Using a real-life case involving an accidental discovery of misattributed paternity as a springboard for discussion, I reflect on several practical and theoretical issues surrounding truth-telling in the doctor-patient relationship. I present the moral dilemma and identify arguments in favour of and against disclosure. I then examine the theoretical difficulties in balancing conflicting reasons and in establishing what constitutes the 'truth'. I conclude that withholding the information from the patients would be ethically permissible and, more generally, that honesty is not (...) always the best policy. (shrink)

edited by Tuija Takala and Matti Häyry, welcomes contributions on the conceptual and theoretical dimensions of bioethics.

The medical profession’s role should be limited to advice and informationThe medical establishment’s desire to interfere with the autonomous wishes of boxers seems at odds with the principle of respect for autonomy prevalent in contemporary biomedical practice. I argue that the role of the medical profession in boxing should be solely an advisory and informational one. In addition, the distinctions made between boxing and other high risk sports often rely on an insufficient knowledge of the sport. This leads to misdirected (...) criticisms and excessive emphasis on the colourful discourse of boxing, as opposed to the practice of boxing itself. Dr Herrera’s claim in his article that boxing differs from other sports in the acceptability of its acts outside the realm of sport is refuted.1 The importance of consent as a legitimising factor is highlighted, and a number of possible solutions to improve safety within the sport are tentatively suggested.In the United Kingdom, a competent adult may legally refuse medical treatment, irrespective of the severity of his condition or the validity of his reasons. With the pre-eminence of an autonomy based model of bioethics, respecting a patient’s wishes forms an integral part of acting in his best interests. It is puzzling, then, to find that the Australian Medical Association have called for a ban on boxing on the grounds that the activity is excessively hazardous to the health of boxers. The often mentioned principle of respect for autonomy is abandoned once the person drops the privileged title of “patient”. This suggests that being a patient …. (shrink)

Case 1 reminds us that patients have duties too, while case 2 presents an instance of justified withholding of informationHow refreshing to read these two cases! No conjoined twins, fantastical chimeras, or other incredible scenarios at the fringes of medical reality. Each case highlights the practical and theoretical difficulties that doctors face in their everyday practice.Case 1: In case 1, the patient, who had declined an HIV test, changed his mind and requested an HIV test on the request form without (...) informing the doctor. The pathologist performed the tests and returned the results to the unsuspecting doctor, who duly investigated the matter. The doctor’s anxiety at the situation, as well as the worries of the entire practice and pathology laboratory, must have been deeply unpleasant. Thus the patient, no doubt unintentionally, caused much distress by requesting the HIV test. He was, at the very least, guilty of a lack of foresight and consideration. As a minimum, he should have informed the doctor of his last minute alteration. This would have enabled the doctor to discuss the implications of the test, to organise appropriate counselling, and, most importantly, to receive the results in full knowledge of the situation.As Dr Fraser points out, the experience of case 1 reinforces the importance of taking good medical notes. Even if the patient’s refusal had been documented in the notes, however, this would not have prevented him from requesting the HIV test, and indeed other tests, on the blood form. Pharmacists may still occasionally be faced with situations when they are unsure whether the doctor prescribed 10 capsules of a drug, or 110 capsules, as the patient may have added a “1” in front of the doctor’s original prescription. Similarly, how …. (shrink)

The public revelation in 2003 that medical students perform intimate examinations without patient consent has engendered much debate in the press and scientific journals. Using this case as a springboard for discussion, I will argue that medical schools should encourage students to raise their ethical concerns and call for a change of policy making it easier for students to do so. I will also address the question of medical students’ moral obligations towards their patients, and conclude that medical students ought (...) to express their discontent when faced with unethical practices or attitudes.In early January 2003, a study appeared in the British Medical Journal revealing that nearly a quarter of rectal and vaginal examinations on anaesthetised patients were performed by medical students without patient consent.1 Although the study did not generate the firestorm of controversy many expected, it engendered much discussion on ethical issues surrounding informed consent and patient autonomy, as well as stressing the need for greater ethics training for medical students. As an ethical problem, however, the case of intimate examinations is, to my mind, relatively uninteresting. If we agree that it is wrong for doctors to perform a vaginal examination on a conscious person without their consent, then it follows that it will still be …. (shrink)

Although telephone consultations are widely used in the delivery of healthcare, they are vulnerable to breaches of patient confidentiality. Current guidelines on telephone consultations do not address adequately the issue of confidentiality. In this paper, we propose a solution to the problem: a password system to control access to patient information. Authorised persons will be offered the option of selecting a password which they will use to validate their request for information over the telephone. This simple yet stringent method of (...) access control should improve security while allowing the continuing evolution of telephone consultations. (shrink)

Case presentations, esthetics, insurance considerations, communicable diseases, referral questions, dental phobia, and legal concerns all play a role in doctor-patient relationships. These topics, and many others, are the subject of this one-of-a-kind resource, designed to show dental students and practitioners how to approach patient relationships.

Petrić motivira svoj pokušaj deheleniziranja filozofije i kršćanske teologije činjenicom da su oko četiri stotine godina nakon »starih teologa«, koji su bili pod utjecajem Platonove filozofije, skolastički teolozi počeli u teologiju uvoditi Aristotelovu filozofiju i uzimati njegove »bezbožnosti« kao temelje vjere. Ispričava ih što nisu poznavali niti mogli poznavati stare teologe jer nisu znali grčki i stoga su im bili nepoznati Platonovi i Aristotelovi izvorni tekstovi u kojima se ti stari mudraci spominju. Ne oprašta im, međutim, što su pokušali »bezbožnošću (...) poduprijeti pobožnost«. Stoga Petrić nastoji pokazati da je Aristotel našao sve problemske motive svoje metafizike, fizike i etike u prastarih egipatskih i kaldejskih mudraca, i to najvećim dijelom posredovanjem Platona. Isto tako nastoji pokazati kako je spomenute probleme Aristotel preformulirao, pretumačio u duhu starogrčkog jezika i duha, ali djelomično i prešućivao.Heideggerov analogni noviji pokušaj dehelenizacije filozofije i kršćanske teologije polazi od teze o »zaboravu pitanja o bitku«, odnosno o »smislu bitka«. Taj »zaborav« skrivila je tradicionalna metafizika koja je tretirala bitak kao »najopćenitiji« i stoga »najrazumljiviji« pojam i na taj način dispenzirala filozofiju da ponovo promišlja pitanje o bitku. Pitanje o bitku blokirala je metafizika i time što je bitak tretirala kao »biće« i navela teologiju da i Boga tretira kao »biće«, doduše kao »najviše«, ali ipak kao biće. To je omogućilo da se teologija razumije kao »pozitivna« znanost i time se uvrsti među druge »pozitivne« znanosti. Heideggerov motiv da »destruira« tradicionalnu metafiziku jest da usmjeri mišljenje prema njegovoj zaboravljenoj bitnoj zadaći, a time i teologiju da se, oslobođena od tradicionalne metafizike, uputi novim putovima.Najnoviji poticaj kritičkom tematiziranju dehelenizacije kršćanske vjere, i uopće europskog duha, dao je teolog i sadašnji papa Joseph Ratzinger, posebno u svom predavanju na Sveučilištu u Regensburgu, u kojem je desetak puta kritički apostrofirao dehelenizaciju. Podvrgnuo je kritici tri vala dehelenizacijskog programa u kršćanskoj teologiji: od izgona metafizike iz teologije u Reformaciji, preko historiziranja u liberalnoj teologiji 19. i 20. stoljeća, do brisanja tragova helenizacije kršćanske vjere u ideji inkulturacije. Ratzinger podvrgava kritici ograničavanje uma , započeto matematizacijom europske znanosti u renesansnom platonizmu, koje je Kant kanonizirao. Posljedice toga ograničavanja uma nisu relevantne samo za kršćanstvo koje teži suprotnome, tj. proširenju uma , nego i za zapadnoeuropski duh u cjelini.Petrić’s attempt at dehellenizing philosophy and Christian theology was motivated by the fact that about four centuries after the “ancient theologians”, who were influenced by Plato’s philosophy, scholastic theologians began to introduce Aristotle’s philosophy into theology and adopt his “impieties” as the foundations of faith. He justifies their ignorance and inability to learn about the ancient wise men by the fact that they had no knowledge of Greek and were thus not familiar with the original texts of Plato and Aristotle in which the wise men were mentioned. He does not forgive them, however, for trying to “support piety by impiety”. Thus Petrić attempts to demonstrate how Aristotle found all the problem motives of his metaphysics, physics and ethics in the wise men, drawing mostly upon Plato. He also attempts to show how Aristotle reformulated the mentioned problems, reinterpreted them in the spirit of the old Greek language and thought, but also ignored some of them.Heidegger’s more recent similar attempt at dehellenizing philosophy and Christian theology is grounded on a thesis of the “neglect of the question of being” – that is, the “meaning of being”. This “neglect” is the result of traditional metaphysics which treated being as “the most general” and thus “the most understandable” notion, and in such a way dispensed philosophy to reconsider the question of being. The question of being was blocked by metaphysics in that it treated being as an “entity”, prompting theology to treat God as an “entity” as well, though “the supreme” but still an entity. This led to the understanding of theology as a “positive” science and its eventual classification among the “positive” sciences. Heidegger’s motive to “destroy” traditional metaphysics is to stream thought towards his forgotten major goal, and thus prompt theology, once freed from traditional metaphysics, to seek new strands.The most recent attempt at critical thematization of dehellenization of Christian faith and European spirit in general has been made by the theologian and present pope, Joseph Ratzinger, particularly in his lecture delivered at the University in Regensburg in which he repeatedly criticized dehellenization. Three stages of dehellenization program in Christian theology are the subject of his criticism: from the banishment of metaphysics from theology in the Reformation, through historization in liberal theology of the nineteenth and twentieth century to the erasing of the traces of Hellenization of Christian faith in the idea of inculturation. He also argues against mind limitation started by mathematization of European science in Renaissance Platonism and canonized by Kant. The consequences of mind limitation are not only relevant to Christianity which strives towards the very opposite – broadening of the mind , but to the Western spirit on the whole. (shrink)

In preparing for a lecture on the ethics of surgical complications, it became apparent that confusion exists about the definition of a ‘‘surgical complication.’’ Is it, as one medical website states, ‘‘any undesirable result of surgery?’’ [1]. In the European Journal of Surgery, Veen et al. [2] provide a more elaborate definition: ‘‘every unwanted development in the illness of the patient or in the treatment of the patient’s illness that occurs in the clinic’’ [2]. An esteemed historian of science suggests (...) yet another definition in a recent volume on surgical complications: ‘‘a complication, in any sphere of endeavour, is something out of the norm, and the product of extraneous and unexpected factors’’ [3]. Such is the discrepancy in definitions that Rampersaud et al. [4] declared in 2006 that ‘‘presently, there is no clear or consistent definition of a complication in the surgical literature.’’ Much research in surgery aims to reduce the risk of surgical complications. However, until we have a stable and agreed definition of what counts as a surgical complication, we cannot reliably compare different studies to discover what best reduces the chance of surgical complications [5]. Therefore, the topic is more than mere pedantry; defining surgical complications will help us with the broader question of how to improve surgical practice. A basic PubMed search returned nearly 800 articles with the phrases ‘‘surgical complications’’ or ‘‘surgical complication’’ in the title. But unlike the sources above. (shrink)

In February 1828 a Royal Commission was appointed to examine the law of Real Property of England and Wales. The Commission sat for four years and examined a vast amount of material, recommended certain changes in the law, and drafted several bills for consideration by parliament. Four massive reports were eventually presented to parliament in May 1829, June 1830, May 1832, and lastly in April 1833. As a result parliament enacted a limited number of piecemeal reforms, but did not attempt (...) a major revision of the law. (shrink)

This chapter contains sections titled: References.

Much research in the field of emotions has shown that people differ in the cues that they use to perceive their own emotions. People who are more responsive to personal cues (personal cuers) make use of cues arising from their own bodies and behavior; people who are less responsive to personal cues (situational cuers) make use of cues arising from the world around them. An evolutionary explanation of this well-documented phenomenon is that it occurs because of the operation of a (...) cognitive module designed to enable the organism to predict its own impending behavior. This theory suggests that situational cuers would be people for whom external factors are the best source of information about their own future behavior, whereas personal cuers are people for whom cues about themselves are the best source of information about their own future behavior. Such a view is founded in the New Realist philosophy of the early twentieth century, a philosophy that affected psychology through the work of E. C. Tolman and J. J. Gibson. (shrink)

We find the idea that infant crying arises from thermoregulation more consistent with a coregulatory account of its evolutionary history than it is with the informational account advocated in the target article.

In 1982, Jonsen, Siegler and Winslade published Clinical Ethics, in which they described the “four quadrants” approach, a new method of analysing clinical ethics cases. Although the book is now in its 6th edition, a literature search has revealed only one academic paper demonstrating the method at work. This paper is an attempt to start filling this gap. As a way of describing and testing the approach, I apply the four quadrants method to a detailed clinical ethics case. The analysis (...) is interspersed with reflections on the method itself. It is hoped that this experiment will encourage ethicists and clinicians to devote more attention to this neglected approach. (shrink)

In 1982, Jonsen, Siegler and Winslade published Clinical Ethics, in which they described the “four quadrants” approach, a new method of analysing clinical ethics cases. Although the book is now in its 6th edition, a literature search has revealed only one academic paper demonstrating the method at work. This paper is an attempt to start filling this gap. As a way of describing and testing the approach, I apply the four quadrants method to a detailed clinical ethics case. The analysis (...) is interspersed with reflections on the method itself. It is hoped that this experiment will encourage ethicists and clinicians to devote more attention to this neglected approach. (shrink)

Being a healthcare professional in both paediatric and adult hospitals will mean being exposed to human tragedies and stressful events involving conflict, misunderstanding, and moral distress. There are a number of different structured approaches to reflection and discussion designed to support healthcare professionals process and make sense of their feelings and experiences and to mitigate against direct and vicarious trauma. In this paper, we draw from our experience in a large children’s hospital and more broadly from the literature to identify (...) and analyse four established approaches to facilitated reflective discussions. Each of the four approaches seeks to acknowledge the stressful nature of health professional work and to support clinicians from all healthcare professions to develop sustainable skills so they continue to grow and thrive as health professionals. Each approach also has the potential to open up feelings of uncertainty, frustration, sorrow, anguish, and moral distress for participants. We argue, therefore, that in order to avoid unintentionally causing harm, a facilitator should have specific skills required to safely lead the discussion and be able to explain the nature, scope, safe application, and limits of each approach. With reference to a hypothetical but realistic clinical case scenario, we discuss the application and key features of each approach, including the goals, underpinning theory, and methods of facilitation. (shrink)

This essay offers an overview of the diversity of women’s prose writing that emerged on the Czech cultural scene in the post-communist era. To that end it briefly characterizes the work of eight Czech women authors who were born within the first two decades after World War II and began to create during the post-1968 era of ‘normalization’. In this broad sense they belong to a single generation. With rare exception their work was not officially published in their homeland until (...) the 1990s. The writers included are: Lenka Procházková, Tereza Boučková, Alexandra Berková, Zuzana Brabcová, Daniela Hodrová, Sylvie Richterová, Iva Pekárková, and Eva Hauserová. The overview is followed by a concise comparative analysis of texts by three very different writers (Procházková, Pekárková, and Hodrová), using a feminist critical approach. There is also an appendix of works by these writers available in English translation. (shrink)