Showing 321 - 330 of 470 annotations tagged with the keyword "Medical Ethics"
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.
The framing story of this novel is simple: an elderly literary agent receives word that a person named Yvonne Bloomberg would like to meet with him. When he at last visits the woman, he discovers that she was an acquaintance from their youth--Yvonne Roberts--and she wishes to publish the journal that a mutual acquaintance, Dr. Simmonds, had bequeathed her. The agent agrees to read this journal, which provides most of the novel's text. A series of letters that appear in the last few pages indicate that, indeed, the journal is accepted for publication.
The journal recounts the first six months of 1950. Dr. Simmonds is an unmarried general practitioner nearing his 40th birthday. He has mixed feelings about his practice and his patients. For example, he likes Michael Butler, an irascible middle-aged man dying of cancer, but he dislikes many of his other patients, including Anton Bloomberg, a repulsive Jew with a "hooked nose," "too thick lips," and a "wheezing chest." (p. 25)
Bloomberg originally consults Simmonds about his young wife's frigidity; she simply will not perform her wifely duties. Simmonds himself is attracted to Bloomberg's beautiful young Yvonne, who mysteriously sends him a copy of a novel called Doctor Glas, published in 1905 by the Swedish author Hjalmar Soderberg [see annotation in this database]. Dr. Glas is the fictional journal of a doctor who treats Rev. Gregorius, a 57-year-old minister and his young wife. The wife complains that her husband's sexual advances are repulsive. From this point on, the story of Dr. Simmonds parallels in many ways that of Dr. Glas, a parallelism which Simmonds records in his journal and struggles to understand. Dr. Glas ultimately murders Rev. Gregorius.
Simmonds becomes obsessed with Yvonne Bloomberg and imagines that she is attracted to him. They interact in a variety of social settings, including a forum in which he suggests that he approves of euthanasia. She speaks to him of her husband's unwelcome advances. He considers killing her husband under the guise of treating his asthma, but shies away from taking that step. However, when Anton Bloomberg fails to respond to repeated injections of adrenalin during a severe asthmatic attack, Simmonds gives him morphine (which could kill him), then immediately relents and calls for an ambulance. Bloomberg recovers, but is permanently brain damaged.
Subsequently, Yvonne is free to spend the next 50 years living with her real lover (Hugh Fisher), and the two of them take care of her childlike husband. Simmonds, however, sinks into melancholy and several years later commits suicide.
Penny (Michele Hicks), working as a prostitute, is called to a room in a seedy hotel where she finds her client is a pair of adult conjoined twins, Blake and Francis Falls (played by identical but not conjoined twins, Mark and Michael Polish, who also co-wrote the screenplay). Shocked, she flees but later returns and, when she learns that one of the twins is ill, calls a doctor friend of hers to examine them. She cares for the twins and they become friends. At Halloween, "the only night of the year they [can pass for] normal," she takes them to a party and then back to her apartment where she and Blake almost make love while Francis, evidently the weaker twin, is sleeping.
She tells her lawyer/pimp about the twins, and he tries to persuade them to sell him their story (which he imagines in terms of separation: "The greatest divorce of all time: not who gets the kid but who gets the kidney . . . "). Offended by her betrayal, they return to their hotel room, and, apparently for the first time, the twins fight. Blake wants to get away from his brother.
The next morning Francis is ill once more, and the twins are hospitalized. Michele visits them and learns that they are dying. Francis's heart is becoming weaker, straining Blake's, and the only way to save Blake will be by separating them. Francis cannot survive separation. Penny tracks down their mother (Lesley Ann Warren), who gave them up for adoption at birth. She visits them in hospital. It emerges that Penny herself has a "retarded" child who is being raised by others. Francis's heart fails, and the twins are taken to the operating room.
Later, Penny tracks Blake down where he is now living alone in the trailer where the twins had lived before, as circus performers. The film ends with Blake, now a man with one arm and one functioning leg, telling Penny that the "story of me is over," but also that stories continue after sad endings. What makes an ending sad, he tells her, is the knowledge that the storyteller is continuing without you.
This thorough and fascinating treatment of the politics of anatomy studies in 19th-century America provides a variety of perspectives on the vexed question of how appropriately to study human anatomy while also maintaining respect for the human body and honoring the various, deeply held community beliefs, and attitudes toward treatment of the dead. Sappol seeks, as he puts it, to "complicate the cultural history of medicine in late-eighteenth- and nineteenth-century America. . . by telling it from an anatomical perspective."
That statement of his objectives hardly suggests the startling range of approaches to the topic he takes in the book's nine chapters. These cover such issues as the legacies of belief about the "personhood" of the dead human body; the status of anatomy as both a legitimate and valuable study and also as an "icon of science"; the relationship of dissection and anatomy study to medical status and professionalization; the political tensions engendered by the "traffic in dead bodies" that most often expropriated corpses from marginalized communities; and the relationship of anatomy studies to sexual commerce and sensationalist fiction.
This gripping narrative traces the history of the efforts to eradicate smallpox in the 1970s, the top-level decisions to keep a few vials of it for emergency purposes in American and Soviet freezers, and the reemergence of smallpox not only as a health threat, but as a potential bioweapon of unequaled destructive power. Preston details maverick natural cases that surfaced after worldwide eradication efforts, how it was discovered that undocumented reserves of smallpox were not only being kept, but researched and possibly "weaponized," and how hotly, in the US, teams of scientists and military intelligence personnel debated funding new smallpox research in the US with a view to developing a new vaccine as a defense.
The ethical issues in those debates are unprecedented in the scope of the possible public health threat and the variables that might make traditional vaccination ineffective against the weaponized virus. As in his previous books on biological threats, The Hot Zone and The Cobra Event (see annotation), Preston follows the work and lives of several key scientists and includes scenes from interviews with a variety of persons involved in confronting the political, ethical, and medical dilemmas posed by smallpox research and efforts to track and control it.
This masterful collection of essays was written by Gawande while he was a general surgery resident. The book consists of fourteen essays divided into three sections: Fallibility, Mystery, and Uncertainty. Although some of the essays fall clearly within the boundaries of the section title (such as "When Doctors Make Mistakes" and "When Good Doctors Go Bad" in the Fallibility section), others cross boundaries or don’t fall as squarely in these general themes ("Nine Thousand Surgeons," an anthropological essay on the cult and culture of a major surgical convention, is also located in the Fallibility section). Nevertheless, the many pleasures of the individual essays, the range of topics explored in depth, and the accuracy of the medicine portrayed are the true strengths of this work.
The book begins Dragnet-style with an Author’s Note: "The stories here are true." (p. 1) And it is this attention to fidelity that makes the essays so compelling. Because even when the truths are hard--the terrible acknowledgment by the medical neophyte about lack of skill and knowledge, the mistakes in judgment at all levels of doctoring, the nature of power relations and their effects on medical pedagogy and on the doctor-patient relationship, the gnawing uncertainties about so many medical decisions--the author confronts the issues head on with refreshing rigor, grace and honesty.
Many of the essays reference scientific and medical research (historical and current) as part of the exploration of the topic. This information is imbedded within the essay, hence avoiding a dry recitation of statistical evidence. Typically, the reader’s interest in an essay is immediately piqued by a story about a particular patient. For example, the story of an airway emergency in a trauma patient, her oxygen saturation decreasing by the second as Gawande and the emergency room attending struggle to secure an airway, surgical or otherwise, sets the scene for "When Doctors Make Mistakes."
This leads to a meditation on not only the culture of the Morbidity and Mortality Conference, with its strange mix of third-person case narrative and personal acceptance of responsibility by the attending physician (see Bosk, Charles, Forgive and Remember: Managing Medical Failure, U. Chicago Press, 1981 for an in depth analysis of this culture), but also a positive examination of the leadership role that anesthesiologists have played in improving patient safety via research, simulator training and systems improvement.
Gawande’s journalistic verve takes him beyond the confines of his own hospital and training to interview patients and physicians on topics as diverse as incapacitating blushing ("Crimson Tide"), chronic pain ("The Pain Perplex"), malpractice and incompetence ("When Good Doctors Go Bad") and herniorraphy ("The Computer and the Hernia Factory"). In addition, he visits his own post-operative patients at home ("The Man Who Couldn’t Stop Eating" and "The Case of the Red Leg") which gives a longer view of postoperative recovery and a broader exposure to patients’ perspectives.
Some of the most telling moments come with the introduction of his children’s medical problems into the text. These range from the relatively straightforward (a broken arm, but a chance to comment on detection of child abuse in the emergency room) to the downright parental nightmare scary (severe congenital cardiac defect in their oldest child and a life-threatening respiratory infection in their prematurely born youngest).
These last two experiences are introduced to provide an angle on issues of choice. Choice of a fully trained, attending physician rather than a fellow to provide follow-up cardiac care for their oldest, and the choice to opt out of the decision-making process for whether to intubate the trachea of the youngest and hence leave the medical decisions up to the care team.
An anthology of poetry and prose by doctors, nurses, patients, and other authors, A Life in Medicine is divided into four sections: "Physicians Must Be Altruistic"; "Physicians Must Be Knowledgeable"; "Physicians Must Be Skillful"; and "Physicians Must Be Dutiful." Each section begins with the Association of American Medical Colleges' (AAMC) definition of the physician trait examined in that section, and short "explications" precede each individual poem and prose piece, linking them to the section's overall theme.
The anthology has a preface outlining the editors' goals and Robert Coles's introduction, "The Moral Education of Medical Students." These organizational touches make the anthology a classroom-ready text for medical students. The anthology's poems and prose--many of which are stunning--were taken from previously published works and exclude many well-known and often-used pieces. But those selections are readily available elsewhere, and the editors do readers a greater service by introducing many lesser-known, but equally important, poems and essays.
A lonely neurosurgical resident becomes involved with a comatose patient. Susan, a dying woman with an inoperable brain tumor, is the subject of a research study. Scientists are attempting to discern her thoughts with the aid of computers. The resident serendipitously stumbles onto a program that successfully translates the electrical activity of Susan's brain into speech. He labels the computer program a failure (but saves a copy for himself) so that others are unable to eavesdrop on her dreams.
He spends nights listening to her thoughts and soon begins communicating with Susan, sharing his own secrets with her. When the resident learns that the research project is about to be terminated, he decides that Susan is in desperate need of human contact. He kisses her and presumably has sexual intercourse with the comatose woman. The next morning he is found asleep beside her and is dismissed from the hospital.
A corporate narrator ("We here at Progressive Health") thanks the poem's addressee (presumably the poet) for "being one of the generous few who've promised / To bequeath your vital organs to whoever needs them." However, the narrator goes on to point out that there is another, even more generous, step he could take, by "acting a little sooner than you expected." In fact, why not turn tomorrow morning's routine physical examination, which wouldn't ordinarily benefit anyone except the poet himself, into a splendid opportunity to save six lives?
Yes, indeed, at this very moment there are six persons whose lives are hanging by a thread in the ICU, and the poet is a good tissue match for every one of them. If he would agree to have his liver, spleen, lungs and kidneys removed, and transplanted into these patients, he would save six lives.
Of course, the poet would die, but look at the situation from a cost-benefit analysis: The poet, who is "an aging bachelor," has perhaps 20 more years of life left in him and the poems he might yet write--even assuming they are better than those he has thus far written--are not going to "raise one Lazarus from a grave / Metaphoric or literal." On the other hand, the six potential beneficiaries have a multiplier effect because of their husbands and wives, parents and children.
The great gratitude of so many people will mean that the poet will be remembered after death--"Summer and winter they'll visit your grave, in shifts, / For as long as they live, and stoop to tend it, / And leave it adorned with flowers . . ."
Alternatively, if he chooses selfishly to refuse, and to grow old and die, his friends will likely forget him after death; and, moreover, his conscience will probably be stricken by having failed to respond to these patients' needs. The poem concludes, "You could be a god, one of the few gods / Who, when called on, really listens?" [48 lines]
Set in contemporary Boston, this medical thriller not only gets the reader's blood moving, but also raises some important ethical questions: How do corporate interests influence the judgment and character of physician researchers? To what length should older persons go to slow down the aging process? How does one's lifework of health care fit in with obligations to one's family?