socio-economic change at will. But we are not. Therefore, a more interesting and more important question is what equality of opportunity consists in given the very large number of constraints within which we must work to achieve it. (shrink)

Scientific discovery and scientific progress are made by scientists, not philosophers. Philosophers sometimes overlook this fact. It appears to be completely ignored by those who call themselves feminist philosophers of science. A favored claim among them is that the production of a feminist epistemology, or of a feminist society, or of both together, will produce something called ‘feminist science’. Feminist science will be different, they say, from the science we now have. One leading proponent of this view, Sandra Harding, writes: (...) “[t]he sciences that gain world ascendancy in the future are unlikely to be so distinctively Western and androcentric as are the dominant tendencies today.” But just how will they differ? Like all utopians these feminists are short on specifics and we are never told what such a science as science would look like, even in outline, much less in detail, nor how it is likely to differ as science from swnh. (shrink)