Fundamental science is rapidly approaching its asymptote because it has been so successful. We already have a “theory of everything, that matters to the human race.” The laws of chemistry and physics cannot be replaced. Although most scientists react to this as though it were religious blasphemy, the proof is in our record. Since the discovery of quantum mechanics, no fundamental science of any significance to other sciences has appeared—in 70 years and with, perhaps, expenditures of$ 0.5 trillion. In contrast, (...) engineering and applied sciences have taken over the fundamental role, insofar as it is their advances from electric lights to cars, to planes, to computers that affect all science and all citizens. The reductionist model of approaching reality has been discredited. The most visible arena for the victory of the new integrationist approaches is in the reemergence of integrative medicine, which includes high-tech medicine in the larger body-mind-spirit, or whole person approach. (shrink)

A silent revolution has occurred in the most highly industrialized countries. This is the utilization and acceptance of various healing practices (which for convenience has often been labeled as “alternative medicine,” a.k.a. “whole person healing”) by an enormous fraction of the population. Moreover, this population cohort is much wealthier and better educated than the average citizen. It is no longer possible for this generation in the Western world to ignore or denigrate the medicine and healing practices (...) used by hundreds of millions in other cultures. What is obviously needed is a retreat from the innate skeptical reaction of much of the stance of western medicine, the development of a mutual respect for other cultures and their achievements, and a genuinely open, scientific and wholistic approach to the issues, especially in this context, to other practices of whole person healing. (shrink)

In some recent discussions the implications of postmodernism for education have been wrongly conceived. An alternative approach is offered and this is used as a means for challenging any grand design in the provision of schooling and in the conception of education. Through this, ideas of the whole person implicit in much educational theory and practice (including personal and social education) are questioned. With some reference to the work of Stanley Cavell an attempt is made to show the (...) sort of thinking which might inform education, avoiding both the relativistic and complacent excesses of postmodernism and the explicit systematic planning of the grand design. (shrink)

The aim of this paper is to investigate Plato’s conception of the whole in the Phaedrus and the theory of medical dialectic underlying this conception. Through this analysis Plato’s conception of kairos will also be adressed. It will be argued that the epistemological holism developed in the dialogue and the patient-typology emerging from it provides us with a way of perceiving individual situations of medical discourse and decision-making that makes it possible to bridge the gap between observations of a (...) professional nature, i.e. of diagnostics and therapy—of whom to treat and in what magnitude—and individual patients’ perceptions of their situation. Besides, it will be argued that such a patient-typology represents a conceptual framework to assess and deal normatively with patients’ ailments and needs that is more robust than the current standards in use, i.e. the Subjective Standard, the Reasonable Person Standard and the Professional Practice Standard. Finally, it will be argued that the possession of kairos, which according to Plato is the hallmark of a true physician, represents a normative conception of time that today’s medicine is in need of revisiting. (shrink)

Against the prevailing outcomes-based education and the instrumentalization of education, a movement has arisen towards holistic education. This aims to go beyond objective measurement of the outcomes of education in order to treat the student as a whole person. In this paper, we shall examine some strands of education in Japan which in some way or another feature the idea of the whole person. This includes the tradition of clinical pedagogy, which originated in Kyoto University, Yukichi (...) Shitahodo’s educational anthropology (Kyoiku-Ningengaku), Kuniyoshi Obara’s Zenjin Education (the education of the whole person) and holistic education. Notwithstanding the fact that such education is benevolent in intention, it can be miseducative in some respects. In the light of this, and with some reference to criticism of the idea of the whole person, we shall point to an alternative vision of education of the whole person following Cavell’s Emersonian moral perfectionism – a perfectionism that is thoroughly anti-foundationalist and that transcends self-entrapment in circulatory discourse on the whole. In critical dialogue between the rich traditions of Japanese thought and the critical voice of liberalism raised from within the West, we hope to find a more nuanced answer to the question of how being a whole might make sense. (shrink)

In a world which can be increasingly described as a “society of organizations,” it is incumbent upon organizational researchers to account for the role of organizations in determining the well-being of societies and the individuals that comprise them. Workplace spirituality is a young area of inquiry with potentially strong relevance to the well-being of individuals, organizations, and societies. Previous literature has not examined ethical dilemmas related to workplace spirituality that organizations might expect based upon the co-existence of multiple ethical work (...) climates, nor has previous literature accounted for the relevance of the cosmopolitan source of moral reasoning in the ethical treatment of workplace spirituality. The purpose of this paper is to address these gaps by articulating two such ethical dilemmas related to workplace spirituality: the “quiet desperation” dilemma and the instrumentality dilemma. Moreover, I propose two theoretical contexts that foster “both-and” rather than “either-or” thinking, thereby mitigating the relationships between climate combinations and conflictual aspects of the ethical dilemmas. For the “quiet desperation” dilemma, I propose a person–organization fit perspective to emphasize diversity of individual preferences instead of a managerially prescribed uniformity of spirituality. For the instrumentality dilemma, I propose a multiparadigm approach to workplace spirituality research to avoid the privileging of one research interest over another. I conclude with suggestions for future research. (shrink)

In this chapter, we explain how Karl Jaspers’ concept of empathy can be expanded by drawing upon the tradition of philosophical phenomenology. In the first section, we offer an account of Jaspers' concepts of empathy and incomprehensibility as he develops them in General Psychopathology and “The Phenomenological Approach in Psychopathology.” In the second section, we survey the recent literature on overcoming Jaspers' notion of incomprehensibility and expanding his concept of empathy. In the third section, we outline the levels of investigation (...) at which phenomenological inquiries into psychopathology may proceed. These levels of human existence are, in descending order of depth, (1) phenomenal experiences, (2) interpretive frameworks, (3) modes of existence, and (4) existentials. In the fourth and final section, we argue that to fully empathically comprehend patients with schizophrenia and other mental disorders, the possibility of alterations at all four levels of existence must be acknowledged. (shrink)

Book reviewed in this article: Philosophy in Medicine: Conceptual and Ethical Problems in Medicine and Psychiatry. By Charles M. Culver and Bernard Gert. Psychiatric Ethics. Edited by Sidney Block and Paul Chodoff. Man, Mind, and Morality: The Ethics of Behavior Control. By Ruth Macklin.

In 1785, George Washington described a “knowing farmer” as “one who can convert every thing he touches into manure, as the first transmutation towards Gold.” With these words, Washington linked the “knowing farmer” to the alchemist who endeavored to transform base metals into gold with the aid of a philosopher's stone. In each instance, the challenge was to convert raw materials into something new and precious.Today, the “knowing bioethicist” is in a similar position. American bioethics harbors a variety of ethical (...) methods that emphasize different ethical factors, including principles, circumstances, character, interpersonal needs, and personal meaning. Each method reflects an important aspect of ethical experience, adds to the others, and enriches the ethical imagination. (shrink)

The emerging concept of systems medicine (or ‘P4 medicine’—predictive, preventive, personalized and participatory) is at the vanguard of the post-genomic movement towards ‘precision medicine’. It is the medical application of systems biology, the biological study of wholes. Of particular interest, P4 systems medicine is currently promised as a revolutionary new biomedical approach that is holistic rather than reductionist. This article analyzes its concept of holism, both with regard to methods and conceptualization of health and disease. Rather (...) than representing a medical holism associated with basic humanistic ideas, we find a technoscientific holism resulting from altered technological and theoretical circumstances in biology. We argue that this holism, which is aimed at disease prevention and health optimization, points towards an expanded form of medicalization, which we call ‘holistic medicalization’: Each person’s whole life process is defined in biomedical, technoscientific terms as quantifiable and controllable and underlain a regime of medical control that is holistic in that it is all-encompassing. It is directed at all levels of functioning, from the molecular to the social, continual throughout life and aimed at managing the whole continuum from cure of disease to optimization of health. We argue that this medicalization is a very concrete materialization of a broader trend in medicine and society, which we call ‘the medicalization of health and life itself’. We explicate this holistic medicalization, discuss potential harms and conclude by calling for preventive measures aimed at avoiding eventual harmful effects of overmedicalization in systems medicine (quaternary prevention). (shrink)

In 1785, George Washington described a “knowing farmer” as “one who can convert every thing he touches into manure, as the first transmutation towards Gold.” With these words, Washington linked the “knowing farmer” to the alchemist who endeavored to transform base metals into gold with the aid of a philosopher's stone. In each instance, the challenge was to convert raw materials into something new and precious.Today, the “knowing bioethicist” is in a similar position. American bioethics harbors a variety of ethical (...) methods that emphasize different ethical factors, including principles, circumstances, character, interpersonal needs, and personal meaning. Each method reflects an important aspect of ethical experience, adds to the others, and enriches the ethical imagination. (shrink)

Book reviewed in this article: Philosophy in Medicine: Conceptual and Ethical Problems in Medicine and Psychiatry. By Charles M. Culver and Bernard Gert. Psychiatric Ethics. Edited by Sidney Block and Paul Chodoff. Man, Mind, and Morality: The Ethics of Behavior Control. By Ruth Macklin.

This book presents an interpretation of pharmaceutical, surgical and psychotherapeutic interventions based on a univalent metalanguage: biosemiotics. It proposes that a metalanguage for the physical, mental, social, and cultural aspects of health and medicine could bring all parts and aspects of human life together and thus shape a picture of the human being as a whole, made up from the heterogeneous images of the vast variety of sciences and technologies in medicine discourse. The book adopts a biosemiotics (...) clinical model of thinking because, similar to the ancient principle of alchemy, tam ethice quam physice, everything in this model is physical as much as it is mental. Signs in the forms of vibrations, molecules, cells, words, images, reflections and rites conform cultural, mental, physical, and social phenomena. The book decodes healing, dealing with health, illness and therapy by emphasizing the first-person experience as well as objective events. It allows readers to follow the energy-information flows through and between embodied minds and to see how they form physiological functions such as our emotions and narratives. (shrink)

This book offers a rich collection of voices from diverse settings and illustrates ways in which lectio divina as a contemplative practice can transform teaching and learning. Drawing on holistic education and embodied learning, lectio divina empowers teachers and roots students in their own meaning making.

In lieu of an abstract, here is a brief excerpt of the content:The Origins and Evolution of Bioethics: Some Personal ReflectionsEdmund D. Pellegrino (bio)AbstractBioethics was officially baptized in 1972, but its birth took place a decade or so before that date. Since its birth, what is known today as bioethics has undergone a complex conceptual metamorphosis. This essay loosely divides that metamorphosis into three stages: an educational, an ethical, and a global stage. In the educational era, bioethics focused on a (...) perceived “dehumanization” of medicine by the rising power of science and technology. Remedies were sought by introducing humanities, ethics, and human “values” into the medical curriculum. Ethics was one among the humanistic disciplines, but not the dominant one. In the second era, ethics assumed a dominant role as ever more complex dilemmas emerged from the rapid pace of biological research. As such dilemmas were applied to medical practice, the need for a more rigorous and more formal analysis of their moral status was clear. Philosophically-trained ethicists had an obvious role. They began to teach, write, and profoundly influence medical education and practice. In the third—and present—period, the breadth of problems has become so broad that ethicists must, themselves, draw on disciplines well beyond their expertise—e.g., law, religion, anthropology, economics, political science, psychology, and the like. The era of bioethics as a global enterprise is upon us. The original hope for humanizing medicine has not been overtly successful; however, much has been accomplished of value to patients, the profession, and society. Medical morality has been transformed into a formal, systematic study of a whole range of issues of the greatest significance to humanity. Now the major challenge is one of identity, or inter-relationships and connections between the theoretical and the practical. Bioethics has outgrown its beginnings.I have been invited to give a “personal recollection” of the early development of bioethics. Such invitations are notoriously hard to resist, but also problematic when they are the recollections of a participant [End Page 73] in the events to be described. We need only be reminded of the vagaries common to the plethora of memoirs on the book stands today. Few have escaped the perils of selective memory, self-promotion, or the settling of old scores. Yet their perils notwithstanding, memoirs may serve some useful purpose. They are the raw material—verbal kitchen middens so to speak—out of which historians can later sift fact from fancy. They enable “tribal elders” to give witness to the past from which the present can fashion some sense of continuity.I will organize my reflections around three very arbitrary time periods that represent my own way of thinking about the evolution of bioethics: (1) an era of “proto-bioethics” (1960–1972), (2) an era of philosophical bioethics (1972–1985), and (3) an era of global bioethics (1985-present). Each era, of course, overlaps with the others, and the dominant strand of each runs through the others as well.In the proto-bioethics period, the language of human values predominated; in the era of bioethics philosophically construed, it was the language of philosophical ethics; and in the era of bioethics globally construed, the social and behavioral sciences have gained greater prominence. In each period, interest in the traditional humanities other than philosophy waxed and waned. In the earlier years, religion and theology predominated. Beginning in the 1970s, philosophy took a dominant role. In the last two decades, other disciplines, like law, literature, and the social sciences, have exerted more and more influence (McNeur 1963; Pellegrino 1997; Barker 1987).I make no pretense here of writing any part of the formal “history” of bioethics. Works of this nature are beginning to appear (Rothman 1991; Jonsen 1998 ; Dell’Oro and Viafora 1996). Thomas McElhinney and I are preparing our own account of the work and influence of the Institute on Human Values in Medicine, one of the influential programs of the Society for Health and Human Values (Pellegrino and McElhinney, n.d.). Space limitations as well as prudence preclude any attempt to do justice to all the events, institutions, and people who have made the field of bioethics what it is today. I apologize for these omissions, for any unintentional lapses of... (shrink)

From the end of the First World War, a broad discussion took place within the framework of the revived German constitutional teaching on the question of the physical normality of man. The founder of the so-called statistical concept of normality, which preceded the still widespread normal (reference) interval concept, is H. Rautmann, who gave it the character of a tool for discriminating between health and disease. Among some of his successors (Bauer, Borchardt, Günther), however, it was considered more a means (...) of establishing a type, without supposing any precise relation between the frequency of a character in the population and the probability of the occurrence of disease. The concept of a statistical norm as a certain region of the variation range of a character determined by the parameters of Gaussian distribution was criticized both by the supporters of the ideal norm (Hildebrandt) and those who were in favour of a ‘personal’ norm (Grote). The underlying motifs of these three conceptions of normality influenced German constitutional doctrine until after the end of the Second World War, but without a satisfactory solution to the diagnosis of physical normality being found. Since the 1950s, world medicine has moved more and more in the direction of prevention, with the emphasis on a study of individual dispositions to disease and its precursors. In this connection a new view of health has gained importance whereby it is considered a smoothly gradated condition, not sharply distinguished from disease (‘continual’ model of health and disease as opposed to the previous ‘alternative’ model). The purpose of diagnostic characters is no longer merely to place patients in clearly defined categories as healthy or affected by one disease or another, but has taken on the function of indices of the disposition to disease among those who exhibit ‘gross normality’. Discrimination between the alternative and continuous models allows a clarification to be made of the sources of the confusion in which the pre-war concept of statistical normality had found itself. Today many exceptions are known to the rule that the functional optimum lies in the region of the population mean, both for the population as a whole and for individuals; and immense variability has been found in the manner in which individuals in the population attain health. Thus a distinction between health and disease by statistical means alone (such as establishing some sort of species design) is not possible at all. The ideal of a personal norm is pursued today through the concept of a multivariate norm backed up by modern data processing methods, though it was anticipated in principle by Kaup even in the 1920s. CiteULike Connotea Del.icio.us What's this? (shrink)

Dr Kottow in his paper Classical medicine v alternative medical practices (1) places the alternative/orthodox medicine debate within an historical context of anti-quackery literature. My paper explores the nature of science as it is applied to clinical practice and challenges the narrow view of the diagnostic process as outlined by Dr Kottow. Research methodologies more appropriate to 'whole person' medicine are suggested as having more ethical value than those based on the clinical trial.

The concept of whole‐brain death is under attack again. Scholars are arguing that the concept of brain death per se—regardless of the focus on “higher,” “stem” or “whole”—is fundamentally flawed. These scholars have identified what they believe are serious discrepancies between the definition and criterion of brain death, and have pointed out that medical professionals and lay persons remain confused about its meaning. Yet whole‐brain death remains the standard for determining death in much of the Western world (...) and its defenders believe this concept best maps onto our everyday conception of death. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Convention for Protection of Human Rights and Dignity of the Human Being with Regard to the Application of Biology and Biomedicine: Convention on Human Rights and BiomedicineCouncil of EuropePreambleThe Member States of the Council of Europe, the other States and the European Community signatories hereto,Bearing in mind the Universal Declaration of Human Rights proclaimed by the General Assembly of the United Nations on 10 December 1948;Bearing in mind the (...) Convention for the Protection of Human Rights and Fundamental Freedoms of 4 November 1950;Bearing in mind the European Social Charter of 18 October 1961;Bearing in mind the International Covenant on Civil and Political Rights and the International Covenant on Economic, Social and Cultural Rights of 16 December 1966;Bearing in mind the Convention for the Protection of Individuals with Regard to Automatic Processing of Personal Data of 28 January 1981;Bearing also in mind the Convention on the Rights of the Child of 20 November 1989;Considering that the aim of the Council of Europe is the achievement of a greater unity between its members and that one of the methods by which that aim is to be pursued is the maintenance and further realisation of human rights and fundamental freedoms;Conscious of the accelerating developments in biology and medicine;Convinced of the need to respect the human being both as an individual and as a member of the human species and recognising the importance of ensuring the dignity of the human being; [End Page 277]Conscious that the misuse of biology and medicine may lead to acts endangering human dignity;Affirming that progress in biology and medicine should be used for the benefit of present and future generations;Stressing the need for international co-operation so that all humanity may enjoy the benefits of biology and medicine;Recognising the importance of promoting a public debate on the questions posed by the application of biology and medicine and the responses to be given thereto;Wishing to remind all members of society of their rights and responsibilities;Taking account of the work of the Parliamentary Assembly in this field, including Recommendation 1160 (1991) on the preparation of a Convention on bioethics;Resolving to take such measures as are necessary to safeguard human dignity and the fundamental rights and freedoms of the individual with regard to the application of biology and medicine;Have agreed as follows:Chapter IGeneral provisionsArticle 1. (Purpose and object)Parties to this Convention shall protect the dignity and identity of all human beings and guarantee everyone, without discrimination, respect for their integrity and other rights and fundamental freedoms with regard to the application of biology and medicine.Each Party shall take in its internal law the necessary measures to give effect to the provisions of this Convention.Article 2. (Primacy of the human being)The interests and welfare of the human being shall prevail over the sole interest of society or science.Article 3. (Equitable access to health care)Parties, taking into account health needs and available resources, shall take appropriate measures with a view to providing, within their jurisdiction, equitable access to health care of appropriate quality. [End Page 278]Article 4. (Professional standards)Any intervention in the health field, including research, must be carried out in accordance with relevant professional obligations and standards.Chapter IIConsentArticle 5. (General rule)An intervention in the health field may only be carried out after the person concerned has given free and informed consent to it.This person shall beforehand be given appropriate information as to the purpose and nature of the intervention as well as on its consequences and risks.The person concerned may freely withdraw consent at any time.Article 6. (Protection of persons not able to consent)1. Subject to Articles 17 and 20 below, an intervention may only be carried out on a person who does not have the capacity to consent, for his or her direct benefit.2. Where, according to law, a minor does not have the capacity to consent to an intervention, the intervention may only be carried out with the authorisation of his or her representative or an authority or a person or... (shrink)

This issue of The Journal of Medicine and Philosophy brings together an international group of scholars from Hong Kong, Mainland China, and North America, critically to explore whole-body/head transplantation. The proposed procedure raises significant philosophical, ethical, and social/political questions. For example, assuming transplant is successful, who survives the surgery? Does personal identity necessarily follow the head? The contributors to this special thematic issue explore the nature and ground of personal identity, what it would mean to preserve personal identity, (...) given such a significant set of physical changes, as well as the morality of such a procedure. As the authors make clear, careful conceptual philosophical analysis is essential for understanding whether whole-body/head transplantation is a life-saving/life-enhancing technological innovation, or a bioethical morass that should not be attempted. How we come to terms with such conceptual and moral concerns will have a significant impact on the future of medicine and medical technological innovation. (shrink)

While evidence-based medicine (EBM) is often accused on relying on a paradigm of 'absolute truth', it is in fact highly consistent with Karl Popper's criterion of demarcation through falsification. Even more relevant, the first three steps of the EBM process are closely patterned on Popper's evolutionary approach of objective knowledge: (1) recognition of a problem; (2) generation of solutions; and (3) selection of the best solution. This places the step 1 of the EBM process (building an answerable question) in (...) a pivotal position for the understanding of the whole process, and underscores a few aspects which are often overlooked in EBM courses. First in this step internal evidence (including personal expertise) must be appraised and integrated in the problem. Second, issues of applicability of the possible solution should be anticipated. Third, and possibly more important, the goal of the intervention should be set at this stage (typically by choosing the outcome in a PICO question). Depending whether or not goals depend on the goals of others, and whether they concern others' voluntary behaviour, goals may be classified as self-serving, moral, altruistic or moralistic. Thus, delicate ethical questions must be addressed at this stage, which means that patient preferences and values must be carefully sought, so that empathy, counselling and narrative medicine must be mastered to be able to formulate correctly an answerable question. The need to modify the current description of the EBM process to increase the recognition of implicit assumptions and increase the consistency of this model is discussed. (shrink)

Archetypal medicine and past life therapy have received only scant attention in mainstream medical and psychological literature. Nonetheless, the epistemological and practice assumptions underlying Alfred Ziegler's model of archetypal medicine are highly congruent with those of past life therapy and both proffer salient alternatives to traditional reductionistic practice in psychotherapy and medicine. This paper explores the manner in which both seek to understand the meanings embedded in "health" and "illness" through a metaphorical interpretation of symptoms. Dualistic thinking (...) gives way to unitary consciousness as we begin to understand symptomatology in the larger scheme of a human being's entire lived experience. The transcendent, psychospiritual work of past life therapy is viewed in integrated partnership with archetypal medicine in healing the whole person rather than merely assessing symptoms in isolation and remediating them through mechanistic techniques and external applications of treatments. (shrink)

This article challenges the widespread assumption that Plato’s valuation of medicine remains steady across the corpus. While Plato’s opposition to poetry and sophistry/rhetoric endures, in the Laws he no longer views medicine as a rival concerning phusis and eudaimonia. Why is this dispute laid to rest, even as the others continue? This article argues that the Laws’ developments with a bearing onmedicine stem ultimately from the philosopher-ruler’s disappearance. The deeper appreciation of good medical practice that ensues, combined with (...) an array of sociopolitical mechanisms for detecting injustice, means that the health care setting is no longer—as in the Republic—the crossroads where judgments of the whole person must be made. For the first time, by Plato’s lights, medicine may be a truly self-standing technē. (shrink)

Contemporary epistemology seems almost exclusively focused on questions concerning knowledge and justification. Such a focus has had two broad consequences. First, epistemologists have neglected other equally important concepts. Specifically, the concept of understanding is absent in most discussions. Secondly, discussions have avoided the role of the will in the agents to whom we attribute knowledge and justification. Surprisingly, virtue epistemology also suffers from this narrow view. Specifically, virtue epistemologists of all kinds have neglected these two important aspects of our epistemic (...) lives. I examine the spectrum of virtue theories in epistemology, and locate a gap between the two sides—responsibilism and reliabilism. This gap, I suggest, might be bridged if we take seriously (i) the idea that there are other epistemic goals apart from knowledge and justification (e.g., understanding), and (ii) that cognition requires the whole person—intellect and will—and not simply the intellect in isolation from other faculties. (shrink)

Contemporary epistemology seems almost exclusively focused on questions concerning knowledge and justification. Such a focus has had two broad consequences. First, epistemologists have neglected other equally important concepts. Specifically, the concept of understanding is absent in most discussions. Secondly, discussions have avoided the role of the will in the agents to whom we attribute knowledge and justification. Surprisingly, virtue epistemology also suffers from this narrow view. Specifically, virtue epistemologists of all kinds have neglected these two important aspects of our epistemic (...) lives. I examine the spectrum of virtue theories in epistemology, and locate a gap between the two sides—responsibilism and reliabilism. This gap, I suggest, might be bridged if we take seriously (i) the idea that there are other epistemic goals apart from knowledge and justification (e.g., understanding), and (ii) that cognition requires the whole person—intellect and will—and not simply the intellect in isolation from other faculties. (shrink)

In the tradition of Western medicine that goes back to Hippocrates, we teach medical students to see beyond the disease and to consider the patient as a whole—to take into account the broader context of family, lifestyle, and environmental exposures. For instance, when measuring blood pressure to diagnose hypertension, family history and situational stress must be considered. Moreover, repeated measurements at multiple time points must be performed to avoid a false-positive diagnosis due to temporary fluctuations of blood pressure. (...) The diagnosis then provides, in adherence to standard-of-care guidelines, the indication for antihypertensive therapy. The recommendations have been... (shrink)

The anticipation of ethical issues that may arise with the clinical use of genomic technologies is crucial to envision their future implementation in a manner sensitive to local contexts. Yet, populations in low- and middle-income countries are underrepresented in studies that aim to explore stakeholders’ perspectives on the use of such technologies. Within the framework of a research project entitled “Personalized medicine in the treatment of epilepsy”, we sought to increase inclusiveness by widening the reach of our survey, inviting (...) neurologists from around the world to share their views and practices regarding the use of whole-genome sequencing in clinical neurology and its associated ethics. We discuss herein the compelling scientific and ethical reasons that led us to attempt to recruit neurologists worldwide, despite the lack, in many low- or middle-income countries, of access to genomic technologies. Recruitment procedures and their results are presented and discussed, as well as the barriers we faced. We conclude that inclusive recruitment remains a challenging, albeit necessary and legitimate, endeavour. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Intersection of Medicine and ReligionJohn C. DormoisThe practice of medicine offers a host of rewards to the practitioner. Besides the obvious intellectual satisfaction of solving a difficult diagnostic problem or the ability to make a comfortable living, I have found the greatest personal sense of moral gratification when helping [End Page 196] families negotiate the most challenging event in life: making decisions at end of life. (...) Whether the condition was a ruptured intracranial aneurysm with brain death or a patient with far advanced cancer struggling with the choice between experimental chemotherapy or choosing comfort therapy at home surrounded by family for the remaining days of life, the moral courage required to provide the best guidance was considerable. In my early years of practice I didn’t call my actions in these situations “courageous” nor were there moral “guidelines” providing a blueprint. I knew I responded with empathy and compassion and that this ability had a lot to do with being raised in a religious or spiritual home. At the same time, I suspected that some of the lack of empathy and compassion I witnessed in some of my colleagues was related to the very training programs of physicians. This essay traces the origin of my moral and ethical concerns about medical education and my intention to reinvigorate the spiritual or existential voice in medicine.An early life experience had a great deal to do with shaping my moral development. At age seven my family traveled through the West Indies. My father’s amateur radio hobby meant that at every stop we would be greeted by one of his radio contacts. One stop in particular was life changing.Port au Prince, Haiti was an unknown place to this seven year–old, but to say it was a culture shock to a boy from Kansas would be an understatement of epic proportions. It was during this visit that I experienced true poverty in its most blatant form. In downtown Port au Prince I saw limbless beggars and the deformed from polio and malnutrition. But it was the sight of the garbage dump near the center of town that changed my world forever. There, among piles of detritus, I saw children and families making their home in the dump. They had hollowed out a sort of cavern in the piles of trash that served as a place of refuge from both the rain and the sun.This experience in many ways has served as a framework and background for my life. Although seen through the eyes of a seven year–old, the picture can only be adequately understood within the context of being raised by religiously faithful parents, parents free of hypocrisy whose lives personified the best in Christian virtues and practices. These early experiences planted the seeds that would only fully blossom some 60 years later.Medical school was a demanding but exhilarating experience. Each day was a day of discovery … anatomy, physiology, pathology … all subjects opening up a whole new world to explore. Internal medicine suited me best since it was the specialty that most closely integrated all the basic sciences necessary to arrive at a diagnosis. I loved the elegance of endocrinology in particular where a given hormone mediator could cause widely different effects if present in excess or completely absent. But I was in the end drawn to cardiology since it combined complex physiology with my avocation, the love of running.There was, however, a disturbing aspect of medicine education that I observed affecting many of my classmates. Although I can vividly recall the enthusiasm that all of us shared as we donned our white coats for the first time and envisioned a future of caring for our patients, things gradually and insidiously changed over the next four years. The altruism and empathy that was so evident in the early years gradually lessened as graduation approached. I could not help being struck by this change and wondered at the time why that should happen. I had no insight then that what I had observed was a well recognized consequence of the medical school experience. I’m sure that the passage from professional training to practice in... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Philosophy of George Engel and the Philosophy of MedicineJeffrey P. Spike (bio)KeywordsGeorge Engel, psychosocial medicine, medical education, medical humanities, interviewing skills, philosophy of medicine, scientific methodDoctor Brad Lewis has encouraged us to consider George Engel’s philosophy with his excellent essay on Engel and Pragmatism. As a philosopher teaching full time in a medical school, it is refreshing to have an opportunity to analyze the work of (...) two physicians at this level of reflection and abstraction. It is even more of a pleasure because I knew Dr. Engel personally while I was teaching at the University of Rochester School of Medicine. I will make some observations of the philosophy behind Dr. Engel’s work, both published and practical, that is, as reflected in his writing but also in his influence in the medical curriculum at the institution that he called home for some thirty years (as seems appropriate when considering someone’s bona fides as a pragmatist).Engel’s Philosophy and Medicine’s PhilosophyGeorge Engel’s primary philosophical concern was to fight the powerful belief (or perhaps delusion) that medicine was evolving into a pure physical science, an extension of biochemistry and cell biology, or as we would now call them, proteomics and genomics. There is little evidence that he espoused any one methodology for basic science, so much as he opposed any one methodology for medicine. So to say he was a pragmatist seems underdetermined by his words, if that is taken to mean he advocated for changing the methodological model for scientific research. Rather the question is whether his preferred medical methodology is best characterized as pragmatic, or by some other description. On that score I agree with Lewis wholeheartedly.Of course, it might be that the claim of pragmatism is not meant to suggest a change in method for basic science, but to advocate for retaining an appreciation for the whole range of approaches to knowledge, from experimental science to epidemiology, and from epidemiology to acculturation. By that definition of pragmatism, Engel was indeed a pragmatist. Interpreted this way, he wanted medicine to stop worshipping the scientific method and appreciate that there are many paths to knowledge besides through the wet lab.It might be said that there are different scientific methods for different sciences, and Engel wanted us to appreciate that the reductionist methods [End Page 315] appropriate to the sciences of the small are not necessarily methods that can be applied to all sizes of objects we study, or all levels of reality (like the psychological and social). This is the truth about the world, although I am not sure that this is what Engel meant. As Lewis notes, Engel’s writing does sometimes sound as if he worshipped at the alter of science, as if all subjects of importance can be studied scientifically. But if he believed that, he was not correct. It might be, if all the subjects of the university that Lewis mentions are important, that some will turn out to be able to be studied in academically rigorous methods that are not scientific in any of the usual meanings of the word. Consider philosophy itself, for example.To the degree that it may stretch the evidence to say that Engel would have advocated for a pragmatic scientific method, it is still the case that pragmatism as outlined by Lewis and Engel’s biopsychosocial model can both be used to help medicine understand itself and overcome the temptation to idolize science. Medicine is not a science, or at least it is not just a science; in fact, I would suggest that it never was a science, and it will never be a science. Medicine is about health and illness, and uses whatever science it can to promote health and to treat (ameliorate or cure) illness.None of this should necessarily lead us to idolize pragmatism either. If each subject has its own ideal methodology for study, then it may be that pragmatism is the preferred method for, say, clinical judgment, whereas the scientific method is the best for the ‘hard’ sciences, and logic for philosophy. Or perhaps pragmatism and inductive logic are competing models for clinical... (shrink)

There is a dire need today to create spaces in which people can make meaning of their existence in the world, abiding by cultural frameworks and practices that acknowledge and validate a meaningful existence for all. People are not just isolated individuals but are connected in diverse ways with other persons within our natural and social environment which is part of the whole universe. The African philosophy of uBuntu or humaneness is re-emerging for its timely relevance and potential as (...) indispensable in our quest for global citizenship, peace, and mutual understanding in securing sustainable human development in the broader ecosystem. Comparative educationists have the challenge to devise theoretical frameworks, epistemological and pedagogical constructs as well as pragmatic, useful and effective ways of promoting the virtues of compassion and recognition of our common humanity in eliminating the ills of domination and control that are guided by greed, hatred, jealousy, and intolerance. Comparative Education for Global Citizenship, Peace and Shared Living through Ubuntu paves the way for a better understanding of the critical importance of the collective search and endeavor towards achieving the virtues of nonviolence, peace, shared values of living together, global citizenship, improved quality of life for all and a better appreciation of the positive implications of interdependence. (shrink)

This book offers a comprehensive overview of the compatibility of palliative care with the vision of human dignity in the Catholic moral and theological traditions. The unique value of this book is that it presents expert analysis of the major domains of palliative care and how they are compatible with, and enhanced by, the holistic vision of the human person in Catholic health care. This volume will serve as a critically important ethical and theological resource on palliative care, including (...) care at the end of life, for bioethicists, theologians, palliative care specialists, other health care professionals, Catholic health care sponsors, health care administrators and executives, clergy, and students. Patients receiving palliative care and their families will also find this book to be a clarifying and reassuring resource. (shrink)

The COVID-19 pandemic has, of necessity, demanded the rapid incorporation of virtual technologies which, suddenly, have superseded the physical medical encounter. These imperatives have been implemented in advance of evaluation, with unclear risks to patient care and the nature of medical practice that might be justifiable in the context of a pandemic but cannot be extrapolated as a new standard of care. Models of care fit for purpose in a pandemic should not be generalized to reconfigure medical care as virtual (...) by default, and personal by exception at the conclusion of the emergency. (shrink)

This article develops a phenomenology of suffering with an emphasis on matters relevant to medical practice and bioethics. An attempt is made to explain how suffering can involve many different things—bodily pains, inability to carry out everyday actions, and failure to realize core life values—and yet be a distinct phenomenon. Proceeding from and expanding upon analyses found in the works of Eric Cassell and Elaine Scarry, suffering is found to be a potentially alienating mood overcoming the person and engaging (...) her in a struggle to remain at home in the face of loss of meaning and purpose in life. Suffering involves painful experiences at different levels that are connected through the suffering-mood but are nevertheless distinguishable by being primarily about my embodiment, my engagements in the world together with others, and my core life values. Suffering is in essence a feeling , but as such, it has implications for and involves the person’s entire life: how she acts in the world, communicates with others, and understands and looks upon her priorities and goals in life. Suffering-moods are typically intense and painful in nature, but they may also display a rather subconscious quality in presenting things in the world and my life as a whole in an alienating way. In such situations, we are not focused directly upon the suffering-mood—as in the cases of pain and other bodily ailments—but rather, upon the things that the mood presents to us: not only our bodies, but also other things in the world that prevent us from having a good life and being the persons we want to be. Such suffering may in many cases be transformed or at least mitigated by a person’s identifying and changing her core life values and in such a manner reinterpreting her life story to become an easier and more rewarding one to live under the present circumstances. (shrink)

Because research involving human subjects exposes people to risk not always for their own potential benefit, the question arises as to how best ensure that: research participants are protected and benefited according to the highest ethical standards, while, on the other hand, researchers are protected and free to do research that will produce clinical advances for both research participants and society as a whole.The balancing of the risk to research participants versus the benefits derived from the research is performed (...) in many counrries by a system for the protection of human research participants that is laid out in national laws and regulations. In the United States, this system is based on principles emanating from the Nuremberg Code, the World Medical Association Declaration of Helsinki,and the report of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. (shrink)

Because research involving human subjects exposes people to risk not always for their own potential benefit, the question arises as to how best ensure that: research participants are protected and benefited according to the highest ethical standards, while, on the other hand, researchers are protected and free to do research that will produce clinical advances for both research participants and society as a whole.The balancing of the risk to research participants versus the benefits derived from the research is performed (...) in many counrries by a system for the protection of human research participants that is laid out in national laws and regulations. In the United States, this system is based on principles emanating from the Nuremberg Code, the World Medical Association Declaration of Helsinki,and the report of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. (shrink)

Bullying often results in negative coping in victims, including an increased consumption of alcohol. Recently, however, an increase in alcohol use has also been reported among perpetrators of bullying. The factors triggering this pattern are still unclear. We investigated the role of empathy in the interaction between bullying and alcohol use in an adolescent sample (IMAGEN) at age 13.97 (±0.53) years (baseline (BL), N = 2165, 50.9% female) and age 16.51 (±0.61) years (follow-up 1 (FU1), N = 1185, 54.9% female). (...) General empathic distress served as a significant moderator of alcohol use in perpetrators (F9, 493 = 17.978, p < 0.01), which was specific for males and FU1. Male perpetrators, who are generally less sensitive to distress, might thus be more vulnerable to alcohol abuse. (shrink)

Recent years have witnessed a growing concern that terminally illpatients are needlessly suffering in the dying process. This has ledto demands that physicians become more attentive in the assessment ofsuffering and that they treat their patients as `whole persons.'' Forthe most part, these demands have not fallen on deaf ears. It is nowwidely accepted that the relief of suffering is one of the fundamentalgoals of medicine. Without question this is a positive development.However, while the importance of treating suffering (...) has generally beenacknowledged, insufficient attention has been paid to the question ofwhether different types of terminal suffering require differnt responsesfrom health care professionals. In this paper we introduce a distinctionbetween two types of suffering likely to be present at the end of life,and we argue that physicians must distinguish between these types if theyare to respond appropriately to the suffering of their terminally illpatients. After introducing this distinction and explaining its basis,we further argue that the distinction informs a (novel) principle ofproportionality, one that should guide physicians in balancing theircompeting obligations in responding to terminal suffering. As weexplain, this principle is justified by reference to the intereststerminally ill patients have in restoration, as well as in therelief of suffering, at the end of life. (shrink)

Medicine today, as both art and science, embodies a split personality. The ensuing tension—between individualized consideration, experience, and judgment on the one hand, and standardization, objective evidence, and guidelines on the other—plays out in the simultaneous aspirations of the medical humanities and evidence-based medicine, and in a host of other telling terms and movements. This is not a new tension, however. We turn in this paper to the critical but complex history of the term “personal equation” as both (...) reflective and generative of this tension on both sides of the Atlantic during a formative period in medicine from the mid-19th through the mid-20th centuries. The term was featured in almost every... (shrink)

The ArgumentThe status of the person is analyzed as represented by the life sciences under the influence of modern physico–chemical and molecular biology.At the same time the linguistic structure of reality as seen through formalized scientific discourse is not that of a language, but rather that of operational symbolisms, so that the judeo–Greek tradition of Verb as creating and Logos as procreating — which is probably at the origin of the surprising confidence in the possibility of dominating nature through (...) words and formulae — could be suc–cessful only through the depersonalization of language.Notwithstanding appearances, the phenomena of structural and functional self–organization do not really change this situation.In this context the question of the status of the person and of the intentional subject has to be dealt with pragmatically, giving up the notion of a unified scientific theory that would take into consideration at the same time the experi–mental sciences and the human sciences as linking subjectivity and intentionality. (shrink)