Showing 331 - 340 of 476 annotations tagged with the keyword "Medical Ethics"

Demon in the Freezer

Preston, Richard

Last Updated: May-10-2003
Annotated by:
McEntyre, Marilyn

Primary Category: Literature / Nonfiction

Genre: Investigative Journalism

Summary:

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.

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Annotated by:
Shafer, Audrey

Primary Category: Literature / Nonfiction

Genre: Collection (Essays)

Summary:

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.

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Annotated by:
Davis, Cortney

Primary Category: Literature / Literature

Genre: Anthology (Mixed Genres)

Summary:

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.

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Heart of the Land

Gray, Andrew

Last Updated: Jan-28-2003
Annotated by:
Miksanek, Tony

Primary Category: Literature / Fiction

Genre: Short Story

Summary:

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.

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Progressive Health

Dennis, Carl

Last Updated: Jan-22-2003
Annotated by:
Coulehan, Jack

Primary Category: Literature / Poetry

Genre: Poem

Summary:

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]

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Life Support

Gerritsen, Tess

Last Updated: Jan-13-2003
Annotated by:
Kohn, Martin

Primary Category: Literature / Fiction

Genre: Novel

Summary:

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?

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The Case of Dr. Sachs

Winckler, Martin

Last Updated: Nov-27-2002
Annotated by:
Coulehan, Jack

Primary Category: Literature / Fiction

Genre: Novel

Summary:

At the heart of this novel is a simple love story. Dr. Bruno Sachs, a slight, stooped, and somewhat unkempt general practitioner in a French village is dedicated to his work and loved by his patients. Sachs is a solitary, self-effacing man who takes his Hippocratic duties seriously and is especially sensitive to the needs of his patients.

In addition to his private practice, Sachs works part-time at an abortion clinic, where he performs an abortion on a distraught young woman named Pauline Kasser. Soon the doctor and his patient fall in love. She moves in with him and becomes pregnant. An editor by profession, Pauline also encourages and assists Dr. Sachs in completing the book he is writing.

The story has many additional layers and dimensions. The reader views Sachs through the eyes of multiple narrators--his patients, colleagues, friends and acquaintances, all of whom write in the first person and present Bruno Sachs as "you" or "he." Thus, the reader gradually builds up a "connection" (empathy) with Sachs by synthesizing multiple glimpses of his behavior and facets of his character. At the same time, Sachs is trying to find his own voice, his own connection, by becoming a writer. At first he jots down random thoughts, then he keeps a notebook, and eventually he produces a complete manuscript.

The book has innovative structural elements that introduce other layers of meaning. For example, the 112 short chapters are organized into seven sections, corresponding with the components of a complete clinical case history: presentation (as in "chief complaint"), history, clinical examination, further investigations, diagnosis, treatment, and prognosis. Similarly, the narratives delve progressively into Sachs' "illness" and follow the "patient" through his course of "treatment."

Another structural element is the cycle of fertility and gestation. The story takes place from September through June, precisely 40 weeks, a pregnancy of nine months, during which Sachs is re-born.

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Annotated by:
Kohn, Martin

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

Set in post- World War II Vienna, this movie is "a portrait of postwar corruption and the death of idealism" (Michael Wilmington, in the DVD insert). Holly Martins (Joseph Cotton) comes to Vienna at the request of his old friend Harry Lime (Orson Welles). He arrives to find that Harry has been killed in a questionable automobile accident. A police inspector (Trevor Howard) informs Holly that his friend Harry had been involved in racketeering and maybe deserved to die.

Trying to clear the name of his friend, Holly discovers the depth of his friend's evilness--Harry was not a petty thief; he was involved in stealing penicillin from military bases and then selling diluted (and thus ineffective) doses to hospitals. The police inspector convinces Holly to turn on his friend (Harry was not the victim of the automobile accident--another of his cruel deeds!) who is finally killed by Holly in the sewers of Vienna. Of course there is Harry's girlfriend (Alida Valli) who rebuffs Holly and remains true till the end to Harry.

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Summary:

This collection is a wide-ranging view of physician poets writing not only about their professional roles, but about themselves and those around them as human beings. The anthology came about as a tribute to one of its major contributors, poet-physician Rita Iovino who spent many years of her life working with other physician writers and their creative natures.

All of the 29 contributors are physicians and the range of subject matter is broad. The collection is divided into subject matter clusters: Of Medical Matters; Of Love Matters; Of Family Matters; Of Natural Matters; Of Life and Death Matters; Of Philosophical Matters; Of Holy Matters; and two prose essays on the role of poetry in the lives of physicians.

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Year of Wonders

Brooks, Geraldine

Last Updated: Aug-20-2002
Annotated by:
McEntyre, Marilyn

Primary Category: Literature / Fiction

Genre: Novel

Summary:

The narrator of this historical novel, Anna Frith, works as a servant in the household of the local minister. The story recounts the horrific events in a plague-ridden village of 17th-century England. Anna, having lost her young husband in a mining accident, loses both her sons to the plague, as well as a boarder in her household who seems to have been the first case in the village.

After these losses, she stays her grief by tending the sick in many families. Particularly after the village works out terms of quarantine with the earl, no help but food and supplies comes in from outside. She learns much from the local herbalists, two midwives whose work she carries on after their violent deaths. In this work she develops a close partnership with the pastor's wife.

The story takes us through the whole trajectory of loss, accusations, spiritual struggle, shared grief, creative adaptations, and eventually emergence from sickness and quarantine. Anna's own journey takes some surprising turns as her confidence and clarity about her own mission grow and deepen.

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