Showing 271 - 280 of 472 annotations tagged with the keyword "Medical Ethics"
This is an ambitious and far-ranging book, the result of years of thinking, teaching, and working with patients. An internist at the College of Physicians and Surgeons at Columbia University, Charon sees a wide range of patients in an urban setting. Also a Ph.D. in English literature, Charon has devised a "Parallel Chart" and other means for caregivers to write personally about the dynamics between healer and patient, to read texts--narratives in particular--and, as a result, to listen better to patients, thus improving the delivery of medical care.
Charon defines narrative medicine as "medicine practiced with these skills of recognizing, absorbing, interpreting, and being moved by the stories of illness" (4). She calls this a "new frame" for medicine, believing that it can improve many of the defects of our current means of providing (or not) medical care. Caregivers who possess "narrative competence" are able to bridge the "divides" of their relation to mortality, the contexts of illness, beliefs about disease causality, and emotions of shame, blame, and fear.
Charon finds that medical care and literature share five narrative features; she argues that careful reading of narratives builds skills that improve medical care, including intersubjectivity between caregiver and patient, and ethicality. Beyond the theory, there are powerful and persuasive examples of interactions between caregiver and patient, many from Charon's own practice. A mother of a sick daughter experiences stress that makes her ill; when she sees a narrative connection, she begins to heal.
Charon sees wider applications. As caregivers understand better concepts of attention, representation, and affiliation, they become more ethical, more community minded, and better healers to their patients. Patient interviews will be different: instead of following a grid of questions, physicians will converse with patients in an open-ended way. What is most important will emerge and emerge in ways that are most beneficial to the patient. Yes, this method will take more time but it will be more efficient in the long run. Bioethics, Charon argues, has been limited by legal approaches and philosophical principles. For her, narrative bioethics offers more human values in how people feel, experience reality, and relate to each other. Finally, there are implications for social justice: why are the poor underserved in this country and in many others?
One of the most exciting and radical formulations comes late in the book: ". . . practitioners, be they health care professionals to begin with or not, must be prepared to offer the self as a therapeutic instrument" (p. 215). This notion links up fruitfully with concepts of energy medicine (v1377v), therapeutic touch (Tiffany Field), and intentionality (Wayne W. Dyer).
The site of the multiple stories interwoven in this novel is a teaching hospital in San Francisco. One of the featured characters is a young single mother who comes in with a swollen arm and finds herself in more medical trouble than she anticipated. She suffers a mild stroke after debatable treatment. Two doctors attend her, but differ markedly in their ideas of how to treat her and their human responses to her. One ends up having a brief affair with her that changes his life.
In addition to these there are stories of a comatose young man and the family that refuses to believe he will not awaken (he does); a volunteer coordinator who observes the politics of hospital life from a privileged margin, and sundry staff people who represent alternative points of view. The single mother recovers, but only after a stay in the hospital has convinced her she may not yet be too old to go to medical school to find a life not in marrying a doctor, but in being one.
Born in 1728 the tenth child in a struggling Scottish farm family, John Hunter was a wayward and unteachable child who spent most of his time outdoors. At the age of 20, with no prospects and having lost his father and 6 siblings, he wrote for help to his older brother William, who was practicing midwifery in London and had just opened England's first anatomy school, one featuring the revolutionary opportunity for students to dissect their own cadavers.
John rode the 400 miles to London on horseback, apprenticed with great success under William, learned dissection, then surgery, and went on to become a supremely gifted anatomist and surgeon, one whose brilliant and tireless experimentation broke with ancient and outmoded medical traditions and established the foundation for modern science-based surgery. (When John arrived in London, the city's Company of Barber-Surgeons had only just dissolved to allow surgeons to organize themselves independently of barbers.)
One of his most important activities in working for his brother--and which continued when he made his own way--was the procuring of cadavers, which because of the customs of the time involved him intimately in the grisly business of grave-robbing.
Shannon Moffett, a medical student at Stanford University School of Medicine, became fascinated with the brain during her anatomy and neurobiology courses. She set off across the country to interview people--scientists, doctors, patients, ethicists, and religious leaders--who devote their careers trying to understand the brain and cognition. With infectious enthusiasm and energy, Moffett brings the reader to meet these dedicated people, their work, their theories and their lives.
The book contains eight chapters and hence eight mini-biographies: 1) neurosurgeon Roberta Glick, 2) cognitive neuroscientist and brain imagist John Gabrieli, 3) Francis Crick (of DNA double helix fame) and Christof Koch--scientists studying consciousness, 4) sleep researcher Robert Stickgold, 5) Judy Castelli who has dissociative identity disorder (multiple personality disorder), 6) philosopher Daniel Dennett, 7) neuroethicist Judy Illes, and 8) Zen monk Norman Fischer.
Separating the chapters are "interludes" that map neural and brain development from conception to death. The book has a reference list for each chapter and a complete index, as well as a web resource (www.shannonmoffett.com) to which the reader is directed for graphics.
The writing is compelling, direct, fresh and insightful. For example, in "Touching the Brain," we follow the exhausting lifestyle of an academic neurosurgeon who works at Cook County Hospital in Chicago as she performs surgery, teaches, attends services at a temple, drives her car, takes care of her family including two young children, rounds on patients, hosts a potluck dinner, and simultaneously discusses her reading, travel and spirituality.
Moffett aptly describes Glick with her "waist-length red hair, ... beaten-metal earrings dangling almost to her shoulders and a saffron batik dress" as someone you'd "expect to find reading storybooks to kindergartners in a public library" (8). In fact, it is Moffett's eye for accessible detail that makes not only the people, but also neuroscience come alive. Artfully woven into the text are lessons on the history of brain research and current understanding (and questions) about the brain, its meaning and function.
This concise and well-written biography is meant to be, as Sherwin Nuland tells us, "a guide for the perplexed," for those who may recognize the name of Maimonides and his historical importance to Jewish religion and culture, or who may even have read some of his works, but have no knowledge of the man behind the name. The story begins, as it should, in Medieval Spain with its vibrant Judaeo-Islamic culture, in which the historical relationship between Judaism and medicine developed and later expanded throughout the European and Islamic worlds. Though they were outsiders in both civilizations, Jewish physicians became the most sought after healers in the Christian and Muslim worlds.
Moses son of Maimon (also known as Maimonides and the Rambam, 1138-1204) was born in Cordoba, the cultural and political center of Muslim Spain. He and his family had to flee Cordoba to avoid persecution in 1148. They wandered through Spain until 1160, when they settled in Fez, Morocco. Again fleeing from persecution, Maimonides moved to Fustat, Egypt, when he was 30 years old and remained there for the rest of his life. During these early years, the young rabbi wrote numerous biblical commentaries, culminating in the Mishneh Torah, his great code of Jewish law. Later, he attempted to reconcile faith with reason in another great work, The Guide for the Perplexed, completed in 1190.
Maimonides's specifically medical work is difficult to characterize and evaluate. The traditional historical assessment is that he was "unique in his time in the theory and practice of medicine." Essentially, he practiced Galenic medicine, as transmitted and developed in the flourishing Islamic tradition. We don't know how he acquired his medical knowledge, but by the time he reached Fustat, Maimonides was acknowledged to be a leading physician and in 1190 he was appointed personal physician to the vizier of Egypt. Late in life, Maimonides wrote a number of medical treatises, most importantly his Medical Aphorisms, which presents a coherent, well-organized, and practical medical system based on Galen and Aristotle.
This is a comprehensive social history of European (or "Western") attitudes toward death and dying over the last thousand years. Ariès organizes his history into five sequential cultural constructs, each of which conveys the meaning of death to the individual and community, as well as the social institutions around death and dying, during a different period of Western history, beginning in the Middle Ages.
Cultural responses to death must begin by acknowledging that death is mysterious and overwhelming; a wild beast; a meaningless monster. Death lurks at the edge of our consciousness, ready to destroy us and demolish whatever meaning we attribute to our lives. In medieval Europe Christianity had domesticated this monster by establishing a comprehensive set of beliefs and practices that Ariès calls the "tame death." Death was merely a transition to eternal life. The individual was understood as an integral part of the community and not as autonomous and isolated. Therefore, death and dying were communal events, supported by specific prayers and practices (i.e. ars moriendi) that "tamed" the unknown.
In the centuries that followed, Ariès's "tame death" evolved through five stages into the radically different cultural conception of death that characterizes Western society--especially in its American form--today. These changes result largely from the gradual replacement of community-oriented personal identity with today's radical individualism; and the gradual sequestration of death to a position behind the scenes, so that dying and death become remote from ordinary experience.
In today's world we encounter "invisible death," a somewhat paradoxical name because its invisibility allows the savage beast free rein. Death is no longer "tame" because we deny its existence so effectively we no longer develop personal and communal resources to give it meaning. Death's invisibility enhances its terror; our culture's loss of spirituality enhances death's meaninglessness.
Martin Arrowsmith is from a tiny mid-western town. He goes to college and then to medical school in the largest town in the state. He begins to worship Gottlieb, Professor of Bacteriology, one of the few professors who is devoted to pure science instead of lucrative practice. Martin becomes Gottlieb’s assistant and annoys his professors and friends by constantly talking about methodology. He is engaged to Madeline, a rather dull graduate student in English. When he meets Leora, a nurse, he breaks his engagement to Madeline. Martin grows disenchanted with his career, leaves school, and wanders around the midwest. Finally, he marries Leora and returns to school. Now, however, he becomes a disciple of the Dean, Silva, whose science is much less precise and who is devoted to making people comfortable at all costs.
Martin sets up practice after graduation in Leora’s home town. The Swedish and German farmers find him invasive and unwilling to cater to their small-town expectations. When Martin misdiagnoses a case of smallpox, he is forced to leave town. He has by then found a new hero, Gustave Sondelius, who fights plagues abroad and returns to America to lecture. Sondelius finds him a job in a larger town as an assistant to Dr. Almus Pickerbaugh, Director of Public Health. Pickerbaugh writes popular poems against sidewalk spitting and alcohol but does little else. The town loves him. He becomes a senator and Martin takes over the department. He quickly makes enemies of the very people Sondelius pleased. He also returns to research. Between annoying the upper crust with his brusqueness and annoying the farmers by closing their diseased dairies, he is soon drummed out of town.
He is then hired as a pathologist at the Rouncefield Clinic, where he does meaningless, repetitive work. His old mentor, Gottlieb, saves him by getting him a position at the McGurk Institute in New York. The Institute is very rich and gives scientists a chance to work without the interruption of patients or a need for practical application. Martin returns to Gottlieb’s principles and discovers a cure for bubonic plague. The Institute, which is not free from economic interests, sends him off to the tropical island of St. Hubert to test his material and save the population.
Martin is determined to conduct a controlled trial. When his wife and Sondelius both die of the plague, however, he injects everyone, saves the island, and returns to New York. Gottlieb has dementia and can neither blame nor forgive Martin for his lack of scientific aplomb. Martin marries an heiress and briefly lives the rich life he always dreamed of, but finds that his new wife will not let him work. Finally, he joins a friend who has built a laboratory in Vermont and happily returns to research.
Noah Praetorius (Cary Grant) is a physician who cares for patients as human beings and not just bodies. His unorthodox methods are being challenged by Dr. Elwell (Hume Cronyn), who wishes to discredit Praetorius by exposing the secrets of his past. While Elwell investigates, Praetorius cares for a pregnant, unwed student (Jeanne Crain), who on learning of her condition, tries to commit suicide.
In order to give her hope, Praetorius tells the student that he was mistaken about her pregnancy and eventually marries her. In the conclusion, Praetorius reveals to a committee his secret life, which includes the historical questionable necessity of procuring his own cadaver for anatomy study, and wins the day.
The Bacteriologist has a visitor to his laboratory, a pale stranger who arrives with a letter of introduction from a good friend of the scientist. The scientist shows his visitor the cholera bacillus under a microscope and they talk about the disease. The visitor is particularly interested in a vial containing living bacteria, and the scientist describes the power of cholera, saying what a terrible epidemic could be caused if a tube such as the one he holds were to be opened into the water supply.
The scientist's wife calls him away for a moment; when the scientist returns, the visitor is ready to leave. As soon as the visitor has gone, however, the scientist realizes the vial of bacteria is missing, that the visitor must have stolen it. He runs out in a panic, sees the visitor's cab leaving, and hails another cab to give chase. The scientist's wife, horrified by his inappropriate dress and hurry, follows in a third cab, with her husband's shoes and coat and hat.
We shift to the point of view of the visitor in his cab. He has indeed stolen the vial. He is an Anarchist who plans to release the bacteria into London's water supply. His motivation is fame: he feels he has been neglected by the world, and now he will reveal his power and importance. In the speeding cab, however, he accidentally breaks the glass vial.
He decides to become a human vector. He swallows what is left in the vial, and stops the cab, realizing that he no longer needs to flee. When the scientist catches up and confronts him, the Anarchist gleefully announces what he has done. The scientist allows him to walk away, and tells his wife that the man has ingested the stolen bacteria.
There is a twist: the vial, it turns out, did not contain cholera, but a strange new microbe the Bacteriologist had been studying, the only known effect of which is to make the skin of the animals exposed to it turn bright blue. The Bacteriologist reluctantly puts on his coat and returns home with his wife, complaining that he will now have to culture the bacillus all over again.
A screening chest X-ray reveals the presence of a cardiac myxoma in a 72-year-old dictator. His personal physician (fearing for his own life) timidly informs Mr. President about the tumor and the likelihood that it will claim the dictator's life in a matter of months. The physician lacks the training and ability to remove the tumor but recommends Dr. Gala Sampras as the surgeon most qualified to perform the procedure.
Slight problem: Sampras was one of 14 surgeons who "disappeared" in 1992 after criticizing the dictator and his regime. She was imprisoned and abused in a labor camp. Her husband and three children were also removed from society. A bargain is struck. Sampras will do the operation. After the surgery is done, she will be reunited with her family.
The dictator shows Sampras pictures of her family. Although the photos of her children appear to be recent, the picture of her husband seems to have been taken years ago. On the day of surgery, the dictator directs the doctor's attention to the courtyard where soldiers surround her daughter. Sampras realizes the dictator might not survive the operation given the complexity of the procedure and the patient's age. Before succumbing to his anesthesia-induced sleep, the dictator is told by Sampras not to worry, but her every move is closely monitored by his soldiers. The night is likely to be long and hard for the doctor and the dictator.