Showing 201 - 210 of 471 annotations tagged with the keyword "Medical Ethics"
Primo Levi was imprisoned at the Auschwitz concentration camp in 1944. He survived the experience, probably in part because he was a trained chemist and as such, useful to the Nazis. Soon after the war ended, he wrote several books about his experience. The Drowned and the Saved, however, was written 40 years later and is the work of memory and reflection not only on the original events, but also on how the world has dealt with the Holocaust in the intervening years. Fundamental to his purpose is the fear that what happened once can happen (and in some respects, has happened) again.
Chapter 1, "The Memory of the Offense," dissects out the vagaries of memory, rejection of responsibility, denial of unacceptable trauma and out and out lying among those who were held to account by tribunals as well as among the victimized. Levi does not spare himself: "This very book is drenched in memory . . . it draws from a suspect source and must be protected against itself" (34). Even so, he insists, memory and the historical record are crucial to combating Nazi assumptions that their deeds would go unnoticed (they were destroying the evidence), or disbelieved.
In "The Gray Zone" (2) Levi challenges the tendency to over-simplify and gloss over unpleasant truths of the inmate hierarchy that inevitably developed in the camps, and that was exacerbated by the Nazi methodology of singling some out for special privileges. He outlines the coercive conditions that cause people to become so demoralized that they will harm each other just to survive. (And when they refused to collaborate, they were killed and immediately replaced.)
Chapter 3, " Shame," is, in my opinion, the most profound and moving section of the book. Levi begins it by discussing a phenomenon that occurred following liberation from the camps: many who had been incarcerated committed suicide or were profoundly depressed. This Levi attributes to shame and feelings of guilt. "Coming out of the darkness, one suffered because of the reacquired consciousness of having been diminished . . . Our moral yardstick had changed [while in the camps]" (75). Beyond that, there is the sense that "each one of us (but this time I say 'us' in a . . . universal sense) has usurped his neighbor's place and lived in his stead" (81-82).
In the concentration camp, says Levi, it was usually "the selfish, the violent, the insensitive, the collaborators of the 'gray zone,' the spies" who survived ["the saved"] while the others did not ["the drowned"] (82). Only the drowned could know the totality of the concentration camp experience, but they cannot testify; hence, the saved must do their best to render it. Since Levi was one of those saved, he is "in permanent search of a justification . . . " and although he feels compelled to bear witness, he does not consider doing so sufficient justification for having survived. In this chapter Levi also discusses why inmates did not commit suicide during their incarceration:" . . . suicide is an act of man and not of the animal . . . because of the constant imminence of death there was no time to concentrate on the idea of death" (76).
"Communicating" (4) deals with the emotional and practical consequences of not being able to understand the German commands of the captors, or the conversation of the mostly German speaking prisoners (Levi was Italian but spoke some German). Levi also describes the additional suffering of those who were cut off from all communication with friends and family. "Useless Violence" (5) gives examples of how the Nazis tormented their prisoners with "stupid and symbolic violence."
In "The Intellectual in Auschwitz" (6) Levi speculates about how and in what circumstances being educated or cultured was a help or hindrance to coping with the situation. In this chapter he considers also whether religious belief was useful or comforting, concluding that believers "better resisted the seduction of power [resisted collaborating]" (145) and were less prone to despair. Levi, however, was never a believer, although he admits to having almost prayed for help once, but caught himself because "one does not change the rules of the game at the end of the match, not when you were losing" (146).
Chapter 7, "Stereotypes," addresses those who question why many concentration camp inmates or ghetto inhabitants did not attempt to escape or rebel, and why many German Jews remained in Germany during Hitler's ascendance. As in all the other chapters of his book, Levi discusses the complexity of these situations. "Letters from Germans" summarizes his correspondence with Germans who read his earlier books. The book ends ("Conclusion") with the exhortation that "It happened, therefore it can happen again . . . " (199).
In this rich opening chapter of his work on the Nazi doctors, Lifton lays out the groundwork for answering the question of how German doctors became the agents of Hitler’s vision of the purified Aryan race, sterilizing involuntarily several hundred thousand citizens with a variety of mental and physical deficiencies. His answer, in brief: a romanticized genetics coupled with total political control.
Amazingly, the Nazi medical atrocities were carried out not against the opposition of Germany’s medical establishment, but with its approval. (Of course, there were individual dissenters, the more vocal of whom were removed from positions of authority or put to death). Nazi leaders worked hard to convert medical people to the official position. This was accomplished partly by force, but also partly by metaphor, as the normal language of medicine was used to hide the unethical nature of what doctors were being asked to do.
Individual patients were replaced by the racial term "Volk," meaning the (Aryan) people, and their rights were superceded by their doctors’ new duty to assure the health of this collective political idea. According to Nazi publicity, the Aryan race was in grave danger of "Volkstod," of dying out, because its genetic pool had been contaminated both by the transmission of inherited genetic defects and by the "foreign invasion" of Jews and their intermingling with members of the "superior" Aryan race.
To save their new patient, German doctors were expected to carry out the sterilizations, medical experiments, and, later, the euthanasia required by Nazi doctrine, which, in the words of one Nazi writer, declared that "misery can only be removed from the world by painless extermination of the miserable." Doctors were urged not to worry about ethical issues, because Nazi medicine was "nothing but applied biology."
In these ways, says Lifton, Hitler’s racial policies were ’medicalized’ and their evil made less obvious. Those who went along were billed as the "saviors of mankind," the "alert biological soldiers" whose actions would restore the purity of the Aryan race. Jewish doctors were not invited, of course, their research having been officially discredited in the mid-1930s, Lifton tells us, and their medical licenses revoked in 1939--in spite of the fact that they made up half the doctors in some large cities.
Sarah (Whoopi Goldberg) is an African-American woman who runs a bookstore, the "African Queen," in San Francisco. She has an adolescent daughter, Zora (Nia Long), conceived with donor sperm after the death of Sarah's husband, Charlie. Zora believes she is Charlie's daughter until she discovers a discrepancy while learning about blood types in biology class. Sarah tells Zora about her conception and Zora, determined to find out the identity of her "real father," breaks into the computer records of the California Cryobank.
She discovers the name of the sperm donor, Halbert Jackson, and tracks him down, discovering that he is a white truck salesman (Ted Danson). She and Sarah are both horrified (Sarah had requested the sperm of a black man), as is Hal, but after some comic conflict, Sarah and Hal fall in love and Zora begins to think of Hal as her father. They then learn that there was a mix up in the records and Hal is NOT after all Zora's genetic father, but by this point they have nonetheless become a family.
Tessa Quayle, the young wife of a British civil servant in Kenya, is mysteriously murdered. Tessa, a lawyer, had been an outspoken human rights activist, and something of an embarrassment to her husband. But shaken from his marital and political complacency by her death and the rumors that quickly surround it, Justin Quayle sets out to solve the mystery and in doing so inherits her cause.
Tessa had discovered, as Justin now learns, that a new tuberculosis drug was being prematurely tested on Kenyan patients: clinical trials were effectively being carried out on the African population by the drug's giant pharmaceutical producer without the patients' knowledge or consent, but with the support and cover of a global corporation with African interests and of the British High Commission in Kenya. Lethal side effects and deaths were being concealed, the drug retitrated and retested in preparation for its safer and more lucrative release in the west in time for a predicted rise in incidence of multi-resistant strains of TB.
Justin, now a kind of rogue agent, uncovers the layers of sinister plotting to be expected in one of Le Carré's intelligence thrillers, but in the process we are led to consider, vividly, the interlocking roles of international biomedical research, postcolonial political interests, and global capital in determining the fates of impoverished, uneducated, and deeply vulnerable patients in developing countries--as well as the fates of those who try, often against all odds, to offer them the best available care. The novel also gives us, in Justin Quayle's odyssey, a moving study of desire, loss, regret, and, finally, outraged action.
Frank Eloff, the novel’s narrator, is a white doctor working at a hospital in the former capital of one of South Africa’s now-defunct independent homelands (rural areas set aside by the apartheid government for black "separate development"). The hospital, in its deserted and decaying city, is understaffed and understocked, and there are hardly any patients. Those who do arrive usually need to be taken elsewhere if they need any significant treatment. The homeland’s former leader, the Brigadier, has returned as a criminal gang leader to loot the place, and a white former army commander, now in the employ of the present government, is trying to capture him.
Frank moved to this place when promised directorship of the hospital (and in flight after his wife left him for his best friend), but the previous director has not left yet, and Frank is in a kind of personal and professional bureaucratic limbo. He has a sexual relationship with a black woman who runs a roadside souvenir stall. It is not quite prostitution, not quite a love affair: she is married, speaks little English, and Frank regularly gives her money.
A new doctor, Laurence Waters, arrives. He is fresh from medical school, sent to the hospital in order to complete the rural community service year required by the government of all new physicians. He and Frank become roommates and begin an uneasy friendship. Laurence is an idealist, planning to make heroic changes, but he misunderstands the complex balance of tolerance, cynicism and patience that characterize survival at the hospital, and his well-intentioned efforts, such as trying to end theft from the hospital and to establish a clinic in a local tribal village, lead to disaster. The novel ends with Frank appointed hospital director at last, and things returning to their depressingly ineffective "normality."
Couser, long interested in autobiography, explores the ethics of representation in biographical writing, and in particular, the ethics of representing vulnerable subjects--for example, the aged or very young, the sick or impaired, or those who are "socially or culturally disadvantaged." He is concerned with representation of people who are intimately connected to the biographer, either as family members, or in some other "trust-based relationship." Couser argues that the relationship between vulnerable subjects and their biographers is analogous to that between patients and their physicians and that therefore principles of bioethics should be applied to such life writing, especially the principles of autonomy, nonmaleficence, and beneficence.
Couser explores life writing and betrayal (Chapter 1), outlines how he will apply the principles of biomedical ethics and ethnographical ethics to life writing (Chapter 2), and applies these principles to examples of collaborative autobiography (Chapter 3). He then critiques in detail Michael Dorris’s memoir about his adopted son, The Broken Cord (Chapter 4); the work of Oliver Sacks (Chapter 6); memoirs of euthanasia (Couser calls these "euthanographies"), Saying Goodbye to Daniel: When Death Is the Best Choice, by Julia Cassutto Rothman; Rescuing Jeffrey, by Richard Galli, and But What If She Wants to Die, by George DeLury (Chapter 7). Finally, in the last chapter, Couser considers how investigation of the human genome might influence the "scripts" of our lives and hence life writing, and also how life writing might be a counter discursive force against genomic essentialism.
Imago is set in the future, after a nuclear war has decimated most of the earth. A foreign species, the Oankali, has made Earth a colony. The Oankali are male and female but also have a third sex, the Ooloi. Ooloi are necessary to Oankali reproduction; they lie between partners, gather and recombine genetic material, and inseminate the female to produce offspring. The main Ooloi organ, the yashi, contains genetic information about every living thing. Ooloi can cure anything with a single touch. Also, of course, an evil Ooloi could start diseases no one has ever seen before.
The Ooloi and Oankali breed with earthlings who are willing and cure them of the tumors, infertility and other effects of the war. Unwilling humans are also repaired and sent to a colony on Mars where they can live autonomously. The Oankali have little hope for these humans, as their biological aggression will eventually cause another war. The Oankali do learn one thing from the humans, cancer. While for humans the fast reproduction of cells is a dreaded disease, the Ooloi control it and use it to recreate lost limbs and repair other damage.
Imago focuses on one particular Ooloi, Judahs. He is an anomaly because he has human parents. Judahs searches for human mates, finally finding two rebels. This pair tell him of a hidden community of humans unknown to the invaders. This area too becomes a colony, but with a more human aspect.
Ian Young spent the summer of 1970 as a medical student working at a hospital in the province of Kabylia in Algeria. He was assigned to the Maternity department, where he worked primarily with two Bulgarian doctors. Most foreign medical personnel in Algeria at the time came from Eastern bloc countries, as "Islamic Socialism" was the official political system in the newly independent (1962) North African country. According to Young, obstetrical care for the mostly Berber women of the area was brutal, disorganized, antiquated, and dangerous.
Dr. Vasilev, the head of the department, is a passive and indecisive man, who spends most of his day reading the newspaper. Once roused from his lethargy, which doesn't happen very often, he demonstrates competence and concern for his patients. His colleague, Dr. Kostov, is an aggressively brutal man who introduces himself to pregnant patients by shoving his fist into their vaginas.
Both doctors excuse their behavior by saying, "We just can't do it here they way we do it in Bulgaria." For the most part, they do not use sterile technique, and although anesthetics are available, neither Kostov nor Vasilev typically use them. The Algerian nursing staff provides at least a modicum of organization and care in this dreadful environment.
At first Young approaches the situation with disbelief and anger. He then attempts to improve the quality of care, first by introducing a flow sheet for obstetrical care, and later by submitting a report on the poor conditions to the hospital director.
Mild-mannered Dr. Vasilev supports him, but no one uses the new flow sheets, and the Director considers the report a personal (and political) affront. Meanwhile, Ian Young presents the reader with a seemingly endless series of fascinating patient cases and interesting stories about hospital personnel, as well as about his excursions to various parts of Kabylia.
An American-trained Japanese surgeon working in Japan during World War II, pulls a wounded American sailor, presumably an escaped POW, from the surf behind his home. Against the advice of his wife, he hides the sailor, operates on him, and preserves his life temporarily.
Becoming fearful for his family, he reports what he has done to his patient, an official in the Japanese military. The officer says he will arrange to have the American assassinated in order to spare possible retribution against Sadao, the surgeon, and his family. It doesn’t happen, and Sadao is left with determining how to rid himself of this hazard he has brought into his home and healed. He makes a series of decisions that lend themselves to widely varying interpretations in terms of his motivation.
Summary:From a fishing trip the local doctor is summoned to an Indian village to assist a woman in labor. With him are his young son and an older male relative. The physician assesses the situation in the closed, pungent hut and determines that his only option is section--with a pen knife and fishing leader as his instruments, and no anesthesia for the Indian woman. The doctor arrogantly, but only briefly, celebrates his success as a surgeon only to discover that the woman's husband, apparently unable to tolerate his wife's pain and the racism of the white visitors, has silently slit his own throat. The child, who has observed the entire proceedings asks, "Is dying hard, Daddy?"