In the faculty of arts at the University of Padua in the years around 1600 professors debated the reliability of astrology, the existence of occult celestial influences, and the idea that celestial heat is present in living bodies. From the 1570s to the 1620s many professors in the faculty of arts pushed back against astrology and Jean Fernel's theories surrounding astral body. Girolamo Mercuriale, Alessandro Massaria and Eustachio Rudio thought that some forms of astral causation and Fernel's ideas (...) were incompatible with their observations of disease, Aristotle's philosophy and Hippocratic theories. Later, Santorio Santorio and Cesare Cremonini, who were allied to the political circle of Paolo Sarpi, polemicized against astrology. Their writings show that at Padua medical theory was linked to Aristotelian cosmology, which emphasized the incommensurability between celestial and terrestrial elements. Their rejection of astrology, however, did not lead to the complete marginalization of astrology at Padua. By the middle of the 1620s, as the political climate changed in Venice, the University of Padua hired professors who promoted astrology and Fernel's theories about the celestial nature of innate heat. The diversity of opinions about astrology reflected Venice's divided politics and multiple approaches to interpreting Aristotle and other authorities. (shrink)

It seems quite natural to explain the activities of human and non-human animals by referring to their special faculties. Thus, we say that dogs can smell things in their environment because they have perceptual faculties, or that human beings can think because they have rational faculties. But what are faculties? In what sense are they responsible for a wide range of activities? How can they be individuated? How are they interrelated? And why are different types of faculties assigned to different (...) types of living beings? The six chapters in this book discuss these questions, covering a wide period from Plato up to contemporary debates about faculties as modules of the mind. They show that faculties were referred to in different theoretical contexts, but analyzed in radically different ways. Some philosophers, especially Aristotelians, made them the cornerstone of their biological and psychological theories, taking them to be basic powers of living beings. Others took them to be inner causes that literally produce activities, while still others provided a purely functional explanation. The chapters focus on various models, taking into account Greek, Arabic, Latin, French, German and Anglo-American debates. They analyze the role assigned to faculties in metaphysics, philosophy of mind and epistemology, but also the attack that was often launched against the assumption that faculties are hidden yet real features of living beings. The short "Reflections" inserted between the chapters make clear that faculties were also widely discussed in literature, science and medicine. (shrink)

The conflict between Kant and the medical faculty was far more complex and substantial than is indicated in the section of his famous Conflict of the Faculties addressing this matter. In this essay I will consider not only what Kant, as a philoso­pher, thought of medicine as a faculty, but what medicine as a faculty thought of Kant as a philosopher.

Recruiting minorities into research studies requires special attention, particularly when studies involve “extra-vulnerable” participants with multiple vulnerabilities, e.g., pregnant women, the fetuses/neonates of ethnic minorities, children in refugee camps, or cross-border migrants. This study retrospectively analyzed submissions to the Ethics Committee of the Faculty of Tropical Medicine (FTM-EC) in Thailand. Issues related to the process and outcomes of proposal review, and the main issues for which clarification/revision were requested on studies, are discussed extensively.

It is in the interest of the totalitarian state that subjects not think for themselves, much less confer about their thinking. Writing under the hostile watch of the Prussian censorship, Immanuel Kant dared to argue the need for open argument, in the university if nowhere else. In this heroic criticism of repression, first published in 1798, he anticipated the crises that endanger the free expression of ideas in the name of national policy. Composed of three sections written at different times, (...) The Conflict of the Faculties dwells on the eternal combat between the "lower" faculty of philosophy, which is answerable only to individual reason, and the faculties of theology, law, and medicine, which get "higher" precedence in the world of affairs and whose teachings and practices are of interest to the government. Kant makes clear, for example, the close alliance between the theological faculty and the government that sanctions its teachings and can resort to force and censorship. All the more vital and precious, then, the faculty of philosophy, which encourages independent thought before action. The first section, "The Conflict of the Philosophy Faculty with the Theology Faculty," is essentially a vindication of the right of the philosophical faculty to freedom of expression. In the other sections the philosopher takes a long and penetrating look at medicine and law, the one preserving the physical "temple" and the other regulating its actions. (shrink)

Debate over the status of medicine as an Art or Science continues. The aim of this paper is to discuss the meaning of Art and Science in terms of medicine, and to find out to what extent they have their roots in the field of medical practice. What is analysed is whether medicine is an "art based on science"; or, the "art of medicine" has lost its sheen (what with the rapid advancements of science in course (...) of time, which has made present day medicine more sophisticated). What is also analysed is whether the "science of medicine" is a pure one, or merely applied science; or the element of science in it is full of uncertainty, simply because what is accepted as "scientific" today is discarded by medical practitioners tomorrow in the light of newer evidence. The paper also briefly touches upon how, in the field of present medical education, the introduction of medical humanities or humanistic education has the potential to swing the pendulum of medicine more towards the lost "art of medicine". The paper concludes by saying that the art and science of medicine are complementary. For successful practice, a doctor has to be an artist armed with basic scientific knowledge in medicine. (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)

The topic of professionalism has dominated the content of major academic medicine publications during the past decade and continues to do so. The message of this current wave of professionalism is that medical educators need to be more attentive to the moral sensibilities of trainees, to their interpersonal and affective dimensions, and to their social conscience, all to the end of skilled, humanistic physicians. Urgent calls to address professionalism from such groups as the Association of American Medical Colleges, the (...) American Board of Internal Medicine, and the Accreditation Council for Graduate Medical Education, among others. In fact, at the 2004 annual meeting of the AAMC six separate presentations addressed professionalism with such titles as "Evaluating Humanism and Professionalism," Professionalism: Expectation, Education, Evaluation," or "Toward Assessing Professional Behaviors of Medical Students through Peer Observations". Professionalism, then, has become part of the current academic medicine parlance, used by administrators, clinical faculty, residency programs, and professional organizations with an expectation of shared meanings and goals. All of these stakeholders focus on what has become a consistent list of attributes deemed to be the essence of professionalism, which usually include variations on altruism, duty, excellence, honor and integrity, accountability, and respect. In fact, most of the scholarly work to date has been listing, describing, decrying, and measuring/evaluating it. In this collection of essays, we don’t argue with these attributes. Instead, we ask questions of the discourse from which they arise, how the specialized language of academic medicine disciplines has defined, organized, contained, and made seemingly immutable a group of attitudes, values, and behaviors subsumed under the label "professional" or "professionalism." This collection aims to be a critical text, one that questions the profession’s beliefs about the nature of its work and how such beliefs are enacted in medical education, particularly as they fuel the professionalism discourse. In addition, we will scrutinize how the discourse is enacted in both the formal and hidden curriculum, and in the larger medical environment. (shrink)

Over the last decade, a plethora of international policies and guidelines on research integrity have been produced, and many countries have developed national codes of conduct. Recently, as a way of implementing these codes, institutions have begun offering mandatory training in research integrity for PhD fellows. This paper is based on a case study of a mandatory course in research integrity for PhD fellows at a faculty of medicine in Denmark. The study comprised a small survey, participatory fieldwork, (...) and interviews with six course participants, the course leader and a teacher. Based on this study, the paper shows that the PhD fellows perceived the integrity course as if it, to some extent, contributed to normalising the questionable research practice and grey zone behaviour that the course was conceived to prevent. The interviews, however, also show that this latent normalisation must be seen in the context of the PhD fellows’ position within a strongly competitive culture, which sometimes rewards questionable behaviour. For this reason, creating a culture of research integrity cannot be accomplished by integrity training alone, it demands a wider structural change in the incentives for career advancement that sustain the current asymmetries of power. (shrink)

Edmund D. Pellegrino has played a central role in shaping the fields of bioethics and the philosophy of medicine. His writings encompass original explorations of the healing relationship, the need to place humanism in the medical curriculum, the nature of the patient’s good, and the importance of a virtue-based normative ethics for health care. In this anthology, H. Tristram Engelhardt, Jr., and Fabrice Jotterand have created a rich presentation of Pellegrino’s thought and its development. Pellegrino’s work has been dedicated (...) to showing that bioethics must be understood in the context of medical humanities, and that medical humanities, in turn, must be understood in the context of the philosophy of medicine. Arguing that bioethics should not be restricted to topics such as abortion, third-party-assisted reproduction, physician-assisted suicide, or cloning, Pellegrino has instead stressed that such issues are shaped by foundational views regarding the nature of the physician-patient relationship and the goals of medicine, which are the proper focus of the philosophy of medicine. This volume includes a preface by Dr. Pellegrino and a comprehensive Introduction by the editors. Of interest to medical ethicists as well as students, scholars, and physicians, _The Philosophy of Medicine Reborn_ offers fascinating insights into the emergence of a field and the work of one of its pioneers. “After a long period of dormancy, philosophy of medicine has blossomed with new life. The single most important physician-philosopher in that rebirth has been Edmund Pellegrino. His contributions to virtue theory, the concept of beneficence, the dispute over the internal and external sources of a morality for medicine, and the role of the Hippocratic tradition are all critical. The essays collected in this volume have changed the history of the philosophy of medicine. He shows that philosophy of medicine can be done with both passion and compassion.” —_Robert M. Veatch, Kennedy Institute of Ethics, Georgetown University_ “Edmund Pellegrino's words have helped medical students, faculty, scholars and patients address the challenges they encounter in medicine and medical practice. His personal support has also been critical for many of us in developing programs in medical ethics and philosophy of medicine in our universities. Dr. Pellegrino combines the wisdom of a great physician with those of a great philosopher to produce a body of writing that will continue to inspire us all. This volume contains some of his best and most influential work.” —_Loretta Kopelman, The Brody School of Medicine, East Carolina University_ _ _ “Edmund Pellegrino has been a leading light in the philosophy of medicine for a generation. He was instrumental in the birth of bioethics, founded one of the leading journals, and provided able leadership in organizing early activities of the profession. He has served as department chairman, dean, and university president. Most recently, he chairs the President’s Council on Bioethics. In all this, first and foremost, he has been a physician. Those who are ill and suffering make a claim upon him. To respond to this claim, Pellegrino creatively brings together the worlds of science and of the humanities. For him, that is what medicine is about, making it the most scientific of the humanities and the most humane of the sciences. Fortunately for us, Pellegrino brings these worlds together in thought, as well as in practice. In this selection from his writings, Engelhardt and Jotterand have captured the heart of Pellegrino’s project, both in depth and breadth, so we can also hear that claim of the ill and so we can see what worlds must come together if we are to respond in the appropriate way.” —_George Khushf, University of South Carolina_ “Pellegrino’s work is both a treasure and important for understanding bioethics. His work in philosophy of medicine addresses the crucial questions that are so important to understanding the practice of medicine and the ethics of health care.” —_Kevin Wildes, President, Loyola University_ _ _. (shrink)

Foot-and-mouth disease was the event which led to the increased and improved training of veterinarians able to produce through their research new veterinary knowledge for practical application.It led to the transformation of the Mexican veterinary profession. It changed the kind of knowledge veterinarians received at university, and it also changed the work they did as professionals. Veterinarians gradually began to perform a much wider range of tasks: they did research, taught, worked as civil servants, or assumed positions as academic administrators (...) and as high governmental officials with a large amount of influence on governmental agricultural activities. They also engaged directly in animal husbandry and in food production.In parallel with these changes, the National University, and within it the Faculty of Veterinary Medicine and Animal Husbandry, underwent a concomitant series of changes which ran hand-in-hand with the growth of the Mexican state. The university provided training for specialised research workers by offering scholarships and programmes of graduate study. This consolidated the activities of an academic community working on applied veterinary medicine. The beneficiaries of these efforts take part in and influence, to varying degrees, the planning and programming of agricultural policies in a way that would not formerly have been possible. (shrink)

The conflicts of interest that may arise in relationships between academic researchers and industry continue to prompt controversy. The bulk of attention has focused on financial aspects of these relationships, but conflicts may also arise in the legal obligations that faculty acquire through consulting contracts. However, oversight of faculty members' consulting agreements is far less vigorous than for financial conflicts, creating the potential for faculty to knowingly or unwittingly contract away important rights and freedoms. Increased regulation could (...) prevent this, but it is unclear what forms of oversight universities view as feasible and effective. In this article, we report on a Delphi study to evaluate several approaches for oversight of consulting agreements by medical schools. The panel was comprised of 11 senior administrators with responsibility for oversight of faculty consulting relationships. We found broad agreement among panelists regarding the importance of institutional oversight to protect universities' interests. There was strong support for two specific approaches: providing educational resources to faculty and submitting consulting agreements for institutional review. Notwithstanding the complexities of asserting authority to regulate private consulting agreements between faculty members and companies, medical school administrators reached consensus that several approaches to improving institutional oversight are feasible and useful. (shrink)

The best things in my Ufe have come to me by accident and this book results from one such accident: my having the opportunity, out of the blue, to go to work as H. Tristram Engelhardt, Jr. 's, research assistant at the Institute for the Medical Humanities in the University of Texas Medi cal Branch at Galveston, Texas, in 1974, on the recommendation of our teacher at the University of Texas at Austin, Irwin C. Lieb. During that summer Tris "lent" (...) me to Chester Bums, who has done important schol arly work over the years on the history of medical ethics. I was just finding out what bioethics was and Chester sent me to the rare book room of the Medical Branch Library to do some work on something called "medical deontology. " I discovered that this new field of bioethics had a history. This string of accidents continued, in 1975, when Warren Reich (who in 1979 made the excellent decisions to hire me to the faculty in bioethics at the Georgetown University School of Medicine and to persuade Andre Hellegers to appoint me to the Kennedy Institute of Ethics) took Tris Engelhardt's word for it that I could write on the history of modem medical ethics for Warren's major new project, the Encyclopedia of Bioethics. Warren then asked me to write on eighteenth-century British medical ethics. (shrink)

Background: Physicians sometimes are asked by co-workers for prescriptions to deal with their medical problems. These “hallway” requests typically occur outside a formal doctor-patient relationship. There are professional guidelines on serving as physician for family members and friends, but no guidelines address writing prescriptions for co-workers. The frequency of these requests and the factors physicians consider in responding to them have not been examined.Objectives: To obtain data on the frequency of these requests and physicians’ attitudes and practices in responding to (...) them, and to explore the ethical considerations in writing prescriptions for co-workers.Design: A survey was administered to all physician faculty and residents in an academic department of internal medicine. The questions included whether the respondent had ever been asked for a prescription by a co-worker and how often the respondent had received such requests and written such prescriptions in the previous three months. Respondents also were asked to rate how likely they would be to write such a prescription in 15 hypothetical scenarios.Results: Of the 113 respondents who completed surveys, 68 percent reported having been asked for a prescription by a co-worker. Among those who had ever been asked, 59 percent had been asked one or more times during the previous three months and 88 percent had ever written such a prescription. Also, 88 percent of all respondents stated they were “very likely” or “likely” to write the prescription in one or more of the hypothetical scenarios.Conclusions: Most physicians in our sample had been asked for prescriptions by co-workers, and most had written such prescriptions. Many respondents indicated a willingness to write such prescriptions in a variety of scenarios, despite the absence of a formal doctor-patient relationship. Further discussion of the ethical considerations in writing prescriptions for co-workers is needed. (shrink)

We have a desire to discover and create order, and our constitution, including our rational faculties, indicates that we are predisposed for such productivity. This affinity for order and the establishment of order is fundamental to humans and naturally also leaves its mark on the medical discipline. When this profession is made subject to criticism, frequently in terms of well-used reproofs such as reductionism, reification and de-humanisation, this systematising productivity is invariably involved in some way or other. It is, however, (...) problematic that we rarely delve deeper and ask what order means, or reflect on its underlying, omnipresent and self-evident role. In order to approach this challenge, we initially and briefly place order in a conceptual and historical context. In what follows, we examine order explicitly, i.e. made an object of study, by taking a closer look at extensive multidisciplinary efforts to uncover the secrets of all its facets. Here we also try to identify some systems of order in medical science, including methodological and procedural order, which are indispensable as well as a source of problems. In the sections that follow, order is not defined as an explicit object of study, but comes to light in some exploratory and philosophising projects based on physics, mathematics and phenomenology. Each of these lets order and that which is ordered emerge in ways that may also shed light on opportunities and paradoxes in the medical domain. Key themes here include the Gordian knot of psyche – soma, the order of disorder and the patient as Other. (shrink)

ObjectiveThere have been increased efforts to implement medical ethics curricula at the student and resident levels; however, practising physicians are often left unconsidered. Therefore, we sought to pilot an ethics and professionalism curriculum for faculty in obstetrics and gynaecology to remedy gaps in the formal, informal and hidden curriculum in medical education.MethodsAn ethics curriculum was developed for faculty within the Department of Obstetrics and Gynaecology at a tertiary care, academic hospital. During the one-time, 4-hour, mandatory in-person session, the (...) participants voluntarily completed the Oldenburg Burnout Inventory, Handoff Clinical Evaluation Exercise, University of Missouri-Kansas City School of Medicine and overall course evaluation. Patient satisfaction survey scores in both the hospital and ambulatory settings were compared before and after the curriculum.ResultsTwenty-eight faculty members attended the curriculum. Overall, respondents reported less burnout and performed at the same level or better in terms of patient handoff than the original studies validating the instruments. Faculty rated the professionalism behaviours as well as teaching of professionalism much lower at our institution than the validation study. There was no change in patient satisfaction after the curriculum. However, overall, the course was well received as meeting its objectives, being beneficial and providing new tools to assess professionalism.ConclusionThis pilot study suggests that an ethics curriculum can be developed for practising physicians that is mindful of pragmatic concerns while still meeting its objectives. Further study is needed regarding long term and objective improvements in ethics knowledge, impact on the education of trainees and improvement in the care of patients as a result of a formal curriculum for faculty. (shrink)

Although medical centres have established boards, special committees, and offices for the review and redress of breaches in ethical behaviour, these mechanisms repeatedly prove themselves ineffective in addressing research misconduct within the institutions of academic medicine. As the authors see it, institutional design: systematically ignores serious ethical problems, makes whistleblowers into institutional enemies and punishes them, and thereby fails to provide an ethical environment.The authors present and discuss cases of academic medicine failing to address unethical behaviour in academic (...) science and, thereby, illustrate the scope and seriousness of the problem. The Olivieri/Apotex affair is just another instance of academic medicine’s dereliction in a case of scientific fraud and misconduct. Instead of vigorously supporting their faculty member in her efforts to honestly communicate her findings and to protect patients from the risks associated with the use of the study drug, the University of Toronto collaborated with the Apotex company’s “stalling tactics,” closed down Dr Olivieri’s laboratory, harassed her, and ultimately dismissed her.The authors argue that the incentives for addressing problematic behaviour have to be revised in order to effect a change in the current pattern of response that occurs in academic medicine. An externally imposed realignment of incentives could convert the perception of the whistleblower, from their present caste as the enemy within, into a new position, as valued friend of the institution. The authors explain how such a correction could encourage appropriate reactions to scientific misconduct from academic medicine. (shrink)

Academia bases reputation and standing on the number of published articles. As a result, the abilities and potential of researchers are also being judged by the number of articles they write, as well as on the impact factor of the journals in which their articles are being published. In itself this is not a problem, although one could of course question the assumption that the quantity of the output reflects the competence of individual researchers. As Altman has stated: “The length (...) of a list of publications is a dubious indicator of ability to do good research.”1 However, if senior faculty decide that the career progress of junior researchers in academia should be based on these criteria, academic medicine is bound to fail in fulfilling its role, namely maximising the quality of medical research and doing research for the right reasons. And to some extent it already has.1 …. (shrink)

Ethics is central to scientific and engineering research and practice, but a key challenge for promoting students’ ethical formation involves enhancing faculty members’ ability and confidence in embedding positive ethical learning experiences into their curriculums. To this end, this paper explores changes in faculty members’ approaches to and perceptions of ethics education following their participation in a multi-year interdisciplinary faculty learning community (FLC). We conducted and thematically analyzed semi-structured interviews with 11 participants following the second year of (...) the FLC. Qualitative themes suggested that, following two years of FLC participation, faculty members (1) were better able to articulate their conceptualizations of ethics; (2) became cognizant of how personal experiences, views, and beliefs informed how they introduced ethics into their curriculum; and (3) developed and lived instructional principles that guided their ethics teaching. Results thus suggested that faculty members benefitted from exploring, discussing, and teaching ethics, which (in turn) enabled them to see new opportunities and become confident in integrating ethics into their courses in meaningful ways that aligned with their scholarly identities. Taken together, these data suggest faculty became agents of change for designing, implementing, and refining ethics-related instructional efforts in STEM. This work can guide others interested in designing faculty learning communities to promote instructional skill development, faculty members’ awareness of their ethical values, and their ability and agency to design and integrate ethics learning activities alongside departmental peers in an intentional and continuous manner. (shrink)

Purpose Intellectual honesty and integrity are the cornerstones of conducting any form of research. Over the last few years, scholars have shown great concerns over questionable research practices (QRPs) in academia. This study aims to investigate the questionable research practices amongst faculty members of medical and dental colleges in Pakistan. Method A descriptive multi-institutional online survey was conducted from June-August 2022. Based on previous studies assessing research misconduct, 43 questionable research practices in four domains: Data collection & storage, Data (...) analysis, Study reporting and Collaboration & authorship were identified and investigated. Descriptive (Frequencies, Percentages, Mean, SD) and Inferential (chi square) statistics were calculated. Results A total of 654 faculty members responded. Every respondent reported committing at least one QRP in their career. The most common QRPs included deliberately failing to mention funding, publishing program evaluation data not meant for research purposes or approved by an ethical body, inappropriately storing identifiable information and non-disclosure of any conflicts. There was significant association of age, gender and academic rank with QRPs in ‘Data collection and storage’ and ‘Data Analysis’ domains. Conclusion Medical and dental faculty members participating in this study are involved in a range of questionable research practices (QRPs) in Pakistan. Their confession might have contributed to the faculty developing self-awareness and reinforcing academic integrity. There is a need for reviewing policies and practices to improve research culture. Future research should explore the factors resulting in such practices. (shrink)

This book is a collection of contributions written by philosophers and scientists active in different fields, such as mathematics, logics, social sciences, computer sciences and linguistics. They comment on and discuss various parts of and subjects and propositions introduced in the Handbook of Analytical Philosophy of Medicine from Kadem Sadegh-Zadeh, published by Springer in 2012. This volume reports on the fruitful exchange and debate that arose in the fuzzy community upon the publication of the Handbook. This was not only (...) very much appreciated by the community but also seen as a critical starting point for beginning a new discussion. The results of this discussion, which involved many different perspectives from science and the humanities and was warmly encouraged by Kadem Sadegh-Zadeh himself, are accurately reported in this volume, which is intended to be a critical companion to Kadem Sadegh-Zadeh ́s handbook. Rudolf Seising is currently an adjunct researcher at the European Centre for Soft Computing in Mieres, Asturias (Spain) and a college lecturer at the Faculty of History and Arts, at the Ludwig Maximilians University of Munich (Germany). Marco Elio Tabacchi is currently the Scientific Director of the Italian National Research & Survey Organization Demopolis, and a research assistant in the Soft Computing Group at University of Palermo (Italy). (shrink)

In his embryological treatise De plastica seminis facultate , Jacob Schegk , professor of philosophy and medicine at the University of Tübingen, developed, through a unique interpretation of the Aristotelian embryology, a theory of the "plastic faculty" , whose origin lay in the Galenic idea of the formative power. The present study analyses the precise nature of Schegk's theory, by setting it in its historical and intellectual context. It will also discuss the hitherto unappreciated Neoplatonic dimension of Schegk's (...) notion of the soul's vehicle. (shrink)

In many settings, and perhaps especially in low-middle income countries, training institutions do not adequately prepare their students for the ethical challenges that confront them in professional life. We conducted a survey to assess the training needs in research ethics among the faculty at the University of Zambia, School of Medicine using a structured questionnaire distributed to faculty members in January 2015. The study was approved by the University of Zambia Biomedical Research Ethics Committee. Seventy-five faculty (...) members of various ranks completed the questionnaire. It was found that 31% of the faculty had not received any research ethics training. Of those who had received training, most of them had received it through short workshops of five days or less, while only 27.7% received ethics training as a component of an academic degree and 22.2% obtained it through electronic web-based courses. While most faculty reported being well-prepared to guide their students in developing a research methods section of a research protocol, only 25.3% felt they were well-prepared to guide on ethical considerations. This study has demonstrated gaps in research ethics training among faculty members at UNZASoM. Mandatory instruction in research ethics among faculty and students is recommended. (shrink)

This is a case study of a program to address professionalism at the Universidad de la República in Uruguay. We describe a five-year ongoing international collaboration. Relevant characteristics of the context, the program components, activities, and results were analyzed. The expected outcomes were to introduce standards of professional practices in the curricula of medical students and residents and the implementation of a program that might lead to a significant change in the culture of medicine in the University. Traditional didactics, (...) interactive theater, and professional development workshops, issues such as teamwork and communication, professional behavior, and the culture of medicine, and physician wellness were addressed. A total of 359 faculty members, general practitioners, stakeholders, and other healthcare professionals participated in the intervention. The process led to specific achievements including new content in the curricula, the use of educational innovations to address issues of professionalism, a growing institutional culture of accountability, and the establishment of new rules and regulations. The strategies and interventions followed in the case of Uruguay can serve as a model to other developing countries to promote physician professionalism, wellness, and joy. (shrink)

This paper begins the last instalment of a six-part project correlating the key aspects of Kant’s architectonic conception of philosophy with a special version of the Chinese Book of Changes that I call the “Compound Yijing”, which arranges the 64 hexagrams (gua) into both fourfold and threefold sets. I begin by briefly summarizing the foregoing articles: although Kant and the Yijing employ different types of architectonic reasoning, the two systems can both be described in terms of three “levels” of elements. (...) Starting at an unnumbered level devoid of any element (the tao or thing in itself), the system proceeds by elaborating a key fourfold distinction (or “quaternity”) on the first level, a twelvefold distinction on the second level, and twelve quaternities (grouped in four quadrants, each with a set of three quaternities) on the third level. Each set of three quaternities (i.e., each quadrant) on the third level corresponds to one of the four “faculties” of the university, as elaborated in Kant’s book, The Conflict of the Faculties. Previous papers have examined the correlations between three key quaternities that Kant defends in relation to each of three faculties (philosophy, theology, and law) and the 12 gua that correspond to that faculty in the Compound Yijing. The final step is to explore the fourth quaternity on the third level, the 12 gua corresponding to the medical faculty. The “idea of reason” in Kant’s metaphysics that guides this wing of the comparative analysis is freedom, and the ultimate purpose of this faculty of the university is to train doctors to care for people’s physical well-being, as free agents imbedded in nature. But this paper will focus only on the four gua that correspond to four basic concepts in Kant’s theory of medicine. The two quaternities in the “yin-yang” (medical) quadrant of the Compound Yijing that will be skipped here are as follows. First, Kant’s account of the idea of freedom itself, which gives rise to the area of traditional metaphysics known as rational cosmology, comes in the first Critique’s Dialectic, in the section on the Antinomy of Reason (CPR A405-567/B432- 595). There he examines four irresolvable issues: whether the world has a beginning in time; whether composite substances consist of simple parts; whether a causality of freedom operates in the natural world; and whether an absolutely necessary being exists. Later I will argue that these correspond to the quaternity consisting of gua 15, 22, 36, and 52. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Ideas 65.2 (2004) 191-211 [Access article in PDF] Oratory and Rhetoric in Renaissance Medicine Nancy G. Siraisi Hunter College In Renaissance medical practice rhetoric had an ambiguous reputation. Many authors warned physicians against use of persuasion or repeated some version of the truism that patients are cured not by eloquence but by medicines. On the other hand, physicians were also reminded that by (...) speaking well they helped patients to have confidence in their advice and to understand directions, which in turn facilitated cure.1 Yet some aspects of medical culture of the period between 1450 and 1600 seem profoundly attentive to rhetoric, at least as regards the use of language, performative elements, and the influence of these features in ancient models (most notably Galen himself).2 One area in which rhetoric had an unambiguous, acknowledged, and essential place was in the medical orations pronounced at university ceremonies. A sample follows: Pursuit of all these different things by study, investigation of obscurities with ingenuity, conquest of difficulties with industry, and—after penetrating into the very fibers of the earth and searching everywhere into the arcana of the whole of nature and from all herbs, fruits, trees, animals, gems, and even poisons—inquiry after remedies and the proper way to use them for all the ills of human life from so many authors, so many disciplines, and even from the very stars: these things, I say, [End Page 191] have uncovered so many hidden cures, been attained with such arduous powers of the mind, completed with so much effort of memory, offer so many things necessary for the health of the entire human race in common, that does not indeed [the entire enterprise of medicine] seem to have been superhuman and really in a certain way divine?3This nicely exuberant example of Renaissance medical rhetoric exemplifies the genre in several respects. The oration to which it belongs was originally delivered to an academic faculty of medicine by a physician; it shows the impact in medical settings of the revival of epideictic rhetoric, and its author drew on learned sources and commonplaces about medicine that belonged to a store of broadly humanistic erudition, shared both in and outside the medical profession. In fact the only truly distinctive feature of this passage is its author. It comes from Erasmus's Encomium medicinae, which he wrote in 1499 for a friend—a physician named Gysbertus—to deliver to the medical faculty of the University of Paris.4If Gysbertus was exceptionally fortunate in his ghost, many other surviving medical orations are internal products of medical faculties, the work of university masters or students of medicine. But whoever their authors, orations delivered in or written for an academic medical setting offer some telling illustrations both of the way in which certain kinds of humanistic interests and requirements came to penetrate medical learning and of the reaction of humanistic rhetoric to medicine. "Medical humanism" is usually understood to encompass both the core enterprise of intensive philological study, editing, and translation of Greek medical texts—never the occupation of more than a handful of hellenist scholars—and also the reception and scientific influence of the fruits of their labors among a wider medical audience. But Renaissance medicine was also a humanistic discipline in a much broader and more inclusive sense; that is, it both fostered and provided ample scope for the development among learned physicians of interests characteristic of humanistic culture in general: rhetoric, history, biography, fascination with remote peoples and places, and antiquarianism. At the same time, as the passage from Erasmus quoted [End Page 192] above demonstrates, humanists outside the medical profession interested themselves in medicine and controlled a stock of rhetorical commonplaces on the subject. To be sure, the penetration of terminology and concepts from medicine into the general culture long antedated the Renaissance.5 But the revival of rhetoric together with attention to ancient sources and commonplaces provided humanist observers with new tools for commenting, sometimes in quite specific and detailed terms, on the contemporary medical scene, a phenomenon... (shrink)

For ten years, 1971–1981, the Institute onHuman Values in Medicine (IHVM) played a keyrole in the development of Bioethics as afield. We have written this history andanalysis to bring to new generations ofBioethicists information about the developmentof their field within both the humanitiesdisciplines and the health professions. Thepioneers in medical humanities and ethics cametogether with medical professionals in thedecade of the 1960s. By the 1980s Bioethics wasa fully recognized discipline. We show the rolethat IHVM programs played in defining thefield, (...) training faculty and helping schools todevelop programs. We review the beginnings ofthe IHVM in the crucible of social andtechnological change that led to theestablishment of the IHVM's parentorganization, the Society for Health and HumanValues. We then turn to the IHVM programsthrough which Faculty members receivedfellowships to explore new crossovers betweenthe humanities and the health professions. Wehave not only described the Fellows Program asit existed in 1973–1980, but have completed asurvey of the fellows a quarter of a centuryafter they held their fellowships. We describeother IHVM programs designed to facilitate theinitiation and development of new humanitiesprograms, to explore conceptual issues betweenmedicine and five humanities fields, to conductissue driven or educational method conferencesand to advance humanities programs intograduate education through the Directors ofMedical Education. (shrink)

Summary This paper discusses the emergence of new medical experimental specialties at the Medical School of Surgery (Escola Médico-Cirúrgica) and the Faculty of Medicine of Lisbon University (Faculdade de Medicina da Universidade de Lisboa) between 1897 and 1946, as a result of the activities of Marck Athias's (1875?1946) histophysiology research school. In 1897, Marck Athias, a Portuguese physician who had graduated from the Faculty of Medicine in Paris, founded a research school in Lisbon along the lines (...) of Michael Foster's physiology research school in England and Franz Hofmeister's physiological chemistry school in Germany. His research programme was highly innovative in Portugal. Not only did it bring together many disciples and co-workers, but it branched out and created new medical specialties within Portuguese medical science. These new disciplinary areas grew out of the study of the histology of the nervous system but eventually expanded into normal and pathological histophysiology, physiological chemistry and experimental endocrinology. The esprit de corps that existed between research school members ensured the school's success and influence in various fields social and political as well as scientific. Athias's school was strongly influenced by positivist ideals and promoted a teaching and research style that sought inspiration in Humboldt's university model, thus helping to bring about a change in the dominant scientific ethos and to modernize scientific research in Portugal during the first half of the twentieth century. (shrink)

BackgroundMedical errors, unsatisfactory outcomes, or treatment complications often prompt patient complaints about healthcare providers. In response, physicians may adopt defensive practices to mitigate objections, avoid complaints, and navigate lengthy trial processes or other potential threats. However, such defensive medicine (DM) practices can carry risks, including potential harm to patients and the imposition of unnecessary costs on both patients and the healthcare system. Moreover, these practices may run counter to accepted ethical standards in medicine.MethodsThis qualitative study involved conducting semi-structured (...) interviews with 43 physicians, among whom 38 were faculty members at medical universities, 42 had administrative experience at various levels of the health system, and 23 had previously served as health system policymakers. On average, the participants had approximately 23.5 years of clinical experience. The selection of participants was based on purposive sampling. Data collection through interviews continued until data saturation was achieved.ResultsBased on the findings, DM manifests in both positive and negative forms, illustrated by instances like ordering unnecessary lab tests, imaging, or consultations, reluctance to admit high-risk patients, and avoiding high-risk procedures. The study participants identified a range of underlying and contextual factors contributing to DM, encompassing organizational-managerial, social, personal, and factors inherent to the nature of defensive medical practices. The results also highlight proposed strategies to address and prevent DM, which can be grouped into organizational-managerial, social, and those focused on modifying the medical complaints management system.ConclusionDM is a multifaceted and significant phenomenon that necessitates a comprehensive understanding of its various aspects, including interconnected and complex structures and underlying and contextual factors. While the results of this study offer a solid foundation for informing policy decisions within the healthcare system and include some explanatory policy suggestions, we encourage policymakers to complement the findings of this study with other available evidence to address any potential limitations and to gain a more comprehensive understanding of the policymaking process related to DM. (shrink)

Diderot’s reading of Le Camus’ Médecine de l’Esprit may occupy a prominent position in his research for the Eléments de physiologie, but his thoughts on the matter are not restricted to a criticism of this work, which appeared in 1753. In his edition of the Eléments de physiologie, Jean Mayer showed that Diderot had instigated an ongoing debate with other physicians who were also concerned with the issue of a ‘medicine of the mind’: Bonnet, Marat, Le Cat, not to (...) mention Bordeu and Haller. In view of the poignancy of Le Camus’ questions, however, his Médecine de l’Esprit may be taken as the hidden clue to a series of questions ranging from the perfectibility of the human mind to the curing of insanity, and thus spanning the limits of the human spectrum—from idiot to genius. The open possibility of creating a medicine of the mind is in fact a restatement of the problem of the respective weight of ‘organization’ and education, understood here in the broadest sense. This problem forms an essential part of the Réfutation d’Helvétius. Furthermore, this possibility leads one to inquire into the physician’s ability to intervene in the organization itself. Thus the question of the ‘innate’ and the ‘acquired’ shifts in some sense, so that it is now located within the problem of organization, which now means more than just the material organ of thought. Ultimately, it is this expression, ‘organization’, which I wish to elucidate further. (shrink)

This concluding essay offers reflections on core components of the faculty fellowship program, its outcomes and results, and program design and administration. Amid the current calls for reform in legal and other professional education, the lessons we learned and perspectives we gained during this fellowship program may be relevant to any faculty members and university administrations that are seeking to create more effective and engaged professional and graduate school programs, whatever may be their subject-matter discipline.

We assessed students’ and employees’ perception of ethical climate at a university school of medicine compared to that of social sciences and humanities, as well as temporal changes in the employees’ perception of ethical climate. We also explored potential predictors of ethical climate, including moral foundations. This cross-sectional questionnaire study was conducted at the University of Split School of Medicine and the Faculty of Humanities and Social Sciences, in Croatia, from April to September 2019. We used 36-item (...) Ethical Climate Questionnaire and 22-item Moral Foundation Questionnaire to survey employees, senior and doctoral students. We collected responses using ballot boxes as well as online survey. We collected 449 complete responses. The dominant ethical climates at two schools were “Company rules and procedures” and “Laws and professional codes”. We compared our results with a study conducted in 2012 and found that the perception of ethical climate had not changed dramatically in last 8 years. Ethical climate, or shared social and work-related behaviours, does not seem to change in these institutions even when students and staff are included with faculty in surveys. We provide further discussion of why this seems to be the case. (shrink)

The policy changes governing the relations between the pharmaceutical, medical device and service industries and academic clinical research physicians, recommended by the Institute of Medicine,1 the American Academy of Medical Colleges,2 and much discussed in the media and on our campuses, aim to create some protective ethical firewalls. However, some potentially critical consequences of these steps are missed if we do not acknowledge what else is on the table, and who is sitting at it. By only reacting defensively to (...) the juggernaut of righteous indignation over the loss of purity in a faculty physician's approach to medical problem solving, we are allowing the process to blind us to the difficulties in establishing fair and equitable management of all of the potential conflicts of commitment and conflicts of interest we incur, not only as faculty members, but also as departments and academic medical centres . Critically, this involves all sources of revenue—private, commercial and public—that support our professional and institutional commitments as well as our personal finances.i To counter the present crackdown on inappropriate financial relationships effectively, we will need to reframe the questions, and convince all stakeholders to the process that there is more to this crisis than can be resolved through our public confessions of commercial largesse obliged. The Phrma Code guidelines3 have resulted in what is believed to be a defensible, if as yet legally untested, compartmentalisation of the commercial sector's marketing, medical education and research sponsorship activities. We at the AMC are a long way from understanding how those same missions, as they emanate from our multifarious commitments, can be isolated and individually managed. Defining the parameters for establishing institutional conflicts of interest and commitment are beyond our essay's scope, but with the very public emphasis on capitalist subversion of …. (shrink)

We determined the prevailing ethical climate at three different schools of a single university, in order to explore possible differences in the ethical climate related to different research fields: the School of Electrical Engineering, Mechanical Engineering, and Naval Architecture; the School of Humanities and Social Sciences; and the School of Medicine. We used the Ethical Climate Questionnaire to survey the staff at the three schools, and used the research integrity and organizational climate survey for early-stage researchers at the three (...) schools. The dominant ethical climate type perceived collectively at the three university schools was Laws and professional codes, which is associated with the cosmopolitan level of analysis and the ethical construct of principle. Individually, the same climate predominated at the schools for engineering and humanities, but the School of Medicine had the Self-interest ethical climate, which is associated with the individual level of analysis and the egoism ethical construct. In the RIOC survey, early-stage researchers from the three university schools did not differ in their perceptions of the organizational research integrity climate, or in their perceived individual, group or organizational pressures. Our study is the first, to the best of our knowledge, to show differences in perceived ethical climate at a medical school compared to other schools at a university. Further studies are needed to explore the reasons for these differences and how they translate to organizational outcomes, such as job satisfaction, commitment to the institution and dysfunctional behaviour, including research misconduct. (shrink)

This paper examines philosophy as a way of life in a time of crisis by focusing on Buddhism, envisioned as a path exercising the faculty of “mindfulness.” From this standpoint of “Buddhist philosophy as mindful exercise,” and following the Kyōto School’s inspiration of engaging a dialogue with Western traditions, including modern psychology and medicine, the paper reflects upon the role of philosophy during this critical period. In response to the contemporary fragmentation of knowledge, it conceives creatively a set (...) of core principles in the form of maxims – to be examined and adapted by each potentially interested individual – as tools to retain vital information, organize reflection, and reorient one’s attention and destiny. Structured according to the Buddhist categories of view, meditation, and conduct, this collection of maxims serves to articulate the organic movement that goes back and forth between the distinctions made in philosophical discourse and the unity of lived philosophy. (shrink)

This article reviews the strengths and limitations of five major paradigms of medical computer-assisted decision making (CADM): (1) clinical algorithms, (2) statistical analysis of collections of patient data, (3) mathematical models of physical processes, (4) decision analysis, and (5) symbolic reasoning or artificial intelligence (Al). No one technique is best for all applications, and there is recent promising work which combines two or more established techniques. We emphasize both the inherent power of symbolic reasoning and the promise of artificial intelligence (...) and the other techniques to complement each other. Keywords: Diagnosis, Computer Assisted Decision Making, Artificial Intelligence * Current address: Intelligenetics, 124 University Avenue, Palo Alto, CA. 94301, U.S.A. ** Dr. Shortliffe is a Henry J. Kaiser Family Foundation Faculty Scholar in General Internal Medicine and recipient of research career development award LM0048 from the National Library of Medicine. CiteULike Connotea Del.icio.us What's this? (shrink)

Interactions between medicine and the pharmaceutical and device industries have become widespread in medicine. Despite their promise for improving patient care through innovation, there are ways in which these relationships may compromise patient care by creating conflicts of interest for physicians—both actual and perceived—that may result in delivery of poorly justified treatment, mistrust of doctors by the public, and an undermining of the integrity of the medical profession (IOM 2009). Conflicts of interest can arise in all arenas of (...) medicine, due to discord between the responsibility to patients and the opportunity for personal financial gain. But academic medicine presents an additional interest to protect: .. (shrink)

Within medical education, there is an increasing need to provide ethics education for learners embarking on service learning. The concept of hospitality, as illustrated in Homer’s classic epic the Odyssey, has the potential to underpin such ethics education. This paper describes the implementation and evaluation of an ethics education session for medical students, built on the concept of hospitality, before they embark on a three-year longitudinal service-learning home visit program. In preparation for their household visits, second-year students at a medical (...) school in Miami, Florida, participate in weekly didactic sessions. One of these classes consisted of a two-hour ethics session, involving a brief introductory large-group lecture, followed by self-administered small-group discussions of a series of case scenarios. An innovative web-based platform called Rise allowed the students to run their own small group activities. To assess the impact on the students’ ability to identify, and on their confidence in handling, ethical dilemmas, we administered pre- and post-session surveys. Students indicated statistically significant improvement in median responses to all questions, for two consecutive years. Students also listed three adjectives, both before and after the session, that they associated with good and bad hosts and guests. The consistency of the terms listed suggests that hospitality is a robust concept for the learners. In our experience, the concept of hospitality provides a robust framework for the students, and the mixed large-group and self-facilitated small-group format offers a valuable tool for ethics education related to service learning in medicine. Our study supports the utility of the concept as a teaching tool, and the format facilitates a session using minimal faculty. The notion of hospitality seems particularly fruitful for various ethical considerations in medicine, even beyond those that involve home visits. (shrink)

Introduction Illegal practice of medicine by medical students is a worldwide problem. In Brazil, information about this issue is scarce.Objective To describe the perception of illegal practice of medicine by medical students.Methods A cross-sectional study in a stratified random sample of 130 medical students in the 6th to 12th semesters from a private faculty of medicine in Salvador, State of Bahia, Brazil, from September to October 2011. Students responded to a standardised questionnaire about the illegal practice (...) of medicine by medical students.Results Knowing medical students who practised medical activities without supervision was reported by 86% of the respondents, and 93.8% had heard about someone who performed such practices. Medical specialties most often associated with illegal practice were general medicine and occupational health . Illegal practice of medicine was more common in peripheral cities/towns than in the State capital, Salvador City . Only 10.5% of illegal activities were reported to the authorities. Unsupervised medical practice was more often reported in the 8th–9th semester and 10th–11th semester of medical school.Conclusions Illegal practice of medicine was commonly reported by the medical students questioned. The high frequency of reported illegal practice for financial reasons highlights the need for greater availability of paid internships for medical students. Educational institutions represent the social control responsible for supervising the activities of academics. (shrink)

Partiendo de las deficiencias detectadas en la realización de la discusión diagnóstica por los estudiantes de Medicina, determinadas en un estudio previo realizado en la Facultad de Ciencias Médicas de Camagüey, se diseñó una metodología para perfeccionar la realización de la discusión diagnóstica en la carrera de Medicina, en la cual se incluyeron un sistema de tareas y las acciones que permiten alcanzar el desarrollo de las habilidades relacionadas con la misma. También se reflejaron las formas organizativas de enseñanza y (...) las actividades de educación en el trabajo en las que se deben abordar los elementos de la metodología, así como la propuesta de criterios evaluativos para estas habilidades, y otros aspectos como la ejecución y evaluación de la metodología. Se consideró que esta propuesta metodológica puede constituir una herramienta útil para los profesores en la conducción del proceso de adquisición de las habilidades de razonamiento clínico en los estudiantes. On the basis of the deficiencies identified in the realization of the diagnostic discussion by medical students, which were determined in a previous study carried out in the Faculty of medical sciences of Camagüey, a methodology was designed to improve the realization of the diagnostic discussion in Medicine degree, which included a set of tasks and actions that allow the development of skills related to it. Also, the teaching organization forms and education activities at work that must deal with methodology elements were stated, as well as the proposal of assessment criteria for these skills and other aspects like assessment and implementation of methodology. It was considered that this methodology can be used as a useful tool for teachers as guides in the process of students´ acquirement of clinical reasoning skills. (shrink)