As they age, many people are afraid that they might become a burden to their families and friends. In fact, fear of being a burden is one of the most frequently cited reasons for individuals who request physician aid in dying. Why is this fear so prevalent, and what are the issues underlying this concern? I argue that perceptions of individual autonomy, dependency, and dignity all contribute to the fear of becoming a burden. However, this fear is misplaced; common conceptions (...) of these values should be re-framed and re-examined. Practices that support a more community-centered type of autonomy can be found in dependency and dignity. This paper offers some practical examples of how to address common end-of-life situations that may cause anxiety to patients who are worried about being a burden. These practices include discussing expectations, both for care and how the relationship among the participants might change, and modeling respectful caregiving behaviors. Most difficult of all, though, includes cultural and societal attitude changes so that people recognize the good in receiving care and get used to the idea that they do not need to do anything to be valuable. (shrink)
BackgroundNarrative medicine is a well-recognized and respected approach to care. It is now found in medical school curricula and widely implemented in practice. However, there has been no analysis of the perception and usage of narrative medicine across different medical specialties and whether there may be unique recommendations for implementation based upon specialty. The aims of this study were to explore these gaps in research.MethodsFifteen senior physicians who specialize in internal medicine, pediatrics, or surgery were interviewed in a semi-structured format (...) about the utilization, benefits, drawbacks, and roles pertaining to narrative medicine. Qualitative content analysis of each interview was then performed.ResultsThree themes emerged from our analysis: roles, practice, and outcomes. Through these themes we examined the importance, utilization, barriers, benefits, and drawbacks of narrative medicine. There was consensus that narrative medicine is an important tool in primary care. Primary care physicians also believed that narrative medicine is not as important for non-primary care providers. However, non-primary care providers generally believed narrative medicine is valuable in their practice as well. Within specialties, providers’ choice of language varied when trying to obtain patients’ narratives, but choice in when to practice narrative medicine did not differ greatly. Among specialties, there was more variability regarding when to practice narrative medicine and what barriers were present. Primary care physicians primarily described barriers to eliciting a patient’s narrative to involve trust and emotional readiness, while surgeons primarily described factors involving logistics and patient data as barriers to obtaining patients’ narratives. There was broad agreement among specialties regarding the benefits and drawbacks of narrative medicine.ConclusionsThis study sheds light on the shared and unique beliefs in different specialties about narrative medicine. It prompts important discussion around topics such as the stereotypes physicians may hold about their peers and concerns about time management. These data provide some possible ideas for crafting narrative medicine education specific to specialties as well as future directions of study. (shrink)
This article offers a critique of the recently revised BMA guidance on routine neonatal male circumcision and seeks to challenge the assumptions underpinning the guidance which construe this procedure as a matter of parental choice. Our aim is to problematise continued professional willingness to tolerate the non-therapeutic, non-consensual excision of healthy tissue, arguing that in this context both professional guidance and law are uncharacteristically tolerant of risks inflicted on young children, given the absence of clear medical benefits. By interrogating historical (...) medical explanations for this practice, which continue to surface in contemporary justifications of non-consensual male circumcision, we demonstrate how circumcision has long existed as a procedure in need of a justification. We conclude that it is ethically inappropriate to subject children—male or female—to the acknowledged risks of circumcision and contend that there is no compelling legal authority for the common view that male circumcision is lawful. (shrink)
This is a critical introduction to modern French philosophy, commissioned from one of the liveliest contemporary practitioners and intended for an English-speaking readership. The dominant 'Anglo-Saxon' reaction to philosophical development in France has for some decades been one of suspicion, occasionally tempered by curiosity but more often hardening into dismissive rejection. But there are signs now of a more sympathetic interest and an increasing readiness to admit and explore shared concerns, even if these are still expressed in a very different (...) idiom and intellectual context. Vincent Descombes offers here a personal guide to the main movements and figures of the last forty-five years. He traces over this period the evolution of thought from a generation preoccupied with the 'three H's' - Hegel, Husserl and Heidegger, to a generation influenced since about 1960 by the 'three masters of suspicion' - Marx, Nietzsche and Freud. In this framework he deals in turn with the thought of Sartre, Merleau-Ponty, the early structuralists, Foucault, Althusser, Serres, Derrida, and finally Deleuze and Lyotard. The 'internal' intellectual history of the period is related to its institutional setting and the wider cultural and political context which has given French philosophy so much of its distinctive character. (shrink)
Among the remains of Archilochus is an iambic trimeter which is as mysterious as it is charming. Zenobius, who quotes it , says that it was written by Homer and used by Archilochus in his Epodes. If he is telling the truth, it must, as Bergk saw, come from the Margites. But its origin and original purpose need not now concern us. The important fact is that Archilochus used it, and we ought to be able to discover how he used (...) it. What was his precise intention when he quoted or composed the line πλλ᾽ οδ᾽ λπη λλ᾽ χνος ν μγα, what was the contrast he drew between the Fox and the Hedgehog, and how did he make use of it? Zenobius gives two aids, but neither is so easy as it looks at first sight. First, he says that the proverb was used π τν πανουργοττων, and secondly he quotes as relevant some lines from the Phoenix of Ion of Chios about the hedgehog: λλ᾽ ν τε χρσ τς λοντος ᾔνεσα ἢ τς χνου μλλον οζυρς τχνας. ς ετ᾽ ν λλων κρεισσνων ρμν μθ, στρβιλος μΦ᾽ κανθαν ελας δμας κεîται δακεν τε κα θιγεν μχανος. (shrink)
While there had still been an increasing flow of foreign direct investment (FDI) into China during the 2002 downturn in FDI globally, such investments have historically been only sporadically successful. Much writing has detailed and discussed problems associated with China FDI but several costs remain dangerously overlooked. One such cost is that of micro-monitoring plants for work conditions and employee treatment in violation of local Chinese laws and possible home country ethics. Further, a more personal cost is presented – the (...) personal cost associated with maintaining an investment in a facility that violates standards of ethical employee treatment. Background information related to these issues is presented, along with a general overview of FDI in China. (shrink)
Cet article propose une réponse critique à quelques thèmes du livre de Kyle Johannsen,A Conceptual Investigation of Justice. La discussion se penche sur l’analyse du pluralisme fondamental de la valeur proposée par Johannsen et met en cause cette même analyse. Je soutiens que l’analyse proposée par Johannsen ne parvient pas à expliquer comment des conflits entre des valeurs fondamentales peuvent être résolus et qu’il y a davantage de convergence entre des valeurs fondamentales que ne le reconnaît Johannsen.
The medical humanities were organized, beginning in the late 1960s, by a small group of people who shared a critique of medical education and a commitment to vigorous action to change it. They proposed to create several demonstration programs in humanities education at American schools. Although the group began with a religious orientation, it soon acquired a broader, more secular mission. As a result of shrewd political organizing, the group attracted members from within medicine, and was awarded a grant to (...) promote the medical humanities. This paper describes these events and sets them in the context of the social and medical history of the 1960s and early 1970s. (shrink)