In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 10.2 (2000) 175-188 [Access article in PDF] Scope Note 38 Bioethics Resources on the Web * Once described as an "enormous used book store with volumes stacked on shelves and tables and overflowing onto the floor" (Pool, Robert. 1994. Turning an Info-Glut into a Library. Science 266 (7 October): 20-22, p. 20), Internet resources now receive numerous levels of organization, from basic directory listings (...) to elaborate "links" (cross-references to other Internet documents) that flash and glow in the dark. In many ways, the Internet functions as a direct extension of the traditional library. Following linked references across various sites is an electronic version of browsing library stacks, and the serendipitous discoveries made while "surfing the Net" recall the wonders of physically going "book-to-book." Although many of the Internet's best aspects augment library strengths by eliminating physical distance from sources, Net resources pose unique problems for researchers. It is not always clear who is responsible for the content of Web documents, when the document was produced, or how often (if ever) it is updated. Internet resource tools, then, must enable researchers to identify appropriate resources and to evaluate what they find when they get there. Web Research as Taking "Snapshots" Given the Internet's visual nature and fluid content, the process of conducting research on the Web has been likened to taking an informal picture of information on a specific date at a particular time. This metaphor also conveys the "zoom-in" aspect of searching through Web pages by going from general to specific categories. In the first section of this Scope Note, National Reference Center for Bioethics Literature (NRCBL) staff present a snapshot of bioethics resources taken during the spring months of 2000. Entries are divided into the categories of directories, electronic journals, full-text documents, news/current awareness, and teaching resources. In the two subsequent sections, this series of categories is repeated for entries on a specific topic within bioethics-genetics-and again for general search and evaluation tools. Where a Web site may contain pages applicable [End Page 175] to more than one category, multiple entries are made for that site with appropriate information for each category.Much as telecommunication advances have strengthened the relationship of patients and providers as partners, the dynamic nature of the Internet acknowledges that the researcher functions as a librarian whenever accessing the Web. It is our hope that BIOETHICSLINE and the other NRCBL databases not only will enable researchers to search the Web more efficiently, but also will help them to evaluate what they find when they get there. Bioethicsline on the Web: An International Plan in Progress Once only available through libraries, the U.S. National Library of Medicine (NLM), the funding agency for the ongoing development of the BIOETHICS LINE® database from the Kennedy Institute, has provided free Web access to that database of 63,000 citations since September 1998 through Internet Grateful Med. Plans are now underway to eliminate such specialty databases and incorporate all citations into PubMed (for journal articles) or LOCATORplus (for book-like materials and chapters in books). Both of these databases are likewise available at no cost on the Web. In the transition to PubMed and LOCATORplus some features of BIOETHICSLINE that presently are available may be lost. Researchers are encouraged to contact the National Reference Center for Bioethics Literature with search requests or for search strategy assistance with either the current or the future system ([email protected]).The inclusion of bioethics citations in PubMed and LOCATORplus will have several advantages. First, unique keywords from the Bioethics Thesaurus will be considered for inclusion in Medical Subject Headings (MeSH), the indexing vocabulary for PubMed and LOCATORplus, thereby enhancing retrieval of relevant clinical literature by offering more precise terminology covering ethical issues. Second, it will be easier to identify foreign-language materials, which are not currently included in the scope of BIOETHICSLINE. Third, the updating schedule will become more frequent. On the other hand, there may be some loss of searching precision because certain specialized features... (shrink)

The volume examines the interrelationships between the history of medicine and literature from the 17th until the 19th centuries. The papers in the volume analyse these interrelationships using the styles of medical and literary texts, which show how the dimensions of knowledge and of representation determine each other – for example in the case of narrative structures in medical case histories or a diagnostic narrative stance in a novel.

There are various ways in which medicine and literature interact, but this paper concentrates on the contribution which literature can make to 'whole person understanding'. Scientific understanding is concerned with seeing events and actions in terms of patterns or similarities. But 'whole person understanding' is concerned with uniqueness or with what it is for a given person to have an illness. Literature can in various ways develop this kind of understanding.

In this essay, I look back at some of the earliest attempts by the first generation of literature-and-medicine scholars to answer the question: Why teach literature and medicine? Reviewing the development of the field in its early years, I examine statements by practitioners to see whether their answers have held up over time and to consider how the rationales they articulated have expanded or changed in the following years and why. Greater emphasis on literary criticism, narrative (...) ethics, narrative theory, and reflective writing has influenced current work in the field in ways that could not have been foreseen in the 1970s. The extraordinary growth of interest and work in the field nationally and, especially since 1996, internationally has included practitioners in many additional areas such as disability studies, film studies, therapeutic writing, and trauma studies. Along with the emergence of narrative medicine, this diverse community of scholars and practitioners—affiliated more through their use of narrative methodologies than the teaching of literature—makes the perennial challenge of evaluation and assessment even more complicated. (shrink)

Mark Geller is well known to everyone in his field and, unsurprisingly, his Festschrift is a bulging volume of contributions—from thirty-four scholars in a variety of different specialties. Like most Festschriften, it is of uneven quality, but there are some very fine articles, including useful text editions and offerings that raise interesting scholarly questions. Although there is nothing here on economics, there are articles that engage historical and/or anthropological questions, exegetical issues, and matters of composition of literary texts, including one (...) offering on Akkadian grammar. None of these would be expected from a volume entitled Mesopotamian Medicine and Magic, but their presence is a testimony to the very broad interests of the honoree. (shrink)

In recent years, personalized medicine (PM) has become a highly regarded line of development in medicine. Yet, it is still a relatively new field. As a consequence, the discussion of its future developments, in particular of its ethical implications, in most cases can only be anticipative. Such anticipative discussions, however, pose several challenges. Nevertheless, they play a crucial role for shaping PM’s further developments. Therefore, it is vital to understand how the ethical discourse on PM is conducted, i.e. (...) on what – empirical and normative – assumptions ethical arguments are based regarding PM’s current and future developments. (shrink)

Purpose: This review identifies the prominent topics in the literature pertaining to the ethical, legal, and social issues raised by research investigating personalized genomic medicine. Methods: The abstracts of 953 articles extracted from scholarly databases and published during a 5-year period were reviewed. A total of 299 articles met our research criteria and were organized thematically to assess the representation of ELSI issues for stakeholders, health specialties, journals, and empirical studies. Results: ELSI analyses were published in both scientific (...) and ethics journals. Investigational research comprised 45% of the literature reviewed and the remaining 55% comprised normative analyses. Traditional ELSI concerns dominated the discourse including discussions about disclosure of research results. In fact, there was a dramatic increase in the number of articles focused on the disclosure of research results and incidental findings to research participants. Few papers focused on particular disorders, the use of racial categories in research, international communities, or special populations. Conclusion: Considering that strategies in personalized medicine increasingly target individuals’ unique health conditions, environments, and ancestries, further analysis is needed on how ELSI scholarship can better serve the increasingly global, interdisciplinary, and diverse PGM research community. (shrink)

Three years' experience in teaching a course in Literature and Medicine is reviewed. Examples of the Laboratory or in vitro functions of art are given, as they relate to and benefit both medical students and practitioners. The usefulness of literature (especially) in the medical setting is underscored, together with the need for medical personnel to be more aware of their heritage in this area. Examples of well-known physicians who have excelled in the arts (literature, music, painting/sculpture) (...) are given and their major contributions discussed. There are some surprises. (shrink)

Research and writing at the intersection of faith and medicine by now include thousands of published studies, review articles, books, chapters, and essays. Yet this emerging field has been described, from within, as disheveled on account of imprecision and lack of careful attention to conceptual and theoretical concerns. An important source of confusion is the fact that scholarship in this field constitutes two distinct literatures, or rather meta-literatures, which can be termed faith as a problematic for medicine and (...) medicine as a problematic for faith. These categories represent distinct theoretical lenses for viewing the intersection of faith and medicine. Observations about these two approaches are offered, along with insights about why the discourse on faith and medicine should become better integrated into discussions of religion and science. (shrink)

This essay originated from a re-reading of Umberto Eco's Six Walks in the Fictional Woods (1994) and from discussions of Charles Darwin's illnesses. The question of historical truth arises whenever we seek to validate a scientific analysis of a fictional incident. Whereas Darwin may actually have suffered from several health conditions, Robinson Crusoe's illness is the product of Daniel Defoe's imagination. But the search for a medical diagnosis must follow the same methods in both cases. After eight months as sole (...) inhabitant of his island, Crusoe is taken ill. A detailed description of the symptoms is duly registered in his diary, along with his attempts at finding its possible nature and origin. The island, according to Crusoe, lies in the tropical waters of the Caribbean Sea, not far from the coast of Venezuela. From the standpoint of medical geography, his illness is a tropical disease that was prevalent in South and Central America in the seventeenth century. Five possible diseases are suggested and discussed. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Laying Medicine Open: Innovative Interaction Between Medicine and the HumanitiesLaurence B. McCullough and Warren Thomas ReichThe past three decades have witnessed the emergence and remarkable success of the fields of bioethics and medical humanities. The intellectual landscape of medicine and that of the humanities have been remarkably altered in the process. Twenty-five to 30 years ago in the United States there existed but a few courses (...) in what came to be called “bioethics” in departments of philosophy, religious studies, and theology in colleges and universities, a handful of programs of teaching in medical schools such as the University of Texas Medical Branch at Galveston and Pennsylvania State University School of Medicine at Hershey, and but one independent research center (the Hastings Center) and one university-based research center (the Kennedy Institute of Ethics at Georgetown University). Articles on bioethics began to appear in the peer-reviewed medical, nursing, and humanities literature and some books were published. There was only one journal in bioethics, The Hastings Center Report (which consolidated two previously separate journals from the Hastings Center). Graduate programs in bioethics and medical humanities in colleges and universities and fellowship training in bioethics and medical humanities in medical schools did not exist. Very little existed in colleges, universities, and medical schools in other countries. Now, of course, everything is different.Teachers, scholars, and students of bioethics and medical humanities should not take these remarkable changes for granted, for they represent a sustained and innovative interaction between medicine and the humanities. We have chosen the metaphor of “laying medicine open” to characterize the history of bioethics and medical humanities of the past three decades. This surgical metaphor was used in eighteenth-century Britain by a number of writers who wanted to make medical science and practice more accessible to the sick and to the lay public more generally (Lawrence 1975). We use the metaphor to characterize the efforts of teachers and [End Page 1] scholars over the past three decades and more to make the value-laden dimensions of biomedical science and practice and of health care policy more accessible to patients and to the lay public more generally. The result of this laying open of medicine has gone a long way toward bringing closer together the two cultures of science and the humanities that had, as C. P. Snow famously described, become significantly isolated from each otherAlbert Jonsen (1998) has recently contributed the first book-length history of what he calls the “birth” of bioethics, adding to the work of other scholars such as Warren Reich (1994; 1995) and Robert Baker (1993) and, before them, Corrado Viafora (1990) and David Rothman (1991). The articles in this issue of the Kennedy Institute of Ethics Journal make additional contributions to the developing understanding of the history of the past thirty years of interaction between medicine and the humanities.Laurence McCullough provides an historical context for the three accounts of the recent laying open of medicine that follow. McCullough examines two times in the history of medicine when it has been laid open to accountability (in addition to its being laid open to and by bioethics and medical humanities). The first laying open occurred in the work of the eighteenth-century Scottish physician and philosopher John Gregory, who set out to create a profession of medicine in a true moral sense of a fiduciary profession by making medicine accountable for its scientific and moral quality. The second occurred in the late twentieth century in which the managed practice of medicine in general, and managed care in particular, have begun to lay medicine open to accountability for its scientific and moral quality, as well as its cost and, at least in the public sector, its accessibility. McCullough argues that, just as Gregory responded to the ethical challenges of medicine laid open more than two centuries ago, bioethics should respond to the ethical challenges in the current laying open of medicine.Warren Reich provides an account of André Hellegers, whose premature death left an enormous gap in the field that will never be filled. Reich claims that Hellegers was engaged substantially in much more than the laying open of medicine: he... (shrink)

How did physicians come to dominate the medical profession? Lyn Bennett challenges the seemingly self-evident belief that scientific competence accounts for physicians' dominance. Instead, she argues that the whole enterprise of learned medicine was, in large measure, facilitated by an intensely classical education that included extensive training in rhetoric, and that this rhetorical training is ultimately responsible for the achievement of professional dominance. Bennett examines previously unexplored connections among writers and genres as well as competing livelihoods and classes. Engaging (...) the histories of rhetoric, medicine, literature, and culture throughout, she goes on to focus specifically on the work of women who professed as well as practiced medicine. Pointing to some of the ways women's writing shapes realities of body, mind, and spirit as it negotiates social, cultural, and professional ideologies of gender, this book offers an important corrective to some long-held beliefs about women's role in early modern discourse. (shrink)

The best studies on the relationship between pharmaceutical corporations and medicine have recognized that it is an ambiguous one. Yet most scholarship has pursued a simpler, more saleable narrative in which pharma is a scheming villain and medicine its maidenly victim. In this article, I argue that such crude moral framing blunts understanding of the murky realities of medicine's relationship with pharma and, in consequence, holds back reform. My goal is to put matters right in respect to (...) one critical area of scholarly interest, the medical journal publication.Pharma relies on peer advocacy to sell its wares to prescribing doctors. This is an arrangement in which clinicians’ qualified colleagues, including “key opinion leaders,” are recruited by pharmaceutical corporations and marketing agencies to deliver commercially expedient content to their professional fellows. Precisely how this practice works in the setting of publications is not well understood because ethicists studying the problem have made too much of the narrative of corporate villainy and medical victimhood. Accordingly, criticism of industry publications has been preoccupied with the crudely dishonest practices of ghostwriting, ghost authorship, and “ghost management,” vices condemned as “dirty little secrets” perpetrated from “behind the scenes” with the connivance of academic “shills” or “guest authors,” in contempt of standards set by the International Committee of Medical Journal Editors. This account is appealing, and yet it is wrong or, at the very least, seriously incomplete, with only limited relevance to the actualities of contemporary industry practices. In truth, many commercial publications are not developed in secret but fashioned within a culture of open collaboration, where academic authors make substantial, independent contributions; pharmaceutical companies are showcased rather than hidden; and medicine's editorial standards assist rather than impede the workings of commerce. (shrink)

Debates about how knowledge is made and valued in evidence-based medicine (EBM) have yet to understand what discursive, social, and historical conditions allowed the EBM approach to stabilize and proliferate across western medical education. This paper uses a genealogical approach to examine the epistemological tensions that emerged as a result of various problematizations of uncertainty in medical practice. I explain how the problematization of uncertainty in the literature and the contingency of specific social, political, economic, and historical relations (...) allowed the EBM approach to become a programmatic and pedagogical focus of the Faculty of Medicine at McMaster University and beyond. (shrink)

Archetypal medicine and past life therapy have received only scant attention in mainstream medical and psychological literature. Nonetheless, the epistemological and practice assumptions underlying Alfred Ziegler's model of archetypal medicine are highly congruent with those of past life therapy and both proffer salient alternatives to traditional reductionistic practice in psychotherapy and medicine. This paper explores the manner in which both seek to understand the meanings embedded in "health" and "illness" through a metaphorical interpretation of symptoms. Dualistic (...) thinking gives way to unitary consciousness as we begin to understand symptomatology in the larger scheme of a human being's entire lived experience. The transcendent, psychospiritual work of past life therapy is viewed in integrated partnership with archetypal medicine in healing the whole person rather than merely assessing symptoms in isolation and remediating them through mechanistic techniques and external applications of treatments. (shrink)

Books have their origins in conversations and seek to extend and expand those conversations over time and with different audiences. The conversations that have culminated in this book were initially stimulated through a research project at The Hastings Center on the role of religious voices in the professional fields of bioethical inquiry. Those professional conversations have continued throughout my academic career as a member of various institutional ethics committees, organizational ethics task forces, and in local, state, and national public policy (...) settings. The professional context of bioethics conversations can sometimes miss the richness of conversations that occur in the classroom and with various communities, including family members, friends, and religious and civic communities. These conversations provide an experiential depth, a groundedness in the lives and stories of persons, which augments and corrects the professionalized perspectives. I have been particularly fortunate and appreciative of opportunities to bridge the academic and professional with the personalized and communal through conversations about the ethical commitments and moral culture cultivated by The Church of Jesus Christ of Latter-day Saints (LDS or Mormon). I was invited to develop an overview essay on "Bioethics in Mormonism" for the professional reference work, Encyclopedia of Bioethics (3rd ed., 2004), and some years later received my first invitation to make a presentation on "LDS Ethics" in an academic setting at the University of Virginia. This book is the outgrowth of these many conversations and seeks to advance my communal bridging. My aim in this book is to begin bridging these various intersections between the LDS religious community and its moral culture, the professional fields of bioethics, and practical decision-making. This work seeks to be a catalyst for expanding discourse within the interdisciplinary field of Mormon studies to include ethics and bioethics. Ethics has not been a well-developed area in Mormon studies, in contrast to studies in LDS history, theology, or literature. To remedy this oversight, I present a substantive interpretation of the sources, theological background, and moral principles of LDS ethics. The historical narratives and conceptual intertwining I offer of both bioethics and of LDS moral culture is intended to complement and expand the realm of Mormon studies. A further objective is to create opportunities for reciprocal dialogues between the bioethics community and LDS scholarship. This conversation has yet to occur within academic disciplines, professional communities, or in public policy deliberations. My exposition, analysis, and critiques will intertwine and contextualize LDS moral values and health care practices within the ethical inquiry undertaken in the broader professional scholarship of bioethics. My arguments will disclose some points of common ground as well as areas of divergence towards the end of establishing the LDS faith tradition as a community of moral discourse for the bioethics field and the healing professions (medicine, nursing, pharmacy, etc.) it informs. My claim is that given its emerging cultural prominence, LDS ethical scholarship should engage in bioethical literacy and bioethics should be LDS-literate. I am also engaged in an effort to initiate more reflective dialogues regarding LDS ethics and moral culture among LDS scholars, LDS health care professionals, and the interested general LDS reader. The focus of the book on the interrelationship of religion, ethics, medicine, and health care should present for these various audiences new opportunities for mindful reflection and creative scholarship on the ethical implications of faith commitments, the responsibilities of the healing professions, and religious dimensions of public policy and public bioethics. A religious community that is formed through narratives and practices of covenantal commitments of love of neighbor needs to have a robust discourse about its ethical character. I have understood my scholarship in biomedical ethics and in religious ethics through a linking metaphor of my moral culture, of medicine, and the law, of bearing witness. The witness offers moral realities, moral truths about the way things are, vocalizes and embodies moral experience, and prophetically critiques the hypocrisies of the powerful and their oppression of the vulnerable by offering a new story, a re-storying, of tradition and conventional practice. (shrink)

While medicine is solidly grounded on scientific areas such as biology and chemistry, some argue that it is in its essence not a science at all. With medicine playing a substantial societal role, addressing questions about the scientific nature of medicine is of obvious urgency. This paper takes on such a task and starts by consulting the literature on the “demarcation” problem in the philosophy of science. Learning from failures of earlier approaches, it proposes that we (...) adopt a Deflated Approach, which acknowledges that “science” is a family resemblance concept that admits differences of degrees to nonscientific undertakings. Then, drawing on Paul Hoyningen-Huene’s ; account of systematicity and Alexander Bird’s analysis of examples from the history of medicine, the paper argues that medicine meets the requirement for systematicity on all dimensions and thereby qualifies as a science. The paper then considers and defuses two objections. First, it is shown that nonepistemic differences linked to the distinctive duality of medicine do not warrant thinking that medicine is not science. Second, against some recent criticism, the paper uses homeopathy as an example to show that systematicity can succeed as a demarcation criterion. (shrink)

Our present day knowledge in the area of medicine in Ancient Egypt has been severally sourced from medical papyri several of which have been deduced and analyzed by different scholars. For educational purposes it is always imperative to consult different literature or sources in the teaching of ancient Egypt and medicine in particular. To avoid subjectivity the author has found the need to re-engage the efforts made by several scholars in adducing evidences from medical papyri. In the (...) quest to re-engage the efforts of earlier writers and commentaries on the medical papyri, we are afforded the opportunity to be informed about the need to ask further questions to enable us to construct or reconstruct both past and modern views on ancient Egyptian medical knowledge. It is this vocation the author sought to pursue in the interim, through a preliminary review, to highlight, comment and reinvigorate in the reader or researcher the need for a continuous engagement of some pertinent documentary sources on Ancient Egyptian medical knowledge for educational and research purposes. The study is based on qualitative review of published literature. The selection of those articles as sources was based on the focus of the review, in order to purposively select and comment on articles that were published based either on information from a medical papyrus or focused on medical specialization among the ancient Egyptians as well as ancient Egyptian knowledge on diseases and medicine. It was found that the Egyptians developed relatively sophisticated medical practices covering significant medical fields such as herbal medicine, gynecology and obstetrics, anatomy and physiology, mummification and even the preliminary form of surgery. These practices, perhaps, were developed as remedies for the prevailing diseases and the accidents that might have occurred during the construction of their giant pyramids. It must be stated that they were not without flaws. Also, the key issues raised from these literatures are but a few among the Egyptian medical corpus across the academic and publishing world. It should therefore afford researchers, students and readers the opportunity to continue the educational dialogue on the medical practices of the Ancient Egyptians. (shrink)

The idea of personalised medicine (PM) has gathered momentum recently, attracting funding and generating hopes as well as scepticism. As PM gives rise to differing interpretations, there have been several attempts to clarify the concept. In an influential paper published in this journal, Schleidgen and colleagues have proposed a precise and narrow definition of PM on the basis of a systematic literature review. Given that their conclusion is at odds with those of other recent attempts to understand PM, (...) we consider whether their systematic review gives them an edge over competing interpretations. We have found some methodological weaknesses and questionable assumptions in Schleidgen and colleagues’ attempt to provide a more specific definition of PM. Our perplexities concern the lack of criteria for assessing the epistemic strength of the definitions that they consider, as well as the logical principles used to extract a more precise definition, the narrowness of the pool from which they have drawn their empirical data, and finally their overlooking the fact that definitions depend on the context of use. We are also worried that their ethical assumption that only patients’ interests are legitimate is too simplistic and drives all other stakeholders’ interests—including those that are justifiable—underground, thus compromising any hope of a transparent and fair negotiation among a plurality of actors and interests. As an alternative to the shortcomings of attempting a semantic disciplining of the concept we propose a pragmatic approach. Rather than considering PM to be a scientific concept in need of precise demarcation, we look at it as an open and negotiable concept used in a variety of contexts including at the level of orienting research goals and policy objectives. We believe that since PM is still more an ideal than an achieved reality, a plurality of visions is to be expected and we need to pay attention to the people, reasons and interests behind these alternative conceptions. In other words, the logic and politics of PM cannot be disentangled and disagreements need to be tackled addressing the normative and strategic conflicts behind them. (shrink)

The purpose of this article is to present a normative theory of the goals of medicine (a theory that tells us in what respects medicine should benefit the patient) that is both comprehensive and unified. A review of the relevant literature suggests that there are at least seven plausible goals that are irreducible to each other, namely to promote functioning, to maintain or restore normal structure and function, to promote quality of life, to save and prolong life, (...) to help the patient to cope well with her condition, to improve the external conditions under which people live, and to promote the growth and development of children. However, it seems that all these goals need to be qualified in different ways, e.g. it does not seem reasonable to improve physiological function or functional ability unless this is expected to have positive effects on quality of life and/or length of life, or to improve the quality of life in any respect, or by any means. These qualifications all suggest that the proposed goals are, as goals, conceptually, and not just causally, related to one another, and that they should therefore not be regarded in isolation. Instead, we should think of the medical enterprise as having a multidimensional goal structure rather than a single goal. In order to depict clearly how the different goals are related to one another, a multidimensional model is constructed. (shrink)

This book provides a systematic analysis of the ethical implications of traditional and complementary medicine, focusing on pragmatic solutions. The author uses a bioethical methodology called the “Ethical Matrix,” to consider the impact of T&CM use for animals and the environment as well as for humans. A systematic search of the literature reveals that most published ethical concerns are related to the safety of T&CM use for humans. However, application of the Ethical Matrix demonstrates that the ethical implications (...) for T&CM use are much broader. In this book, the author analyses the most serious implications, including adverse events related to homeopathy, the use of animals in T&CM products, and the impact of herbal medicine on the environment. Comparisons with the ethical implications of conventional biomedicine help readers to contextualise debate, and highlight aspects that may be unique to T&CM. Globally, many high-level health policy makers promote T&CM as an accessible and affordable healthcare option. However, their use is considered by some to be a waste of resources, unscientific, and unethical. Offering a frank analysis of this largely ignored field of healthcare ethics, this book is both timely and essential. It helps patients, policy makers, practitioners, researchers, and students gain the knowledge they need to make more informed decisions. (shrink)

Dr Kottow in his paper Classical medicine v alternative medical practices (1) places the alternative/orthodox medicine debate within an historical context of anti-quackery literature. My paper explores the nature of science as it is applied to clinical practice and challenges the narrow view of the diagnostic process as outlined by Dr Kottow. Research methodologies more appropriate to 'whole person' medicine are suggested as having more ethical value than those based on the clinical trial.

Recently, dramatic price increases by several pharmaceutical companies have provoked public outrage. These scandals raise questions both about how pharmaceutical firms should be regulated and about how pharmaceutical executives ethically ought to make pricing decisions when drug prices are largely unregulated. Though there is an extensive literature on the regulatory question, the ethical question has been largely unexplored. This article defends a Kantian approach to the ethics of pharmaceutical pricing in an unregulated market. To the extent possible, pharmaceutical companies (...) must price drugs so that those who genuinely need them can get them without financial ruin. This requirement is an ethical side constraint, like the moral prohibitions on deception and theft, that takes precedence over a business’s interest in maximizing profit. That said, the requirement’s application is sensitive to the need to recoup the costs of research and to produce a return that financially justifies the original investment. It may not be either feasible or desirable for government to attempt to enforce the ethical requirements concerning just pharmaceutical pricing. Either price regulation or subsidy could fulfill government’s obligation to protect patients from being objectionably vulnerable to pricing decisions by private companies. (shrink)

Literatures of Madness: Disability Studies and Mental Health brings together scholars working in disability studies, mad studies, feminist theory, Indigenous studies, postcolonial theory, Jewish literature, queer studies, American studies, trauma studies, and comics to create an intersectional community of scholarship in literary disability studies of mental health. The collection contains essays on canonical authors and lesser known and sometimes forgotten writers, including Sylvia Plath, Louisa May Alcott, Hannah Weiner, Mary Jane Ward, Michelle Cliff, Lee Maracle, Joanne Greenberg, Ann Bannon, (...) Jerry Pinto, Persimmon Blackridge, and others. The volume addresses the under-representation of madness and psychiatric disability in the field of disability studies, which traditionally focuses on physical disability, and explores the controversies and the common ground among disability studies, anti-psychiatric discourses, mad studies, graphic medicine, and health/medical humanities. (shrink)

This chapter contains sections titled: The Rise of Nanomedicine Diagnostics and Medical Records Treatment Moving Forward.

This article examines various meanings of solitude in eighteenth-century Europe, with emphasis on French thought and culture. Part 1 is a survey of literary representations of solitude and contemplation. Part II is devoted to the Jansenist convulsionnaires, Catholic dissidents who took part in a larger appeal against the repressive Unigenitus Bull of 1713. Although the convulsionary movement sought to attract crowds and publicity, it was also grounded in a Jansenist tradition of spiritual retreat that was emulated by the movement’s de (...) facto patron saint, the appellant deacon François de Pâris. Part III features writings by Zimmermann and Tissot, who medicalized solitude for three reasons: belief in the ethos of sociability, concern over the pathogenic powers of the imagination, and suspicion towards the passions that drove some people to fix their minds exclusively on certain ideas. To show solitude’s harmful consequences for those who spent too much time absorbed in ideas, they made intriguing connections between secular knowledge-seekers and the religiously devout. The Jansenist convulsionnaires were one of the dangerously zealous groups whom they cited to illustrate their arguments. (shrink)

There seem to be some misunderstandings abroad in the literature about medical epistemology and person-centered medicine concerning the nature of 'modest' or aetiological foundationalism, and some vagueness about 'emergence'. This paper urges a greater tolerance for a modest, Humean variety of foundationalism, not least because it seems to offer significant support for person-centred medicine. It also suggests a closer examination of emergence as an explanation or justification for medicine, since emergence is a complex concept that does (...) nothing to rule out foundationalism. Foundationalism has been condemned tout court without recognizing that it comes in various styles and degrees. Emergence has been used as a property of medicine to dismiss any need to seek its foundations. But emergence too comes in different forms, not all of them at odds with modest foundationalism. Modest or aetiological foundationalism is far more flexible than Cartesian foundationalism, and is compatible with modern understandings of emergence. Modest foundationalism and a particular understanding of emergence support the ontological and epistemological underpinning of person-centered medicine. (shrink)

Evidence-based medicine (EBM) puts forward a hierarchy of evidence for informing therapeutic decisions. An unambiguous interpretation of how to apply EBM's hierarchy has not been provided in the clinical literature. However, as much as an interpretation is provided proponents suggest a categorical interpretation. The categorical interpretation holds that all the results of randomised trials always trump evidence from lower down the hierarchy when it comes to informing therapeutic decisions. Most of the critical replies to EBM react to this (...) interpretation. While proponents of EBM can avoid some of the problems raised by critics by suitably limited the claims made on behalf of the hierarchy, further problems arise. If EBM is to inform therapeutic decisions then a considerably more restricted, and context dependent interpretation of EBM's hierarchy is needed. (shrink)

Our past century was exemplary in a number of ways. The advances it made in science and medicine were unparalleled. Also without precedent was the destructiveness of its wars. In part, this was due to an increasing technological sophistication. The time lag between a scientific advance and its technological application was, in the urgency of the century, constantly diminished. Modern weaponry combined with mass production, communication and mobilization to produce what came to be known as “total war.” This was (...) a war without any of the limits that characterized the conflicts of the previous centuries. It was this lack of restraint that, perhaps more than anything else, led to the terrible excesses of this century: its war time terror bombings, deportations, and genocidal slaughters. It also led to the chief problem this century presents to ethics: that of the grasp and comprehension of collective evil. This problem is not just theoretical. An inability of those involved in its collective processes to take thought--to actually apprehend the evil they were engaged in--characterized the disasters of our century. At least in part, the participants’ lack of restraint was based on a lack of recognition. (shrink)

The main purpose of this article is to explore, from an ethical perspective, one particular branch of what is today called “spiritual medicine”: namely, prayer therapy. Several landmark studies in the literature will be thoroughly examined, respectively the classical study of Byrd (1988), the replica of Harris et al. (1999), and the controversial study of Leibovici (2001). Beginning with these studies and the related controversies surrounding them, the religious features and ethical consequences of prayer therapy are investigated. The (...) ethical aspects of prayer therapy – the informed consent issue, the issue of respecting bioethical principles, and the issue of medical competence in offering such techniques – are thoroughly addressed. Finally, an alternative way of framing the prayer therapy discussion is offered, in the context of public-private dichotomy. (shrink)

Although science supplies medicine's “gold standard,” knowledge exercised in the care of patients is, like moral knowing, a matter of narrative, practical reason. Physicians draw on case narrative to store experience and to apply and qualify the general rules of medical science. Literature aids in this activity by stimulating moral imagination and by requiring its readers to engage in the retrospective construction of a situated, subjective account of events. Narrative truths are provisional, uncertain, derived from narrators whose standpoints (...) are always situated, particular, and uncertain, but open to comparison and reinterpretation. Reading is thus a model for knowing in both morality and clinical medicine. While principles remain essential to bioethics and science must always inform good clinical practice, the tendency to collapse morality into principles and medicine into science impoverishes both practices. Moral knowing is not separable from clinical judgment. While ethics must be open to discussion and interpretation by patients, families, and society, it is nevertheless substantively and epistemologically an inextricable part of a physician's clinical practice. (shrink)

Books have their origins in conversations and seek to extend and expand those conversations over time and with different audiences. The conversations that have culminated in this book were initially stimulated through a research project at The Hastings Center on the role of religious voices in the professional fields of bioethical inquiry. Those professional conversations have continued throughout my academic career as a member of various institutional ethics committees, organizational ethics task forces, and in local, state, and national public policy (...) settings. The professional context of bioethics conversations can sometimes miss the richness of conversations that occur in the classroom and with various communities, including family members, friends, and religious and civic communities. These conversations provide an experiential depth, a groundedness in the lives and stories of persons, which augments and corrects the professionalized perspectives. I have been particularly fortunate and appreciative of opportunities to bridge the academic and professional with the personalized and communal through conversations about the ethical commitments and moral culture cultivated by The Church of Jesus Christ of Latter-day Saints (LDS or Mormon). I was invited to develop an overview essay on "Bioethics in Mormonism" for the professional reference work, Encyclopedia of Bioethics (3rd ed., 2004), and some years later received my first invitation to make a presentation on "LDS Ethics" in an academic setting at the University of Virginia. This book is the outgrowth of these many conversations and seeks to advance my communal bridging. My aim in this book is to begin bridging these various intersections between the LDS religious community and its moral culture, the professional fields of bioethics, and practical decision-making. This work seeks to be a catalyst for expanding discourse within the interdisciplinary field of Mormon studies to include ethics and bioethics. Ethics has not been a well-developed area in Mormon studies, in contrast to studies in LDS history, theology, or literature. To remedy this oversight, I present a substantive interpretation of the sources, theological background, and moral principles of LDS ethics. The historical narratives and conceptual intertwining I offer of both bioethics and of LDS moral culture is intended to complement and expand the realm of Mormon studies. A further objective is to create opportunities for reciprocal dialogues between the bioethics community and LDS scholarship. This conversation has yet to occur within academic disciplines, professional communities, or in public policy deliberations. My exposition, analysis, and critiques will intertwine and contextualize LDS moral values and health care practices within the ethical inquiry undertaken in the broader professional scholarship of bioethics. My arguments will disclose some points of common ground as well as areas of divergence towards the end of establishing the LDS faith tradition as a community of moral discourse for the bioethics field and the healing professions (medicine, nursing, pharmacy, etc.) it informs. My claim is that given its emerging cultural prominence, LDS ethical scholarship should engage in bioethical literacy and bioethics should be LDS-literate. I am also engaged in an effort to initiate more reflective dialogues regarding LDS ethics and moral culture among LDS scholars, LDS health care professionals, and the interested general LDS reader. The focus of the book on the interrelationship of religion, ethics, medicine, and health care should present for these various audiences new opportunities for mindful reflection and creative scholarship on the ethical implications of faith commitments, the responsibilities of the healing professions, and religious dimensions of public policy and public bioethics. A religious community that is formed through narratives and practices of covenantal commitments of love of neighbor needs to have a robust discourse about its ethical character. I have understood my scholarship in biomedical ethics and in religious ethics through a linking metaphor of my moral culture, of medicine, and the law, of bearing witness. The witness offers moral realities, moral truths about the way things are, vocalizes and embodies moral experience, and prophetically critiques the hypocrisies of the powerful and their oppression of the vulnerable by offering a new story, a re-storying, of tradition and conventional practice. (shrink)

As many studies around the theme of ‘too much medicine’ attest, investigations are being ordered with increasing frequency; similarly the threshold for providing treatment has lowered. Our contention is that trust is a significant factor in influencing this, and that understanding the relationship between trust and investigations and treatments will help clinicians and policymakers ensure ethical decisions are more consistently made. Drawing on the philosophical literature, we investigate the nature of trust in the patient–doctor relationship, arguing that at (...) its core it involves a transfer of discretion. We show that there is substantial empirical support for the idea that more trust will reduce the problem of too much medicine. We then investigate ways in which trust can be built, concentrating on issues of questioning, of acknowledging uncertainty and of shouldering responsibility for it. We argue that offering investigations or treatments as a way of generating trust may itself be an untrustworthy way of proceeding, and that healthcare systems should provide the institutional support for facilitating continuity, questioning and the entrusting of uncertainty. (shrink)

While much excitement has been generated surrounding evidence-based medicine, internal documents from the pharmaceutical industry suggest that the publicly available evidence base may not accurately represent the underlying data regarding its products. The industry and its associated medical communication firms state that publications in the medical literature primarily serve marketing interests. Suppression and spinning of negative data and ghostwriting have emerged as tools to help manage medical journal publications to best suit product sales, while disease mongering and market (...) segmentation of physicians are also used to efficiently maximize profits. We propose that while evidence-based medicine is a noble ideal, marketing-based medicine is the current reality. (shrink)

Despite its vagueness Personalized, Precision, P4, P5, individualized, stratified medicine—or p-medicine in short—has become an increasingly popular term in biomedical literature. Philosophers have attempted to analyze what these various terms involve and have discussed consequences for medical practices. In this article, I argue that an important question remains unaddressed: what has made this project of p-medicine convincing to so many? My argument is that without real achievements, it would never have been. I also make the case (...) that these achievements stem from the domain of monoclonal antibodies, a new type of drug that justifies talks of personalized, precise, stratified, etc., medicine. In conclusion, while it may be possible to label any projection in the future of medicine as ‘p-medicine’, it is impossible to overlook mab-medicine as the spearhead. (shrink)

Why on earth should literary skills, or even a love of literature, make for a better doctor? Gribble (1992) has argued that encouraging literary critical skills sharpens those specific skills but has no benefits that flow into other cognitive areas. Nussbaum (1995), per contra, has claimed that literature does indeed allow imaginative participation in situations that are ethically challenging and therefore encourages the development of phronesis, or practical wisdom. Robin Downie (1994) taught an immensely popular course on (...) class='Hi'>medicine and the arts in Glasgow. Osler (1948) listed the great works that every medical student should read. And so it goes, one authority after another telling us that education in the humanities makes for better ethics, communication, empathy, humanity, understanding, and so on in medical practitioners, while in the background is a small voice saying that such things as literary skills promote only literary skills.Behind the propaganda that underpins humane medic. (shrink)

There has been a great deal of discussion, in this journal and others, about obstacles hindering the evolution of the philosophy of medicine. Such discussions presuppose that there is widespread agreement about what it is that constitutes the philosophy of medicine.Despite the fact that there is, and has been for decades, a great deal of literature, teaching and professional activity carried out explicitly in the name of the philosophy of medicine, this is not enough to establish (...) that consensus exists as to the definition of the field. And even if consensus can be obtained as to what constitutes the philosophy of medicine, this does not mean that it exists as a field. (shrink)

Ghostwriting for medical journals has become a major, but largely invisible, factor contributing to the problem of credibility in academic medicine. In this paper I argue that the pharmaceutical marketing objectives and use of medical communication firms in the production of ghostwritten articles constitute a new form of sophistry. After identifying three distinct types of medical ghostwriting, I survey the known cases of ghostwriting in the literature and explain the harm done to academic medicine and to patients. (...) Finally, I outline steps to address the problem and restore the integrity of the medical literature. (shrink)

Based on ethnographic research within refugee-serving institutions in Philadelphia, Pennsylvania, this paper examines the relationship between physicians and the knowledge they produce and consume about caring for refugees from around the world. I explore the “seething presence” of race in refugee medicine, a domain of medical practice whose entanglement with racial ideology and practice has been underexamined. I consider how knowledge about refugees from different groups—whether racially laden designations like “Asian” or “African” or national markers like Congolese or Burmese—circulates (...) in clinical spaces as health-care teams diagnose and treat refugees using standards of “evidence-based” medicine. Assessing the primary literatures that refugee health-care providers use to justify varying care plans, I argue that race, while often unmentioned, structures the practice of refugee medicine. Additionally, the implicit use of race as an analytic, not racism or economic injustice, often disguises the impact of structural racism and inequality in refugee health disparities. I end with some reflections on how we might conduct a more just practice of refugee health care—and by extension, health care more generally—by shifting our gaze from the particularities of seemingly obvious cultural difference to social structure. (shrink)

An interactive DVD-ROM that examines the doctor-patient relationship, changing nature of illness, ethics and practice of everyday medicine, and the goals of medical pedagogy; it also features interviews with prominent physicians, caretakers, writers, researchers, and philosophers, and is used at the University of Oklahoma in its continuing education for physicians.

Background Symptom checker apps (SCAs) are mobile or online applications for lay people that usually have two main functions: symptom analysis and recommendations. SCAs ask users questions about their symptoms via a chatbot, give a list with possible causes, and provide a recommendation, such as seeing a physician. However, it is unclear whether the actual performance of a SCA corresponds to the users’ experiences. This qualitative study investigates the subjective perspectives of SCA users to close the empirical gap identified in (...) the literature and answers the following main research question: How do individuals (healthy users and patients) experience the usage of SCA, including their attitudes, expectations, motivations, and concerns regarding their SCA use? Methods A qualitative interview study was chosen to clarify the relatively unknown experience of SCA use. Semi-structured qualitative interviews with SCA users were carried out by two researchers in tandem via video call. Qualitative content analysis was selected as methodology for the data analysis. Results Fifteen interviews with SCA users were conducted and seven main categories identified: (1) Attitudes towards findings and recommendations, (2) Communication, (3) Contact with physicians, (4) Expectations (prior to use), (5) Motivations, (6) Risks, and (7) SCA-use for others. Conclusions The aspects identified in the analysis emphasise the specific perspective of SCA users and, at the same time, the immense scope of different experiences. Moreover, the study reveals ethical issues, such as relational aspects, that are often overlooked in debates on mHealth. Both empirical and ethical research is more needed, as the awareness of the subjective experience of those affected is an essential component in the responsible development and implementation of health apps such as SCA. Trial registration German Clinical Trials Register (DRKS): DRKS00022465. 07/08/2020. (shrink)

The essays in this Journal issue offer examples of how textual analysis, literary theory, and the reading and writing of literature can contribute to an understanding of ethical issues in medicine. The editors' purpose in such an issue is to stimulate discussion between philosopher-ethicists and literary scholars whose work concerns this topic. With the concluding essays by editors Clouser and Hawkins, this discussion begins.

Background In bioethics, especially nursing ethics, systematic reviews are increasingly popular. The overall aim of a systematic review is to provide an overview of the published discussions on a specific topic. While a meta-review on systematic reviews on normative bioethical literature has already been performed, there is no equivalent for systematic reviews of empirical literature on ethical topics. Objective This meta-review aims to present the general trends and characteristics of systematic reviews of empirical bioethical literature and to (...) evaluate their reporting quality. Research design Literature search was performed on PubMed and Google Scholar. Qualitative content analysis and quantitative approaches were used to evaluate the systematic reviews. Characteristics of systematic reviews were extracted and quantitatively analyzed. The reporting quality was measured using an adapted PRISMA checklist. Findings Seventy-six reviews were selected for analysis. Most reviews came from the field of nursing (next to bioethics and medicine). Selected systematic reviews investigated issues related to clinical ethics (50%), followed by research ethics (36%) and public health ethics or organizational ethics (14%). In all, 72% of the systematic reviews included authors’ ethical reflections on the findings and 59% provided ethical recommendations. Despite the heterogeneous reporting of the reviews, reviews using PRISMA tended to score better regarding reporting quality. Discussion The heterogeneity currently observed is due both to the interdisciplinary nature of nursing ethics and bioethics, and to the emerging nature of systematic review methods in these fields. These results confirm the findings of our previous review of systematic reviews on normative literature, thereby highlighting a recurring methodological gap in systematic reviews of bioethical literature. This also indicates the need to develop more robust methodological standards. Conclusion Through its extensive overview of the characteristics of systematic reviews of empirical literature on ethical topics, this meta-review is expected to inform further discussions on minimal standards and reporting guidelines. (shrink)

PREFACE This volume is a sequel to yet independent of our Paranoia: A Study in Diagnosis, Reidel, Dordrecht and Boston, 1976. Whereas our first book centered on diagnosis, this centers on treatment. In our first volume, all discussions of nosology (theory of illness) and of treatment was ancillary to our discussion of diagnosis; similarly all discussion of this volume dealing with nosology - there is very little on diagnosis here - is ancillary to our discussion of psychotherapy. It is still (...) our profoundest conviction that to speak of treatment without diagnosis is meaningless, if not irresponsible, since otherwise one does not know what one is talking about. Hence, our present study, though it centers on theories of treatment, links psychotherapy with psychopathology. It is the rationale of psychotherapy which is of importance, and the rationale dwells in this link. We wish our present study to be self-contained and understood by readers who are not familiar with our first book - or with any specific literature. Our discussion of medicine in general, meaning the rationale of therapy in general, helps the uninitiated reader, as well as the initiated, we hope: it certainly has helped us. We did not see how else can we study a branch of medicine; we felt the need for some idea of how medicine is supposed to work. (shrink)

A madhouse can be regarded as the realm where concepts do not have a constantly changing topos. This autarchic sanctuary has no “patients” and is a true malady of the soul. An “engaged” philosophy is one which deals with the selection of concept consumption. On behalf of the healthiness of the spirit, the authorial voices have engaged themselves in a therapeutic writing. ”The world” had to be cured, the maladies of the soul were a threat everywhere. The concepts, qua therapeutic (...) agents have taken on this role. But if the malady itself would be constitutive of the spirit, a medicina mundi through which the creation of concepts is a Genesis, a permanent naming is offered as an alternative for the “healing” of the spirit. This is the thesis through which in Six Maladies of the Contemporary Spirit, the philosopher Constantin Noica chose to portray six maladies of which the soul would be “suffering” and which make the object of this paper. (shrink)

A less analytic and more wholistic approach to philosophy, described as best overall fit or seeing how things all hang together, is defended in recent works by John Rawls and Richard Rorty and can usefully be applied to problems in philosophy of medicine. Looking at sickness and its impact upon the person as a central problem for philosophy of medicine, this approach discourages a search for necessary and sufficient conditions for being sick, and instead encourages a listing of (...) true and interesting observations about sickness which reflect the convergence of a number of different viewpoints. Among the relevant viewpoints are other humanities disciplines besides philosophy and the social sciences. Literature, in particular, provides insights into the meaning and the uniqueness of episodes of sickness in a way that philosophers may otherwise fail to grasp. (shrink)