Showing 231 - 240 of 477 annotations tagged with the keyword "Medical Ethics"
Summary:This little novel is the retrospective tale of a childhood event told by the protagonist 40 years later. Family relationships and bonds in conflict with professional and community obligations vie with the shadow of racism and sexual abuse in the doctor/patient relationship for the core tensions in the book. The setting is a small rural community where the pioneer family about which the tale evolves controls the law and the medicine. The boy narrator relates his view of the breakdown of family as its secret--a physician uncle who is suspected of sexually abusing his native-American women patients--becomes a force that demands action from the doctor’s brother who serves as the sheriff.
In March, 1981, in Vermont, Charlotte Bedford goes into labor. She has decided to give birth at home with the help of a midwife, Sybil Danforth, but complications develop. Charlotte has a seizure, her heart stops, and she does not respond to CPR. The fetus is still alive, so Sybil delivers him successfully by Cesarean section, with a kitchen knife. But the bleeding when Sybil makes the incision convinces her assistant that the patient’s heart was still beating. She reports this to the police and Sybil is put on trial for involuntary manslaughter.
The story of the trial is told by Sybil’s daughter, Connie, fourteen years old at the time and now an obstetrician-gynecologist. The acquittal comes at a price: the midwife finds herself no longer capable of delivering babies, and both she and her daughter are given a new insight into the uncertainty which underlies so many of medical decisions. At the end of the novel we are left uncertain whether or not Charlotte was still alive when her baby was delivered.
The New Medicine and the Old Ethics, in Albert Jonsen’s own words, is a "secular aggadah." Jonsen explains that one Talmud reviewer defined aggadah as "a magical rabbinic mode of thought in which myth, theology, poetry and superstition robustly mingle" (4). The book begins with a personal essay entitled "Watching the Doctor." Jonsen establishes his premise that the moral history of Western medicine is best understood as a paradox between altruism and self-interest, a paradox alive and well entering the 21st Century.
He then takes the reader on his "secular aggadah," blending history, myths, and stories that trace important moral developments in the practice of Western medicine. In "Askelepios as Intensivist," we learn of the early Greek values of competence in shaping medical practice. Through the influence of the Church in the medieval period, Western medicine incorporates the value of compassion through the Biblical Good Samaritan, struggles with problems of justice in the care of the poor, and further elaborates the meaning of benefit.
In "The Nobility of Medicine," Jonsen describes the contribution of Sir William Osler and other knighted medical men of the 19th Century who established the ethics of noblesse oblige in the medical profession. He traces this noble tradition to the medieval Knights Hopitallers of Saint John of Jerusalem, a group of religious who provided hostels for pilgrims to the Holy Land and cared for the sick. With essays on John Locke and Jeremy Bentham, Jonsen brings us to the 20th Century and the play of individual rights and utilitarian values in the moral life of Western medicine.
In the final essays, Jonsen describes the mingling of these traditions as a means to establish a moral frame for Western medicine in our current times where technology and science have achieved and threatened so much. Ethics, he argues, "is disciplined reflection on ambiguity" (130). In the last essay, "Humanities Are the Hormones," Jonsen brings his "secular aggadah" full circle.
He argues that the paradox of altruism and self-interest that runs through the moral history of Western medicine must continually be vitalized and examined through the Humanities. The Humanities are "the chemical messengers that course through the complicated institution of medicine and enable it to respond to the constantly changing scientific, technological, social, and economic environment" (147).
An extraordinary phenomenon began to emerge a century or so ago, which, as it proceeded, allowed us a glimpse into what a society would look like when most of its members, rather than a select few, lived to, or more precisely, near, the limit of the human lifespan. Now we are facing the possibility of extending the upper limit of the human lifespan. How we live within this new world will be the result of numerous individual as well as corporate (in its fullest sense--business, professional societies, religious organizations, political bodies) decisions.
Stephen Hall, through compelling and clear writing takes us behind the scenes and into the lives and labs of the researchers and entrepreneurs who are seeking to slow down, stop, or reverse the aging process--those who intend to bring about, if not actual, then practical immortality. Figuring prominently throughout the book are Leonard Hayflick, early pioneering researcher on aging cells, and the charismatic (and former creationist) researcher-entrepreneur, Michael West. Rounding out the narrative are commentaries by noted ethicists and the chronicling of the political responses to these scientific and business developments, especially in regard to stem cell research.
Summary:This is a selection from "The Call of Stories" in which Robert Coles argues for a medical ethics rooted in particular lives and particular situations, rather than (or to supplement) the ethics of abstract rules and principles. He tells the tale of an "uppidy nigger" in Clarksdale, Mississippi, in 1967 who took issue with her clinic doctor because he was insulting and condescending toward his patients: "I told him I expected more of him. Isn’t he a doctor? If he can lord it over people, being a doctor, then he ought to remember how our Lord, Jesus Christ behaved . . . did He go around showing how big and important He was . . . ?"
In their introduction to this anthology, the editors write that their goal is "to illustrate and to illuminate the many ways in which medicine and culture combine to shape our values and traditions." Using selections from important literary, philosophical, religious, and medical texts, as well as illustrations, they explore, from a historical perspective, the interactions between medicine and culture. The book is arranged in nine major topical areas: the human form divine, the body secularized, anatomy and destiny, psyche and soma, characteristics of healers, the contaminated and the pure, medical research, the social role of hospitals, and the cultural construction of pain, suffering, and death.
Within each section, a cluster of well-chosen (and often provocative) texts and drawings illuminate the topic. Specifically, literary selections include poems by W. D. Snodgrass ("An Envoi, Post-TURP"), William Wordsworth ("Goody Blake and Harry Gill: A True Story"), and Philip Larkin ("Aubade"); and prose or prose excerpts by Robert Burton ("The Anatomy of Melancholy"), Zora Neale Hurston (My Most Humiliating Jim Crow Experience), Sara Lawrence Lightfoot ("Balm in Gilead: Journey of a Healer"), William Styron (Darkness Visible: A Memoir of Madness), George Orwell ("How the Poor Die"), Ernest Hemingway (Indian Camp), and Paul Monette (Borrowed Time: An AIDS Memoir). (The full texts of the pieces by Hurston, Styron, Hemingway, and Monette have been annotated in this database.)
This volume nicely supplements the few other anthologies of literature on medical themes currently available in that it covers a wider historical span. Selections from the Bible, Giovanni Boccaccio, William Shakespeare, Rabelais, as well as 18th-century writers including Pepys, Daniel Defoe, Malthus, Schiller, and Goldsmith provide an array of historical touchstones that offer windows onto medical and literary history and points of comparison for the larger selection of works from the 19th and 20th centuries.
The selections are mostly short--averaging around 10-12 pages. Each is introduced with lively, often witty, comments by Gordon, whose popular Doctor in the House series was adapted for stage and screen in England, and whose associations with the medical world include an editorial position on the British Medical Journal as well as a wife and two children who are physicians. Many of the selections focus on the figure of the physician viewed variously from the viewpoints of patients, other physicians, and him or herself.
Selections from novels by three Victorian women doctors as well as selections from several physicians’ diaries provide unusual additions to a useful collection of excerpts from well-known literature including works by Scott, John Keats, Jane Austen,George (Marian Evans) Eliot, George Bernard Shaw, Hardy, Aldous Huxley, Sir Arthur Conan Doyle, Sinclair Lewis, F. (Francis) Scott Fitzgerald, Waugh, Orwell, and more recent and popular fiction, up through Erich Segal.
Ten months after being burned over 68% of his body, Dax Cowart was interviewed on videotape at the University of Texas Medical Branch in Galveston by Dr. Robert B. White. Blind, disfigured and helpless, Dax had consistently asserted his right to refuse medical treatment, including further corrective surgery on his hands (useless, unsightly stumps) as well as the daily, excruciatingly painful baths in the Hubbard tank.
At the time of his admission to UTMB, he had become adamant that he be allowed to leave the hospital and return home to die--a certain outcome since only daily tankings would prevent overwhelming infection. Dr. White had been called in as a psychiatric consultant, and much of the twenty-nine minute documentary is a conversation between patient and psychiatrist.
Calm and coherent, Dax states his wishes clearly and presents his case compellingly. He does not "want to go through the pain"; he does not "want to go on as a blind and a crippled person"; and he does not understand or accept any physician’s "right to keep alive a patient who wants to die."
Young Maurice Hall (James Wilby) is instructed in the facts of life by his well-intentioned teacher (Simon Callow), who warns the fatherless child never to speak of it to his mother or sisters. The boy says that he will never marry; the teacher promises that he will.
Years later, Maurice is at Cambridge, silent, prudish, inexperienced, adhering to his teacher’s wisdom, until he finds himself falling in love with the young aristocrat, Clive Durham (Hugh Grant). When they realize that their affection is mutual, Maurice loses direction as a scholar, skips classes and chapel. He is "sent down" with no hope of return unless he apologizes, which he refuses to do. For his part, Clive acknowledges the powerful sexual feelings, but will not act on them, conscious of the ruin that will befall him and his family if the relations are discovered. He hopes for a life managing his family estate and a career in politics. Platonic love between men is best, he says.
Middle-class Maurice goes into banking and earns a respectable living without a degree. Clive completes his studies and assumes the family estate, but when he decides to marry a woman whom he met in Greece, Maurice is devastated at his own loss and at the monstrous lie that Clive is willing to live.
Perhaps, Maurice wonders, the "love that dare not speak its name" is a disease. He seeks medical advice from the old family friend Dr. Barry (Denholm Elliott) who misunderstands his problem as venereal infection, which he cheerfully offers to treat; however, when Maurice bravely persists by confessing his unnatural longings--on which he still has yet to act--the doctor responds with anger and revulsion. Maurice then consults a sympathetic hypnotist (Ben Kingsley) who tries to cure him; finding the patient resistant, he suggests emigration to a country more accepting of his "kind."
A frequent guest in the strange Durham household, Maurice likes Clive’s vapid wife, sensing without certainty that the marriage is celibate. He falls in love with their gamekeeper, Alec Scudder (Rupert Graves), a deeply intelligent rustic, bound to quit domestic service and Old England for Argentina. Smitten with passion, they conduct a one-night affair. Simultaneously, however, they are wracked with fear: Maurice fully expects Alec to blackmail him; Alec fully expects Maurice to reject him for not being a gentleman. Society makes it nearly impossible for them to trust each other.
Maurice confronts Clive to say goodbye, choosing identity over social approbation, education, wealth, and privilege.
This anthology frames a rich selection of fiction and nonfiction with astute and helpful introductions to issues in nineteenth-century medicine and the larger culture in which it participated. The fiction is comprised of Mikhail Bulgakov’s The Steel Windpipe in its entirety; Sir Arthur Conan Doyle’s story, "The Doctors of Hoyland" from Round the Red Lamp; and selections from George Eliot’s Middlemarch, Gustave Flaubert’s Madame Bovary, Sarah Orne Jewett’s A Country Doctor, Sinclair Lewis’s Arrowsmith, Thomas Mann’s Buddenbrooks, W. Somserset Maugham’s Of Human Bondage, George Moore’s Esther Waters, Robert Louis Stevenson’s Strange Case of Dr. Jekyll and Mr. Hyde, Eugène Sue’s Les Mystères de Paris, and Anthony Trollope’s Doctor Thorne [the full-length versions of many of the above have been annotated in this database]. The nonfiction consists of two versions of the Hippocratic Oath, two American Medical Association statements of ethics, and selections from Daniel W. Cathell’s The Physician Himself (1905).