"The medical establishment has become a major threat to health. The disabling impact of professional control over medicine has reached the proportions of an epidemic. Iatrogenesis, the name for this new epidemic, comes from iatros, the Greek word for physician, and genesis, meaning origin. Discussion of the disease of medical progress has moved up on the agendas of medical conferences, researchers concentrate on the sick-making powers of diagnosis and therapy, and reports on paradoxical damage caused by cures for sickness (...) take up increasing space in medical dope-sheets [...] The public has been alerted to the perplexity and uncertainty of the best among its hygienic caretakers [...] This book argues that panic is out of place. Thoughtful public discussion of the iatrogenic pandemic, beginning with an insistence upon demystification of all medical matters, will not be dangerous to the commonweal."-- from Introduction. (shrink)

I examine the positive and negative features of synthetic biology (‘SynBio’) from a utilitarian ethical perspective. The potential beneficial outcomes from SynBio in the context of medicine are substantial; however it is not presently possible to predict precise outcomes due to the nascent state of the field. Potential negative outcomes from SynBio also exist, including iatrogenesis and bioterrorism; however it is not yet possible to quantify these risks. I argue that the application of a ‘precautionary’ approach to SynBio is (...) ethically fraught, as is the notion that SynBio-associated knowledge ought to be restricted. I conclude that utilitarians ought to support a broadly laissez-faire stance in respect of SynBio. (shrink)

Ethical concerns have been raised about routine practice in paediatric gender clinics. We discuss informed consent and the risk of iatrogenesis in the prescribing of gonadotropin-releasing hormone...

Tardive dyskinesia is a serious, well publicized adverse effect resulting from long-term neuroleptic drug use. However, little progress has been made during the last two decades in ensuring that these drugs are prescribed with necessary caution. Incentives and constraints operating on the major participants in the decision-making process leading to the prescription of neuroleptics increase the likelihood that the benefits of drugs will be exaggerated and their adverse effects minimized. When combined with imbalances of power, these factors ensure that persons (...) having little power and information to make the decision to prescribe will bear most costs of that decision. This points to the operation of an ineffective system which can be expected to yield sub-optimal results. We suggest ways to make the decision process more efficient by more closely aligning responsibility with cost. If those who hold power in the decision process are held accountable for the unwanted risks they impose upon others, both the use of neuroleptics and its inevitable iatrogenesis would probably be reduced. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Commentary on “Multiple Personality and Moral Responsibility”Daniel W. Shuman (bio)Stephen Braude’s essay, “Multiple Personality and Moral Responsibility,” discusses a number of important issues about the moral and legal responsibility of persons diagnosed with multiple personality disorder (MPD), known in DSM-IV as Dissociative Identity Disorder (DID). One issue that is fundamental to this debate, which Braude does not address, however, is the empirical reality underlying the debate. Does MPD/DID exist? (...) A prerequisite to a debate about the legal consequences of MPD/DID is legally sufficient proof of its existence and its behavioral consequences.Proof that MPD/DID exists, its impact on legal standards of responsibility, and that the defendant suffers from it, must come from expert testimony; it is not part of the common knowledge or experience of the typical judge or juror. Courts are, however, increasingly, unwilling to assume that because an expert has impressive qualifications, he or she will necessarily present scientifically valid evidence. Particularly in cases of psychiatric and psychological evidence, courts that once looked solely at the expert’s qualifications to determine the admissibility for expert scientific evidence, now understand that the expert’s qualifications are a necessary but not a sufficient condition for the presentation of accurate expert testimony. Courts increasingly want to know how experts know what they claim to know and whether their methods of knowing meet the hallmarks of good science.Thus, from a legal standpoint, a prerequisite to admissibility of the evidence that serves as a basis for a discussion of the legal implications of MPD/DID is rigorous scientific proof of its existence. Proof of the existence of MPD/DID has not, however, been the subject of rigorous scientific research, but instead has consisted of non-falsifiable clinical experience where the risk of iatrogenesis (i.e., hypnosis and suggestion) is ever present. While these clinical observations and opinions may ultimately be proven valid by subsequent research, there is simply no way to know whether that is so in the absence of rigorous scientific research. If proof of the existence of MPD/DID is clinically but not scientifically grounded, legal rules based upon it are suspect. Moreover, claims of MPD/DID often arise in a legal context where there are significant benefits to be gained from receiving the diagnosis which heightens the importance of rigorous scientific scrutiny.Diagnostic validity and reliability matters in different ways in the forensic context than it does in the therapeutic context. These contextual differences [End Page 59] are reflected in disparate standards for scrutinizing each. There is no threshold requirement, for example, that a psychotherapist prove that a diagnostic category is valid or that a psychotherapeutic treatment used for a person suffering from it is generally recognized as safe and effective before using it; however, there is a threshold requirement of rigorous scientific scrutiny before admission of this information in evidence. If a therapist’s diagnostic hypothesis that there are two personality states influencing a patient’s behavior is not borne out, it can be revised in later sessions. Even if MPD/DID does not exist, treatment that assumes it does may nonetheless be effective because therapeutic outcome is more closely tied to the nature of the therapist-patient relationship than the content of therapy, or because multiple personality states is an effective therapeutic metaphor. Moreover, if the patient is not satisfied that the diagnosis or treatment rendered is helpful, the patient can leave therapy or seek another therapist.In contrast, judicial determinations are a one-shot determination which cannot be revisited in light of subsequently acquired knowledge. The defendant/patient is not free to change courts, or withdraw from the legal proceedings. Thus, it would be entirely appropriate for psychiatrists and psychologists to treat patients presenting symptoms of what they label MPD/DID and for courts to reject exculpatory evidence from psychiatrists and psychologists of that disorder.Related ArticlesFeature Article: Multiple Personality and Moral ResponsibilityCommentary: Commentary by ClarkCommentary: Commentary by ShumanDaniel W. Shuman Daniel W. Shuman, Professor of Law, Southern Methodist University, Dallas, TX 75235, USA.Copyright © 1996 The Johns Hopkins University Press... (shrink)

In this paper I attempt to show how my graduate work in interpretive studies transformed my previous work as a special education consultant. Using Hans-Georg Gadamer's hermeneutics, as well as Ivan Illich's notions of iatrogenesis and counter-productivity, I discuss my work with a school team as they struggled throughout a school year with a special education classroom for students with diagnosed mental health disorders.

A recent article published in Nursing Ethics, written by Professor Bridgit Dimond, highlighted the topic of noncompliance by patients and attention was drawn to a number of issues relevant to health care professionals. In this response, some specific challenges facing nurses are considered in the light of Professor Dimond’s arguments. In doing so, the notion of compliance as an appropriate concept in modern nursing practice is questioned. The recommendations to emerge include strategies to consider patient response to treatment regimens in (...) the form of adherence to health care advice through negotiated therapy. The claimed benefits of health care recommendations are considered and caution about iatrogenesis is advised. (shrink)

Ivan Illich, philosopher, historian, priest and social commentator died in Bremen, Germany on December 2, 2002. Illich was noted for his critique of the Church, education and medicine but his concepts dealt with more fundamental issues. This article reveals aspects of Illich, the man, and explores his ideas as they apply to the meaning of medicine and, in particular, the role of health care in contemporary society.