One of the most significant changes in the medical professions in Europe is the trend towards feminization. Some of the patterns of gender inequality arising from the feminization of the European medical professions are clearly apparent within the Russian medical profession, which experienced feminization 70 years ago. Yet little is known about the processes by which these patterns of gender inequality emerged and were maintained. This article is based on interviews with female doctors in Voronezh, Russia in (...) 1996. It explores the attitudes of these women to gender divisions within the medical profession. This is placed within the wider context of Soviet and post-Soviet employment and family policies directed at women. It is suggested that the material and ideological focus on women’s role in reproduction had direct implications for the choices women made in relation to paid labour. (shrink)

The advent of the internet age has impacted every sphere of modern medicine, including medical education. The new generation of trainees require novel approaches to teaching to make the requisite impacts on their minds. Conventional classroom teaching might be considered obsolete by some, especially when the subject being talked about is ethics and philosophy of medicine. An untapped resource for the teachers lies perhaps in the colossal reserve of decades of cinema. This novel concept of using movies to teach (...) is enumerated in this article by using the 1979 film “Apocalypse Now” to draw parallels between the situations occurring in the film with the ethical dilemmas that a clinician might face or philosophies that may be of utility to a physician. This article presents a conceptual framework of this ideology by exploring a film that might be considered by some to have no correlation with the queries that a medical mind might have while proving that it might not be the content of the film but the viewpoint of the teacher/trainee that may define the interpretations that may be drawn from it. Soldiers and doctors both work in a strict structure of hierarchy and are both put in situations where ethical dilemmas have life and death implications. This core philosophy has served as an inspiration for this article. (shrink)

Is it time to leave the non-professional aspects of personal life at the door and face patients as medical professionals and no more?Ever wondered about the appropriateness of Christian doctors displaying pictures of Pope Benedict, Muslim doctors displaying pictures of Osama son of Laden or former PLO leader Yassir Arafat, or gay doctors proudly flying the rainbow flag in their rooms? I suggest that we should be concerned about such display of religious, political, or other allegiance to non-professional causes (...) in loci of health care delivery.Let us take a step back, however, and ask why we seek health care professionals’ help or assistance. Our reasons have, of course, primarily to do with doing our fair share by way of enabling health care delivery services to achieve their primary objectives for being in existence, namely to ensure that we live as long as is feasible at as high a quality of life as is possible. While legitimate questions may be asked about acceptable trade-offs between length and quality of life, broadly speaking, that is what we expect health care providers to do for us. Importantly, we expect them to do so in a professional manner. This is very much in line with the historical roots of the idea of professionalism, meaning essentially to profess publicly to serve the public good.1 The public …. (shrink)

Bioethics at the Movies explores the ways in which popular films engage basic bioethical concepts and concerns. Twenty philosophically grounded essays use cinematic tools such as character and plot development, scene-setting, and narrative-framing to demonstrate a range of principles and topics in contemporary medical ethics. The first section plumbs popular and bioethical thought on birth, abortion, genetic selection, and personhood through several films, including The Cider House Rules, Citizen Ruth, Gattaca, and I, Robot. In the second section, the contributors (...) examine medical practice and troubling questions about the quality and commodification of life by way of Dirty Pretty Things, Eternal Sunshine of the Spotless Mind, and other movies. The third section's essays use Million Dollar Baby, Critical Care, Big Fish, and Soylent Green to show how the medical profession and society at large view issues related to aging, death, and dying. A final section makes use of Extreme Measures and select Spanish and Japanese films to discuss two foundational matters in bioethics: the role of theories and principles in medicine and the importance of cultural context in devising care. Structured to mirror bioethics and cinema classes, this innovative work includes end-of-chapter questions for further consideration and contributions from scholars from the United States, Canada, the United Kingdom, Israel, Spain, and Australia. Contributors: Robert Arp, Ph.D., Michael C. Brannigan, Ph.D., Matthew Burstein, Ph.D., Antonio Casado da Rocha, Ph.D., Stephen Coleman, Ph.D., Jason T. Eberl, Ph.D., Paul J. Ford, Ph.D., Helen Frowe, M.A., Colin Gavaghan, Ph.D., Richard Hanley, Ph.D., Nancy Hansen, Ph.D., Al-Yasha Ilhaam, Ph.D., Troy Jollimore, Ph.D., Amy Kind, Ph.D., Zana Marie Lutfiyya, Ph.D., Terrance McConnell, Ph.D., Andy Miah, Ph.D., Nathan Norbis, Ph.D., Kenneth Richman, Ph.D., Karen D. Schwartz, LL.B., M.A., Sandra Shapshay, Ph.D., Daniel Sperling, LL.M., S.J.D., Becky Cox White, R.N., Ph.D., Clark Wolf, Ph.D. (shrink)

The best things in my Ufe have come to me by accident and this book results from one such accident: my having the opportunity, out of the blue, to go to work as H. Tristram Engelhardt, Jr. 's, research assistant at the Institute for the Medical Humanities in the University of Texas Medi cal Branch at Galveston, Texas, in 1974, on the recommendation of our teacher at the University of Texas at Austin, Irwin C. Lieb. During that summer Tris (...) "lent" me to Chester Bums, who has done important schol arly work over the years on the history of medical ethics. I was just finding out what bioethics was and Chester sent me to the rare book room of the Medical Branch Library to do some work on something called "medical deontology. " I discovered that this new field of bioethics had a history. This string of accidents continued, in 1975, when Warren Reich (who in 1979 made the excellent decisions to hire me to the faculty in bioethics at the Georgetown University School of Medicine and to persuade Andre Hellegers to appoint me to the Kennedy Institute of Ethics) took Tris Engelhardt's word for it that I could write on the history of modem medical ethics for Warren's major new project, the Encyclopedia of Bioethics. Warren then asked me to write on eighteenth-century British medical ethics. (shrink)

Higher education continues to see a shift toward online course delivery. Many professional graduate programs offer online courses when content does not necessarily require face-to-face contact. The use of movies to teach ethics and professionalism to medical students is not a new pedagogical approach. At a university in the United States, a shift in a tracked physical therapy curriculum triggered a course in ethics and professionalism to be delivered earlier in the program, leaving students without prior clinical experience before (...) starting the course. The instructor revised this online course using movies to provide context for the topics covered making them relatable to physical therapy practice. This article describes student reactions to the implementation of movies into this course. Students valued the addition of the movies as they provided context using relevant health care situations, ultimately helping them relate the concepts to the physical therapy profession. (shrink)

Medical Professionals: Conflicts and Quandaries in Medical Practice offers a fresh approach to understanding the role-related conflicts and quandaries that pervade contemporary medical practice. While a focus on professional conflicts is not new in the literature, what is missing is a volume that delves into medical professionals' own experience of the conflicts and quandaries they face, often as a result of inhabiting multiple roles. The volume explores the ways in which these conflicts and quandaries are exacerbated (...) by broader societal forces, including changing scientific and technological paradigms, commercialization, and strengthened consumer movements, which simultaneously expand the scope of roles and responsibilities that medical professionals are expected to fulfill, and make it more difficult to do so. Several empirical chapters analyze data from qualitative interview studies with clinicians and other stakeholders. The studies highlight the burdens on clinicians who are expected to make informed and justified judgments and decisions in the midst of competing pressures; authors describe the methods that clinicians use to address the associated tensions within specific contexts. Two conceptual chapters follow and offer some innovative ways to think about the challenges facing medical professionals as they strive to make sense of the changing landscape within healthcare. The first reflects on the challenges to clinical practice in the midst of shifting and often competing definitions of disease and associated ideologies of care. The second reflects more broadly on the utility of value pluralism as a framework for conceptualizing and working through moral and professional quandaries. The book concludes with a chapter containing suggestions for how members of the medical profession might reframe their thinking about their roles, responsibilities, and decision-making in the midst of inevitable quandaries such as those presented here. This book will be of vital reading for academics, researchers, educators, postgraduate students, and interested health care practitioners and administrators. (shrink)

This paper analyzes one dimension of the frequently alleged contradiction between treating medicine as a business and as a profession, namely the incompatibility between viewing the physician patient relationship in economic and moral terms. The paper explores the utilitarian foundations of economics and the deontological foundations of professional medical ethics as one source for the business/medicine conflict that influences beliefs about the proper understanding of the therapeutic relationship. It, then, focuses on the contrast and distinction between medicine as business (...) and profession by critically analyzing the classic economic view of the moral status of medicine articulated by Kenneth Arrow. The paper concludes with a discussion of some advantages associated with regarding medicine as a business. (shrink)

The ArgumentMedicine is only a cultural system of its own. It also performs specific roles in the broader culture of society at large. This article examines the role of medical arguments in the critique of“enthusiasm” on the eve of the Enlightenment. The enthusiasts, who claimed to prophesy and to have direct divine inspiration, were increasingly see in the seventeenth century as melancholics. With the decline of humoral medicine, however, the account of melancholic disturbances – including enthusiasm – that was (...) offered tended to be chemical, mechanistic, and clearly corpuscular. Protestant ministers, in adopting such an account of enthusiasm, also adopted a strict distinction between the realm of the mind (to which true prophecy belonged) and that of the body (in which they located the phenomena of enthusiasm). Such a distinctions served in turn to demarcate more specifically the limits between the clerical and medical professions. Yet in relegating the treatment of enthusiasts to the physicians, rather than seeing the enthusiasts as heretics, the ministers stood in danger of relying too much on a secular profession and secular arguments, thus paving the way to a more general secularization of the ideological basis of the social order. (shrink)

Medical ethics needs to be on its guard against those in military or political power who would seek to subvert its most basic tenets in order to serve their own endsEmergencies and warlike situations often force medical personnel to follow orders and perform actions or duties pertaining to their field of expertise in flagrant violation of their professional code of ethics. Opposing such orders may be contextually impossible, or elicit unduly high personal costs. Medical ethics, while lamenting (...) these impositions, is often reduced to passive and silent disagreement. In recent years, however, biomedical ethics has become active in accepting and supporting these estrangements from accepted standards and values of the healthcare professions, coming up with justifications of torture; suggesting non-treatment of the wounded, depending on their combatant status; prompting collaboration in the development of biological weapons, and disregarding informed consent.Physicians’ participation in torture has been unanimously condemned and, although acknowledging that such conduct “is the result of the displacement of their medical vocation by the doctrine of ‘national security’”, such an “ideological substrate” has nevertheless been deemed untenable.1 Perpetrators were found to have committed their deeds in an ethical void2; this was recognised, but in no way did it serve to excuse physicians from the duty of opposing induced suffering and assuaging its effects to the best of their abilities.Torture in its “humane” form has been defended on utilitarian grounds,3 using weak arguments that are unable to justify physicians’ active participation in torture. For the most part, professional ethics has remained adamant in its undaunted disapproval of medical non-therapeutic involvement in violent scenarios such as war, terrorism, and even torture. Nobody would have thought, in earlier times, that medical ethics could take any other position than to unrelentingly reject physicians’ participation in torture, …. (shrink)

The apartheid ideology in South Africa had a pervasive influence on all levels of education including medical undergraduate training. The role of the health sector in human rights abuses during the apartheid era was highlighted in 1997 during the Truth and Reconciliation Commission hearings. The Health Professions Council of South Africa subsequently realised the importance of medical ethics education and encouraged the introduction of such teaching in all medical schools in the country. Curricular reform at the University (...) of Stellenbosch in 1999 presented an unparalleled opportunity to formally introduce ethics teaching to undergraduate students. This paper outlines the introduction of a medical ethics programme at the Faculty of Health Sciences from 2003 to 2006, with special emphasis on the challenges encountered. It remains one of the most comprehensive undergraduate medical ethics programmes in South Africa. However, there is scope for expanding the curricular time allocated to medical ethics. Integrating the curriculum both horizontally and vertically is imperative. Implementing a core curriculum for all medical schools in South Africa would significantly enhance the goals of medical education in the country. (shrink)

In June 1995, the Italian code of medical ethics was revised in order that its principles should reflect the ever-changing relationship between the medical profession and society and between physicians and patients. The updated code is also a response to new ethical problems created by scientific progress; the discussion of such problems often shows up a need for better understanding on the part of the medical profession itself. Medical deontology is defined as the discipline for the (...) study of norms of conduct for the health care professions, including moral and legal norms as well as those pertaining more strictly to professional performance. The aim of deontology is therefore, the in-depth investigation and revision of the code of medical ethics. It is in the light of this conceptual definition that one should interpret a review of the different codes which have attempted, throughout the various periods of Italy's recent history, to adapt ethical norms to particular social and health care climates. (shrink)

The emergence of the genetic counseling profession has allowed laypeople to understand and benefit from biological advances, and to make critical decisions about their application. The discipline of genetic counseling has been criticized from its very beginning, in particular because of its early association with the eugenics movement. This paper presents a critical and reflective overview of how genetic counseling is implicitly embedded in the history of eugenics but also counteracts past eugenic practices and ideas. After World War II, attempts (...) were made to distance genetic counseling from eugenics. The first definition of genetic counseling did not position this field as a medical encounter but "as a kind of genetic social work aimed primarily to provide people with an understanding of their family's genetics problems." This approach was a reaction to the genetic and social evolutionary ideas that informed eugenic theories during the first half of the 20th century. Professionals engaged in genetic counseling during the 1940s and1950s rejected eugenic practices, but there was still support for eugenics’ goals of improving heredity and eliminating disease. From the 1960s, genetic counseling underwent professionalization alongside feminization and a definition of core values. Among these values were nondirectiveness counseling and the autonomy of the counselee. The dark shadow of Nazi ideology and other eugenic practices, attempts to employ the historical responsibility of geneticists, and the dynamic medical, social, political, and educational changes of the 1960s and 1970s helped to frame approaches and delineate the goals and limits of the new profession of “genetic counseling.”. (shrink)

BROOKS J and RAFFERTY AM. Nursing Inquiry 2010; 17: 142–150Education and role conflict in the health visitor profession, 1918–39Health visiting was the public health profession in the UK, which arose during the Victorian period to support and supervise the mothers of the nation. The health visitor was expected to teach the new mothers hygiene, infant feeding and diet, help them in the home when necessary and then report back to the Medical Officer for Health. Her role therefore was multifaceted (...) and required education and training from a number of differing bodies. She needed nursing skills to help with the practicalities of observation and home care, sanitary knowledge to ensure that the buildings were safe and training in law and epidemiology. In order to fulfil these professional requirements, by the middle of the twentieth century the health visitor was expected to be a nurse by background, be educated for health visiting in a university and understand community medicine. These differing and sometimes opposing requirements meant that the health visitor was often caught in-between conflicting ideologies. It is this idea of ‘in-betweenness’ from the work of the anthropologist Marilyn Strathern and its relation to the work and education of the health visitor that this article will focus. (shrink)

This paper was given as a talk at the Venice Biennale on 9 December 1977. It was part of a symposium on "The Freedom of Science--Problems of Science of Scientists in Eastern Europe". Dr Bloch details some of the problems of psychiatry and its vulnerability to improper use and thus the dilemmas which must ensue in day to day practice. He looks at psychiatry in the USSR and the system within which Soviet psychiatrists must work. The Communist Party and career (...) advancement for psychiatrists would appear to be closely related and it is suggested that, in all probability, the majority of psychiatrists are as perturbed at the misuse of their profession as their Western colleagues, but act compliantly out of fear. Severe punishments have been imposed on those psychiatrists who have dared to speak out against the régime and the system as operated. Dr Bloch concludes by urging Western psychiatrists to do all they can to help their Soviet colleagues to initiate a return to an independent and automous psychiatric profession. (shrink)

This article describes the most important determinant of contemporary American medical practice: the corporatization of the health care delivery system. It argues that there is an urgent need for greater reflection by physicians on the values inherent in profit-based health care and on the implications of such a model of care. Other pressures on the medical profession and several available responses are examined. The article then poses a challenge to the profession to assume a more forthright advocacy for (...) social equity in health care provision. (shrink)

This book explores the controversial relationship between physicians and the pharmaceutical industry, identifies the ethical tensions and controversies, and proposes numerous reforms both for medicine's own professional integrity and for effective public regulation of the industry.

That a homosexual -- man or woman -- is neither a sinner nor a sick person is the thesis of this paper by an authority on sexual deviation. Therefore, such a man or woman neither needs penance and pardon nor cure in the medical sense. Nevertheless such individuals sometimes need the help of doctors and must be treated with understanding. The medical profession also has, in the view of the behaviourist school of psychiatrists, of which Dr Bancroft is (...) a member, the duty of influencing social attitudes towards homosexuals. Obviously homosexuals who come into conflict with the law are special cases, and must be treated as such but this is not 'medical' treatment so much as social control even if drugs and other forms of therapy are used. (shrink)

T. A. Cavanaugh's Hippocrates' Oath and Asclepius' Snake: The Birth of the Medical Profession articulates the Oath as establishing the medical profession's unique internal medical ethic - in its most basic and least controvertible form, this ethic mandates that physicians help and not harm the sick. Relying on Greek myth, drama, and medical experience (e.g., homeopathy), the book shows how this medical ethic arose from reflection on the most vexing medical-ethical problem -- injury caused (...) by a physician -- and argues that deliberate iatrogenic harm, especially the harm of a doctor choosing to kill (physician assisted suicide, euthanasia, abortion, and involvement in capital punishment), amounts to an abandonment of medicine as an exclusively therapeutic profession. The book argues that medicine as a profession necessarily involves stating before others what one stands for: the good one seeks and the bad one seeks to avoid on behalf of the sick, and rejects the view that medicine is purely a technique lacking its own unique internal ethic. It concludes noting that medical promising (as found in the White Coat Ceremony through which U. S. medical students matriculate) implicates medical autonomy which in turn merits respect, including honoring professional conscientious objections. (shrink)

Review of British Medical Association handbook on human rights and doctors.

The medical profession contains five “spheres of morality”: clinical care, clinical research, scientific knowledge, population health, and the market. These distinct sets of normative commitments require physicians to act in different ways depending on the ends of the activity in question. For example, a physician-scientist emphasizes patients’ well-being in clinic, prioritizes the scientific method in lab, and seeks to maximize shareholder returns as a board member of a pharmaceutical firm. Physicians increasingly occupy multiple roles in healthcare and move between (...) them frequently, creating the possibility of conflict between the ethical obligations of their various roles. This paper examines the entire moral landscape of medicine through the lens of role morality. It develops a novel framework that helps physicians recognize how their moral commitments depend on the nature and context of the situation, clarifies ethical conflicts that physicians face, and concludes with ideas for resolving these conflicts. (shrink)

: Money motivates people, lubricates the movement of resources, mobilizes talent, and breaks down some barriers. But money also has a darker side; it can distract, corrupt, distort, and cruelly exclude. Money is a useful but unruly servant; sometimes, a hard master. The professional, at least in part, belongs to the world of money. We sometimes distinguish the amateur from the professional in that the amateur does it for love; the professional, for money. The professional has one foot in the (...) marketplace, but also, purportedly, professes something else--beyond the bottom line. The following discussion explores the morally complex ties and tensions between money and the medical professions. (shrink)

This paper reviews the concept of professional autonomy from anhistorical perspective. It became formalised in the United Kingdom onlyafter a long struggle throughout most of the nineteenth century. In itspure form professional autonomy implies unlimited powers to undertakemedical investigations and to prescribe treatment, irrespective of cost.Doctors alone should determine the quality of care and the levels ofremuneration to which they should be entitled. In the second half of thetwentieth century a steady erosion of professional autonomy occurred inthe United Kingdom. The (...) level of remuneration has been restricted formost doctors for nearly fifty years, whilst the costs of health carehave steadily reduced the doctor's ability to provide unrestricted carewithin the health care system. Reorganisation of the National HealthService in 1983 and 1991 has substantially eroded professional autonomy,to the point where research developments, clinical judgement and ethicalstandards are all now being placed at risk. (shrink)

Over the past decades the mortality rate in the United States has decreased and life expectancy has increased. Yet a number of recent studies have drawn Americans attention to the fact that racial and ethnic disparities persist in health care. It is clear that the U.S. health care system is not only flawed for many reasons including basic injustices, but may be the cause of both injury and death for members of racial and ethnic minorities.In 2002, an Institute of Medicine (...) report requested by Congress listed more than 100 studies documenting a wide range of disparities in the United States health care system. This report found that people belonging to racial and ethnic minorities often receive lower quality of health care than do people of European descent, even when their medical insurance coverage and income levels are the same as that of the latter. (shrink)

원격의료는 대개 의사와 환자가 떨어져 있는 상태에서 이루어지는 의료 행위 내지 환자와 의사 간의 비대면 의료행위를 지칭하며, 정보통신기술을 매개로 하는 것을 의미한다. 최근 원격의료가 활성화됨에 따라 보건의료 체계는 변화하고 있으며, 그 결과 이로 인해 발생하는 다양한 문제에 대한 신중한 논의가 요청되고 있다. 특히 원격의료 상에서는 컴퓨터를 이용한 의료 정보의 처리가 광범위하게 일어나게 되며, 이에 따라 환자의 의료 정보가 잘못 취급됨으로써 개인 정보 유출 및 사생활 침해 등이 심각한 문제로 떠올랐다. 또한 환자의 치료에 있어 환자와 의사의 신뢰 및 공감 형성이 매우 (...) 중요한 역할을 한다는 점에서 직접적인 대면 관계를 통해 환자에 대한 치료를 도모하지 않고 온라인 장치를 통해 환자와의 관계를 형성하는 원격 의료에서는 전통적인 환자-의사 관계 이상의 신뢰 및 책임감이 요청된다. 이러한 점에서 아리스토텔레스의 프로네시스는 원격의료에서 의료전문직의 실천 원리로서 중요한 의미를 가질 수 있을 것이다. 프로네시스는 훌륭한 행위를 하는 데 필요한 지식으로서의 ‘실천적 지혜’를 의미한다. 따라서 프로네시스는 상황의 특수성 및 개별성에 대한 고려를 바탕으로 보편적인 지식을 활용하여 지금 내가 행동해야 할 행위에 대한 판단을 내리고 지금 이 상황에서 내가 어떻게 행동하는가에 관심을 둔다. 원격의료에서 개별 환자의 다양성과 의료 체계의 복잡성 속에서 의료전문직의 유능함은 과학적인 의학 기술의 습득과 더불어 환자의 상태 및 맥락을 적절하게 해석하는 능력과 여러 가지 대안들 가운데 최선의 치료 행위를 선택하는 통찰력에 달려 있다고 할 수 있을 것이다. 따라서 의료인은 원격의료 시 개별 환자에게 적절한 최선의 치료 행위를 결정하기 위해 구체적인 상황에서 요구하는 특수한 행동 과정을 숙고해야 한다는 점에서 프로네시스는 의료인에게 중요한 실천원리가 된다. (shrink)

While there has been much discussion of how the scientific establishment’s culture can engender research misconduct and scientific irreproducibility, this has been discussed much less frequently with respect to the medical profession. Here the authors posit that a lack of self-criticism, an encouragement of novel scientific research generated by the recruitment policies of the UK Royal Training Colleges along with insufficient training in the sciences are core reasons as to why research misconduct and dishonesty prevail within the medical (...) community. Furthermore, the UK General Medical Council’s own data demonstrates a historic inattentiveness to the ease with which doctors can engage in research misconduct. Suggestions are made as to how these issues can be investigated and alternative incentives for career advancement are adumbrated. (shrink)

Doctors in Denial examines the relationship between the Canadian medical profession and the pharmaceutical industry, and explains how doctors have become dependents of the drug companies instead of champions of patients' health. Big Pharma plays a role in every aspect of doctors' work. These giant, wealthy multinationals influence how medical students are trained and receive information, how research is done in hospitals and universities, what is published in leading medical journals, what drugs are approved, and what patients (...) expect when they go into their doctors' offices. But almost all doctors deny the influence and control the drug companies exert. In this book Dr. Lexchin urges the medical profession to make the changes needed to give priority to protecting and promoting patients' health and benefitting society, rather than enabling Big Pharma to dominate health care while raking in billions in profits from citizens and governments. (shrink)

The medical profession’s role should be limited to advice and informationThe medical establishment’s desire to interfere with the autonomous wishes of boxers seems at odds with the principle of respect for autonomy prevalent in contemporary biomedical practice. I argue that the role of the medical profession in boxing should be solely an advisory and informational one. In addition, the distinctions made between boxing and other high risk sports often rely on an insufficient knowledge of the sport. This (...) leads to misdirected criticisms and excessive emphasis on the colourful discourse of boxing, as opposed to the practice of boxing itself. Dr Herrera’s claim in his article that boxing differs from other sports in the acceptability of its acts outside the realm of sport is refuted.1 The importance of consent as a legitimising factor is highlighted, and a number of possible solutions to improve safety within the sport are tentatively suggested.In the United Kingdom, a competent adult may legally refuse medical treatment, irrespective of the severity of his condition or the validity of his reasons. With the pre-eminence of an autonomy based model of bioethics, respecting a patient’s wishes forms an integral part of acting in his best interests. It is puzzling, then, to find that the Australian Medical Association have called for a ban on boxing on the grounds that the activity is excessively hazardous to the health of boxers. The often mentioned principle of respect for autonomy is abandoned once the person drops the privileged title of “patient”. This suggests that being a patient …. (shrink)

This unique textbook utilizes an integrated, case-based approach to explore how the domains of bioethics, public health and the social sciences impact individual patients and populations. It provides a structured framework suitable for both educators (including course directors and others engaged in curricular design) and for medical and health professions students to use in classroom settings across a range of clinical areas and allied health professions and for independent study. The textbook opens with an introduction, describing the intersection of (...) ethics and public health in clinical practice and the six key themes that inform the book's core learning objectives, followed by a guide to using the book. It then presents 22 case studies that address a broad spectrum of patient populations, clinical settings, and disease pathologies. Each pair of cases shares a core concept in bioethics or public health, from community perspectives and end-of-life care to medical mistakes and stigma and marginalization. They engage learners in rigorous clinical and ethical reasoning by prompting readers to make choices based on available information and then providing additional information to challenge assumptions, simulating clinical decision-making. In addition to providing a unique, detailed clinical scenario, each case is presented in a consistent format, which includes learning objectives, questions and responses for self-directed learning, questions and responses for group discussion, references, and suggested further reading. All cases integrate the six themes of patient- and family-centered care; evidence-based practice; structural competency; biases in decision-making; cultural humility and awareness of the culture of medicine; and justice, social responsibility and advocacy. The final section discusses some challenges to evaluating courses and learning encounters that adopt the cases and includes a model framework for learner assessment. (shrink)

This is a condensed description of the contents and overarching argument found in Hippocrates’ Oath and Asclepius’ Snake: The Birth of the Medical Profession. In that work, I maintain that the basic medical ethical problem concerns iatrogenic harm. I focus particularly on what I refer to as ‘role-conflation’. This most egregious form of iatrogenic harm occurs when a physician deliberately adopts the role of wounder. A contemporary practice such as physician-assisted suicide exemplifies a doctor’s deliberate wounding. I argue (...) that the author of the Hippocratic Oath – aware of the chronic risk of role-conflation – responds to this threat by having the oath-taker specifically forswear signal acts that wound the sick, such as giving a deadly drug even if asked, giving an abortifacient, sexual predation, and gossiping. I argue that by means of the Oath, Hippocrates founds medicine as a profession, a practice intimately involving promising. (shrink)

When picking up a book titled Licensed to Practice: The Supreme Court Defines the American Medical Profession, one cannot be faulted for expecting a rather dry legal discourse on the Supreme Court case that cemented medical licensure as the norm of American life. James Mohr dispels these expectations from the very first page of the volume. Instead of recitation of legal doctrine, Mohr begins with a murder mystery. While we know from the very first pages the answer to (...) “whodunit,” the rest of the book masterfully explains why they did it. As it turns out, what led to the murder was an intense fight over the proper way to practice medicine. Mohr’s work is.. (shrink)

In 2006, the Chief Medical Officer for England published the report Good Doctors, Safer Patients in a call for strengthened regulation of the medical profession. The changing relationship between patients and doctors in the United Kingdom arises from the interplay between societal expectation and clinical governance, personal formation and professional practice, private being and public doing. The wisdom of professional practice is in the habits of professionals, a practical wisdom that is the reflex of professional identity. Socialization into (...) a profession is the formation of such identity through the legitimate peripheral participation of the apprentice, oriented towards the contingent granting of admission to the community of practice. The conditional nature of continued insider status, permitting members to interact with clients across the professional boundary, is essential to the contract through which the profession enjoys the privileges conferred by society. The governance of the profession is therefore also necessarily circumscribed, a political reality that is currently evidenced in the regulation of medical practice in the United Kingdom. (shrink)