Showing 311 - 320 of 469 annotations tagged with the keyword "Medical Ethics"

Before the Change

Munro, Alice

Last Updated: Oct-21-2003
Annotated by:
Belling, Catherine

Primary Category: Literature / Fiction

Genre: Short Story

Summary:

The story, set in small-town Ontario in 1960, takes the form of letters to her ex-fiancé from a young woman who has returned to the home of her father, a widowed physician who lives with his housekeeper, Mrs. Barrie. She recalls growing up with her strict and remote father and realizes now that he had been performing illegal abortions all her life. He will not discuss it, will not allow the word "abortion" to be said in his house, though she tells him she believes abortion should be legalized.

We are led to suspect that she herself has recently been pregnant.

When Mrs. Barrie breaks her arm, the doctor is forced to ask his daughter to assist with one of his "special" patients. She helps the young woman throughout the procedure, and disposes of the aborted fetus afterwards. Later, trapped indoors by a heavy snowfall, she and her father are sitting together at the kitchen table when she tells him about her own pregnancy.

She had carried it to term, giving up the baby for adoption. She had ended the engagement because her fiancé, a theology student, had insisted that she have an abortion before their wedding because he feared the social consequences of rumors that she had been pregnant before marriage. She is about to ask her father about his own work, and about what might happen should the law change and abortion become legal, when she realizes that he is not listening. He has had a massive stroke, and dies later the same day. The daughter turns away the next patient who calls about having an abortion.

She learns from the lawyer that, mysteriously, her father had virtually no money saved. She gives Mrs. Barrie most of the small amount her father had given her, and then realizes that all his money has already been given to Mrs. Barrie, either because she was blackmailing him, or because he loved her. She cannot tell which, but is oddly exhilarated and is now able to say goodbye to her fiancé for good.

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Skin Tight

Hiaasen, Carl

Last Updated: Oct-21-2003
Annotated by:
Kohn, Martin

Primary Category: Literature / Fiction

Genre: Novel

Summary:

The strange cast of characters in this satirical detective thriller includes most prominently, Dr. Rudy Graveline, a hack plastic surgeon trying to cover up the "accidental" death of a patient during a rhinoplasty procedure four years prior to the start of action. "One of the wondrous things about Florida, Rudy Graveline thought as he chewed on a jumbo shrimp, was the climate of unabashed corruption: There was absolutely no trouble from which money could not extricate you . . . Since the medical board was made up mostly of other doctors, Rudy Graveline had fully expected exoneration-- physicians stick together like shit on a shoe." (p.95)

Doctors, however, are not the only profession slammed by the author. Also receiving their comeuppance are corrupt lawyers, politicians, police officers, and judges. Searing satire is also directed at "reality journalists" through the character Reynaldo Flemm (i.e. Geraldo Rivera). Not surprisingly the "good guys" win and the "bad guys," including Dr. Graveline, lose. But the hideous way in which Dr. Graveline meets his demise is too gruesome to reveal here.

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Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

A philosopher and a clinical ethicist conduct an analysis of the practice of assisted suicide. They begin with the premise that health care providers may at times be assisting with suicide now, whether or not it is legal and whether or not the ethical dimensions have been solved. They contend that assisting a suicide might be morally right, but only when the patient’s choice is rational and free.

Referring to an earlier publication by Prado (Last Choice: Preemptive Suicide in Advanced Age, 1990; 2nd ed. 1998), they devote a chapter to each of three criteria used to determine the "rationality" of a choice for suicide, and another chapter to the "slippery slope" argument. A final chapter summarizes their contribution to this topic.

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Summary:

The sculptor Ken Harrison (Richard Dreyfuss) is badly injured in a car accident and finds himself in the middle of life permanently paralyzed below the neck and dependent on others for his care and survival. Ken is a strong-minded, passionate man totally dedicated to his art, and he decides he does not want to go on with the compromised, highly dependent life that his doctors, his girlfriend Pat (Janet Eilber), and others urge on him. He breaks up with Pat and fights to be released from the hospital, to gain control of his life in order to stop the care that keeps him alive and unhappy.

His antagonist is the hospital's medical director Dr. Emerson (John Cassavetes), who believes in preserving life no matter what, and so tries to get Ken committed as clinically depressed. Ken's attending physician, Dr. Scott (Christine Lahti), begins with the establishment but gradually moves toward Ken's position.

The film ends with the judge at a legal hearing deciding that Ken is not clinically depressed and that he thus has the right to refuse treatment and be discharged. In the last scene, Ken lies in a hospital bed framed by his own sculptural realization of the forearm and hand of God from Michelangelo's Creation of Man.

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Annotated by:
Woodcock, John

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

This medical thriller begins with two crazed naked men escaping from an unmarked urban institutional building. One of them winds up in the Gramercy Hospital (NYC) Emergency Room under the care of the young Dr. Guy Luthan (Hugh Grant). The patient dies while exhibiting baffling symptoms and under suspicious circumstances. Dr. Luthan decides to investigate, against the advice of his boss, but with the assistance of ER nurse Jodie Trammel (Sarah Jessica Parker). Suddenly, police are breaking into his apartment and finding (obviously planted) cocaine. Luthan is fired by the hospital, his promising career apparently ruined by a faceless criminal conspiracy.

Still intrigued by the mystery patient, Luthan follows some street leads that take him to the Inferno-like caverns underneath Grand Central Station and the homeless people who live there. He is pursued by armed agents, is wounded, and wakes up in a hospital bed paralyzed from the neck down. Enter the prize-laden Dr. Lawrence Myrick (Gene Hackman), who explains to Luthan that he is trying to develop a medical procedure that will regenerate human nerve tissue and has been secretly using the homeless as guinea pigs. He rationalizes this practice on the basis of its huge potential benefits and tries to enlist Luthan on his side, explaining that his paralysis is temporary (but under Myrick's control) and in part an attempt to stir up Luthan's empathy for the patients who could be helped by Myrick's procedure if it is developed.

Of course, Luthan escapes from the bed. On the way out he encounters Myrick and his armed agents in the lobby, where there is one last round in the ethical debate before Myrick is accidentally killed by one of his henchman. Luthan's career is reconstituted, he is awarded a fellowship, and the film ends with Myrick's widow standing at the gate of the NYU School of Medicine giving Myrick's data to Luthan, saying that her husband was trying to do good but in the wrong way. She hopes that Luthan will use the data in the right way. Luthan smilingly enters a stone building with "Neurology" carved in the lintel.

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Annotated by:
Woodcock, John

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

Following the death of an aphasic hermit woman in the woods of North Carolina, it is discovered that she is survived by a daughter (Jodie Foster), a young woman who lives by herself as a kind of wild child, speaking a private language, and intensely fearful of human contact. The authorities decide that she must be normalized for her own good, but Dr. Jerry Lovell (Liam Neeson) disagrees, arguing that, although different, she is fine and has not asked for help. He insists on getting her informed consent before treatment. A judge agrees to give Lovell three months to observe the woman, whose name turns out to be Nell, and find evidence that she should not be treated against her will.

Lovell recruits a partner, psychologist Paula Olsen (Natasha Richardson), and together they set up an observation base on a houseboat with a view of Nell's cabin. From there Lovell makes a series of attempts to win Nell's confidence and understand her language. (Olsen for much of the film mainly represents a set of professional values more conservative that Lovell's unconventional therapeutic moves--which, for example, make her suspect that he is sexually attracted to Nell. Her own sexual presence, while downplayed, serves to defuse this potential.)

Lovell wins Nell's confidence (she calls him her "guardian angel") and the secrets of her speech and wounded psyche (a twin sister died young, and Nell has apparently at least witnessed sexual abuse). Following a court hearing in which Nell speaks in her own defense, the world gets word of her case and journalists descend on her remote cabin on foot and by helicopter.

Fearing that civilization will destroy Nell, Lovell arranges to have her hospitalized as the least available evil. However, when he finds her drugged, he sees that hospitalization is no solution, and he carries Nell out of the hospital and back to her cabin. He tries to make her understand that he is not her guardian angel.

The film switches to a warmly-lit lakeside scene five years later, when all problems seem to have been solved. Lovell and Olsen, who are married with a little girl, and several other sympathetic characters are picnicking with Nell near her cabin, and Nell is shown entranced and somehow emotionally fulfilled in being with the child, who is the age at which her twin sister died.

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Summary:

A year in the life of a group of interns in a big city hospital guided by the wise internist (Buddy Ebsen) and the irascible, woman-hating surgeon (Telly Savalas). Contortionist posturing designed to lead to desired residencies is the major theme. The only female intern, and the most brilliant of the lot, wants to be a surgeon, but she is repeatedly belittled by the surgical chief until he realizes--not that she is good--but that she is the sole support of a daughter.

Another intern falls in love with a young Asian patient and at her death resolves to work in her country. A crisis emerges around the overdose of a suicidal patient with syringomyelia; all the interns are held responsible until they rather brutally force a confession from the man's wife. Friends throughout medical school, Lou Worship (James MacArthur) and Sean Otis (Cliff Robertson) plan to become surgeons and open a clinic for the poor. Otis falls for a glamorous model, while Worship is smitten with obstetrics and a student nurse (Stephanie Powers).

Forsaking the original plan, Worship applies to obstetrics, pressures his fiancee to sacrifice her dream of an international career, and tells on Otis when he discovers that he is helping his girlfriend abort her unwanted child. His career ruined, Otis marries the irretrievably pregnant woman and expresses his admiration to Worship for doing the right thing.

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Death on Request

Nederhorst, Maarten

Last Updated: Oct-21-2003
Annotated by:
Shafer, Audrey

Primary Category: Performing Arts / Film, TV, Video

Genre: Video

Summary:

In this documentary film about euthanasia in the Netherlands, a man--Kees van Wendel de Joode--with amyotrophic lateral sclerosis (ALS, Lou Gehrig's disease) requests death in his home, to be performed by his doctor, Wilfred Sidney van Oijen. The film mostly consists of what appear to be unscripted discussions between Kees, his wife Antoinette, and the doctor; however, there are also interviews with the doctor and views of the doctor seeing other patients. The film shows the doctor performing euthanasia: we watch him inject a barbiturate and then a muscle relaxant and we see him supporting Antoinette during the bedside deathwatch.

Kees has had a rapid deterioration of his ability to function: he is unable to move his legs and right arm, he can no longer speak coherently, and he is having difficulty swallowing. His wife cares for him in their Amsterdam apartment. The film documents the legal requirements for euthanasia in the Netherlands: Kees's repeated requests for euthanasia, confirmation that he has an incurable disease, the second opinion doctor's visit, and reporting the death to the municipal coroner and public prosecutor.

The film's strength lies in the sensitive treatment of the impact of this request on the patient, his wife, and especially on his doctor. Dr. van Oijen is an introspective man who cares for his patients--he makes house calls, explains medical terms to his patients, touches his patients, and asks what they are concerned about. He allows his patients (Antoinette is, in many ways, his patient too) to weep and be emotional.

The religious and moral dimensions of euthanasia are explored mostly with the doctor, who does not view himself as a wanton killer, but rather a doctor whose duty includes the alleviation of suffering. The film concludes with a voice-over stating the doctor will not sleep this night, but still has a clinic full of patients awaiting him in the morning.

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Marcella

Ward, Mary Augusta (Mrs. Humphry)

Last Updated: Oct-21-2003
Annotated by:
Kennedy, Meegan

Primary Category: Literature / Fiction

Genre: Novel

Summary:

The headstrong beauty Marcella Boyce, who has acquired radical political views while at school, returns home and becomes engaged to Aldous Raeburn, the son of her father's neighbor Lord Maxwell and a moderately conservative politician and landowner. Marcella champions Jim Hurd, a local poacher accused of murder (who is prosecuted by Raeburn): she nurses his grieving wife and dying, consumptive son and arranges his legal representation by Edward Wharton, a Socialist politician and Raeburn's romantic rival.

After Hurd's execution, Marcella breaks off her engagement, trains as a nurse, and turns her reformist efforts toward the London poor instead of the rural poor in rural villages. She refuses Wharton's offer of marriage and finally accepts Raeburn's hand.

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Annotated by:
Martinez, Richard

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

In Rethinking Life and Death: The Collapse of Our Traditional Values, Peter Singer argues that "the traditional western ethic has collapsed" as we enter "a period of transition in our attitude to the sanctity of life" (pp. 1). The book begins with the tale of Trisha Marshall, a twenty-eight year old woman, who in 1993 was seventeen weeks pregnant when a gunshot to her head left her in an intensive care unit, her body warm, her heart beating, a respirator supporting her breathing. However, she was brain dead.

Her boyfriend and her parents wanted the hospital to do everything possible so that the baby would be born. The ethics committee of the hospital supported the decision. For the next 100 days, Trisha Marshall continued to be supported in the ICU until her baby was delivered by cesarean birth. After a blood test showed that the boyfriend was not the father, and after three weeks in the intensive care unit, the baby went to live with Marshall's parents.

Singer uses this introduction to pose the many ethical questions that are raised because of medicine's ability to keep a "brain dead" body warm for an extended period of time. "How should we treat someone whose brain is dead, but whose body is still warm and breathing? Is a fetus the kind of being whose life we should make great efforts to preserve? If so, should these efforts be made irrespective of their cost? Shall we just ignore the other lives that might be saved with the medical resources required?

Should efforts to preserve the fetus be made only when it is clear that the mother would have wanted this? Or when the (presumed?) father or other close relatives ask for the fetus to be saved? Or do we make these efforts because the fetus has a right to life which could only be overridden by the right of the pregnant woman to control her own body--and in this case there is no living pregnant woman whose rights override those of the fetus?" (pp. 17-18).

In the chapters that follow, Singer argues that whether western society will acknowledge it or not, we have, in our actions and decisions, moved to an ethic where "quality of life" distinctions trump "sanctity of life" positions. Yet, many continue to raise the "sanctity of life" position when it is clear that our legal and ethical positions in western society have embraced the "quality of life" stance. For Singer, this paradox results in an incoherent and illogical approach to the ethical challenges presented by modern medicine.

Throughout his book, Singer presents evidence for his argument through ethical and historical analysis of brain death, abortion, physician assisted suicide and euthanasia, organ donation, and the nature of persons. For those uncomfortable with Singer's position on "infanticide," this book allows one to follow Singer's argument and his recommendations in the last chapter for a coherent approach to these "quality of life" decisions.

He closes his book with the recommendation that a new ethic should embrace five new commandments to replace the old "sanctity of life" commandments. His commandments are: 1) Recognize that the worth of human life varies; 2) Take responsibility for the consequences of our decisions (in end of life care); 3) Respect a person's desire to live or die; 4) Bring children into the world only if they are wanted; and 5) Do not discriminate on the basis of species.

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