In focusing their view on Kuhn, Robert Veatch and William Stempsey ignore alternative sources of insight from other voices that could help move us beyond incommensurability. Richard Rorty and Helen Longino, for example, offer another view of science and objectivity with constructive insight for the practice of science and medicine. Keywords: positivism, relativism, scientific knowledge, incommensurability, Kuhn, Rorty, Longino CiteULike Connotea Del.icio.us What's this?

Two articles in this issue of the Hastings Center Report explore two sides of the same problematic coin. In “The Limits of Surrogates’ Moral Authority and Physician Professionalism,” Jeffrey Berger discusses the moral problem of a surrogate refusing a treatment, palliative sedation, on behalf of a patient whose suffering is refractory to intensive palliative efforts provided by a multidisciplinary team. In “After the DNR: Surrogates Who Persist in Requesting Cardiopulmonary Resuscitation,” Ellen Robinson and her colleagues analyze data from a study (...) of cases in which physicians wished not to perform cardiopulmonary resuscitation on patients whom they thought it would harm. Both articles begin from the idea of a professional determination about a physician's duty to a patient that conflicted with a surrogate's determination about what should or should not be done for that patient. Berger's argument stops just short of a solution, however, because a physician's professional obligation to help patients, even within guidelines set by other professionals, is insufficient protection for patients. But if Berger's theory is right—that sometimes surrogates lack moral authority to make decisions on behalf of patients—then the Robinson team has developed a careful and public process for attending to that conflict. (shrink)

The Quality Attestation Presidential Task Force has made a thoughtful and thorough contribution to the establishment of clinical ethics consultation as a professional field. As Eric Kodish, Joseph J. Fins, and colleagues indicate, quality attestation is another step in bringing greater accountability and transparency to CEC. To complete this process, however, the work of the QAPTF must be situated within a larger project. As the field further develops, there will be a move toward restricting CEC to those who have demonstrated, (...) by means of this version of the quality attestation or an eventual iteration of it, that they are capable of conducting an ethics consultation with the skill, knowledge, and rigor necessary. This raises the question of how potential consultants will gain the experience required to produce a portfolio of cases when only those who are qualified are permitted to perform CECs, either by their institution or by some external evaluator, such as The Joint Commission. Now may be the time to begin thinking about further developments in the field that will complement both current academic training programs and the quality attestation process. For this, we might look to the Association for Clinical Pastoral Education for its model for certifying educators of chaplains who wish to become professionals. (shrink)

Homeopathy is a form of complementary medicine which relies heavily on observation and experience. The three distinguishing characteristics of homeopathy are that remedies are prescribed on the totality of a person's symptoms, that the remedy likely to cure a person is a dilution of that substance which would cause the same symptoms in a healthy person, and that remedies are prepared using microdoses of substances which are diluted and then vigorously shaken. Mainstream medicine criticizes homeopathy by saying that its gentleness (...) has outlived its usefulness and treatment successes are probably no more than placebo action. In addition, its critics charge that homeopathy is unscientific, runs counter to the "laws of nature" and will not stand up to scientific scrutiny. Homeopaths reply that mainstream medicine is dangerous, that homeopathy works in children and animals (usually thought resistant to placebo), and that several good controlled clinical trials have shown positive results. There is a difference between showing that homeopathy works and adequately accounting for its mechanism of action. Clinical trials have concentrated on the former and remain unexplained in the latter. Keywords: complementary medicine, empirical homeopathy CiteULike Connotea Del.icio.us What's this? (shrink)

A woman admitted to the emergency room of a hospital died because no surgeon could be found to stop the bleeding from injuries she sustained in a farming accident. The case points to ethical shortcomings both institutionally and professionally. The call system is inadequate, and physician fears of being sued or insufficiently compensated contribute to the overall problem. Potential responses include the institutional equivalent of a root cause analysis and an understanding of the pressures brought to bear on physicians to (...) treat emergencies. (shrink)

Clinicians, operating within complex systems, make mistakes, as people do in every human endeavor, and when they do, patients are sometimes harmed. One important question is how we as clinicians can find resolution in the wake of an error. The published literature has divided errors into those caused by “systems” and by “individuals.” But whereas both “systems” and “individual” approaches are important in understanding the cause of an error, neither alone can fully lead to resolution once an error has occurred. (...) Instead, both are necessary to understand, resolve, and prevent errors. (shrink)