Medical practice has always involved at least three roles, three complimentary identities. Practitioners have been at once clinicians dedicated to a patient’s care, members of a professional organization promoting medicine, and informed citizens engaged in public debates on health issues. Beginning in the 1970s, a series of social and technological changes affected, and in many cases restricted, the practitioner’s ability to function equally in these three identities. While others have discussed the changing realities of medical practice in recent decades, none (...) have commented on their effect on their effect on rights of practitioners as citizens. Here several cases begin an analysis of the manner in which those changes have limited the physician’s right to act conscientiously and speak publicly in the face of organizational agendas and political priorities. (shrink)

This paper advances a social organization approach to examining unethical behavior. While unethical behaviors may stem in part from failures in individual morality or psychological blind spots, they are both generated and performed through social interactions among individuals and groups. To illustrate the value of a social organization approach, a case study of a medical school professor's first experience with pharmaceutical-company-sponsored research is provided in order to examine how funding arrangements can constrain research integrity. The case illustrates three significant ways (...) that institutional corruption can occur in the research process. First, conflicts of norms between pharmaceutical companies, universities, and affiliated teaching hospitals can result in compromises and self-censorship. Second, normal behavior is shaped through routine interactions. Unethical behaviors can be (or can become) normal behaviors when they are produced and reproduced through a network of social interactions. Third, funding arrangements can create networks of dependency that structurally distort the independence of the academic researcher in favor of the funder's interests. More broadly, the case study demonstrates how the social organization approach deepens our understanding of the practice of ethics. (shrink)

What does unethical behavior look like in everyday professional practice, and how might it become the accepted norm? Examinations of unethical behavior often focus on failures of individual morality or on psychological blind spots, yet unethical behaviors are generated and performed through social interactions across professional practices rather than by individual actors alone. This shifts the focus of behavioral ethics research beyond the laboratory exploring motivation and cognition and into the organizations and professions where unethical behavior is motivated, justified, enabled (...) and supported in specific social contexts. For instance, when pharmaceutical firms fund academic research, how do the funding arrangements intersect with individual behaviors that are typical in academic research? In turn, how do academic-industry interactions affect scientific norms, particularly those involving compliance with rules, regulations, and ethical codes of conduct? A social organization approach to ethics allows us not only to examine ethics in practice, but also to tease apart unethical behaviors that might operate on an unreflective level and become accepted as “just the way it is.”. (shrink)

“Medical humanities” is a phrase whose currency is wider than its agreed meaning or denotation. What sort of study is it, and what is its relation to the study of philosophy of medicine? This paper briefly reviews the origins of the current flowering of interest and activity in studies that are collectively called “medical humanities” and presents an account of its nature and central enquiries in which philosophical questions are unashamedly central. In the process this paper argues that the field (...) of enquiry is well-conceived as being philosophical in character, and as having philosophy — albeit pursued over a larger canvas — at the core of its contributing humanities disciplines. The paper characterises humanities disciplines as having an important focus on human experience and subjectivity, of which the experiences and subjectivities at stake in health, medicine and illness form an important sub-set, the preoccupation of the medical humanities as a whole. Claims of interdisciplinarity (as distinct from multidisciplinarity) are noted, but such claims need to be recognised for the high and stern ambition that they embody, and should not be made lightly. (shrink)