Showing 281 - 290 of 477 annotations tagged with the keyword "Medical Ethics"
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.
Atul Gawande, a surgical resident at Harvard Medical School, asks in his well written essay, "when you see your patient making a grave mistake, should you simply do what the patient wants?" (p. 86) He answers this question by sharing a number of cases from his training that suggest that the orthodoxy of 'absolute respect for patient autonomy' may interfere with good patient care.
Gawande also gives the reader insight into the difficulties that young residents especially have in developing an artful approach to medical practice. He suggests that part of respecting autonomy is (at appropriate times) allowing patients to cede that autonomy to an authority figure. He argues further that, "patients frequently don't want the freedom that we've given them." (p. 89)
He also shares in his essay a personal experience with his youngest child. She was a premature baby who at eleven days old ended up in the intensive care unit. He was glad to put the ultimate decision(s) of how to care for his daughter in the hands of physicians--"they could live with the consequences, good or bad." (p. 90)
The italicized sentence under the title of this New Yorker essay summarizes it well: "Wanted: Highly accomplished young women willing to undergo risky, painful medical procedure for very large sums." Mead traces the phenomenon of women selling their eggs through the experience of Cindy Schiller, a 26-year-old law student who was "donating" her eggs for the third time.
In addition to Schiller's observations, the article is full of information about the clinical dimensions of egg donation--the donor shuts down her ovaries so that none of her eggs ripen and none of her follicles develop, followed by injections of follicle-stimulating hormones, followed by eggs that are "sucked out, one by one," and whisked away to be fertilized in a petri dish. Most of the article addresses the legal and ethical dimensions of egg donation, the hopes and expectations of those seeking donors, and the new-found marketing strategies of the American fertility industry.
This novel spans one day in the life of a London neurosurgeon, Henry Perowne. It is set on a specific day, Saturday, February 15, 2003, when mass demonstrations were held in London protesting the coming war on Iraq. This actual historical and geographical context colors the fictional narrative, told entirely from the point of view of Perowne, who wakes in the early hours of the morning to see a burning aircraft descending towards Heathrow. Although this turns out not to be a terrorist attack, as Perowne at first fears, it sets up the book's atmosphere of foreboding and the powerful contrast between dangerous world events and Perowne's essentially happy family.
The Perownes are all talented and successful and fond of each other. Henry's wife, Rosalind, is a media lawyer; their son, Theo, a blues guitarist; and their daughter, Daisy, a published poet. This Saturday's highlight is to be a family dinner, where it is expected that Daisy and her grandfather, John Grammaticus, a famous poet, will reconcile after an argument.
Henry is on the way to his morning squash game when he is involved in a minor car accident with a dubious character named Baxter. He escapes theft and a beating by realizing that Baxter suffers from Huntington's Disease. He tells Baxter the diagnosis and offers hope of a non-existent treatment, shifting the power base of the encounter from brawn to brain and humiliating Baxter in front of his cronies. (This part of the novel was published in the New Yorker as a short story, The Diagnosis. See the annotation in this database for a more detailed account.)
Henry then plays an aggressive game of squash with Jay Strauss, his American colleague, and they discuss the Middle East and the impending war. He buys seafood at the market for the evening's dinner, and he goes to the nursing home to visit his mother, Lily, who has multiple-infarct dementia. He listens to his son's band, goes home and cooks dinner. He argues with Daisy, his daughter, just come from the protest march, about the coming war.
When the family is gathered for dinner, Rosalind returns from work and Baxter and his henchmen force their way into the house. They threaten Rosalind with a knife, break Grammaticus's nose, and force Daisy to strip, at which point Perowne realizes his daughter is pregnant. Then Daisy recites poetry--Matthew Arnold's "Dover Beach"--and, unlikely as it is, the effect of the poem is to distract Baxter enough that Perowne is able to lure him upstairs with the promise of more information on treating Huntington's, and he and Theo then throw Baxter down the stairs. Baxter is taken away in an ambulance, and later Perowne is called in to operate on his brain. The novel ends with Perowne back in bed with his wife.
A down-and-out attorney, who has become somewhat obsessed with the case of a severely impaired woman who had suffered brain damage during the course of a surgical procedure, presses forward to prove medical malpractice. In the course of developing the case he is opposed by the Bishop of the diocese which owns the hospital in question; one of the most powerful law firms in the city; and, acting as "spy" for the defense team, a beautiful woman lawyer.
Galvin, the protagonist, is encouraged to continue his pursuit of justice by an honest former partner and his own belief in the patient's childrens' right to a settlement. Galvin wins his case by proving that the medical records have been altered.
Set sometime in the near future, Cast of Shadows has as its protagonist Davis Moore, a successful private practice physician specializing in cloning human babies for infertile couples. Early in the book, Anna Kat, his high school senior daughter, is murdered and raped. (For a while a likely suspect is Mickey the Gerund, a right wing extremist member of the Hands of God with a fascinating grammatical moniker never explained, who shoots cloning physicians, including Dr. Moore, in the abdomen, a short time before his daughter, Anna Kat, is brutally killed. However, Mickey is only a shadow of a suspect and quickly becomes supplanted by another much more likely villain. Mickey goes on to kill, by various methods, dozens of cloning physicians and staff by book's end.)
After a year of unsuccessful detective work, the local police return Anna Kat's belongings, including a plastic vial with the suspected murderer-rapist's semen. In an act never fully explored by Dr. Moore or the author, an otherwise rational and ethical physician surreptitiously uses the suspect's semen to fertilize a married woman patient.
The offspring, a clone of the suspected killer-rapist, is Justin, who becomes a formidable presence in the book. He is very intelligent--at his psychologist's advice, his parents provide him at an early age with advanced reading materials like Plato (hence one of the allusions to shadows, i.e., Plato's cave, in the book's title and referenced directly on page 118 and indirectly on page 208) and other philosophers. By the time he is a senior in high school, Justin has become a dominant player in the affairs of Dr. Moore; Sally Barwick, a private investigator-turned journalist; and the suspected killer-rapist--his origin of the species as it were.
This book has a number of subplots all of which radiate from the initial cloning and the various members of the extended family and professional staff involved in it, some knowingly, most not. There are narrative threads involving the suspected murderer rapist-now-prominent attorney, Sam Coyne; the triangle of Dr. Moore and Jackie, his alcoholic wife, and Joan, his attractive pediatrician associate; Mickey the Gerund's various murderous and obsessional religious activities and reflections; Justin's life in school and involvement with Sally Barwick's investigation of a serial killer called The Wicker Man; and, most especially, the development of Shadow World, a computer game and a virtual replica of the real world--the world as Justin, Sally, Sam Coyne, and Dr. Davis Moore know it.
Since this is a thriller, it would be inappropriate to divulge more of the plot, which is intricate, often a little far-fetched but always engaging, highly readable and more labyrinthine than most medical thrillers.