The goals of medicine -- A story about a patient with aortic stenosis -- What are facts in medicine? -- Clarify the chain of events that led to the present state : the case as a narrative -- The case of Myra Manner -- Examine your presuppositions and preconceptions -- Separate and examine the values at issue -- A question of judgment -- The patient, the doctor, and the relationship -- Observation, prognosis, and prognosticating -- Thinking in medicine -- Accepting (...) the challenge. (shrink)

Here is a thoroughly updated edition of a classic in palliative medicine. Two new chapters have been added to the 1991 edition, along with a new preface summarizing where progress has been made and where it has not in the area of pain management. This book addresses the timely issue of doctor-patient relationships arguing that the patient, not the disease, should be the central focus of medicine. Included are a number of compelling patient narratives. Praise for the first edition "Well (...) written. . .should be read by everyone in medical practice or considering a career in medicine."---JAMA. "Memorable passages, important ideas, and critical analysis. This is a book that clinicians and educators should read."---New England Journal of Medicine. (shrink)

" Dr. Cassell discusses the world of the sick, the healing connection and healer's battle, the role of omnipotence in the healer's art, illness and disease, and ...

Medicine and ethics alike must learn properly to attend to suffering. We can never truly experience another's distress. We can, however, learn to recognize the particular purposes, values, and aesthetic responses that shape the sense of self whose integrity is threatened by pain, disease, and the mischances of life.

Like the broom in “The Sorcerer's Apprentice,” technologies take on a life of their own. To bring them under control, doctors must learn to tolerate ambiguity, resist the lure of the immediate, cease fearing uncertainty, and rechannel their response to wonder.

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.3 (2003) 225-226 [Access article in PDF] Travelers in the Land of Sickness Eric J. Cassell THE PROBLEM OF knowing another person and the world in which that person lives, particularly someone with major mental illness, is addressed in this interesting and rich essay. The number of different metaphors and concepts Potter employs to describe the task of crossing into and then understanding (...) the thoughts, emotions, symptoms, constraints, context, and perspectives of another testifies to the difficulties involved.Yet, as I read the essay, it was not clear what the clinician world traveler, moral tourist, empathizer (and other categories) is supposed to do on the journey to another person. Why do we reach out to the sick person? What is it that we want to know or do that makes this trip necessary? Potter is primarily concerned with mental illness—the examples she cites are patients with schizophrenia—while my experience has in the main been with persons with physical illness, but for the moment, the differences are less important than the central lesson. The illness that the patient presents—the experience of the symptoms, the impairments, disability, and disruptions of the emotional and social existence that happen because of the disease result from an amalgam of the disease process with the specific nature of the sick person. There is no disease in pure form; there is no disease in abstract for clinicians. There is only this sick person. She correctly quotes me, because of all this, as pointing out the importance of integrating knowledge of this particular patient with the abstract knowledge of disease to understand the illness as it is expressed in this person. All to form a basis for the treatment of the patient and especially to help relieve suffering because suffering is always personal, particular, and individual. (It is important in thinking about this topic to remember that most serious diseases, psychiatric and otherwise, are chronic and take place over significant lived time. The acute schizophrenic symptoms or the acute infectious diseases, as dramatic as they are, distract attention from the importance of the place of the sick person.)In physical disease, our long (and continuing) history of separating human beings from nature and the body, and the importance medicine places on objectivity and the objective, have made the inevitable personalization of the disease and symptoms virtually invisible. After ages of explaining psychiatric diseases as the alienation of the person, and a long psychoanalytic period of finding their origins in the person, in the last 30 years these diseases have become increasingly objectified. The place of the person has been diminished as psychiatry has entered the DSM, neurotransmitter, and effective psychotropic drug era. For both physical and mental disease, however, and whatever the current ideology, the nature of person is crucial in determining the onset, diagnosis, course, treatment, and outcome of each illness. It is in order to have an impact on these crucial aspects of sickness that clinicians must come to know their patients to the degree possible. [End Page 225]But there is something more. Nancy Potter quotes a woman with schizophrenia as saying, "All that was my former self has crumbled and fallen together and a creature has emerged of whom I know nothing. She is a stranger to me... She is not real—she is not I... She is I—and because I still have myself on my hands, even if I am a maniac, I must deal with me somehow." (Potter, 2003, p. 215)Must she deal with this crazy self alone? Is that not what her doctors and caregivers are for? But how can they take care of her, protect her, keep what is left intact, and sustain her until she is (hopefully) better without knowing who she is? She makes clear in those few phrases that inside her there is a person with a past, a family, a world, a culture, a role(s) in life, relationships, a body, dreams for the future, things she does, and all the other things that make up a person. It is in... (shrink)

Although written primarily for medical research, the Belmont principles have permeated clinical medicine as well. In fact, they are part of a broad cultural shift that has dramatically reworked the relationship between doctor and patient. In the early 1950s, medicine was about making the patient better and maintaining optimism when the patient could not get better. By the 1990s, medicine was about the treatment of specific physiological systems, as directed by the patient, but as limited by the society's concern for (...) justice. (shrink)

Healers: Extraordinary Clinicians at Work, by David Schenck and Larry R. Churchill, and What Patients Teach: The Everyday Ethics of Health Care, by Churchill, Joseph B. Fanning, and Schenck are both important and thought‐inspiring books. For the first, Schenck and Churchill recruited fifty practitioners, mostly physicians but some clinicians who practice alternative therapies, “identified by their peers as excellent healers,” and interviewed them to find out what they did to establish a good relationship with their patients. The results of their (...) interviews and how they wrote their book makes this the best and most concrete understanding of a necessary step to healing that I have read. What Patients Teach examines the patients’ perspective about forming relationships with their clinicians. The patients’ clinicians were asked to nominate patients to be interviewed to help answer the question. This volume, while important, is less extraordinary than the first because we hear less what the patients want to say and more what the authors want to tell us. That aside, taken together, these two books are a major advance in the literature of healing. (shrink)

To the Editor: Daniel Callahan is correct when, in “Rationing: Theory, Politics, and Passions”, he tells us that the combination of ever-rising medical costs and ever-increasing demand for expensive resources by physicians and their patients will—in the absence of any workable, generally acceptable mode of official rationing—lead to covert rationing. Or, more precisely, it will encourage us to extend the covert rationing that already exists, where those with more get more. As things stand now, this is unavoidable. However..

Book reviewed in this article: Thinking Clearly About Death. By Jay F. Rosenberg.

Book reviewed in this article: Talking with Patients. By Eric J. Cassell.

Book reviewed in this article: Suffering and the Beneficent Community: Beyond Libertarianism. By Erich H. Loewy. The Nature of Suffering and the Goals of Medicine. By Eric J. Cassell.

How docs Marx stand one hundred years after his death? If we look at the literature written and read by intellectuals, and the polemics among Marxists, the answer is: not too firmly. In the past they disputed about the political and ideological significance of Marx’ theory. Today some of the most basic propositions of the old gentleman are queried even among people claiming to be Marxists, from the materialist conception of history to the labour theory of value. People ask with (...) increasing frequency what precisely has survived in Marxism. So it is important to establish, at the outset, that today—unlike the situation even thirty years ago— nobody seriously doubts that something of Marx has survived, indeed that a great deal has survived. If this were not the case, there would not be such passionate argument about the matter. For there is no argument about thinkers who are dead. (shrink)

Debates concerning the relationship between Tridentine Catholicism and Catholicism after Vatican II dominate theological conversation today, particularly with regard to understandings of the Church and its engagement with the world. Current historical narratives paint ecclesiology after the Council of Trent as dominated by juridical concerns, uniformity, and institutionalism. Purportedly neglected are the spiritual, diverse, and missional aspects of the Church. This book challenges such narratives by investigating the Spanish Jesuit Francisco Suárez's theology of ecclesial unity and catholicity. Analyzing standard as (...) well as overlooked sources of Suárez's ecclesiology, the author shows how Suárez wrestles with the new demands of his time and anticipates later ecumenical developments in twentieth-century Catholic ecclesiology. Early modern expansion prompted theologians after Trent to reckon with the ecclesial status of baptized Protestants, the Greek Orthodox, and non-believers in the New World. It further prompted reflection on the universality, or catholicity, of the Church, and how the Church's mission to the nations serves her greater unity in Christ. Throughout this exposition, the author reveals Suárez's vision of the Church to be deeply spiritual, diverse, and missional-not at the expense of the institutional, but as it's necessary and life-giving source. The Church, for Suárez, is primarily a way of life. This book explores not only Suárez's speculative ecclesiology, but how the unity and catholicity of the body of Christ is lived out in practice, that is, in the worship and works of the faithful, and, most notably, in the charism of his own religious order, the Society of Jesus. Suárez thus shows his readers what the spiritual dynamic between Christic unity and missional catholicity should look like in the Church. (shrink)

Mister Rogers’ Neighborhood, which began as The Children’s Corner in 1953 and terminated in 2001, left its mark on America. The show’s message of kindness, simplicity, and individual uniqueness made Rogers a beloved personality, while also provoking some criticism because, by arguing that everyone was special without having to do anything to earn it, the show supposedly created an entitled generation. -/- In Mister Rogers and Philosophy, thirty philosophers give their very different takes on the Neighborhood phenomenon.

Aristotle's theory of moral character focuses on developing virtues, the deep internal dispositional traits from which external actions naturally flow. Aristotle describes moral virtue as a human excellence that can be developed through practice. The morally worst person is the vicious person who does the wrong thing, desires the wrong thing, and doesn't even know the right thing to do—perhaps even mistaking the wrong thing to do for the right thing. This was the sort of person Eleanor was when she (...) entered The Good Place. One objection to the possibility of moral development is called situationism: the claim that people don't really live according to moral character but are overwhelmingly shaped by the situations around them. As Eleanor learns in The Good Place, the road to being a better person starts with caring about those close to us. (shrink)

This chapter contains section titled: “You're Right. There's No Earth. It's All a Legend” “I'm Not a Cylon!…Maybe, But We Just Can't Take That Chance” “You Have to Have Something to Live For. Let it be Earth” Notes.

Extracorporeal membrane oxygenation (ECMO) is currently reserved predominantly for bridging patients to a different destination therapy, but the use of ECMO as a destination therapy itself (ECMO-DT...

The theory and practice of history and its relevance to the modern world, by Britains greatest radical historian.

To the student of the recent history of theological ideas in the West, it sometimes seems as though, of all the ‘new’ subjects that have been intro duced into theological discussion during the last hundred or so years, only two have proved to be of permanent significance. One is, of course, biblical criticism, and the other, the subject which in my University is still called ‘comparative religion’—the dispassionate study of the religions of the world as phenomena in their own right.