This article examines the role of medical interpreters in structuring interaction between physicians and their patients. Through a detailed analysis of interpreters' involvement in the history-taking part of medical consultations, it is demonstrated that their participation in this activity is organized by their understanding of its goals rather than by the task of translation alone. Specifically, the different ways in which interpreters participate in history taking display their orientation to obtaining from the patient and (...) conveying to the doctor medically relevant information about the patient's symptoms - and doing so as effectively as possible. Medical interpreters are found to share the physicians' normative orientation to obtaining objectively formulated information about relevant biomedical aspects of patients' conditions. Thus, far from being passive participants in the interaction, interpreters will often pursue issues they believe to be diagnostically relevant, just as they may choose to reject patients' information offerings if they contain subjective accounts of their socio-psychological concerns. (shrink)

In an era of ever-increasing dependence upon technology, physicians are losing the basic skills of patient examination and taking the medical history. This book describes the scenario in which the physician sits down with a patient to elicit a medical history. For example, how to greet a patient, how to discover the patient's chief concern, how to elicit symptoms, how to manage feelings as the patient and physician interact, and how to choose topics to explore, (...) and use the appropriate word selection, phrasing, and tone of voice. A good history leads to trust and rapport, and also to the determination of the best management of the patient's condition. Dr. William DeMeyer, a well-known physician and author of the major text on the neurologic exam, describes how to take a medical history, and also explains the reasons why it is done in a particular way. The author reviews the actual questions that a health provider should ask and the responses to a patient's answers. More importantly, the author describes how to listen to the patient's real needs as a person, rather than just a repository of symptoms. (shrink)

Summary Principles Timely support for patients and people close to them, and effective, sensitive communication are essential. Decisions must be based on the individual patient's circumstances and reviewed regularly. Sensitive advance discussion should always be encouraged, but not forced. Information about CPR and the chances of a successful outcome needs to be realistic. Practical matters Information about CPR policies should be displayed for patients and staff. Leaflets should be available for patients and people close to them explaining about CPR, how (...) decisions are made and their involvement in decisions. Decisions about attempting CPR must be communicated effectively to relevant health professionals. In emergencies If no advance decision has been made or is known, CPR should be attempted unless: the patient has refused CPR; the patient is clearly in the terminal phase of illness; or the burdens of the treatment outweigh the benefits. Advance decision making Competent patients should be involved in discussions about attempting CPR unless they indicate that they do not want to be. Where patients lack competence to participate, people close to them can be helpful in reflecting their views. Legal issues Patients' rights under the Human Rights Act must be taken into account in decision making. Neither patients nor relatives can demand treatment which the health care team judges to be inappropriate, but all efforts will be made to accommodate wishes and preferences. In England, Wales and Northern Ireland relatives and people close to the patient are not entitled in law to take health care decisions for the patient. In Scotland, adults may appoint a health care proxy to give consent to medical treatment. Health professionals need to be aware of the law in relation to decision making for children and young people.IntroductionWhy policies are neededCardiopulmonary resuscitation can be attempted on any person whose cardiac or respiratory functions cease. Failure of these functions is part of dying and thus …. (shrink)

When we go to the doctor, he or she will not begin to treat us without taking our history – and not just our history but that of our parents and grandparents before us. The doctor will not see us u...

This fine book tells an important story of how long-standing notions about the body as dominated by spirit-like humors were transformed into scientific descriptions of its solid tissues. Vesalius, Harvey, Descartes, Willis, and Locke all played roles in this transformation, as the cerebral hemispheres and cranial nerves began to take precedence over the role of spirit, passion, and the heart in human thought and behavior. Non of this occurred in a social vacuum, and the book describes the historical context clearly. (...) It also shows how debates over investigative methods and models of body order that first raged over 300 years ago continue to influence biomedicine and the broader culture today. No other book on western mind-body relationships has attempted this. (shrink)

This paper suggests that the practice of anamnesis—the taking of a patient history in preparation for making a diagnosis, as well as the related form of investigation, historia—offers a way to understand the role of medical collections in generating medical knowledge. Anamnesis derives from ancient Greek “recollecting” or “opening of memory,” and “taking a history” from historia, an ancient and early modern epistemic practice of gathering empirical observations from the past and present. Doctors and (...) medical researchers perform, this paper argues, a form of anamnesis when they access collections—of pathological organs, experimental animals, diagnostic slides, samples, and data—and the collections may in turn be seen as constituting institutional and disciplinary memories. It moreover shows that doctors and medical researchers in their work with collections negotiate two ways of organizing observations that are also present in an anamnesis. One way clusters and classifies observations, while the other traces developments and requires significant past observations to understand the present. This double nature plays out in different ways in different historical collections. Last, the paper itself may also be seen as performing an anamnesis: looking for patterns and tracing a development in medical history. It “opens the memory” of medical collection practices, and shows that medicine is past-heavy and that the past plays a central role in modern biomedicine. Anamnesis is thus used as a historiographical stance that seeks to understand present practices of generating knowledge about diseases through an inquiry into the past. (shrink)

Objectives—To study the value of taking an ethics history as a means of assessing patients' preferences for decision making and for their relatives' involvement.Design—Questionnaire administered by six junior doctors to 56 mentally competent patients, admitted into general and geriatric medical beds.Setting—A large district general hospital in the United Kingdom.Main measures—To establish whether patients were adequately informed about their illness and whether they minded the information being communicated to their relatives. To establish their preference regarding truthful disclosure and (...) participation in decision making with risk attached. To establish whether they wished to be involved in CPR decision making, and if not, who should make the decision. To establish whether they knew of living wills and whether they had any advance directives.Results—Twenty-four were inadequately informed of their illness.Forty-six said they would want to know were something serious to be found. Twenty-eight wanted to make their own decision if requiring risky treatment and 11 wanted family members involved. Thirty-one wanted to make a cardiopulmonary resuscitation decision and five of these decisions differed from those made by the doctors. Twenty-five preferred the doctors to decide. Eleven of the patients had heard of living wills but only one had executed such a will. Seven of the patients wished to provide advance directives. Three did not find the history taking helpful but none were discomforted.Conclusion—Taking an ethics history is a simple means of obtaining useful information about patients' preferences. (shrink)

Every human being has a vast store of knowledge about health and sickness and the ability to draw conclusions on the basis of this knowledge. Yet science research continues to be based largely on `objective studies' conducted by academics and to look down on `subjective' studies. The belief that `pure' objective science is highest and subjective information is lowest, inculcated by the way science is taught in schools, deters doctors from communicating information based on personal experience lest it be decried (...) - as it certainly will be - as scientifically worthless. Alternative medicine with its open, flexible approach to the whole person, has something to teach conventional medicine. And doctors must pay more attention to what their patients can tell them. There is no rational justification for accepting the factual information that people give (in a case history) while disregarding what they have to say about their condition. Old-style science is particularly inept in helping doctors deal with psychosomatic problems. What is needed is a new `science of the subjective' which would be truly appropriate to the subject of study, the whole human being. There is a commentary on this paper by Sir Douglas Black, President of the Royal College of Physicians. (shrink)

Using fictionalized case studies this series follows four patients through the medical process, from onset through Diagnosis, Treatment and PrognosisVolume 1: Symptom. Examines the idea of 'symptom' as a route to understanding the structure of clinical practice -- Volume 2: Diagnosis. Explores the meaning of 'diagnosis' as a complex, culturally mediated interaction between individuals, scientific discoveries, social negotiation and historical change. -- Volume 3: Treatment. Considers the concept of treatment as an active process which produces an outcome, be it (...) effective, inappropriate or inadequate. Enlightening reading. -- Volume 4: Prognosis. Contemplates the challenge of the prognosis, attempting to make sense of life and death. Considers, through personal and professional perspectives, the role of the medical profession in guiding patient experience.--. (shrink)

As befits an emerging field of enquiry, there is on-going discussion about the scope, role and future of the medical humanities. One relatively recent contribution to this debate proposes a differentiation of the field into two distinct terrains, ‘medical humanities’ and ‘health humanities,’ and calls for a supersession of the former by the latter. In this paper, we revisit the conceptual underpinnings for a distinction between ‘the medical’ and ‘health’ by looking at the history of an (...) analogous debate between ‘medical geography’ and ‘the geographies of health’ that has, over the last few years, witnessed a re-blurring of the distinction. Highlighting the value of this debate within the social sciences for the future development of the medical humanities, we call for scholars to take seriously the challenges of critical and cultural theory, community-based arts and health, and the counter-cultural creative practices and strategies of activist movements in order to meet the new research challenges and fulfill the radical potential of a critical medical humanities. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Medical Tourism:Crossing Borders to Access Health CareHarriet Hutson Gray (bio) and Susan Cartier Poland (bio)Traveling abroad for one's health has a long history for the upper social classes who sought spas, mineral baths, innovative therapies, and the fair climate of the Mediterranean as destinations to improve their health. The newest trend in the first decade of the twenty-first century has the middle class traveling from developed countries (...) to those with emerging economies to avoid treatment delays, prohibitive costs for life-saving procedures, or simply high costs for elective surgery. Others leave to have access to assisted suicide in countries that have legalized it: Belgium, The Netherlands, and Switzerland. This new era of globalization in health care has arrived without the benefit of international standards, government oversight, or ethical and legal review.Howard Staab, a self-employed carpenter from North Carolina, flew to India for his medically necessary heart surgery, scheduled a side trip to the Taj Mahal, and returned home to work in North Carolina. He spent a total of less than $10,000, instead of the $200,000 required from the local hospital (I, Milstein and Smith 2006).At first blush, the outsourcing of medical care to India seems to be a particular solution for a particular problem. However, the particularity of Mr. Staab is not unique. His experience is emblematic of those patients in the United States with a medical need for major and elective procedures, but who also must bear the total cost of these procedures. These middle-class, under-insured Americans go abroad.In tandem with increasingly aggressive marketing campaigns, American hospitals and companies have begun to leverage their connections in Asia to grow the medical tourism business into a major economic force. What are the consequences of this?Several authors point to the effect on the host country's population, particularly the poor, to be pushed farther down the queue to receive adequate, affordable care. Resources are applied to the foreign trade instead of building the local [End Page 193] medical infrastructure. Another potential problem is the obligation of the home-country physician to provide follow-up care. What are the legal ramifications when the procedure was illegal to begin with? Are there opportunities for redress for medical errors?These factors may be converging into a "perfect storm" for health care in the U.S., in which the potential participation of the major insurance companies in promoting offshore care will be the tipping point in the precarious structure that represents the economic currents in health care. Third-party administrators and self-funded employers may be on the cutting edge in 2009 by providing incentives to employees to travel overseas for care.I. Economic ConsiderationsConnell, John. Medical Tourism: Sea, Sun, Sand and... Surgery. Tourism Management 27: 1093–1100, 2006.As evidence of the interest of traditional tour operators in this newer twist on the industry, the author explores medical tourism as an element of the growth of world tourism. In promoting medical tourism, he urges consideration of such issues as the privatization of health care, the foundational role of technology, and uneven access to health resources.Dunn, Philip. Medical Tourism Takes Flight. H and HN: Hospitals and Health Networks: 40–44, November 2007.Writing for U.S. health care executives, Dunn emphasizes that the reality of medical tourism competes with the local medical center for patients and their insurance dollars in a significant way. He examines the possibility that U.S. insurance plans soon may offer to pay for what is currently a cash only business and that the economic impact to the local medical center could be significant or even devastating.Frontiers of Health Services Management [Selected Articles] 24 (2), Winter 2007.In "Managing Healthcare Services in the Global Marketplace" (pp. 3–18), Bruce J. Fried and Dean M. Harris consider legal, ethical, and financial implications of the international workforce. In "Globalization of Health Care" (pp. 19–30), Lynn Schroth and Ruthy Khawahja point out that the transfer of comprehensive management expertise and intellectual property from U.S. medical centers to international sites is driving the success of collaboration between U.S. and foreign health care centers. In "Is... (shrink)

Qualitative and quantitative research on the impact of medical and health humanities teaching in baccalaureate education is sparse. This paper reviews recent studies of the impact of medical and health humanities coursework in pre-health professions education and describes a pilot study of baccalaureate students who completed semester-long medical humanities courses in the Division of Medical Humanities & Bioethics at the University of Rochester. The study format was an email survey. All participants were current or former baccalaureate (...) students who had taken one or more courses in literature and narrative in medicine, bioethics, history of medicine, and/or visual arts and healthcare during the past four years. The survey gathered numerical data in several areas: demographic information, career plans, self-reported influence of coursework on educational and career plans, and self-reported influence of coursework on intellectual skills and abilities. It also gathered narrative commentary that elaborated on students’ responses to the numerically-based questions. Notable findings from preliminary analysis of the data include higher scores of self-reported impact of the coursework on specific habits of mind and on preparedness for intended career rather than on gaining admission to future educational programs. Discussion of the results focuses on several potential future directions this type of study might take, including multi-center, longitudinal, and sequential approaches. (shrink)

Fundamento. La historia de la Neurocirugía en el territorio está estrechamente relacionada con la de otras especialidades como la Cirugía General y la Ortopedia. Tiene sus primeras referencias establecidas en la etapa colonial en el Hospital General, documentadas en el Boletín del Colegio Médico de Camagüey. Objetivo es resaltar la importancia que tuvieron el Hospital General y el Colegio Médico de Camagüey con su boletín en la historia de la Neurocirugía y la Ortopedia. Método. Es una investigación histórica que se (...) basa en la revisión documental y utiliza el submétodo cronológico para establecer el orden de los hechos que se describen. Desarrollo. El Hospital General a partir de su reconstrucción a finales del siglo XIX, se convirtió en el principal centro médico quirúrgico de la provincia en la época colonial. Muchos de los resultados de la actividad asistencial y científica de sus médicos apareció publicada en el Boletín del Colegio Médico de Camagüey, prestigiosa revista científica que se encargó de divulgar los resultados de la medicina camagüeyana y donde aparecen artículos que evidencian cómo cirujanos generales realizaron las primeras intervenciones neuroquirúrgicas y ortopédicas. Conclusiones. Se consideran al Hospital General y al Colegio Médico de Camagüey y su boletín, como elementos indispensables al escribir la historiografía de la Neurocirugía y la Ortopedia en el territorio. Ground: the history of Neurosurgery in this place is closely linked to other specialties like General Surgery and Orthopedics. The first documented references went back to the colonial period in the General Hospital, documented in the bulletin of the medical college in Camagüey. The objective is to highlight the importance of the General Hospital and the medical college and its bulletin in the history of Neurosurgery and Orthopedics in Camagüey. Methods: This a historical investigation that was carried out taking documented revision and using chronologic sub method to establish the order of the facts that have been described. Development: Since the reconstruction of the General hospital at the end of the XIX century, it became the main medical_ surgical center in the province during the colonial period. Many of the scientific results and medical activities were published in the bulletin of the medical college, which became a well-known scientific magazine that was in charge of publishing the medical success in Camagüey. There are articles to prove that general surgeons performed the first neurosurgical and orthopedic interventions. Conclusions: The General hospital, the medical college and its bulletin are considered crucial elements to describe the history of Neurosurgery and Orthopedics in the territory. (shrink)

In the heady days of 2011–2012, when Barack Obama was in his first term and the Patient Protection and Affordable Care Act heralded a golden future, medical anthropologists and activists had reason to be excited. Their country was about to take—so they believed—the greatest single step in the right direction since LBJ’s “Great Society” welfare spending program. It was in this climate that Inhorn and Wentzell’s collection of essays was published, and the optimism of the times shines through many (...) of the essays.The harsh reality is that at the end of 2012 Obama was re-elected, and after a painful deadlock the health insurance legislation known as “Obamacare” was pushed through. What followed has not turned out quite the way anyone expected and has driven an initial and unprecedented tidal wave of disapproval of the Obama presidency. Reading Medical Anthropology at the Intersections is therefore a sobering lesson in how a week can be a very long time in politics and a year a positive etern. (shrink)

A partir del enfoque desarrollador del proceso de enseñanza- aprendizaje y teniendo en cuenta las dificultades que se muestran con la literatura en la asignatura Historia de Cuba I para algunos contenidos, se presenta un sistema de medios con el objetivo de resolver estas dificultades. Se concluye que el sistema que se ofrece contribuye a la motivación del estudiante por el estudio de la asignatura; eleva la calidad de la clase; proporciona la asimilación y profundización del contenido, así como el (...) desarrollo de habilidades docentes, intelectuales y específicas; permite la participación activa y reflexiva de los estudiantes en la clase y facilita un mayor nivel de organización del contenido para la realización de las tareas docentes. Taking into consideration a developmental approach to the teaching-learning process and the instructional challenges linked to literature content of Cuban History I coursework, a system of teaching aids is presented. It is suggested that the proposed system enhances student motivation to study this subject, raises the quality of instructional lessons, favors the assimilation of the content, and improves the development of educational, intellectual and specific skills. It also allows for the active and reflexive participation of students in the lessons and facilitates a greater level of content organization for successful instruction. (shrink)

Medical practitioners have always been expected to abide by certain standards of conduct and uphold certain values, more or less throughout the world. In this book, besides discussing specific ethical issues, the author ponders questions such as the right to life and the integrity of the human person. Ethics in medicine takes account of the principles that underlie the best decisions, particularly in unusual circumstances – such as a pandemic. Many of these are enshrouded in the oaths most doctors (...) take – the Hippocratic Oath is perhaps the best known, and has influenced numerous others over the centuries. However, these principles and the resulting conduct have taken different directions at various moments in history and in different parts of the globe, though always primarily oriented to the protection of human health. The author compares some interesting similarities and differences, tracing the main social, legal and religious attitudes, in what has come to be known as "medical ethics", with all its benefits to Mankind. Alongside basic human dignity, four main values have been pivotal in medical ethics: Caring for sick people, putting their well-being at the center of concern, and doing good. Not causing harm: never making a patient take risks, and never prescribing a doubtful treatment. Fairness: treating all patients in accordance with their health needs, never favoring or neglecting anyone on the basis of background, occupation, etc. Self-determination: the patient can be informed about treatments and, when possible, should approve the prescriptions. The doctor must show empathy, respect for confidentiality, and responsibility. Briefly, this overview of the medical profession’s ethics focuses on experience, principles, aims, virtues and above all the basic rules which in various places through the centuries have governed the tortuous paths of Mankind. Written by an acclaimed expert in the field, this book is of value for all those working in healthcare, and people interested in its ethics. (shrink)

The main object of criticism of present-day medical ethics is the standard view of the relationship between theory and practice. Medical ethics is more than the application of moral theories and principles, and health care is more than the domain of application of moral theories. Moral theories and principles are necessarily abstract, and therefore fail to take account of the sometimes idiosyncratic reality of clinical work and the actual experiences of practitioners. Suggestions to remedy the illnesses of contemporary (...) medical ethics focus on re-establishing the connection between the internal and external morality of medicine. This article discusses the question how to develop a theoretical perspective on medical ethical issues that connects philosophical reflection with the everyday realities of medical practice. Four steps in a comprehensive approach of medical ethics research are distinguished: (1) examine health care contexts in order to obtain a better understanding of the internal morality of these practices; this requires empirical research; (2) analyze and interpret the external morality governing health care practices; sociological study of prevalent values, norms, and attitudes concerning medical-ethical issues is required; (3) creation of new theoretical perspectives on health care practices; Jensen's theory of healthcare practices will be useful here; (4) develop a new conception of bioethics that illuminates and clarifies the complex interaction between the internal and external morality of health care practices. Hermeneutical ethics can be helpful for integrating the experiences disclosed in the empirical ethical studies, as well as utilizing the insights gained from describing the value-contexts of health care practices. For a critical and normative perspective, hermeneutical ethics has to examine and explain the moral experiences uncovered, in order to understand what they tell us. (shrink)

Martin Sand and Luca Chiapperino find in the concept of serendipity a versatile umbrella term to reassess their previous work on moral luckLuck (also, Epistemic Luck, Moral Luck) and collectiveCollectiveresponsibilityResponsibility. Moral luck supposedly occurs when someone receives praise or blame for things beyond control. Given the ubiquity of luckLuck (also, Epistemic Luck, Moral Luck), this seems to be a seriously disquieting aspect of ordinary morality. The rewards and recognition for serendipitous discoveries fall into exactly this category. That is: more than (...) the intentions, actions, and characters of scientists matters for discoveries to obtain, just as in cases of moral luckLuck (also, Epistemic Luck, Moral Luck) something beyond morality affectsAffect our moral judgments. Even if a theoretical way of resolving the conceptual ambiguities that underlie this debate were found, there remain practical questions of how to perform stratification in science and innovationInnovation in ways that both hinge on, and yet refrain from, considerations of desert and achievement. With the example of Edward Jenner’sJenner, EdwardluckLuck (also, Epistemic Luck, Moral Luck)- and serendipity-infused discoveryDiscovery (also, Scientific Discovery) of vaccination, the authors attempt to better understand the intricate valueValue trade-offs that underlie stratification policies in science, which have to be constantly re-negotiated to maintain their legitimacy. Thereby, Sand and Ciapperino aim to take a bold step towards understanding the ethicsEthics of serendipity. (shrink)

The definition of ‘medical humanities’ may be approached via three conceptions—the humanities as a list of disciplines, as a program of moral development, and as a supportive friend. The conceptions are grounded by linking them to three narratives—respectively, the history of the modern liberal arts college; the history of Petrarch and the studia humanitatis of the early Renaissance; and the life of Sir William Osler. The three conceptions are complementary, each filling gaps in one or more of (...) the others. Getting clearer on a definition of ‘medical humanities’ is practically important if this field is to take its rightful place within health professions education and practice. (shrink)

In 1947, the Cornell psychiatrist Keeve Brodman and a handful of colleagues began developing what would become one of the most widely used health questionnaires of its time—the Cornell Medical Index (CMI). A rigidly standardized form, the CMI presented 195 yes-no questions designed to capture the health status of “the total patient.” Over the following decades, Brodman’s project of standardizing medical history taking gradually evolved into a project of mathematizing and computerizing diagnosis: out of the CMI (...) grew the Medical Data Screen (MDS), one of the first computerized methods of deriving diagnoses from patient data. This essay follows the life course of these tools through the second half of the twentieth century. It argues for a genealogy of biomedical computing and computerized diagnosis that takes more seriously the continuities between computer-based digital practices and paper-based analog ones. The computerized MDS evolved from, and rested upon, paper data practices associated with questionnaires and surveys. The interlocking histories of the CMI and the MDS prompt a reconsideration of the material and temporal parameters within which the history of computerized medicine has conventionally been understood. (shrink)

Scientism in medical education distracts educators from focusing on the content of learning; it focuses attention instead on individual achievement and validity in its measurement. I analyze the specific form that scientism takes in medicine and in medical education. The competencies movement attempts to challenge old “scientistic” views of the role of physicians, but in the end it has invited medical educators to focus on validity in the measurement of individual performance for attitudes and skills that medicine (...) resists conceptualizing as objective. Academic medicine should focus its efforts instead on quality and relevance of care. The social accountability movement proposes to shift the focus of academic medicine to the goal of high quality and relevant care in the context of community service and partnership with the institutions that together with medicine create and cope with health and with health deficits. I make the case for this agenda through a discussion of the linked histories of the opioid prescribing crisis and the professionalism movement. (shrink)

This study seeks to advance the understanding of controversy resolution in science. I take as a case study conceptualization and treatment of ulcer disease. Analysis of causal accounts and effective treatments illustrate the ways in which competing parallel research programs in medicine embody opposing social, political, and economic forces which are bound to the epistemological dimensions of scientific controversy (e.g., standards of evidence, reference, and inference), and which in turn shift perception of the burden of proof. The analysis illustrates the (...) ways in which (1) medical diagnoses create as much as discover useful distinctions and (2) epistemic and non epistemic values divide scientists into competing research programs, as well as (3) the ways in which these structures often effectively prevent scientific controversy closure. (shrink)

The massive expansion of information from the seventeenth century placed considerable demands on mental capacity, and individual scholars responded with strategies of memory training and note?taking that prompted, relieved or replaced memory. It has been acknowledged how cowpox inoculation (vaccination) and smallpox inoculation (variolation) stimulated new forms of record keeping and the standardization and tabulation of medical data for scientific analysis and to inform public policy. Yet the key figure in these developments, Edward Jenner, while a careful observer (...) who thought hard about the patterns he discerned, did not take good notes either from his reading or of his observations. He depended a great deal on his memory, especially a remarkable visual memory, consolidating his recollections and refining his thinking more through conversation and familiar letters than careful note?taking and writing. It was rather in the work of the practitioners who took up Jenners? writings, including some laymen and women, that we find the keeping of records of their vaccinations, in order to provide patient records and to report the results to friends, colleagues and a wider public. (shrink)

A typical problem of modern medicine results from the gap between scientific knowledge and its application in individual cases. Whereas scientific knowledge is generalized and impersonal information, medical practice takes place under conditions which are singular, individual and irreversible. The paper examines whether prognosis is able to bridge this gap or hiatus theoreticus. It is shown that diagnosis of a single case always relies on prognostic considerations. The individual prognosis (as distinguished from the nosologic prognosis of a certain disease) (...) enables doctors to apply scientific knowledge and practice according to the actual situation, the history and personal preferences of the patient. Prognosis – not diagnosis – therefore legitimizes medical interference. A methodology of individual prognosis as the basis for a theory of practice is discussed. (shrink)

In the film Never Let Me Go, clones are forced to donate their organs anonymously. As a work of fiction, this film can be regarded as a negotiation of limited agency, since the clones are depicted as vulnerable individuals. Thereby, it evokes a confrontation with underprivileged positions in technocratic societies, encouraging the audience to take the perspective of the marginalised. The clones are situated in ‘privileged deprivation’; from the audience’s point of view, they are unable to evolve into autonomous agents—but (...) from their own perspective within the dystopian system, they are still ‘privileged’. In this paper, we analyse the depiction of the clones’ personal development. Further, we examine references to bioethical aspects as well as technologies that affect the human body both on a micro and macro level—cloning and its impact on the human embryo and organ donation practised on the full-grown human body. We argue that this film as a reference for the discussion in popular culture focuses on individuals who do not profit from modern technical progress or do not have enough agency to refuse it. To make this point, we analyse the film’s fictional story, set in a form of alternate history, as a negotiation of a historical context which brings out the idea of neglected voices. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Take My Breath AwayEric Hayot (bio)In the middle of everything—in the middle of everything—here we are. Breathing. Not breathing. Choking on the fumes of the history we inherit: climate change, white supremacy, global pandemic. Waiting for the great exhale.At the dedication of St. Gaudens' Boston monument to the first Black regiment raised in the North to fight in the Civil War, Robert Lowell said, William James "could almost (...) hear the bronze Negroes breathe." Lowell's poem, written some seven decades after the monument's unveiling, at the height of the Civil Rights era, is a bitter record of the country's failure to fulfill the promise of emancipation, of its reluctance to let Black people breathe: "The monument sticks like a fishbone / in the city's throat."The country's throat. Still! Another five decades later!I do not think it is too much to say that the global rise of white nationalism is the echo of the still unresolved civil, legal, and political history of the Americas, the tension between the ideal of a multi-racial democracy and the difficulty that whites would have accepting it. The broader question is whether the fruits of Europe's long period of technological and military dominance can be shared with those whose exploitation and domination helped make that period possible, whether at home—where the resistance to immigration and refugees is basically a resistance to the distribution of the goods of the welfare state to people who are not white—or abroad—where the consequences of climate change will be felt most strongly, and where the understandable demand to continue developing, to access the cars and air conditioning and other goods that allow Europe its immense comfort, confronts the (equally understandable) demand to reduce the use of fossil fuels, the building of factories, and the like. We've had our development, the West says. But you can't have yours. And you can't have ours, either.But you know all this.One effect of the moment is that the global-historical forms of conflict now seem to penetrate down the very marrow of daily life, so that a billion tiny moments or gestures that might in other times have happily [End Page 127] signified only in the small local contexts of their occurrence now instead immediately connect to, or allegorize, the global-historical patterns to which they indubitably also belong. This has the effect of destroying what we were used to thinking of as the "private" or even "local" sphere of our actions. We might think of this as a "politicizing" of the formerly "personal," but this formulation, which is already a half century old (Carol Hanisch's essay with that title was published in 1970), feels sadly out of date, as though it itself had been swallowed up by one of its newer versions, "the local is the global," which in turn has been swallowed up by something even larger: there is no local, no personal, anymore. It is all global, all political.Perhaps the condition of having a personal or local sphere was itself a function of European privilege. In some respects, of course, it was. A Black person at a police traffic stop is not having a merely local experience, but a politically and deeply historically overdetermined one. A trans person at a medical appointment is not just having a private conversation between patient and doctor, but participating (and knows they are participating) in a national and transnational discussion about bodies, gender, sexuality, and so on. The examples can be multiplied.So perhaps it was only ever the white bourgeoisie that got to live the illusion of a life completely separated from history, from structure. And perhaps the world-historical shifts that make such illusions difficult—you are no longer experiencing local flooding or a heat wave, but the effects of climate change; you are no longer able to trust the people you see at the store who don't wear masks, because they belong to a mass movement that hates you and people like you—are good, insofar as they force some of us to live in the reality that everyone else... (shrink)

“An original, compelling, and provocative exploration of ethical issues in our society, with thoughtful and balanced commentary. I have not seen anything like it.” —Alan Lightman, author of Einstein’s Dreams Drawing upon the author’s two decades teaching medical ethics, as well as his work as a practicing psychiatrist, this profound and addictive little book offers up challenging ethical dilemmas and asks readers, What would you do? A daughter gets tested to see if she’s a match to donate a kidney (...) to her father. The test reveals that she is not the man’s biological daughter. Should the doctor tell the father? Or the daughter? A deaf couple prefers a deaf baby. Should they be allowed to use medical technology to ensure they have a child who can’t hear? Who should get custody of an embryo created through IVF when a couple divorces? Or, when you or a loved one is on life support, Who says you’re dead? In short, engaging scenarios, Dr. Appel takes on hot-button issues that many of us will confront: genetic screening, sexuality, privacy, doctor-patient confidentiality. He unpacks each hypothetical with a brief reflection drawing from science, philosophy, and history, explaining how others have approached these controversies in real-world cases. Who Says You’re Dead? is designed to defy easy answers and to stimulate thought and even debate among professionals and armchair ethicists alike. (shrink)

in a scientific way, and takes the patient and his family into his confidence. Thus he learns something from the sufferer, and at the same time instructs the invalid to the best of his power. He does not give his prescriptions until he has won the patient's support, and when he has done so, he steadilY aims at producing complete restoration to health by persuading the sufferer in to compliance (Laws 4. 720 b-e, [28]). This passage shows the perennial nature (...) of the problems of treating the patient as a person. It shows as well the historical'depth of philosophical interest in medicine. The history of philosophy includes more reflections upon medical ethics than the casual reader might suspect. Many of these reflections are pertinent to contemporary issues such as abortion and population control. Plato, for example, recommends abortion in cases of incest (Republic 5. 461c); and Aristotle argues for letting seriously deformed children die, while forbidding infanticide as a means of popUlation control, suggesting instead the use of early abortions. 'As to the exposure in rearing of children, let there be a law that no deformed child shall live, but that on the ground of an excess in the number of children... let abortion be procured before sense and life have begun; what mayor may not be lawfully done in these cases depends on the question of life and sensation' (Politics VII, 16,335 b20-26, [4]). (shrink)

Different ethical principles conflict in research conducted in emergency research. Clinical care and its development should be based on research. Patients in critical clinical condition are in the greatest need of better medicines. The critical condition of the patient and the absence of a patient representative at the critical time period make it difficult and sometimes impossible to request an informed consent before the beginning of the trial. In an emergency, care decisions must be made in a short period of (...) time, and the more time is wasted, the more the risk of death or severe tissue damage and incapacity increases. Consent requests take time, and so the time period before treatment might put the patient’s life in jeopardy. Not requesting consent before a trial is also contradictory. A person should not be forced to participate in a trial against his or her will. Due to the dark history of medical research previously, international declarations and conventions have set up ethical principles for medical research. They emphasize the autonomy of the research participant—or his or her legal representative—to give a free and informed consent prior to the initiation of research. In the case of a critical emergency, the unconscious state of the patient, the emotional stress of family members or the lack of time to start life-sustaining measures may often restrict the possibilities of communicating with the patient or his/her representative. Therefore, written informed consent is difficult to achieve, and its voluntariness in emergency situations is, at best, open to question. The mortality of patients is high without clinical interventions in emergency research. Random selection of patients is difficult and requires extra work from personnel in the emergency rooms. Recruitment, information and asking for consent may also take time, postpone the initiation of treatment and increase the risk of death and irreversible tissue and organ damage, and therefore be risky for the patient. It is therefore essential that the health care professionals recruiting suitable research participants are well motivated and well trained. Medical research in an emergency setting should always be regarded as an exceptional situation requiring special provisions. Only such research should be done as cannot be done in other conditions. An independent body must approve the research protocol and the ways in which the consent of the participant or proxy are to be sought. In addition, the trial must be expected to result in direct and significant benefit for the research participants. If research without prior consent is not approved, the development of emergency care is threatened. On the other hand, if prior consent is not required, a person could be recruited into a clinical trial against his or her will. Doing good and avoiding harm, and respecting the autonomy of the patient are in conflict in the context of emergency medical research. To develop better medicines for patients experiencing acute medical emergencies, research into such conditions should be allowed. Research participants should have the possibility to participate or refuse to participate in research that may benefit them and other patients. The risk of irreversible damage occurring as the consequence of time delays for seeking consent is unacceptable. A prior wish about participation in clinical trials should be respected, if known. The conditions under which medical research in emergencies can be considered acceptable can be determined and agreed upon nationally and internationally. (shrink)

At the entrance of the Temple of Delphi, the inscription possibly best known in the history of ideas warned about the importance of self-knowledge. In turn, this inscription is philosophically unfolded by the argument that one can only know oneself who cares, since caring is already in itself, to know oneself. Accordingly, many of the ancient medical practices recommended healing through the word. However, only with the advent of clinical hypnosis has this practice recovered, which in theoretical terms (...) seems to run counter to the main lines of the philosophy of mind, whether from the physicalist or the dualistic point of view. In this essay, we will try to show to what extent the concepts of caring and mind can be compatible according to these areas. (shrink)

Modern health care relies extensively on the use of technologies forassessing and treating patients, so it is important to be certain that health care technologies (i.e., pharmaceuticals, devices, procedures, and organizational systems) perform their professed functions in an effective and safe manner. Philosophers of technology have developed methods to assign and evaluate the functions of technological products, the major elements of which are described in the ICE theory. This paper questions whether the standard of evidence advocated by the ICE theory (...) is adequate for ascribing and assessing technologies employed in health care. The paper proposes that the general problem with the standard of evidence embodied in the ICE theory (i.e.,testimony and evidence of mechanisms) is too permissive for assessing medical technologies, in that it does not take into account the relative benefit and harm of medical technologies in ensuring safe functional performance in patients. The paper illustrates how evidence-based medicine (EBM) has demonstrated the value of clinical research methods, including observational studies, randomized and non-randomized clinical trials, and formal techniques, such as meta-analysis, to measure therapeutic effectiveness. I argue, therefore, that evidence from clinical research studies should take precedence over the testimonial evidence and other types of non-clinical evidence, inproviding justification for health technologies. (shrink)

Although the advantages of flight at high altitude were early recognized, so also were the physiological problems standing in the way of its realization. The idea of surmounting such problems by means of a pressurized cabin was advocated as early as 1909, while the first attempt to translate the concept into actuality occurred in 1921. Neither it nor several successive attempts enjoyed any real success until a project launched by the U. S. Air Corps in 1935 produced a breakthrough aircraft (...) designated the XC-35. The major reason for the favorable termination of that venture was the thoroughness of the engineering involved. But it is equally notable that this was the first instance in the age of powered flight where there was an active collaboration between the scientists and engineers, a rather curious circumstance in view of the fact that the achievement of altitude record-setting balloon flights in the nineteenth century had owed a great deal to an interconnection of aeronauts and scientists' laboratories. This paper focuses on the physiological investigations which informed the XC-35 engineers while at the same time bringing into being a new aeromedical laboratory taking the first small step toward turning aeromedicine into space medicine. (shrink)

The historiography of sexology is young. It is also expanding at a remarkable pace, both in terms of the volume of publications and, more notably, in terms of its geographical, disciplinary, and intersectional reach. This special issue takes stock of these new directions, while offering new research contributions that expand our understanding of the interdisciplinary and transnational formation of this field from the late 19th through to the mid 20th century. The five articles that make up this special issue stage (...) historiographical interventions by challenging the tendency within sexological history to focus on the medical, the homosexual, the human, and the Western European at the expense of other disciplines, diagnoses, non-human subjects, and geographical locations. A particular strength of these contributions is their focus on mapping conversations among and between sexologists on both sides of the Atlantic in the early to mid 20th century – particularly in Germany, Britain, and the US – and between East and West in the early Cold War era. (shrink)

Medical diagnosis has been traditionally recognized as a privileged field of application for so called probabilistic induction. Consequently, the Bayesian theorem, which mathematically formalizes this form of inference, has been seen as the most adequate tool for quantifying the uncertainty surrounding the diagnosis by providing probabilities of different diagnostic hypotheses, given symptomatic or laboratory data. On the other side, it has also been remarked that differential diagnosis rather works by exclusion, e.g. by modus tollens, i.e. deductively. By drawing on (...) a case history, this paper aims at clarifying some points on the issue. Namely: 1) Medical diagnosis does not represent, strictly speaking, a form of induction, but a type, of what in Peircean terms should be called ‘abduction’ (identifying a case as the token of a specific type); 2) in performing the single diagnostic steps, however, different inferential methods are used for both inductive and deductive nature: modus tollens, hypothetical-deductive method, abduction; 3) Bayes’ theorem is a probabilized form of abduction which uses mathematics in order to justify the degree of confidence which can be entertained on a hypothesis given the available evidence; 4) although theoretically irreconcilable, in practice, both the hypothetical- deductive method and the Bayesian one, are used in the same diagnosis with no serious compromise for its correctness; 5) Medical diagnosis, especially differential diagnosis, also uses a kind of “probabilistic modus tollens”, in that, signs (symptoms or laboratory data) are taken as strong evidence for a given hypothesis not to be true: the focus is not on hypothesis confirmation, but instead on its refutation [Pr (¬ H/E1, E2, …, En)]. Especially at the beginning of a complicated case, odds are between the hypothesis that is potentially being excluded and a vague “other”. This procedure has the advantage of providing a clue of what evidence to look for and to eventually reduce the set of candidate hypotheses if conclusive negative evidence is found. 6) Bayes’ theorem in the hypothesis-confirmation form can more faithfully, although idealistically, represent the medical diagnosis when the diagnostic itinerary has come to a reduced set of plausible hypotheses after a process of progressive elimination of candidate hypotheses; 7) Bayes’ theorem is however indispensable in the case of litigation in order to assess doctor’s responsibility for medical error by taking into account the weight of the evidence at his disposal. (shrink)

In this chapter we consider the tension between how pain researchers today typically define pains and the dominant, ordinary conception of pain. While both philosophers and pain scientists define pains as experiences, taking this to correspond with the ordinary understanding, recent empirical evidence indicates that laypeople tend to think of pains as qualities of bodily states. How did this divide come about? To answer, we sketch the historical origins of the concept of pain in Western medicine, providing evidence that (...) during large swaths of this history, medical experts characterized pains as laypeople tend to today—that is, as qualities of bodily states. The conception of pains as experiences that we find in contemporary definitions seems to be a relatively recent development corresponding with changes in the diagnostic tools available to doctors. We argue that this history is important and suggests that the most prominent current scientific definition of pain (IASP) is partly stipulative and fails to match how laypeople most often think of pain. We suggest that either we should acknowledge this stipulative character, or else should amend the IASP definition in a pluralistic fashion that notes both bodily and experiential conceptions of pain. (shrink)

This article takes the following two assumptions for granted: first, that gifts influence physicians and, second, that the influences gifts have on physicians may be harmful for patients. These assumptions are common in the applied ethics literature, and they prompt an obvious practical question, namely, what is the best way to mitigate the negative effects? We examine the negative effects of gift giving in depth, considering how the influence occurs, and we assert that the ethical debate surrounding gift-giving practices must (...) be reoriented. Our main claim is that the failure of recent policies addressing gift giving can be traced to a misunderstanding of what psychological mechanisms are most likely to underpin physicians’ biased behavior as a result of interaction with the medical industry. The problem with gift giving is largely not a matter of malicious or consciously self-interested behavior, but of well-intentioned actions on the part of physicians that are nonetheless perniciously infected by the presence of the medical industry. Substantiating this claim will involve elaboration on two points. First, we will retrace the history of policies regarding gift giving between the medical profession and the medical industry and highlight how most policies assume a rationalistic view of moral agency. Reliance on this view of agency is best illustrated by past attempts to address gift giving in terms of conflicts of interest. Second, we will introduce and motivate an alternate view of moral agency emerging from recent literature in social psychology on implicit social cognition. We will show that proper consideration of implicit social cognition paints a picture of human psychology at odds with the rationalistic model assumed in discussions of COIs. With these two pieces on the table we will be able to show that, without fully appreciating the social-psychological mechanisms of implicit cognition, policy-makers are likely to overlook significant aspects of how gifts influence doctors. (shrink)

Does the practice of questioning the decision-making capacity of patients who disagree with recommended medical interventions amount to paternalism on the part of physicians who would not have raised questions about competence had these patients accepted the recommendation? Brudney and Siegler provide a nuanced argument why the practice can be both pragmatically and ethically justifiable, particularly if physicians follow a “decision tree” that they recommend for cases where disagreements occur. Nonetheless, the history of this subject shows that bioethicists (...) have long been worried that the “outcome approach” (challenging patient’s capacity because of substantive disagreements with their choices) undermines respect for autonomy, and the more refined version from Brudney and Siegler still creates some further concerns about the resulting inadequacies in communication and comprehension in the physician-patient relationship. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 11.2 (2001) 115-116 [Access article in PDF] The Ethics of Medical Mistakes: Historical, Legal, and Institutional Perspectives Introduction In late 1999, the Institute of Medicine (IOM) released its report on medical errors, To Err is Human: Building a Safer Health System. The report estimated almost 50,000 deaths per year nationally due to medical mistakes, making it a leading cause of death. (...) IOM speculated that more than half of the deaths related to medical error are preventable. The IOM report shocked the public and medical professionals alike, sparking a national discussion of how to make the health care system safer. This multifaceted issue has profound implications for all aspects of health care, from the very personal--e.g., the relationship of caregiver and patient--to the societal--e.g., a nation's responsibility to its citizens.On 15 May 2000, the University of Pittsburgh Medical Center hosted an ethics conference devoted to the topic of medical mistakes. The goal was to bring together experts from various disciplines, before an audience of both providers and patients, to discuss medical mistakes and their implications. In this issue of the Kennedy Institute of Ethics Journal, we present selected papers resulting from that conference. These papers reflect not only the original oral presentations, but also much of the discussion those presentations generated. Three key perspectives on the ethics of medical mistakes are offered: historical, legal, and institutional.Rosa Lynn Pinkus offers a revealing historical perspective on the ethics of medical mistakes. In analyzing the history of mistake reporting in neurosurgery, she shows how the notion of a mistake developed only as the notion of a standard of practice emerged. Although much of managed care is directed toward systematically fostering a standard of care, this pursuit is relatively new in health care. One might speculate that as more standards are created, mistakes--defined as deviations from standard practice--must increase. If deviation from standard practice is overly castigated, however, then needed innovation in practice may be stifled. Interestingly, as Pinkus discusses, medical malpractice suits quickly followed the emergence of practice standards, driving the initial open reporting of mistakes underground. [End Page 115]Taking up the issue of medical malpractice, Thomas May and Mark Aulisio consider the ramifications of the current malpractice system for mistake prevention. The current system, they argue, while failing to adequately achieve its purported goals of deterring medical mistakes and compensating victims, itself creates a climate that deters the open reporting of mistakes by engendering fear and shame in clinicians. According to May and Aulisio, this failure to report medical mistakes openly has serious ramifications. Chief among these is the inability to do root cause analysis of mistakes, and then, where possible, to implement safeguards to minimize the occurrence of future mistakes. Ultimately, both the prevention of medical mistakes and the goals of malpractice litigation itself will be better served if substantial malpractice reform is undertaken.Andy Thurman argues that even in the current climate institutions ought to have a policy (and practice) of admitting to and openly reporting medical mistakes. Thurman argues that doing so not only is the right thing to do, but is also in the interest of institutions. Interestingly, he contends that failing to admit and openly report mistakes is both at odds with the mission of health care institutions and puts them at higher risk of litigation, and liability. In light of this, Thurman then suggests an institutional process for handling medical mistakes.Michael DeVita concedes that disclosing mistakes is widely supported by the health professionals' principles of ethics, but argues that there are a number of factors that conspire to make doing so a very difficult task. In analyzing an index case, DeVita contends that platitudes about being honest are not nearly enough to foster honest behavior and that policies that offer specific guidance on handling unfavorable events are needed in health care institutions.Finally, we conclude with the policy on disclosure of unfavorable events (this terminology is chosen because it includes both iatrogenic and natural diseases and conditions) that resulted from... (shrink)

Formal tools are attributed central roles in organizing work within many modern workplaces. How should one comprehend the power of these tools? Taking the medical record as an example, this article builds on recent calls to overcome the dichotomy between the formal and the informal and proposes an understanding of the generative power of such tools that does not attribute mythical capacities to either tool or human work. To do so, it is important to look both at the (...) history offormal tools and to their real-time use in concrete work practices. These steps toward a sociology of the formal are crucial for a more comprehensive understanding and evaluation offormal systems in practice. (shrink)

Two essential periods may be identified in the early stages of the history of vitamin D-resistant rickets. The first was the period during which a very well known deficiency disease, rickets, acquired a scientific status: this required the development of unifying principles to confer upon the newly developing science of pathology a doctrine without which it would have been condemned to remain a collection of unrelated facts with very little practical application. One first such unifying principle was provided by (...) the notion of hygiene; while the blanket explanations provided by this notion alone were much too general to enable rickets to achieve scientific status, it did point out the need to look for specific external causes for the disease and to examine the life-style and dietary habits of the patients. The second phase of the conceptualization of the disease was the assumption of a specific cause — that is, using concepts developed in the area of infectious diseases. This was made possible by fundamental similarities between deficiency and infectious diseases, in spite of their apparent differences. Both types of illness have some of the characteristics of what Georges Canguilhem calls the ontological representation of disease as opposed to dysharmonic representations, which primarily concern the endocrine diseases. It is precisely this shift from one to the other manner of perceiving ill health that enabled the identification of the vitamin D-resistant rickets. Conceptualization of the notion of vitamin D resistancy required that the conditions causing the disease be looked for within the organism rather than outside it; this was thus the first time that endocrine concepts were applied to studying the physiology of vitamin D.The history of resistant rickets therefore represents an interesting model for understanding the growth of biomedical knowledge. It allows the development of a number of more general ideas on the question of the relationship between biology and medicine and on the thorny problem of specificity in medical thinking. As far as this topic is concerned it can be seen that there was an ongoing exchange between medical and biological thinking during the initial period up until 1937, and that one could deny any such specificity in medical thinking during this same period. Albright, for example, used human diseases as spontaneously produced models for experimental biology. It was also more feasible for an experimental biologist to administer toxic doses than for a clinician to do so.What, then, if any, is the place of the specificity of medical thinking in this history? The fact that medicine is characterized not only by it ccognitive content78 but also by its final aim, which is to restore health, makes it necessary to take factors other than objective knowledge into consideration. This is particularly evident in two aspects of medicine, therapeutics and nosology, and in approaching the notion of pathological individuality.Therapeutic activity has a largely empirical approach. Many drugs, such as cod-liver oil, were discovered empirically. Treatment often in the past, and still now, has proceeded by trial and error, upon no established theoretical basis. At this level the relationship between biology and medicine is roughly comparable to that between science and technology79 \3- that is, it is impossible to reduce either therapeutics or technical activities to the simple application of basic science. In this sense, the application of vitamin D to vitamin-resistant rickets is quite typical. Further-more, in the case studied here, the therapeutic activity heralds a definite breaking away from the medicatrix naturae of conventional medicine dating back to ancient times, and it embodies a new concept of the organism and of disease: no longer can the diseased organism be thought of as merely having a perturbed equilibrium requiring restoration by means of a natural style of medicine. On the contrary, vitamin D resistance is an obstacle that indicates profound biological dysfunction, to be rectified only by means of an extremely aggressive and therefore dangerous therapy. The therapy thus serves to reveal the severity of the dysfunction, thereby leading inevitably to conceptual innovation. This sheds light on the theoretical innovations of which the therapeutic activity is capable.Therapeutic activity is also influenced by notions of health and illness, normal and pathological states, none of which may be determined entirely objectively. For example, the term healing as used by Albright in the case of resistant rickets that he described may be discussed in this light.Nosology, or the classification of diseases, depends largely on the description of clinical syndromes, which are themselves mainly based on subjective elements (discomfort, disability, or the extent of a patient's suffering). The advent of pathological anatomy at the beginning of the nineteenth century disrupted classification by introducing the concept of localized anatomical lesions81-and, hence, an element of material objectivity \3- into nosology. Radiological examination further complicated matters by enabling the equivalent of an autopsy on living matter. Lastly, biological examination complicated nosology by showing that biological anomalies may exist in human beings without necessarily leading to a pathological condition. Medical thinking can choose to combine all these elements to describe a disease, but can also separate them and retain only a few, or a single one, according to requirements - as did Albright.The notion of biological and pathological individuality is fundamental to the development of medical thinking. Whatever its theoretical origin, medical thinking has since ancient times incorporated the idea that each individual reacts differently to the same treatment and his own specific pathological tendencies. I mentioned earlier that in the history of vitamin D-resistant rickets the notion of rachitic tendency reflected this type of thinking. After 1937, this history progressed by successively separating new individual entities, affecting smaller and smaller groups of individuals in each case. In other words, the need to understand and to define individual illness more closely required the development of new concepts and the construction of new individual categories of disease linking these concepts to older clinical, radiological, and biochemical elements. (shrink)

This deeply informed history traces the controversial record of "mercy-killing," a source of heated debate among doctors and laypeople alike. Dowbiggin examines evolving opinions about what constitutes a good death, taking into account the societal and religious values placed on sin, suffering, resignation, judgment, penance, and redemption. He also examines the bitter struggle between those who stress a right to compassionate and effective end-of-life care and those who define human life in terms of either biological criteria, utilitarian standards, (...) a faith in science, humane medical treatment, the principle of personal autonomy, or individual human rights. Considering both the influence of technological and behavioral changes in the practice of medicine and the public's surprising lack of awareness of death's many clinical and biological dimensions, this book raises profound personal and collective questions on the future of euthanasia. (shrink)

Taking Poland as a case study, this article examines the sociological and historical-institutional factors that determine the relationship between the process of medical professionalisation and reproductive rights in transitional societies. Focusing on three periods in Polish history, (a) Partition era (1772–1918), (b) the Second Polish Republic (1918–1939), and (c) the post-war period (1945–1989), it identifies ruptures and continuities that have shaped the development of the Polish medical profession and its attitude towards abortion care today. Using insights (...) from feminist historical institutionalism, abortion studies, and the sociology of professions, the article applies the concept of ‘dialectical transformations’ to explain institutional and policy reproduction and change over time. It shows how professional and legal institutions are often transferred from one systemic context to another by individuals or organisations whose positions move from opposition to dominance. Understanding such processes is especially important in light of the retrenchment of reproductive rights across the globe. (shrink)

Even though medics in the present day may think that clinical pathology is derived from normal physiology, I argue here that this is not necessarily the case. Historically, physiology may have been derived from clinical pathology. After deriving physiological knowledge like this, medics can reverse the conceptual priority, to make believe that physiological knowledge is at the foundation of medical practice. This implies that supposedly objective physiological knowledge can be influenced by the evaluative judgements made to define practical concepts (...) of clinical pathology. I argue for this view using the history of the disease heart failure, drawing on an argument made by Georges Canguilhem. (shrink)

Early modern medicine was much more dependent on the senses than its contemporary counterpart. Although a comprehensive medical theory existed that assigned great value to taste and odor of medicaments, historical descriptions of taste and odor appears imprecise and inconsistent to modern eyes. How did historical actors move from subjective experience of taste and odor to culturally stable agreements that facilitated communication about the sensory properties of medicaments? This paper addresses this question, not by investigating texts, but by going (...) straight to the sensory impression, which certain substances convey. The aim is not to overwrite or rectify historical descriptions but to investigate whether modern methodologies for sensory assessment can be enlisted to understand the past. We draw on history of science for framing and research questions, pharmaceutical science for knowledge of pharmaceuticals and preparations, and food and meal science for assaying procedures and protocols. We show that sensory evaluation can yield precise descriptions that would not have been alien to early modern medicine makers. However, there are problems with translating descriptions of taste between different historical contexts. By comparing contemporary descriptions of sensations with eighteenth‐century ones, the article discusses how sensory descriptions are highly dependent on context, and subject to historical change. (shrink)