This paper addresses the recent rise of the use of alternative medicine in Western countries. It offers a novel explanation of that phenomenon in terms of cognitive and economic factors related to the free-market and patient-centric approach to medicine that is currently in place in those countries, in contrast to some alternative explanations of this phenomenon. Moreover, the paper addresses this troubling trend in terms of the serious harms associated with the use of alternative medical (...) modalities. The explanatory theory defended here is then predicated on the idea that an extreme patient-centric model of medical practice that treats largely ignorant patients as consumers of medical products and services endowed with an essentially unrestricted power of freedom to choose treatments predictably leads serious and avoidable harms. Some important moral and epistemological consequences of this model are then articulated and corrective measures are suggested. (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)

This paper suggests that medical education be revised to assist in diffusing potential ethical dilemmas that arise during health care provision. A revised medical education would emphasize the role of the humanities in the training of physicians, especially in light of recent critiques of the canonical scientific model in general, and more specifically in the use of that model for medical training and practice.

This paper argues for seeing in-depth news coverage of political, social, and economic issues as “public policy pedagogy.” To develop my argument, I draw on Nancy Fraser’s democratic theory, which attends to social differences and does not assume that unity is a starting point or an end goal of public dialogue. Alongside the formation of “subaltern counterpublics”, alternative media outlets sometimes develop. There, members of alternative publics debate their interests and strategize about how to be heard in wider, (...) mass-mediated public arenas. I address the normative implications of this non-unitary, multiple-publics model for news journalism, analyzing how current conventions in mainstream news journalism can restrict public debate and impoverish the public policy pedagogy on offer. I illustrate my arguments with a case study of media coverage of the creation and implementation of a social justice curriculum in British Columbia, Canada. (shrink)

Graphic medicine, an interdisciplinary field situated at the crossroads of comics and healthcare, operates as a medium through which the intricate nature of experiences with illness can be articulated, challenging orthodox medical dogmatism in an engaging and accessible way. Combining the affordances of comics and the narrative power of storytelling, graphic medicine elucidates the socio-cultural stigmatization of dementia influenced by a multitude of discourses. Diverging from existing discourses that depict individuals with Alzheimer’s disease (AD) as zombies, brain-dead, or (...) empty shells, graphic memoirs reconstruct these reductive notions and represent them as imaginative, productive, and perceptive. Taking these cues, the present paper close reads some sections of Dana Walrath’s (2016) Aliceheimer’s: Alzheimer’s Through the Looking Glass in order to demonstrate how graphic medicine reconceptualizes the preeminent hallucinatory experiences of her AD-afflicted mother, Alice, as visions. Walrath deploys collage art to epitomize Alice’s ordeal with AD. In particular, Walrath deploys thought-provoking fragments from Lewis Caroll’s Alice in Wonderland, strategically to proximate Alice’s experiences with AD and tackle the problem of dementia and sociality. Additionally, the paper explores how the text fosters interdependence, respect, and trust to recognize and restore Alice’s personhood. The paper concludes by discussing how Aliceheimer’s operates as an alternative paradigm beyond the confines of biomedical and cultural models of dementia through the use of lexical puissance. (shrink)

Whilst India has been debating how to regulate 'surrogacy' the UK has undergone a major consultation on increasing the amount of 'expenses'paid to egg 'donors', while France has recently finished debating its entire package of bioethics regulation and the role of its Biomedicine Agency. Although it is often claimed that there is no alternative to the neo-liberal, market-based approach in regulating (or not) reproductive medicine--the ideology prevalent in both India and the UK--advocates of that position ignore the (...) class='Hi'>alternative model offered by France's tighter regulation, as well as its overarching concern with protecting the vulnerable and ensuring social justice. Whilst the concepts underpinning the French model of regulation also have their provenance in Western political philosophy and not in the developed world, they embody a very different attitude and suggest that there is indeed an alternative to letting the market decide. However, even in France that alternative is highly contested. (shrink)

The primary instrument of dispute management in political liberalism is a form of political thinking and talking that tries to reconcile opposed positions with an impartial settlement based on fair arrangements and mutual respect, one that is careful to treat rival views equitably, and reasoned through from start to finish with open methods that lead to a public justification understandable to the disputants. But this model of reasoning is notoriously deficient in resolving disputes among radically different communities. A more effective (...) form of political reasoning for these disputes that yet respects the background values of liberalism is found in the languages of state depicted in realist accounts of international relations. These languages avoid liberal appeals to be reasonable, reciprocity controlled by moral criteria, and the quest for common reasons. They represent a deliberative search for an accord that will meet the interests of the disputing parties as they define these interests and understand the settlements, and in this sense are welcome models to manage divisive issues in pluralist democracies. A complete version of political reasoning would contain both liberal and realpolitik models and a mechanism to adjudicate the appropriate uses of each model. (shrink)

Although current educational priorities tend to avoid strong moral positions, one of the world's most venerable yet persistently influential moral traditions not only lays out a number of major moral principles but also incorporates them into its pedagogy. Confucius teaches us about the importance of seeking knowledge, learning how to learn, applying ancient wisdom to contemporary situations, valuing virtue over material gain, following the Golden Rule, and living by our principles. He also has ways of assessing his own students' progress (...) in these matters. Confucius' pedagogy is an interesting model to consider and contrast with contemporary models. This chapter introduces these principles and assessments from the Analects and draws out some comparisons to and contrasts with two alternative theories in western moral thought, Augustine and John Dewey. -/- The accepted version of the paper is included here. Pagination does not match the published version. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Evidence-Based Medicine and EvaluativismTim Thornton (bio)KeywordsPhilosophy, psychiatry, values, causalThe rise of evidence-based medicine (EBM) in psychiatry has brought, in its train, a concentration on the validity of psychiatric taxonomy to augment the previous focus on reliability (in the medical sense of inter-subject agreement). This is not surprising. If EBM is to be a trustworthy guide to future events, such as patient recovery, it must be based on (...) projectible predicates (Goodman 1983). Not all the predicates that apparently fit past observations would produce true predictions for the future. Furthermore, there is reason to think that employing projectible predicates goes a long way to satisfy the (widespread if contested) aim of being based on a nomological science (Papineau 1986). Thus, the successful implementation of EBM within psychiatry requires the successful articulation of a valid psychiatric taxonomy.This connection helps to explain why fears about the application of EBM to psychiatry often turn on fears about the application of the criteriological model of diagnosis to individuals. In her commentary in this issue, Gloria Ayob has examined some of the arguments concerning the application of EBM to individuals. In this brief commentary, I examine a different potential source of disquiet focused on the underlying nature of psychiatric taxonomy.Dimensions for Psychiatric TaxonomyIn their recent paper, Peter Zachar and Kenneth Kendler suggest a number of different dimensions according to which rival conceptions of psychiatric taxonomy can be mapped. These include (1) causalism–descriptivism, (2) essentialism– nominalism, (3) objectivism–evaluativism, (4) internalism–externalism, (5) entities–agents, and (6) categories–continua (2007, 557). At the heart of the objectivism-evaluativism dimension is the question:Is deciding whether or not something is a psychiatric disorder a simple factual matterY (objectivism), or does it inevitably involve a value-laden judgment (evaluativism)?(Zachar and Kendler 2007, 558)Objectivists argue that the concept of disorder is a simple or plain factual matter by contrast with an evaluation. The apparently evaluative connotations of disorder, they argue, can either be reduced to, or explained away in, more basic terms, which are not themselves essentially evaluative. Thus, for example, the attempt to explain disorder in statistical terms is a form of objectivism. The more plausible attempt to explain disorder through the idea of a biological or proper function is also usually presented as a form of objectivism. (The most famous proponent of a biological approach, however, Jerome Wakefield, adds to an objectivist-aspiring core an explicit value in the form of harm [End Page 175] [Wakefield 1999].) Whether or not it can be successful as a form of objectivism, in addition to whether an analysis in biological terms is possible, depends on whether the account of function can fully discharge any initial evaluative or normative assumptions.There seems to be good evidence that current psychiatric taxonomy, at least, contains values. John Sadler, for example, makes a powerful case for this in his substantial work Values and Psychiatric Diagnosis (2005). Sadler, furthermore, addresses in some detail a further set of questions concerning the kinds and nature of the values involved. I outline just one further question about the nature of values involved.Zachar and Kendler contrast the presence of values with objectivism. Objectivity has at least two relevant senses reflecting contrasts with two senses of subjectivity. It—objectivity—might mean requiring no special subject for the conception and framing of relevant judgments. (This mirrors primary, by contrast with secondary qualities, and Williams' idea of an absolute conception [Williams 1978]). Or, it might mean disciplining and providing a contrast between correctness and incorrectness, or truth and falsity, for the relevant judgments. This contrasts with subjective whimsy.Although it seems relatively straight forward that the conception and framing of value judgments requires that subjects have a particular kind of mind, that still leaves open the other issue. Are value judgments disciplined by anything or does the "truth" of a value judgment collapse back into its being sincerely made?Evaluativism in Psychiatric Taxonomy and EBMThis question relates to the application of EBM to psychiatry in this way. On a disciplined account, psychiatric taxonomy can aim to get right the mixture or, better, the compound of simple facts and values... (shrink)

Chinese medicine (CM) is one ofseveral ancient systems of medical care basedupon a different worldview than the prevailingbiomedical model; it employs its own language,systems of logic, and criteria forunderstanding health and diagnosing illness.Medicinal herbs play a central role in the CMsystem of practice and knowledgeable CMpractitioners have extensive clinicalexperience using them. However, the establishedscientific and regulatory organizations thatrely upon biomedical understandings ofpathology do not accept the definitions formedicinal herb quality used by CMpractitioners. Furthermore, local medicinalherb growers within the upper (...) Midwest are in aposition to grow many herbs, but are unclearabout the demand for and desired qualities ofthe medicinal herbs they produce. Given thissituation, the Medicinal Herb Network wasfounded as a partnership effort of small-scalemedicinal herb growers and practitioners of CMto develop more appropriate standards ofmedicinal herb quality and to encourage locallygrown, high quality medicinal herbs consistentwith these standards. An overview of CM servesas grounding from which to articulate thedilemmas experienced by CM practitioners ofperceiving medicinal herb quality andintegrating knowledge across divergent medicalsystems. A Network initiative designed toovercome these dilemmas illustrates thepossibility of developing a lexicon of qualitydescriptors for medicinal herbs using Chinesemedical theory, while drawing from descriptivesensory analysis procedures currently practicedby a sub-group of food scientists. (shrink)

Modern medicine has done much in the fields of infectious diseases and emergencies to aid cure. In most other fields, it is mostly control that it aims for, which is another name for palliation. Pharmacology, psychopharmacology included, is mostly directed towards such control and palliation too. The thrust, both of clinicians and research, must now turn decisively towards prevention and cure. Also, longevity with well-being is modern medicine's other big challenge. Advances in vaccines for hypertension, diabetes, cancers etc, (...) deserve attention; as also, the role of meditation, yoga, spirituality etc in preventing disease at various levels. Studies on longevity, life style changes and healthy centenarians deserve special scrutiny to find what aids longevity with wellbeing. A close look at complementary and alternative medicine is needed to find any suitable models they may have, cutting aside their big talk and/or hostility towards mainstream medical care. Medicine is a manifestation of the human eros, and should not become a means of its thanatos. It must realise its true potential, so that eros prevails, and thanatos prevails only ultimately, not prematurely. (shrink)

What does it mean to teach, live, and imagine one’s futures amidst a global pandemic? How to respond to the reality of unequal and overlapping crises, COVID-19 being one of them? Can alternative understandings of time help us create a more just post-pandemic university? Drawing on environmental humanities, disaster and critical time studies, in conversation with qualitative data, this article theorizes a ‘pedagogy of scale’: a practical and conceptual centering on multiple temporalities and diverse interpretative frames. The analysis argues (...) for the need to attend to overlapping, non-linear, and changeable scales of time, reference, and meaning that students draw on in order to make sense of crises: every crisis, even as unprecedented as COVID-19, is embedded in environmental processes, long-term vulnerabilities and injustices. These overlooked and overlapping scales interweave personal, planetary, and theological notions of time—from ecological deep time to the divine time—meaning, and self. In its focus on asynchronicity, overlap and multiplicity, the analysis extends current theorizations of temporality and crisis in higher education, challenges paradigms of mastery, advocates for epistemic plurality, and embraces decolonial notions of human subjectivity, providing a much-needed critical model for the post-pandemic university. (shrink)

Growing interest in complementary and alternative veterinary medicine (CAVM) has sparked a debate among veterinarians, who claim such therapeutic modalities fall under the purview of veterinary medicine, and non-veterinarians, who argue that several modalities do not require the rigorous training of a veterinarian to be performed safely. The veterinary profession must proactively redefine its definition of the practice of veterinary medicine in the face of increasing challenges to state practice acts. By looking to human medicine (...) as a model for how to balance conventional and alternative modalities, the profession can develop a system that provides animal caregivers access to CAVM while still safeguarding animal health. (shrink)

We motivate the possibility of using notions and methods derived from quantum physics, and more specifically from the research field known as ‘quantum cognition’, to optimally model different situations in the field of medicine, its decision-making processes and ensuing practices, particularly in relation to chronic and rare diseases. This also as a way to devise alternative approaches to the generally adopted double-blind gold standard.

We motivate the possibility of using notions and methods derived from quantum physics, and more specifically from the research field known as ‘quantum cognition’, to optimally model different situations in the field of medicine, its decision-making processes and ensuing practices, particularly in relation to chronic and rare diseases. This also as a way to devise alternative approaches to the generally adopted double-blind gold standard.

The current study seeks to validate L2 grit measure among 637 Chinese senior middle school students using a bifactor modeling approach. To do so, we first assessed and compared four alternative measurement models including CFA, bifactor CFA, ESEM, and bifactor ESEM models. Among these models, CFA exhibited the poorest fit to the data collected from the sample. ESEM showed partial fit to the data with a slightly lower factor correlation between two components of L2 grit than (...) CFA. Two bifactor models demonstrated excellent fits to the data. The more parsimonious bifactor CFA model was selected as the optimal one. Based on the bifactor CFA model, we confirmed measurement invariance across gender and predictive validity of L2 grit on subsequent language achievements. Based on these findings, methodological and pedagogical implications were discussed. (shrink)

The most common solutions to the problem of high pharmaceutical prices have taken the form of regulations, price negotiations, or changes in drug coverage by insurers. These measures for the most part transfer the burden of drug expenditures between pharmaceutical companies and payers or between payers. The aim of this study is to propose an alternative model for the relationship between the main stakeholders involved in the price setting and purchasing of pharmaceuticals, one that encourages a more cooperative approach. (...) We draw from principles of ethics and health economics and apply them to the context of the pharmaceutical industry. The model prioritises two objectives, to make drugs financially accessible to the patients who need them, and to keep pharmaceutical companies viable and profitable. It is centered around the sharing of financial risk between the main stakeholders, which we describe as ‘enlightened risk sharing’. After establishing the foundations of this model, we expand on the type of policies that can follow these principles with current day examples. (shrink)

_The_ _Routledge Companion to Philosophy of Medicine _is a comprehensive guide to topics in the fields of epistemology and metaphysics of medicine. It examines traditional topics such as the concept of disease, causality in medicine, the epistemology of the randomized controlled trial, the biopsychosocial model, explanation, clinical judgment and phenomenology of medicine and emerging topics, such as philosophy of epidemiology, measuring harms, the concept of disability, nursing perspectives, race and gender, the metaphysics of Chinese medicine, (...) and narrative medicine. Each of the 48 chapters is written especially for this volume and with a student audience in mind. For pedagogy and clarity, each chapter contains an extended example illustrating the ideas discussed. This text is intended for use as a reference for students in courses in philosophy of medicine and philosophy of science, and pairs well with _The_ _Routledge Companion to Bioethics_ for use in medical humanities and social science courses. (shrink)

Against the backdrop of the political intrigue in biomedicine’s ascendancy to orthodoxy, this article examines its contemporary rapprochement with Complementary Alternative Medicine (CAM), in the move toward an integrated medical regime. It also identifies and explores factors underlying the rapprochement, as well as different ethical challenges that face integrated medicine. It argues that a major approach to tackling these challenges hinges on devising just and equitable criteria for evaluating the efficacy of plural therapeutic paradigms inherent in CAM (...) models. This is attainable through a policy that encourages creating public health policy and medical personnel deliberately exposed as part of their curriculum to the philosophical and theoretical features of diverse therapeutic traditions. (shrink)

This book examines the European discussion about alternative schooling in the 20th century. It refers to a stream of concepts that are often described as New Education, Progressive Education, Education Nouvelle or Reformpädagogik, and discusses a range of different models of alternative schooling. Exploring the works of a range of continental educational philosophers, including Lietz, Blonsky, Kerschensteiner, Freinet, Decroly and Petersen, the book offers a unique insight into texts not yet translated into English. These educational models (...) are presented with regards to the biographical background of the authors; the crucial elements of their construction; the historical interconnections between schooling, society and culture; and finally their connection to today's discussions in educational sciences. The book will be highly relevant for researchers and advanced students working on the theory, history and practice of schooling, particularly those with a focus on alternative schooling and the philosophy of education. Ralf Koerrenz is Head of Chair for Historical Education and Global Education at the Friedrich Schiller University Jena, Germany. Annika Blichmann is Research Associate at the Chair for Historical Pedagogy and Global Education at the Friedrich Schiller University Jena, Germany. Sebastian Engelmann is a research associate and lecturer at the Institute for Bildung and Culture at the Friedrich Schiller University Jena, Germany. (shrink)

In our article, we share the lessons we have learned after creating and running a successful legal laboratory over the past seven years at Yale Law School. Our legal laboratory, which focuses on the intersection of law and severe brain injury, represents a unique pedagogical model for legal academia, and is closely influenced by the biomedical laboratory.

Concepts. Health ; Disease ; Death -- Models and kinds. Causation and kinds ; Holism and reductionism ; Controversial diseases -- Evidence and inference. Evidence in medicine ; Objectivity and the social structure of science ; Inference ; Effectiveness, skepticism, and alternatives ; Diagnosis and screening -- Values and policy. Psychiatry: care or control? ; Policy ; Public health.

In lieu of an abstract, here is a brief excerpt of the content:Integrating the Parts of the Biopsychosocial ModelMichael A. Westerman (bio)Keywordsbiopsychosocial approach, pragmatism, participatory framework, functionalist accounts, mind-body-behavior integrationEngel’s (1977, 1980) call for replacing the biomedical model with his biopsychosocial approach pointed in the right direction. Bradley Lewis recognizes this, but argues that Engel’s framework does not provide us with everything we need to develop the biopsychosocial approach. Lewis attempts to add what is missing by reinterpreting Engel as a (...) pragmatist. As I see it, he is on the right track. We need to add something more to Engel’s position, and Lewis’s reinterpretation is an intriguing attempt to respond to this need. Nevertheless, I believe Lewis’s article only takes us so far. Something is still missing. In what follows, I identify what is missing, make suggestions about additional steps we can take to remedy the situation, and raise the possibility that pragmatism can be helpful in this venture in ways that Lewis does not consider.It should come as no surprise that it will take a lot to accomplish Engel’s objectives, because those goals are extremely ambitious. For one thing, Engel offered his biopsychosocial model as an alternative framework for all of medicine, not just psychiatry. Furthermore, he believed that it was not enough to augment the technological focus of the biomedical model by simply tacking onto it more humane concern with the patient as a person and more attention to the patient–physician relationship (although he certainly advocated changes along those lines). Engel maintained that psychosocial factors play an intrinsic role in the etiology of disease, its assessment, and treatment. He based his biopsychosocial model on general systems theory because he believed that it provides a framework for dealing with disease in a way that reflects this view.This is where Lewis enters the arena. He endorses Engel’s goal of developing a biopsychosocial approach to medicine and psychiatry, but he takes issue with Engel’s belief that we can reach this goal by following along the lines of general systems theory. Indeed, he claims that Engel’s biopsychosocial model was “doomed from the start” because of this idea. At a later point, I will turn to Lewis’s arguments against employing a systems theory framework. I first consider what Lewis proposes we bring to the biopsychosocial endeavor in its place.Lewis argues that pragmatism can get us where we want to go and that it makes sense to reinterpret Engel as a pragmatist because there [End Page 321] are a number of noteworthy similarities between pragmatism and Engel’s work. First, Lewis points out that both Engel and the pragmatists believed that inquiry should start with real problems, that is, with something that is not working. Another similarity is that, like the pragmatists, Engel believed that it is important to be aware of the impact theories and philosophical perspectives have on the ways we deal with problems, even though their influence may not be readily apparent. The third similarity Lewis points to is that even though Engel at times justifies beliefs by taking recourse to idealized notions about “The Method” of science (which, Lewis notes, parallels Peirce’s own early idealization of science), Engel ends up holding the pragmatists’ view that the justification of beliefs rests on their usefulness. Finally, Lewis argues that Engel and the pragmatists (in particular, Dewey) have similar views of nature, or the world, in that they believe nature can be characterized by a hierarchy of “levels” (Engel) or “plateaus” (Dewey).What do we gain from lewis’s reinterpretation?There is a lot to recommend this new reading of Engel. I agree with Lewis that Engel did not provide us with all the tools we need for developing his biopsychosocial approach. I also think that Lewis is right when he asserts that, in particular, we have to place Engel’s ideas about the biopsychosocial model in the context of a richer philosophical perspective. In addition, Lewis has identified a number of interesting similarities between Engel’s work and pragmatism. Hence, there is a basis for reinterpreting him as a pragmatist—and, in my opinion, this brings in a philosophical perspective that does indeed... (shrink)

What position on dualism does medicine require? Our understanding of that ques- tion has been dictated by holism, as defined by the biopsychosocial model, since the late twentieth century. Unfortunately, holism was characterized at the start with con- fused definitions of ‘dualism’ and ‘reductionism’, and that problem has led to a deep, unrecognized conceptual split in the medical professions. Some insist that holism is a nonreductionist approach that aligns with some form of dualism, while others insist it’s a reductionist (...) view that sets out to eradicate dualism. It’s important to consider each version. Nonreductive holism is philosophically consistent and clinically unprob- lematic. Reductive holism, however, is conceptually incoherent—yet it is the basis for the common idea that the boundary between medical and mental health disorders must be vague. When we trace that idea through to its implementation in medical practice, we find evidence that it compromises the safety of patient care in the large portion of cases where clinicians grapple with diagnosis at the boundary between psychiatry and medicine. Having established that medicine must embrace some form of nonreduc- tionism, I argue that Chalmers’ naturalistic dualism is a stronger prima facie candidate than the nonreductive alternatives. Regardless of which form of nonreductionism we prefer, some philosophical corrections are needed to give medicine a safe and coherent foundation. (shrink)

Educational Theory, Volume 71, Issue 6, Page 717-741, December 2021. -/- Gert Biesta has criticized Anglo-American and German models of emancipatory education. According to Biesta, emancipation is understood in these models as liberation that results from a process in which a teacher transmits objective knowledge to his or her students and cultivates student capabilities. He claims that this so-called modern logic of emancipation does not lead to freedom because it installs inequality, dependency, and mistrust in the pedagogical (...) relationship. In this article, Antti Moilanen and Rauno Huttunen analyze whether German models of emancipatory education share the modern logic of emancipation and if they can escape Biesta's criticisms. For this purpose, they interpret Biesta's critique of the modern logic of emancipation and explicate central ideas related to the German models of critical education. They also compare the modern logic of emancipation to the German one, and they then assess German models of emancipatory pedagogy from the viewpoint of Biesta's criticisms. Moilanen and Huttunen conclude that the German models of emancipatory education present at least a partial alternative to the modern logic of emancipation. Despite this, the German models are based on the idea of education as cultivation. Because Biesta criticizes the theory of education as cultivation, it is possible to conclude that he would not accept the German models of emancipatory education. However, the German models of critical pedagogy provide answers to the following question: how can students achieve independence in the pedagogical relationship? When students take part in designing educational processes, they are summoned to assess the validity of the taught knowledge, and they practice independent decision-making at school; the pedagogical relationship, based on authority, can foster student self-determination. (shrink)

Integral Science provides the empirical rigor needed to shift medicine's worldview. The shift in science will give rise to Integral Medicine, which will emerge from the integration and transformational change of biomedicine, psychosocial approaches, Complementary and Alternative Medicine, and other reform movements. The root metaphor of Integral Medicine is a healthy and sustainable ecosystem. At its heart are mind-body holism and collaborative learning. Healing and the creation of health will emphasize educational, self-care, and community support (...) models. Implications are discussed for practice, research, and education. (shrink)

This book critically assesses the implications of modern medicine's claim to be a natural science. Medicine models its scientific and clinical self-understanding on an obsolete positivist conception of science, reality, and consciousness. In this view, the body is modeled as a biological machine, disease as breakdown of the machine, and therapy as physical measures to fix the machine. The problems besetting medical science and practice are rooted in the inadequacy of the positivist philosophical assumptions regarding the nature (...) of science, reality and consciousness To base the diagnostic practices and therapeutic regimes purely on knowledge of physical processes in the human body is, in view of this analysis, at best grossly inadequate, at worst thoroughly dehumanizing (Anton van Niekerk: Editorial Foreword). This means that medicine's clinical method cannot be transformed without transforming the underlying view of science, of reality, and of the human person. The book proposes a broader model of science which overcomes the outdated dichotomy between human and natural sciences. Science is viewed as an interdisciplinary exercise generating multiple perspectives. The insights of the human sciences are essential for scientific clinical medicine. Utilizing evolutionary biology and complexity theory, the author proposes an alternative understanding of reality and human consciousness as a basis for a transformed clinical method. Reality is a hierarchy of systems of increasing complexity. Different levels can be distinguished, namely material systems, living material systems, conscious living material systems and self-conscious living material systems. Each level represents a new manner of being which requires a different scientific discourse of understanding. Using this model of reality the author argues against understanding human consciousness as a byproduct of physical processes in the brain. The human person is a self-conscious, complex, psycho-somatic system, whose well-being is conditioned by much more than physical processes. (shrink)

Following surveys identifying the need for ongoing learning in relation to law and ethics amongst health professionals, the Law and Ethics Education and Development initiative was launched. This was a programme of education designed for, and delivered to, health professionals working within the National Health Service , UK, with the added value of multiprofessional learning amongst colleagues from a single institution. The initiative was funded by the NHS Executive and provided for two lecturers to work for three years within the (...) northwest region. The lecturers, an academic lawyer based at the University of Liverpool, and an ethicist based at the University of Manchester worked in collaboration through the auspices of the Institute of Medicine Law and Bioethics. A central …. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Institute of MedicineRuth Ellen Bulger (bio)IN 1863 the National Academy of Sciences (NAS) was established by federal charter to advise the government on scientific matters. Almost 100 years later, in 1971, the Academy created the Institute of Medicine within the NAS to focus on health-related problems and issues. Today the IOM has a program budget of about $13 million, which includes both private and government funds, and (...) is regarded as a leading center for health policy research.After briefly explaining the structure and general goals of IOM, this article describes several new or anticipated projects as well as some recently completed reports that have a strong ethical component.The IOMThe IOM's distinguished membership is made up of health care professionals of all sorts, scientists working in health-related disciplines, and lawyers, economists, and others knowledgeable in and involved with policies and activities associated with health issues. It is organized around eight working groups or divisions: Health Sciences Policy; Health Care Services; Health Promotion and Disease Prevention, including AIDS activities; International Health; Biobehavioral Sciences and Mental Disorders; the Food and Nutrition Board; the Medical Follow-up Agency; and the Health Policy Fellowship Programs. Each of these divisions is assisted by an oversight board that provides advice on its activities.It is important to know at the outset that IOM has decided that each of the divisions will include consideration of human values and ethical issues in their activities. Therefore, no separate locus was established within the IOM to deal with these matters. I am director of the Division of Health Sciences Policy, which is the only division that has made ethics a priority in its work, and it is the focus of this article.We have addressed questions of ethics, human values, social values, decision making, and priority setting in many of the division's reports. In fact, most of our reports at least raise ethical questions. In addition, a portion of the interest from endowment funds given to IOM by the Howard Hughes Medical Institute has been devoted to work in this area. [End Page 73]The division's advisory board, headed by Claude Bennett, chairman of the Department of Medicine, University of Alabama at Birmingham School of Medicine, has decided on two major priorities for the division: (1) foster an environment conducive to productive research, and (2) anticipate the impact of scientific—especially biomedical—advances on society, monitoring and considering the social and ethical factors that accompany basic scientific and technological progress. These two priorities are interdependent because the fostering of a good environment for research presupposes that the results of this research will produce beneficial effects for the society that supports the research.Upcoming StudiesSociety has been unable to establish a mechanism for discussing in a meaningful way—and possibly resolving—a number of pressing national issues with social, ethical, legal, and scientific ramifications. The President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research considered several such issues and produced important reports about them. However, the commission was funded only until 1983. The Congressional Biomedical Ethics Advisory Committee was authorized in 1985 to address these contentious issues, but it was caught in the crossfire of congressional abortion politics and subsequently died. A new model is needed to attempt to develop national consensus on these complex, contentious issues.The Board on Health Sciences Policy has wrestled with this idea. Recently, it approved a proposal to establish a study committee charged with developing effective alternative methodologies for anticipating and addressing the social, legal, and ethical issues that may accompany rapid advances in biomedical science and technology. This multidisciplinary committee will be given a series of tasks: (1) to explore past experiences with some of these varying methodologies (i.e., town meetings, consensus conferences, forums, commissions, etc.); (2) to develop an agenda of issues likely to arise in the future; (3) to define and test a variety of alternative methodological approaches to these questions; (4) to evaluate strengths, weaknesses, and impact of the various approaches; and (5) to make recommendations on the process and structure by which this fact-finding, analytical, and decision-making function could be... (shrink)

This chapter explores the potential alternatives to the dominant philosophy, policy and practice. Informed by sociological and critical educational frames that recognise the political, social and economic factors that conspire to marginalise learners, it offers a transformative approach to adult literacy whilst locating the model in an underpinning philosophy. Rich empirical data from practice is probed to offer a justification to the recognition accorded the model. The analysis argues that a different value position to the dominant curriculum could yield a (...) different approach to practice. This is illustrated with transformative and emancipatory literacy, which derives its values from a libertarian, equality and justice base. We expose how changes to policy and practice would inform and shape the literacy curriculum and indeed pedagogy, a central driver, we also suggest, being adult education/literacy dis-entangling itself from neo-liberal fusion and creating critical space for contextualised and emancipatory learning. Keywords: emancipatory learning empirical research literacy practice sociology of education transformative literacy. (shrink)

Searching for information is critical in many situations. In medicine, for instance, careful choice of a diagnostic test can help narrow down the range of plausible diseases that the patient might have. In a probabilistic framework, test selection is often modeled by assuming that people's goal is to reduce uncertainty about possible states of the world. In cognitive science, psychology, and medical decision making, Shannon entropy is the most prominent and most widely used model to formalize probabilistic uncertainty and (...) the reduction thereof. However, a variety of alternative entropy metrics (Hartley, Quadratic, Tsallis, Rényi, and more) are popular in the social and the natural sciences, computer science, and philosophy of science. Particular entropy measures have been predominant in particular research areas, and it is often an open issue whether these divergences emerge from different theoretical and practical goals or are merely due to historical accident. Cutting across disciplinary boundaries, we show that several entropy and entropy reduction measures arise as special cases in a unified formalism, the Sharma–Mittal framework. Using mathematical results, computer simulations, and analyses of published behavioral data, we discuss four key questions: How do various entropy models relate to each other? What insights can be obtained by considering diverse entropy models within a unified framework? What is the psychological plausibility of different entropy models? What new questions and insights for research on human information acquisition follow? Our work provides several new pathways for theoretical and empirical research, reconciling apparently conflicting approaches and empirical findings within a comprehensive and unified information‐theoretic formalism. (shrink)

A key question for evidence-based medicine is how best to model the way in which EBM should “[integrate] individual clinical expertise and the best external evidence”. We argue that the formulations and models available in the literature today are modest variations on a common theme and face very similar problems. For example, both the early and updated models of evidence-based clinical decisions presented in Haynes, Devereaux and Guyatt assume that EBM consists of, among other things, evidence from (...) clinical research and clinical expertise. On this A-view, EBM describes all that goes on in a specific justifiable medical decision. There is, however, an alternative interpretation of EBM, the B-view, in which EBM describes just one component of the decision situation and in which, together with other types of evidence, EBM leads to a justifiable clincial decision but does not describe the decision itself. This B-view is inspired by a 100-years older version of EBM, a Swedish standard requiring medical decision-making and practice to be in accordance with ‘science and proven experience’. In the paper we outline how the Swedish concept leads to an improved understanding of the way in which scientific evidence and clinical experience can and cannot be integrated in light of EBM. In addition the paper sketches the as yet unexplored historical background to EBM. (shrink)

The predominant model of the body in modern western medicine is the machine. Practitioners of the biomechanical model reduce the patient to separate, individual body parts in order to diagnose and treat disease. Utilization of this model has led, in part, to a quality of care crisis in medicine, in which patients perceive physicians as not sufficiently compassionate or empathic towards their suffering. Alternative models of the body, such as the phenomenological model, have been proposed to (...) address this crisis. According to the phenomenological model, the patient is viewed as an embodied person within a lived context and through this view the physician comes to understand the disruption illness causes in the patient’s everyday world of meaning. In this paper, I explore the impact these two models of the patient’s body have had on modern medical practice. To that end I first examine briefly the historical origins of the biomechanical and phenomenological models, providing a historical context for the discussion of each model’s main features in terms of machine-world and life-world. Next, I discuss the impact each model has had on the patient–physician relationship, and then I examine briefly the future development of each model. The meaning of illness vis-à-vis each model of the patient’s body is finally examined, especially in terms of how these two models affect the patient’s interpretation of illness. The paper concludes with a discussion of the biomechanical and phenomenological models, in terms of the quality of care crisis in modern western medicine. (shrink)

This paper provides a philosophical critique of professional stereotypes in medicine. In the course of this critique, we also offer a detailed analysis of the concept of care in health care. The paper first considers possible explanations for the traditional stereotype that caring is a province of nurses and women, while curing is an arena suited for physicians and men. It then dispels this stereotype and fine tunes the concept of care. A distinction between ‘caring for’ and ‘caring about’ (...) is made, and concomitant notions of parentalism are elaborated. Finally, the paper illustrates, through the use of cases, diverse models of caring. Our discussion reveals the complexity of care and the alternative modes of caring in health care. (shrink)

In “Obligations of the Gift” Sandra Lee (2021) suggests that social norms of reciprocity and the expectations and obligations associated with gift-giving afford a framework for addressing social justice considerations in precision medicine. Lee is particularly concerned with obligations to marginalized or oppressed racial and ethnic groups, which are also historically under-represented populations in precision medicine. Obligations arise, Lee argues, through the “gift” that research participants make when they contribute their data or biospecimens to precision medicine research. (...) This conceptualization of research participation is distinct from an altruistic donation model that explicitly precludes obligations of reciprocity. I agree with Lee’s overall project to support social justice aims by better recognizing responsibilities of researchers to their research participants, and increasing diverse participation in biomedical research. However, I am not convinced that the account of “the gift” she deploys can achieve the social justice goals she intends because it risks replicating rather than resisting problematic conceptions of labor, property, and ownership of selves and others. However, an alternate conceptualization of “the gift” found in the work of 20th century French philosopher Jacques Derrida recasts ethical obligations on the part of precision medicine to those who contribute their data and biospecimens for precision medicine research. (shrink)

This contribution traces the parallel development of two distinct approaches to peasant agroecological education: the peasant-to-peasant horizontal method that disseminated across Mesoamerica and the Caribbean beginning in the 1970s, and the political-agroecological training schools of combined consciousness-building and skill-formation that have been at the heart of the educational processes of member organizations of La Via Campesina since the 1990s. Applying a theoretical framework that incorporates territorial struggle, agroecology and popular education, we examine spatial and organizational aspects of each of these (...) models for peasant education and movement-building. Recognizing that the models, their respective contexts, and the dialectical relationships therein have been in constant evolution, we share findings on the movement-place as a territorial system with socio-historical subjectivity, that is, peasant movements as territorially-embedded, collective historical actors. This leads to some conclusions in moving past educational theory that has centered upon individual subjects, and approaching a conception of territory as a subject of learning processes. (shrink)

This article answers the question raised by the special issue of this journal in a positive way: managerial practices do need philosophy. In particular, it argues for a more concrete claim: managerial practices have needed philosophy in the past to develop some important intellectual tools, and today they still need to be open to the continuous conceptual and methodological innovations introduced by competing philosophical research programmes, because loyalty to just one favourite philosophical paradigm can hinder the ability of managerial practices (...) to express their full potential, whereas openness to philosophical innovation can help managers keep their conceptual tools up to their tasks. The authors argue for this thesis in concreto: they discuss a specific branch of managerial practice—marketing—and illustrate that a preeminent form thereof, i.e. Experiential Marketing, has needed philosophy, and still needs it nowadays, in order to achieve its goals and overcome certain problems. They also point out that Experiential Marketing needs to renew and integrate some of its philosophical assumptions and conceptual tools in the light of innovations brought about by a recent philosophical turn. In particular, the authors argue that philosophy has provided essential conceptual tools for the articulation of the notions of experience and authenticity used in Experiential Marketing; they claim that the excessive reliance of Experiential Marketing upon a problematic and somewhat outdated ontology produces paradoxes with important repercussions upon managerial practice; and they show that those problems can be overcome by integrating and partially renewing its assumptions and conceptual tools, in the light of a fresher philosophical framework. Shortcomings and solutions are discussed with reference to a specific case study: Venice as an experientially rewarding and authentic tourist destination during the Covid19 crisis, but also as a World Heritage property whose management entails difficult choices. The fruitfulness of the paradigm revision is shown also by integrating the conceptual toolkit of Experiential Marketing with three relatively new notions, deriving from a new realist framework: independence, attrition and perception. (shrink)

In recent decades, the intertwining ideas of self-determination and well-being have received tremendous support in bioethics. Discussions regarding self-determination, or autonomy, often focus on two dimensions—the capacity of the patient and the freedom from external coercion. The practice of obtaining informed consent, for example, has become a standard procedure in therapeutic and research medicine. On the surface, it appears that patients now have more opportunities to exercise their self-determination than ever. Nonetheless, discussions of patient autonomy in the bioethics literature, (...) which focus on individual patients making particular decisions, neglect the social structure within which health-care decisions are made. Looking through the lens of disability and informed by the feminist conception of relational autonomy, this essay argues that the issue of autonomy is much more complex than the individualist model suggests. The social system and the ableist ideology impose various forms of pressure or oppressive power that can affect people’s ability to choose according to their value system. Even if such powers are not directly coercive, they influence potential parents’ decisions indirectly—they structure their alternatives in such a way that certain options are never considered as viable and other decisions must be made. This paper argues that, instead of only focusing on the individual act of decision-making, we need to pay attention to the social structure that frames people’s decision. (shrink)

This article provides an overview of recent contributions to the debate on the ethical use of previously collected biobank samples, as well as a country report about how this issue has been regulated in Spain by means of the new Biomedical Research Act, enacted in the summer of 2007. By contrasting the Spanish legal situation with the wider discourse of international bioethics, we identify and discuss a general trend moving from the traditional requirements of informed consent towards new models (...) more favourable to research in a post‐genomic context. (shrink)

In this article I explore the pedagogical value of Gilles Deleuze and Félix Guattari’s philosophical concepts for helping make an ‘event’ of thought, with a view towards fostering deep learning in Chinese students' learning theory and criticism in a second language. Paying attention to the qualitative role of bodies, humour and creativity alongside an expanded trans-personal concept of ‘educational life forms’ that stretches out to include an affective assemblage of inhuman elements (such as art and technology), I explore how (...) Deleuze and Guattari’s philosophical models provide a ethical alternative to corporate, Confucian and Cartesian models otherwise inhibiting students and teachers in the modern Sino-international university context. (shrink)

The nature of creative thinking is complex and multifaceted, often involving cognitive processes and dispositions modulated by implicit cultural belief systems and ways of thinking. In this article, we build on existing research on the relations of creative thinking and culture, and explore how specific cultural resources can be harnessed to foster creative problem-solving in education. We first review the recent changes in our understanding of creative thinking, from an exclusive focus on cognitive processes to a more inclusive view of (...) creative problem-solving as socially negotiated and culturally modulated, carrying important cultural functions. We then introduce a pedagogical model, QEOSA, to illustrate how cultural resources, particularly culture-specific ways of thinking about the world, can be harnessed to foster creative thinking in education, and what developmental and pedagogical considerations are involved to make it effective. We finally conclude this article by indicating the value of this line of work that integrates psychological, cultural, developmental, and educational principles in fostering the development of a creative mind-set with relevant knowledge, skills, dispositions, and values. (shrink)

This article provides an overview of recent contributions to the debate on the ethical use of previously collected biobank samples, as well as a country report about how this issue has been regulated in Spain by means of the new Biomedical Research Act, enacted in the summer of 2007. By contrasting the Spanish legal situation with the wider discourse of international bioethics, we identify and discuss a general trend moving from the traditional requirements of informed consent towards new models (...) more favourable to research in a post‐genomic context. (shrink)

This article provides an overview of recent contributions to the debate on the ethical use of previously collected biobank samples, as well as a country report about how this issue has been regulated in Spain by means of the new Biomedical Research Act, enacted in the summer of 2007. By contrasting the Spanish legal situation with the wider discourse of international bioethics, we identify and discuss a general trend moving from the traditional requirements of informed consent towards new models (...) more favourable to research in a post-genomic context. (shrink)

The White Coats for Black Lives and #ShutDownSTEM movements have galvanised biomedical practitioners and researchers to eliminate institutional and systematic racism, including barriers faced by Black researchers in biomedicine and science, technology, engineering, and mathematics. In our study on Black–White funding gaps for National Institutes of Health Research Project grants, we found that the overall award rate for Black applicants is 55% of that for white applicants. How can systems for allocating research grant funding be made more fair while improving (...) their efficiency? (shrink)

This paper shows how the classical finite probability theory (with equiprobable outcomes) can be reinterpreted and recast as the quantum probability calculus of a pedagogical or toy model of quantum mechanics over sets (QM/sets). There have been several previous attempts to develop a quantum-like model with the base field of ℂ replaced by ℤ₂. Since there are no inner products on vector spaces over finite fields, the problem is to define the Dirac brackets and the probability calculus. The previous (...) attempts all required the brackets to take values in ℤ₂. But the usual QM brackets <ψ|ϕ> give the "overlap" between states ψ and ϕ, so for subsets S,T⊆U, the natural definition is <S|T>=|S∩T| (taking values in the natural numbers). This allows QM/sets to be developed with a full probability calculus that turns out to be a non-commutative extension of classical Laplace-Boole finite probability theory. The pedagogical model is illustrated by giving simple treatments of the indeterminacy principle, the double-slit experiment, Bell's Theorem, and identical particles in QM/Sets. A more technical appendix explains the mathematics behind carrying some vector space structures between QM over ℂ and QM/Sets over ℤ₂. (shrink)

Nowadays, the increasingly increasing focus on material things and the decreasing importance given to spirituality have started to have negative effects on people. As these observed negativities began to increase, the importance of spirituality was recognized by positive sciences such as psychology, medicine and pedagogy and began to be addressed scientifically again. Studies on this subject are increasing. In this study, the book titled "Spirituality Education", written about spirituality, will be evaluated in terms of its content, scope, contributions to (...) the field and suggestions it offers. Assoc. Dr. This work, written by Yasin Yiğit, is 253 pages and consists of 4 chapters. It is noteworthy that an original spiritual education model is presented, especially in the last chapter of the book. It can be said that the book makes a significant contribution to the systematization of spirituality education. Reading the book by all stakeholders in the field of theology will contribute to their professional development, and the study can be read by everyone in terms of personal development. (shrink)

The convergence of complementary and alternative medicine (CAM) and evidence-based medicine (EBM) is a prominent feature of healthcare in western countries, but it is currently undertheorised, and its implications have been insufficiently considered. Two models of convergence are described – the totally integrated evidence-based model (TI) and the multicultural-pluralistic model (MP). Both models are being incorporated into general medical practice. Against the background of the reasons for the increasing utilisation of CAM by the public and (...) by general practitioners, TI-convergence is supported and MP-convergence is rejected. MP-convergence is epistemologically and clinically incoherent, and it cannot be regulated. It is also inconsistent with developments in the legal determination of the standard of care for both diagnosis/treatment and disclosure. These claims concerning MP-convergence are justified by the fact that science is not a member of the group of perspectives or world-views which postmodernism treats as equally valid, and this is especially important for healthcare. (shrink)

With the increased acceptance of complementary and alternative medicine (CAM) within society, new research reflects deeper folk health histories beyond formal medical spaces. The contested relationships between formal and informal medicine have deep provenance and as scientific medicine began to professionalise in the 19th century, lay health knowledges were simultaneously absorbed and disempowered (Porter 1997). In particular, the ‘medical gaze’ and the responses of informal medicine to this gaze were framed around themes of power, regulation, (...) authenticity and narrative reputation. These responses were emplaced and mobile; enacted within multiple settings by multiple agents and structures over time. The work is drawn from secondary material from Ireland, which identify more indigenous narratives of health and act as potential sources for medical humanities. While assumptions have been made as to the place of folk-medicine being essentially rural, evidence will be presented which shows a more complex network of health beliefs and practices. The narratives of informal practice and folk-medicine drawn from evidence from Ireland point to more fluid and hybrid relations with formal medicine and suggest that the complementary nature of the two models reflected wider cultural debates and models of belief (Del Casino Jnr., Health & Place 10:59-73, 2004). (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hypatia 16.3 (2001) 172-176 [Access article in PDF] Book Review Diagnosis: Difference: The Moral Authority of Medicine Diagnosis: Difference: The Moral Authority of Medicine. By Abby L. Wilkerson. Ithaca: Cornell University Press, 1998. In this compact volume, Abby Wilkerson makes several important contributions to the burgeoning literature of feminist (bio)ethics by providing substantive arguments in support of some of the key intuitive beliefs that are central to (...) much feminist bioethics thinking. Most centrally, she carefully fleshes out a feminist case for re-framing traditional bioethics approaches to the relation between health and justice. Particularly valuable is her richly detailed argument establishing the importance of bringing to the realm of health and health care Iris Marion Young's (1990) important insight that justice involves far more than questions of distribution.At the same time, Wilkerson demonstrates another major feminist tenet: that ethics and epistemology are intimately related. This connection is developed [End Page 172] through a second major theme in which she systematically tracks medicine's tendency to extend its accepted epistemic authority over physical ailments into a general authority over many other aspects of life. She documents examples of medicine's success in leveraging its scientific knowledge about certain aspects of the body into a broader ideological vision through which it claims epistemic authority in the personal and moral realm. By making explicit the gaps between medical knowledge and moral knowledge, she is able to challenge the moral authority and social power that are now granted to medical experts.While these arguments are important, they are not the whole story of the book, for its message is as much about process in bioethics as it is about conclusions. Wilkerson insists that the specific perspective of the theorist affects her/his reasoning. She demonstrates the importance of this fact by using her own distinct position as a bisexual woman to make visible the implicit acceptance and perpetuation of several ideological norms by those in dominant positions in both medicine and bioethics. The central method of the book is what she calls "material-semiotic." It involves the assumption that all human experience is mediated by culture, and the body (specifically the medicalized body) must be recognized as a political site subject to a variety of social values. We must, therefore, attend to the cultural meanings of health and illness and explore the ways that society labels and responds to these conditions. This requires investigation of the specific bodily (material) effects of these meanings in both individual and social experience.The book begins with the epistemological frame of the argument in which Wilkerson claims that medicine is deeply infected by the values and biases of the dominant culture, including its tendencies towards sexist, racist, classist, homophobic, and ablist attitudes. She explores ways in which medical theory and practice stigmatize bodily experiences common to women (in gynecology, obstetrics, and the treatment of victims of sexual or domestic violence). Medicalizing so many aspects of women's experience has the effect of obscuring women's subjective experiences and replacing them with medicine's normative perspectives of appropriate psychological norms. Moreover, the norm of femaleness promoted is a heterosexual, middle class, white variety such that other forms of social difference (e.g., non-white, non-heterosexual) must then also be medicalized and stigmatized; that is, the medical model requires explanations of difference that render pathological most variations on the privileged norm. Hence, alternative sexualities, like differences in class, abilities, race, and gender are interpreted through a medical lens that is thoroughly value-laden. In such ways, the epistemological authority granted to medicine is conflated into an unjustified form of moral authority. Although similar biases are common to every powerful social institution in the United States, they are especially pernicious within medicine because of the enormous influence it exerts in shaping knowledge about the nature of difference between social [End Page 173] groups. This immense social power may be directed towards reducing inequalities and promoting social justice, but, all too often, it is used to convey beliefs and norms that serve the interests of the privileged.Wilkerson's criticism is not reserved... (shrink)

Martial metaphors shape the practice of medicine. Bioethicists who disagree participate in culture wars; public health officials who advocate declare wars on cancer and drugs; surgeons who operate map theaters and fields; physicians who enter graduate training become housestaff officers; nurses who act clinically follow doctor's orders; patients who become ill wage battles against disease. But when we figure medicine as warfare, clinicians become either dutiful combatants or conscientious objectors. Clinicians who serve the mission of medicine are (...) described as loyal, while those who abstain are characterized as disloyal. Disagreement is figured as treason and is punishable by exit from the... (shrink)