This essay examines the claim that physicians have a special obligation to engage in social and political activism. Four ethical paradigms are considered. Two paradigms, the preventive medicine and the social medicine models, embody a limited professional obligation to advocate the priority of health in society; the justification for a more aggressive stance is limited by the failings of paternalism. The radical model and the heroic model speak to issues of personal virtue rather than professional obligation; they are not (...) strictly comparable. (shrink)

There is a perpetrator historiography of the Holocaust and a Jewish historiography of the Holocaust. The former has received the lion’s share of attention in bioethics, particularly in the form of warnings about medicine’s potential for complicity in human atrocity. However, stories of Jewish physicians during the Holocaust are instructive for positive bioethics, one that moves beyond warnings about what not to do. In exercising both explicit and introspective forms of resistance, the heroic work of Jewish physicians in the (...) ghettos and concentration camps tells us a great deal about the virtues and values of medicine. In this article, we frame the stories of four of these Jewish physicians in ways that are instructive for contemporary medicine. By far, the most widely recognized and discussed figure is Viktor Frankl, whose work on hope and the meaning of suffering remains essential insofar as medicine inherently confronts disease and death. Less discussed in bioethics and medical humanities are the cases of Mark Dworzecki, Karel Fleischmann, and Gisella Perl. Dworzecki’s efforts to encourage others in the Vilna Ghetto to document their experiences illustrates the power of narrative for the human experience and the notion of ethics as narrative in the face of suffering. Fleischmann’s art underscores not only the importance of reflective practices for professionals as a form of simultaneous introspection and testimonial, but illuminates hope amid sheer hopelessness. This hope, which was comparatively implicit in much of Fleishmann’s art, is explicated as a method by Frankl, becoming a form of therapy for both physicians wrestling with their professional work, and patients wrestling with their illnesses and diseases. Finally, Perl’s resistance to Mengele’s orders highlights the importance of moral action, not just reflective reaction. The experiences of each of these figures, while certainly located in the unique horrors of Holocaust Germany, portends lessons for today’s physicians faced with moral distress and ethical dilemma in the face of suffering, interpersonal relationships, and socio-political conflicts that increasingly test the professed ideals of medicine. In this article we briefly tell the story of each of these physicians and connect the lessons therein to contemporary medical practice. (shrink)

Now I know why so many stories have been written with the theme: “everything changed in one moment.” More than 1,000 days have come and gone, and I still remember one Sunday morning and still follow and feel the effects of one decision.

The doctor in a foreign country is a recurring theme in physician writer Richard Selzer’s stories. In his 2009 novel, Knife Song Korea, Selzer returns to this theme, examining it in depth through the lens of gender. Selzer features the American military surgeon Sloane’s multiple border-crossings, namely, from America to Korea, from health to patienthood, and from sex-exploitation to love. Crossing those visible or invisible borders in the gender and race conscious contexts of medical profession and military in wartime (...) Korea, Sloane finds himself liminally located among various masculine stereotypes. The mixed-race situation in the novel further pushes Sloane to realize the unbearability of the baggage of American manhood as represented in his profession. Selzer’s punishment of Sloane’s border-crossings seems to suggest that physicians, together with patients, are equally likely to be victimized by the macho norms in medicine. (shrink)

This essay examines Harriet Jacobs’s Incidents in the Life of a Slave Girl (1861) in light of new archival findings on the medical practices of Dr. James Norcom (Dr. Flint in the narrative). While critics have sharply defined the feminist politics of Jacobs’s sexual victimization and resistance, they have overlooked her medical experience in slavery and her participation in reform after escape. I argue that Jacobs uses the rhetoric of a woman-led health reform movement underway during the 1850s to persuade (...) her readers to end slavery. This essay reconstructs both contexts, revealing that Jacobs links enslaved women’s physical and sexual vulnerability with her female readers’ fears of male doctors’ threats to modesty and of their standard bleed-and-purge treatments. Jacobs illustrates that slavery damages women’s health as much as heroic medicine, and thus merits the political activism of her readers. Specifically, Jacobs dramatizes her conflicts with the rapacious physician-master at moments that are crucial to women’s health: marriage, pregnancy, childbirth, and motherhood. Ultimately, this essay advances a new understanding of the role of health reform in social change: it galvanized other movements such as women’s rights and abolition, particularly around issues of bodily autonomy for women and African Americans. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Vagaries and Vicissitudes of WarRichard W Sams III remember standing in the kitchen of our home on Camp Pendleton—a United States Marine Corps base in Southern California—listening to National Public Radio (NPR) and doing dishes in the fall of 2002. President Bush announced to the world that he was considering a pre-emptive invasion of Iraq on the pretext of Saddam Hussein harboring weapons of mass destruction (WMD). Three (...) months later, as a Navy Family Physician, I deployed with a surgical company in support of Operation Iraqi Freedom. Reflecting on the situation with a like-minded close friend, I was not sure— would this be a just war? A necessary war? In my mind, it did not rise to the level of conscientious objection, yet the rightness of invading another country with all the anticipated death and destruction was not clear.En route to Kuwait, we laid over in Spain. While fixed to a TV in a holding area, I watched the Secretary of State make a case to the United Nations (UN) and the world that removing Hussein from power would protect us from mobile anthrax labs that could kill tens of thousands. I thought to myself, Either he is absolutely right, and we are protecting our country and the rest of the free world, or he is terribly mistaken and we are embarking on a disaster.As we trained, prepared, and waited in our tents to invade, we listened to the news on “Voice of America” with a hand crank radio. Thousands of citizens from nations around the world protested. Pope John Paul II, a man well acquainted with the tragedy of war, even spoke out about the planned invasion. “War is not inevitable. It is always a defeat for humanity.” He admonished our leaders that war needed to be the very last option. As a man of faith, I was troubled by his resolute, thoughtful opposition to the crusade I was embarking on. As the day of the invasion approached, scud missiles flew over our camp and we scurried into bunkers, day and night, with our gas masks donned to protect us from possible WMD attacks. In March, with the announcement of a “shock and awe” missile attack on Hussein’s palace, the invasion commenced.Within a day of flying by helicopter into enemy territory to set up a surgical company, the fog of war set in. A series of mass casualties streamed in from nearby Nasiriya. We received dozens of injured enemy combatants and American soldiers. Most troubling were the civilians. An entire extended family fleeing for their lives stumbled into an Iraqi minefield meant for us: a mother dead, the men with shrapnel wounds, and an aunt lost both of her legs. Then there was the little boy. By doctrine, our leaders reassured us we would not care for children. Yet, out of instinct, the field corpsmen scooped up all injured, including children, and [End Page 170] brought them to us. The five-year-old’s legs were blown to bits. We had no pediatric supplies. The anesthesiologist heroically intubated the child’s tiny airway with a urinary catheter and placed an adult IV. The surgeons corrected the wounds the best they could. Hours later, in futility, we performed chest compressions on his tiny mangled body.A day later, the worst sandstorm in a decade struck the area. We struggled to keep the patient-filled tents erect. A Marine appeared on the scene out of the darkness (you could not see beyond your nose in the storm) exclaiming we were going to condition one—lock and load our weapons due to an imminent threat. As healthcare professionals, Geneva Conventions dictated we were to use weapons only in self-defense. We chambered our 9-millimeter pistols to defend our patients and ourselves while Marines formed a defensive perimeter. I thought to myself, Great I’m gonna be shot up and die during a freaking sandstorm in Iraq. Hours later, we were told to stand down. The threat was not from approaching enemy combatants but from shepherds running from the crossfire. I had a small nervous breakdown, sleep deprived and under duress... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Ideas 63.2 (2002) 323-344 [Access article in PDF] Darwinism and Death: Devaluing Human Life in Germany 1859-1920 Richard Weikart The debate over the significance of Social Darwinism in Germany has special importance, because it serves as background to discussions of Hitler's ideology and of the roots of German imperialism and World War I. 1 There is no doubt that Hitler was a Social Darwinist, (...) viewing history as a struggle for existence among unequal races. All Hitler scholars agree on this point, and it is too obvious to deny when one reads Mein Kampf. 2 Whether Social Darwinism contributed to imperialism and militarism is less clear, though some have argued it did, at least as a justification for them. 3 Some Anglo-American writers during and immediately after World War I blamed Social Darwinism for inflaming German militarism. 4 [End Page 323]This discussion over both Social Darwinism in general and its German form in particular has reached something of an impasse lately. While some scholars insist that Darwinism contributed to or at least reinforced a competitive ethos in European political and social thought, others have stressed the varieties of Social Darwinism. 5 The latter remind us that, although some Darwinian social thinkers stressed competition, socialists were also avid Darwinists and saw it as support for their vision of a more cooperative socialist society. 6 Some scholars focus so much on the cooperative and peaceful thrust of Darwinian thinkers that one might think that Peter Kropotkin's Mutual Aid had carried the day in the late nineteenth century. For example, Paul Crook argues that Darwinism produced pacifist inclinations more than it did militarism. 7Another important debate in Darwin scholarship concerns the compatibility or incompatibility of Darwinism with other world views, especially traditional religion. The warfare thesis, which sees religion and science in perpetual conflict (often with science heroically winning the battle), has largely been abandoned by historians of science, who now see greater complexity in the interactions of science and religion. 8 Reacting against the warfare thesis, some have emphasized accommodation, showing how science and religion often work in harmony. As applied to Darwinism the accommodationist view stresses the receptivity of many Christians, including prominent evangelical pastors and [End Page 324] theologians, to evolutionary theory in the nineteenth century. 9 While the warfare thesis was clearly a crude caricature, an overemphasis on accommo-dationism can render the intensely emotional debates over Darwinism in the nineteenth century unintelligible and ignores the polemical uses of Darwinism by materialists and positivists in their fight against religion. 10This essay will attempt to make a contribution to both these debates by focusing on aspects of Darwinism that have been insufficiently explored to date—not the issues of competition vs. cooperation or capitalism vs. socialism or explicitly on religion, as is usual in the discussion over warfare or accommodation, but how Darwinism impacted thinking about the value of human life and the significance of human death. Indeed Darwinism, in harmony with the growth of materialism and positivism, helped alter many people's views on matters of life and death. Many prominent German Darwinists urged their society to reevaluate its stance on what today is known as biomedical ethics—infanticide, euthanasia, suicide, abortion, etc. By focusing on these issues, we will see that leading Darwinists invoked Darwinian science to undermine traditional Judeo-Christian ethical values; this went far beyond merely dismissing the Genesis creation story or even rejecting the supernatural.The scientists and physicians most important in embracing, developing, and popularizing Darwinism in late nineteenth and early twentieth-century Germany vigorously argued that Darwinism did have important implications for religion, ethics, and social thought. Darwinism in the nineteenth and early twentieth centuries produced a significant shift in the world views of many who embraced it, and leading Darwinists insisted that their newly-found world view undermined traditional ways of thinking, including traditional ideas about religion and ethics. Ernst Haeckel, the most famous German Darwinist of the late nineteenth and early twentieth centuries, believed the most important aspect... (shrink)

This paper seeks to circumscribe the concepts, sources, and limits of Nietzsche’s early ethical thought through a reconstruction of his ethical "symptomatology." In the 1870s, Nietzsche stressed that the Greeks understood the true nature of the political phenomenon, and that this could correct fundamental errors that were responsible for the illness of German culture. His definition of the Greek ethos radically challenges modern democratic politics through a reassertion of aristocratic, heroic, and agonistic values. But because Nietzsche did not systematically (...) describe his early ethics, a reconstruction is necessary. His metaphor of the philosopher as a “physician of culture” is a guide for this reconstruction. Using concepts of wellness and illness, Nietzsche identified different symptoms and possible remedies, and hoped to cure German culture through a therapeutic transvaluation of modernity. To reconstruct this symptomatology I turn to The Greek State, Homer’s Contest, and The Birth of Tragedy. First, I define the notions of “agon” and “eris” that are central to his reading of Greek ethics. I then describe four ethical symptoms and their remedies. I conclude with interpretative hypotheses that address issues that were left unanswered by Nietzsche. This symptomatology shows that his reading of Greek ethics functions as a radical—albeit fragmentary—normative critique of his time, and of our democratic age. (shrink)

This history of the modern introduction of assisted suicide in North America follow a tortuous course, with complete rejection of the idea, to implementation in many of its jurisdictions. North America was not a leader in this approach to end-of-life care, with the Netherlands and Belgium playing that role. Tracing the path from a felonious and ethically anathematic place in North American society it was resurrected into a legally and ethically acceptable practice over a period of two decades. The historical (...) course of PAS (Physician Assisted Suicide) and MAID (Medical Assistance in Dying) in many ways mimicked the evolution of other major changes in our view of the world, and like assisted suicide, experienced almost universal rejection and ultimately the embrace of those people and institutions that initially rejected the ideas first expressed by thoughtful and heroic persons. Galileo Galilei was one of the icons of science and discovery: he was almost burned at the stake during the Inquisition only to be “resurrected” to his place in the pantheon of great thinkers – but it took almost four hundred years to reach that pinnacle. We must be very careful how we interpret new ideas and thoughts about the process we apply and the consequences if we reject them. (shrink)

Andrew was a desperately premature baby weighing under two pounds. He died after months of "heroic' efforts in an intensive care facility. The story of his short cruel institutionalised life is a case study in the limits and excesses of modern medicine. The night he told us our son Andrew was about to die the doctor who had taken charge of him six months before also told us we were "intellectually tight' that we had "no feelings only thoughts and (...) words and strategies'. We were "bad parents'. As the parents of a five-year-old daughter we knew the love a mother and father feels for children. Yet as Andrew's parents we were used to condemnation and insult. Andrew was a baby born 15 weeks prematurely weighing only 1lb 12oz and in a state of painful deterioration almost from the start. We wanted him to be allowed to die a natural death. Andrew's story is the story of what can happen when a baby becomes hopelessly entrapped in an intensive care unit where the machinery is more sophisticated than the code of law and ethics governing its use. The letter printed below was sent to the administrator and numerous personnel of the hospital that controlled the life and death of our son. The physician-in-chief of that hospital characterised it as a "carefully documented critique'. The letter appear here somewhat edited and abridged and the names of people and institutions have been changed all but our own. It is the personal record of what happened to our baby and to us. (shrink)

The disease of love appears in an unbroken chain of medical treatises stretching from sixth-century Byzantium through the Middle Ages to post-Renaissance Western Europe. Lovesickness, known variously as amor eros, amor heros, or amor hereos in medieval Latin medical texts, has attracted the attention of literary scholars because many of its symptoms correspond to conventional signs of love in medieval literature. According to George Lyman Kittredge, “What to the physician were symptoms … became, in the chivalric system, duties — (...) ideals of emotion which the true lover must live up to, and which the hypocrite takes pains to counterfeit.” In the late thirteenth century the Catalan physician Arnald of Villanova explicitly compared the disease of love and feudal service in his Tractatus de amore heroico. He claimed that this love “is called heroic as though lordly , not only because it befalls lords, but also either because it dominates, subjugating the soul and ruling a man's heart, or because the acts of such lovers toward the desired object are similar to the acts of servants toward their lords.”. (shrink)

In this paper we propose to trace the historical and epistemological causes of the social construction of the image of nursing in pandemics by COVID-19, where the heroic and vocational attributes of its praxis hide the scientific and technological ones. To do so, we will begin by showing how "empirical" knowledge was historically contrasted with biomedical theoretical knowledge, medical technological praxis with the "art of caring", under a hierarchization of the professions on traditional gender roles. We will then demonstrate (...) the ways in which the romanticized image of nursing manifested itself so far during the pandemic, not only consolidating the status quo of the profession but also deepening it, by emphasizing a heroic attitude of those "on the front line of battle" as opposed to the physicians who made the decisions. Finally, we will analyze epistemologically what nursing theorists understand by "nursing praxis" in order to elucidate what is and is not visible in the constituted image of the profession. (shrink)

During the COVID-19 epidemic, the name of the 19th-century English physician John Snow (1813-1858) has cropped up to a surprising extent, notably in connection with the severe cholera epidemic of 1854 in the district of Golden Square, London. It is repeatedly stated that Snow brought this epidemic of waterborne disease to an end by removing the handle of the Broad Street pump. It is also widely known that this story is a myth. Nonetheless, the Broad Street pump story as (...) told by Snow's close friend Benjamin Ward Richardson remains embedded, partly, it is argued, because of its appeal to areas of the cultural consciousness. In America, Snow and his work on the epidemiology of cholera, including the Broad Street pump story, achieved a serious status which has endured, in one form or another, to the present day. In contrast to Britain, the heroic age of public health in America coincided with the optimism of the bacteriological revolution and higher hopes for medical science. However, this rapidly changing environment exacerbated differences of opinion as to what the small and emergent specialty of epidemiology should look like, what its project was, and where it should be based. Different versions of Snow's persona came to represent basic and often conflicting conceptions of epidemiology and the status (or lack of it) of its practitioners. For many, consciously or otherwise, the removal of the Broad Street pump handle remained an individualistic triumph, a single human intervention which resembled modern medicine in providing a “cure.”. (shrink)

The central aim of the present investigation is to shed light on Nietzsche’s understanding of happiness and a good life, starting from Nietzsche’s appropriation of Plato’s and Aristotle’s doctrine of a hierarchy of human beings and forms of life.

In this entry I will introduce two such puzzles that relate to the heroic actions and testimony. I will first introduce the basic idea of supererogation and why some heroic actions give us reason to accept the existence of supererogatory actions. I will then introduce the problem that supererogation raises for moral theory and explain the main responses that have been offered to this problem. I will then explain two related problems that arise from the way that heroes (...) describe their actions and explore how moral philosophers might respond to these problems. (shrink)

My question in the chapter is this: could (and should) the role of the physician be construed as that of a friend to the patient? I begin by briefly discussing the “friendship model” of the physician-patient relationship—according to which physicians and patients could, and perhaps should, be friends—as well as its history and limitations. Given these limitations, I focus on the more one-sided idea that the physician could, and perhaps should, be a friend to the patient (a (...) “physician-qua-friend model” of the physician-patient relationship). I show that given recent developments in our understanding of the physician-patient relationship, this idea is far from asinine. I then make the case that the most plausible conception of the physician-qua-friend model incorporates the following components: (a) a common goal, that is, one that physician and patient share; (b) certain forms of equality between physician and patient; (c) an ideal of a caring physician. Finally, I show how the model can be instantiated in a certain type of physician-patient interaction, namely, in physician-assisted dying. (shrink)

In this paper I provide a novel argument against the claim that classical genetics is being reduced to molecular genetics. Specifically, I demonstrate that reductionists must subscribe to the unargued and problematic thesis that molecular genetics is 'independent' of classical genetics. I also argue that several standard antireductionist positions can be faulted for unnecessarily conceding the Independence Thesis to the reductionists. In place of a 'tale of two sciences', I offer a 'heroic' stance that denies classical genetics is being (...) reduced, yet sees classical and molecular genetics as fundamentally unified. (shrink)

Although in Italy there is currently no effective law on physician-assisted suicide or euthanasia, Decision No. 242 issued by the Italian Constitutional Court on September 25, 2019 established that an individual who, under specific circumstances, has facilitated the implementation of an independent and freely-formed resolve to commit suicide by another individual is exempt from criminal liability. Following this ruling, some citizens have submitted requests for assisted suicide to the public health system, generating a situation of great uncertainty in the (...) application processes. As a matter of fact, shared and defined procedures are lacking as Decision 242/2019 merely added some principles on which the legislature will have to base its future intervention. This paper analyses the advisory role that the Decision attributes to territorial ethics committees with the aim of stimulating discussions on their role in oversight mechanisms. The proposed conclusion is that the envisaged role does not appear consistent with the functions of these bodies and is ultimately substantially undefined and unjustified. (shrink)

"The fixed person for fixed duties, who in older societies was such a godsend, in the future ill be a public danger." Twenty years ago, a single legal metaphor accurately captured the role that American society accorded to physicians. The physician was "c- tain of the ship." Physicians were in charge of the clinic, the Operating room, and the health care team, responsible - and held accountabl- for all that happened within the scope of their supervision. This grant of (...) responsibility carried with it a corresponding grant of authority; like the ship's captain, the physician was answerable to no one regarding the practice of his art. However compelling the metaphor, few would disagree that the mandate accorded to the medical profession by society is changing. As a result of pressures from a number of diverse directions - including technological advances, the development of new health professionals, changes in health care financing and delivery, the recent emphasis on consumer choice and patients' rights - what our society expects phy- cians to do and to be is different now. The purpose of this volume is to examine and evaluate the conceptual foundations and the moral imp- cations of that difference. Each of the twelve essays of this volume assesses the current and future validity of the "captain of the ship" metaphor from a different perspective. The essays are grouped into four sections. In Section I, Russell Maulitz explores the physician's role historically. (shrink)

본고의 목표는 구혼자들의 악행의 본질이, 영웅의 재산과 아내에 대한 그들의 탐욕에 있는 것이 아니라, 인간가치에 대한 전면적인 파괴라는 것을 보이는 것이다. 이해를 돕기 위해, 구혼자들과 많은 유사성을 보이는 폴뤼페모스와의 비교연구가 이루어질 것이다. 한편, 인간가치를 파괴하고, 신들처럼 살고자 하는 구혼자들의 욕구를 이해함으로써, 민담이나 기타 구송 귀향시에 등장하는 남편의 승리와는 근본적으로 다른, 오뒷세우스의 복수의 의미를 좀 더 깊은 차원에서 이해하고자 한다. 구혼자들은 이타카의 실질적인 지배자들로서, 신과 인간을 능멸하며, 인간의 행위를 지배하는 모든 규범들을 무시한다. 그들은 신들과 인간의 경계를 무시한 채, 마치 신들처럼 행세한다. (...) 따라서, 오뒷세우스와 구혼자들의 전투는 인간조건과 인간의 삶을 두고 대립하는 자들의 대결로 파악할 수 있으며, 이는 양립할 수 없는 두 가치의 충돌이다. (shrink)

This essay looks at Nietzsche in relation to the Epicurean tradition. It focuses on his middle period writings of 1878 texts such as Human, all too Human, Dawn, and The Gay Science heroic-idyllic philosophizing’. At the same time, Nietzsche claims to understand Epicurus differently to everybody else. The essay explores the main figurations of Epicurus we find in his middle period and concludes by taking a critical look at his later and more ambivalent reception of Epicurus.

This book provides a history of Nazi medical euthanasia programs, demonstrating that arguments in their favor were widely embraced by Western medicine before the Third Reich. Contributors find significant continuities between history and current physician-assisted suicide and euthanasia and urge caution about their legalization or implementation.

Involuntary psychiatric commitment for suicide prevention and physician aid-in-dying (PAD) in terminal illness combine to create a moral dilemma. If PAD in terminal illness is permissible, it should also be permissible for some who suffer from nonterminal psychiatric illness: suffering provides much of the justification for PAD, and the suffering in mental illness can be as severe as in physical illness. But involuntary psychiatric commitment to prevent suicide suggests that the suffering of persons with mental illness does not justify (...) ending their own lives, ruling out PAD. Since both practices have compelling underlying justifications, the most reasonable accommodation might seem to be to allow PAD for persons with mental illness whose suffering is severe enough to justify self-killing, but prohibit PAD for persons whose suffering is less severe. This compromise, however, would require the articulation of standards by which persons’ mental as well as physical suffering could be evaluated. Doing so would present a serious philosophical challenge. (shrink)

The non-identity problem arises when an intervention or behavior changes the identity of those affected. Delaying pregnancy is an example of such a behavior. The problem is whether and in what ways such changes in identity affect moral considerations. While a great deal has been written about the non-identity problem, relatively little has been written about the implications for physicians and how they should understand their duties. We argue that the non-identity problem can make a crucial moral difference in some (...) circumstances, and that it has some interesting implications for when it is or is not right for a physician to refuse to accede to a patient's request. If a physician is asked to provide an intervention (identity preserving) that makes a person worse off, then such harm provides a good reason for the physician to refuse to provide the intervention. However, in cases where different (identity-altering) interventions result in different people having a better or worse life, physicians should normally respect patient choice. (shrink)

In Reasons and Persons Derek Parfit defends the principle that it is not irrational to perform an action one believes to be morally right, even if it is no tin one’s self-interest. He calls this principle CP2 and formulates it as follows: -/- "There is at least one desire that is not irrational, and is no less rational than the bias in one’s own favor. This is a desire to do what is in the interests of other people, when this (...) is either morally admirable, or one’s moral duty." (Parfit 1984, 131) -/- I will examine his defense of this principle, which is essentially an invocation of a thought-experiment he labels My Heroic Death, with a view to clarifying its relationship to rational egoism and the principles of rational choice, as explained below. -/- . (shrink)

In C.Q,. xxii , 199 Professor R. G. Austin has drawn attention to the short at the front, unusually long at the back. It must be related to that other heroic ‘long back and sides’, the Theseis, which is described by Plutarch who compares Homer's Abantes Il. 2. 542, and adds by way of explanation that the custom was not learnt from the Arabes, as some think, nor from the Mysians , but because the Abantes liked close combat and (...) short front hair denied their adversaries a hand hold. The same explanation probably serves the Hectorean hair style. (shrink)

The Council on Ethical and Judicial Affairs of the American Medical Association examines physicians’ professional ethical responsibility in the event that the security of patients’ electronic records is breached.

Rationale, aims and objectives To compare the pharmacotherapeutic approaches to diabetic hypertension of family physicians (FPs) and general practitioners (GPs). Methods A retrospective prescription-based study was conducted in 15 out of a total of 20 health centres, involving 115 primary care physicians – 77 FPs and 38 GPs, representing 74% of the primary care physicians of Bahrain. Prescriptions were collected during May and June 2000 to comprise a study population of 1266 diabetic-hypertensive patients. Results As monotherapy, angiotensin-converting enzyme (ACE) inhibitors (...) (37.9%) and β-blockers (38.3%) were the most commonly prescribed classes of antihypertensives by FPs and GPs, respectively. Calcium channel blockers (CCBs) were ranked third by both categories of physicians. For two-drug combinations, a β-blocker and an ACE inhibitor was the combination of choice for both physician categories. Patients managed by the FPs were more likely to receive a β-blocker–CCB combination (17.4 vs. 14.9%) or a diuretic–ACE inhibitor combination (16.7 vs. 11.4%) and less likely to receive a β-blocker–diuretic combination (11.8 vs. 16.7%) than those managed by the GPs. The proportion of patients receiving antihypertensive combinations was 40.6 and 38.5% for FPs and GPs, respectively. While the GPs prescribed CCB as a monotherapy to the elderly most often, the FPs choice was a β-blocker. Diuretics were less preferred by both FPs and GPs. β-Blocker–ACE inhibitor was again the most preferred combination of both FPs and GPs. FPs prescribed CCB–β-blocker combinations more often than GPs (P = 0.01), whereas CCB–ACE inhibitor combinations were less preferred (P = 0.09). A trend towards excessive use of short-acting nifedipine as monotherapy for elderly patients, both by FPs and by GPs, was noticed. Glibenclamide, alone or in combination with metformin, was the foremost antidiabetic drug prescribed by FPs and GPs. Middle-aged (45–64 years) patients seen by GPs were more likely to receive glibenclamide than those treated by FPs (P = 0.001) and less likely to receive gliclazide (P = 0.01). Combinations of a β-blocker with either glibenclamide or insulin were prescribed considerably more often by GPs.Conclusions Within the same practice setting, a substantial difference was observed between FPs and GPs in terms of preference for different classes of drugs in the management of diabetic hypertension. The compliance of both FPs and GPs was suboptimal; overall, the compliance of the FPs was closer to the recommended guidelines, however. Educational programmes should specifically address these inadequacies in order to improve the quality of health care. (shrink)

This paper examines the question whether physicians are obligated by their professional ethos to defend a pacifist position. The question is a more concrete and applied formulation of the general thesis that there are what I will call “pacifist professions”: professions whose ethos requires their members to act in a pacifist way. Since the present paper is rather one in applied philosophy than a theoretical one about the foundation of pacifism, it will concentrate on the practical issue of whether and (...) how physicians can execute their profession in or during war. Theoretical questions on the nature and extent of pacifism will be considered only to the extent necessary to treat the main issue. The introductory section will give a short overview of some histori- cal aspects of physicians’ participation in war and show the relevance of the issue with recent examples. The remainder of this section will thus serve to set the stage and to outline the connections between the medical profession and questions of war and peace. The paper will then be divided into three other main parts: the first part will be devoted to defining in a general manner so-called “professional pacifism”. The second part will investigate whether and to what extent the medical profession can be classified as a pacifist profession, and the third part will look at the consequences of such a classification. (shrink)

In its excitement over the quandries posed by biotechnology, bioethics is in danger of neglecting basic health care needs. What is needed is an understanding of ethics that emphasizes responsibility to others rather than rights.

Gils-Schmidt and Salloch recognise that human and climate health are inextricably linked, and that mitigating healthcare-associated climate harms is essential for protecting human health.1 They argue that physicians have a duty to consider how their own practices contribute to climate change, including during their interactions with patients. Acknowledging the potential for conflicts between this duty and the provision of individual patient care, they propose the application of Korsgaard’s neo-Kantian account of practical identities to help navigate such scenarios. In this commentary, (...) we argue that by focusing attention on this physician–patient level, the authors overlook the complexity of climate change, both within the healthcare sector and beyond. We recognise the importance of individual agency in tackling this issue, and we also recognise that the authors do briefly acknowledge the importance of considering these broader complexities; however, we emphasise the need for climate and health discussions/action to be situated in a wider framework of systemic change. Our concern is that overemphasis on patient-level interactions risks normalising the prioritisation of individual-level approaches to addressing climate change, detracting from such a broader approach. Physician training emphasises the need for trust, confidentiality and shared decision-making in the doctor–patient relationship. …. (shrink)

This book is a history of the crucial developmental years of quantum theory with an emphasis on the literature rather than an overview of this period focusing on personalities or personal stories of the scientists involved. This book instead focuses on how the theoretical discoveries came about, when and where they were published, and how they became accepted as part of the scientific canon.

ArgumentThe tension between theoretical and practical knowledge was particularly problematic for trainee physicians. Unlike civic apprenticeships in surgery and pharmacy, in early modern England there was no standard procedure for obtaining education in the practical aspects of the physician’s role, a very uncertain process of certification, and little regulation to ensure a suitable reward for their educational investment. For all the emphasis on academic learning and international travel, the majority of provincial physicians returned to practice in their home area, (...) because establishing a practice owed more to networks of kinship, patronage and credit than to formal qualifications. Only when (and where) practitioners had to rely solely on their professional qualification to establish their status as young practitioners that the community could trust would proposals to reform medical education, such as those put forward to address a crisis of medicine in Restoration London, which are examined here, be converted into national regulation of medical education in the early nineteenth century, although these proposals prefigured many informal developments in medical training in the eighteenth century. (shrink)

Conflicts of interest are rampant in the American medical community. Today it is not uncommon for doctors to refer patients to clinics or labs in which they have a financial interest (40% of physicians in Florida invest in medical centers); for hospitals to offer incentives to physicians who refer patients (a practice that can lead to unnecessary hospitalization); or for drug companies to provide lucrative give-aways to entice doctors to use their "brand name" drugs (which are much more expensive than (...) generic drugs). In Medicine, Money and Morals, Marc A. Rodwin draws on his own experience as a health lawyer--and his research in health ethics, law, and policy--to reveal how financial conflicts of interest can and do negatively affect the quality of patient care. He shows that the problem has become worse over the last century and provides many actual examples of how doctors' decisions are influenced by financial considerations. We learn how two California physicians, for example, resumed referrals to Pasadena General Hospital only after the hospital started paying $70 per patient (their referrals grew from 14 in one month to 82 in the next). As Rodwin writes, incentives such as this can inhibit a doctor from taking action when a hospital fails to provide proper service, and may also lead to the unnecessary hospitalization of patients. We also learn of a Wyeth-Ayerst Labs promotion in which physicians who started patients on INDERAL (a drug for high blood pressure, angina, and migraines) received 1000 mileage points on American Airlines for each patient (studies show that promotions such as this have a direct effect on a doctor's choice of drug). Rodwin reveals why the medical community has failed to regulate conflicts of interest: peer review has little authority, state licensing boards are usually ignorant of abuses, and the AMA code of ethics has historically been recommended rather than required. He examines what can be learned from the way society has coped with the conflicts of interest of other professionals --lawyers, government officials, and businessmen--all of which are held to higher standards of accountability than doctors. And he recommends that efforts be made to prohibit and regulate certain kinds of activity (such as kickbacks and self-referrals), to monitor and regulate conduct, and to provide penalties for improper conduct. Our failure to face physicians' conflicts of interest has distorted the way medicine is practiced, compromised the loyalty of doctors to patients, and harmed society, the integrity of the medical profession, and patients. For those concerned with the quality of health care or medical ethics, Medicine, Money and Morals is a provocative look into the current health care crisis and a powerful prescription for change. (shrink)

A review of the philosophical debate on theoretical models for the physician-patient relationship over the past fifteen years may point to some of the more productive questions for future research. Contractual models have been criticized for promoting a legalistic and minimalistic image of the relationship, such that another form of model (such as convenant) is required. Shifting from a contractual to a contractarian model (in keeping with Rawls' notion of an original position) provides an adequate response to many criticisms (...) of this type. A deeper criticism, however, is one that advocates a shift to a virtue-based approach. A creative amalgam between a contractarian model and elements of the virtue-based approach, combined with appropriate empirical investigation, may yield richer models in the future. (shrink)

The aim of the present paper is to investigate the connection between ancient medicine and sophistry at the end of 5th century B.C. Beginning with analyses of some passages from the De vetere medicina, De natura hominis and De arte, the article identifies many similarities between these treatises, on the one hand, and the sophistic doctrines, on the other: these concern primarily perceptual/intellectual knowledge and the interaction between reality, knowledge and language. Among the Sophists, Gorgias was particularly followed and imitated, (...) as he was admired not only for his tremendous rhetorical skills, but also for his philosophically significant work On not being, which probably influenced various discussions in the Hippocratic treatises. However, if Gorgias argues in favor of language as dynastēs megas, the authors of VM, NH and De arte consider knowledge to be far more relevant and reliable than logos. These Hippocratic treatises criticize the philosophical thesis and the resulting kind of reductionism. Above all they defend the supremacy of medicine over any other art. By using the same argumentative and rhetorical strategies that were employed by Gorgias, these treatises reverse the thought of those Sophists who exalted only the technē tōn logōn. (shrink)