Within medical education, there is an increasing need to provide ethics education for learners embarking on service learning. The concept of hospitality, as illustrated in Homer’s classic epic the Odyssey, has the potential to underpin such ethics education. This paper describes the implementation and evaluation of an ethics education session for medical students, built on the concept of hospitality, before they embark on a three-year longitudinal service-learning home visit program. In preparation for their household visits, second-year students at a medical (...) school in Miami, Florida, participate in weekly didactic sessions. One of these classes consisted of a two-hour ethics session, involving a brief introductory large-group lecture, followed by self-administered small-group discussions of a series of case scenarios. An innovative web-based platform called Rise allowed the students to run their own small group activities. To assess the impact on the students’ ability to identify, and on their confidence in handling, ethical dilemmas, we administered pre- and post-session surveys. Students indicated statistically significant improvement in median responses to all questions, for two consecutive years. Students also listed three adjectives, both before and after the session, that they associated with good and bad hosts and guests. The consistency of the terms listed suggests that hospitality is a robust concept for the learners. In our experience, the concept of hospitality provides a robust framework for the students, and the mixed large-group and self-facilitated small-group format offers a valuable tool for ethics education related to service learning in medicine. Our study supports the utility of the concept as a teaching tool, and the format facilitates a session using minimal faculty. The notion of hospitality seems particularly fruitful for various ethical considerations in medicine, even beyond those that involve home visits. (shrink)

Within medical education, there is an increasing need to provide ethics education for learners embarking on service learning. The concept of hospitality, as illustrated in Homer’s classic epic the Odyssey, has the potential to underpin such ethics education. This paper describes the implementation and evaluation of an ethics education session for medical students, built on the concept of hospitality, before they embark on a three-year longitudinal service-learning home visit program. In preparation for their household visits, second-year students at a medical (...) school in Miami, Florida, participate in weekly didactic sessions. One of these classes consisted of a two-hour ethics session, involving a brief introductory large-group lecture, followed by self-administered small-group discussions of a series of case scenarios. An innovative web-based platform called Rise allowed the students to run their own small group activities. To assess the impact on the students’ ability to identify, and on their confidence in handling, ethical dilemmas, we administered pre- and post-session surveys. Students indicated statistically significant improvement in median responses to all questions, for two consecutive years. Students also listed three adjectives, both before and after the session, that they associated with good and bad hosts and guests. The consistency of the terms listed suggests that hospitality is a robust concept for the learners. In our experience, the concept of hospitality provides a robust framework for the students, and the mixed large-group and self-facilitated small-group format offers a valuable tool for ethics education related to service learning in medicine. Our study supports the utility of the concept as a teaching tool, and the format facilitates a session using minimal faculty. The notion of hospitality seems particularly fruitful for various ethical considerations in medicine, even beyond those that involve home visits. (shrink)

Within medical education, there is an increasing need to provide ethics education for learners embarking on service learning. The concept of hospitality, as illustrated in Homer’s classic epic the Odyssey, has the potential to underpin such ethics education. This paper describes the implementation and evaluation of an ethics education session for medical students, built on the concept of hospitality, before they embark on a three-year longitudinal service-learning home visit program. In preparation for their household visits, second-year students at a medical (...) school in Miami, Florida, participate in weekly didactic sessions. One of these classes consisted of a two-hour ethics session, involving a brief introductory large-group lecture, followed by self-administered small-group discussions of a series of case scenarios. An innovative web-based platform called Rise allowed the students to run their own small group activities. To assess the impact on the students’ ability to identify, and on their confidence in handling, ethical dilemmas, we administered pre- and post-session surveys. Students indicated statistically significant improvement in median responses to all questions, for two consecutive years. Students also listed three adjectives, both before and after the session, that they associated with good and bad hosts and guests. The consistency of the terms listed suggests that hospitality is a robust concept for the learners. In our experience, the concept of hospitality provides a robust framework for the students, and the mixed large-group and self-facilitated small-group format offers a valuable tool for ethics education related to service learning in medicine. Our study supports the utility of the concept as a teaching tool, and the format facilitates a session using minimal faculty. The notion of hospitality seems particularly fruitful for various ethical considerations in medicine, even beyond those that involve home visits. (shrink)

Within medical education, there is an increasing need to provide ethics education for learners embarking on service learning. The concept of hospitality, as illustrated in Homer’s classic epic the Odyssey, has the potential to underpin such ethics education. This paper describes the implementation and evaluation of an ethics education session for medical students, built on the concept of hospitality, before they embark on a three-year longitudinal service-learning home visit program. In preparation for their household visits, second-year students at a medical (...) school in Miami, Florida, participate in weekly didactic sessions. One of these classes consisted of a two-hour ethics session, involving a brief introductory large-group lecture, followed by self-administered small-group discussions of a series of case scenarios. An innovative web-based platform called Rise allowed the students to run their own small group activities. To assess the impact on the students’ ability to identify, and on their confidence in handling, ethical dilemmas, we administered pre- and post-session surveys. Students indicated statistically significant improvement in median responses to all questions, for two consecutive years. Students also listed three adjectives, both before and after the session, that they associated with good and bad hosts and guests. The consistency of the terms listed suggests that hospitality is a robust concept for the learners. In our experience, the concept of hospitality provides a robust framework for the students, and the mixed large-group and self-facilitated small-group format offers a valuable tool for ethics education related to service learning in medicine. Our study supports the utility of the concept as a teaching tool, and the format facilitates a session using minimal faculty. The notion of hospitality seems particularly fruitful for various ethical considerations in medicine, even beyond those that involve home visits. (shrink)

A case-study, small-group-discussion (“focal problem”) exercise in the history of medicine was designed, piloted, and evaluated in an overseas course and an on-campus elective course for medical students. Results suggest that this is a feasible approach to teaching history of medicine which can overcome some of the problems often encountered in teaching this subject in the medical curriculum.

In this essay, I look back at some of the earliest attempts by the first generation of literature-and-medicine scholars to answer the question: Why teach literature and medicine? Reviewing the development of the field in its early years, I examine statements by practitioners to see whether their answers have held up over time and to consider how the rationales they articulated have expanded or changed in the following years and why. Greater emphasis on literary criticism, narrative ethics, narrative (...) theory, and reflective writing has influenced current work in the field in ways that could not have been foreseen in the 1970s. The extraordinary growth of interest and work in the field nationally and, especially since 1996, internationally has included practitioners in many additional areas such as disability studies, film studies, therapeutic writing, and trauma studies. Along with the emergence of narrative medicine, this diverse community of scholars and practitioners—affiliated more through their use of narrative methodologies than the teaching of literature—makes the perennial challenge of evaluation and assessment even more complicated. (shrink)

The topic of professionalism has dominated the content of major academic medicine publications during the past decade and continues to do so. The message of this current wave of professionalism is that medical educators need to be more attentive to the moral sensibilities of trainees, to their interpersonal and affective dimensions, and to their social conscience, all to the end of skilled, humanistic physicians. Urgent calls to address professionalism from such groups as the Association of American Medical Colleges, the (...) American Board of Internal Medicine, and the Accreditation Council for Graduate Medical Education, among others. In fact, at the 2004 annual meeting of the AAMC six separate presentations addressed professionalism with such titles as "Evaluating Humanism and Professionalism," Professionalism: Expectation, Education, Evaluation," or "Toward Assessing Professional Behaviors of Medical Students through Peer Observations". Professionalism, then, has become part of the current academic medicine parlance, used by administrators, clinical faculty, residency programs, and professional organizations with an expectation of shared meanings and goals. All of these stakeholders focus on what has become a consistent list of attributes deemed to be the essence of professionalism, which usually include variations on altruism, duty, excellence, honor and integrity, accountability, and respect. In fact, most of the scholarly work to date has been listing, describing, decrying, and measuring/evaluating it. In this collection of essays, we don’t argue with these attributes. Instead, we ask questions of the discourse from which they arise, how the specialized language of academic medicine disciplines has defined, organized, contained, and made seemingly immutable a group of attitudes, values, and behaviors subsumed under the label "professional" or "professionalism." This collection aims to be a critical text, one that questions the profession’s beliefs about the nature of its work and how such beliefs are enacted in medical education, particularly as they fuel the professionalism discourse. In addition, we will scrutinize how the discourse is enacted in both the formal and hidden curriculum, and in the larger medical environment. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Contemplative Studies and the Liberal ArtsAndrew O. FortContemplative Studies—meaning both standard “third-person” study of contemplative traditions in history and various cultures as well as actual “first-person” practice of contemplative exercises as part of coursework—is a new field in academia, and aspects have been controversial in some quarters, seen as not completely compatible with the rigorous “critical inquiry” of liberal arts study. While there are agendas within contemplative (...) studies (CS) that go beyond the traditional questions and issues of liberal education, I want to argue that CS has, for a number of reasons, a place right at the heart of such inquiry. CS can be approached from many disciplines, including psychology, medicine, and neuroscience, as well as literature and visual, fine, and performing arts, but here I will focus on its place in liberal arts generally, and in religious studies specifically.1Given my specific focus, I will skip defining some broad terms frequently used in and beyond CS (such as “religion,” “spirituality,” or “meditation”), but, in view of my topic, I do need to say a few words about what I mean by “contemplation” and “liberal arts.” “Contemplation” refers to ways of knowing and focusing attention, often but certainly not always part of a religious tradition. It includes a wide variety of practices: sitting or walking meditation, various other kinds of “mindfulness” practices, yogic postures, visualizations, silent prayer and group chanting, reflective self-inquiry, observing nature, and many others. “Liberal arts” or “liberal education” has many qualities and purposes, but the ones most relevant here include (1) reflective self-awareness, recognizing and critiquing one’s beliefs and assumptions; (2) respectful and empathetic understanding of others (what I call “mental migration” into other worldviews); (3) understanding that humans are socially and culturally conditioned, existing in and shaped by historical contexts; and (4) learning about various ways of thinking or modes of inquiry.Contemplative studies clearly has the goals of enhancing both self-awareness and “mental migration” into other worldviews, and an expected outcome would be ongoing critical reflection on such learning. CS should and does value the analytic study of contemplative states and traditions: scientifically, historically, culturally, and personally. While few would disagree that scientific inquiry, historical study, and knowledge of sociocultural context are significant when learning about contemplative traditions, [End Page 23] there is more dispute about the value of actual “first-person” contemplative practice, both for scholars and for students in academic courses, either during or outside class. Some of my fellow essayists in this volume and many others have argued eloquently that firsthand personal experience is an important way of illumining these traditions as well as alternative ways of knowing and valuing more generally.I will begin by offering a series of connected reasons why the latter view should resonate for a liberal arts teacher, then raise some issues that focus on the practice of contemplative teaching in the classroom.1. There are a variety of ways of knowing oneself or consciousness and the world, and it is important to investigate these various ways, to better understand human existence. In fact, recognizing that there are different kinds of knowing increases one’s capacity for critical analysis.2. Contemplative reflection is one of the ways people come to know themselves and the world, and come to understand the nature of contemplative practice itself.3. Contemplative inquiry has been important to many people in a large number of cultures, so it should be understood through both external study and direct experience, to gain a more accurate (and “lived”) understanding of others’ worldviews and practices.4. Given this broad and long-standing interest, there are, naturally, diverse contemplative traditions and experiences. We should learn how this variety is understood and explained by practitioners (i.e., their personal significance) as well as by scientists (their observable characteristics). Both kinds of study facilitate “mental migration” into others’ worldviews.5. Those within contemplative traditions have a long history of critical analysis and argument about various introspective states, so we should learn about and attend to both the states and the arguments.6. In evaluating what contemplative thinkers say, it is valuable to attend to what and how we... (shrink)

For 50 years, Star Trek has been an inspiration to its fans around the world, helping them to dream of a better future. This inspiration has entered our culture and helped to shape much of the technology of the early 21st Century. The contributors to this volume are researchers and teachers in a wide variety of disciplines; from Astrophysics to Ethnology, from English and History to Medicine and Video Games, and from American Studies to the study of Collective (...) Computing Systems. What the authors have in common is that some version of Star Trek has inspired them, not only in their dreams of what may be, but in the ways in which they work - and teach others to work - here in the real world. Introduced with references to Star Trek films and television shows, and illustrated with original cartoons, each of the 15 chapters included in this volume provides insights into research and teaching in this range of academic fields. (shrink)

The beginning of the COVID-19 pandemic offers a unique case study for understanding conceptual and linguistic propagation. In early 2020, scientists, politicians, journalists, and other public figures had to, with great urgency, propagate several public health-related concepts and terms to every person they could. This paper examines the propagation of coronavirus and social distancing and develops a framework for understanding how the language used to express a notion can help or hinder propagation. I argue that anyone designing a representational (...) device for propagation needs to appreciate the three-way causal relationship between language, people’s mental representations, and the extramental world. Using this framework, I explore what makes “social distancing” a bad name for social distancing and why it is unproblematic that “coronavirus” is a scientifically loose way of speaking about the virus. Through this and further study of the many historical examples of linguistic and conceptual propagation, conceptual engineers can better understand the complex challenges facing people who want to propagate representational devices. (shrink)

Evidence based medicine has much to offer, but a great deal remains to be done to create a better understanding of what it can and cannot do.The term EBM , as we use it nowadays, was introduced in 1992 by the same group of people who, years before, founded the discipline called “Clinical epidemiology” .1 CE stemmed essentially from the idea of adapting and expanding epidemiological methods to medical and health care decision making; CE was in fact defined as (...) “ the discipline dealing with the study of the occurrence of medical decisions in relation to their determinants”.1CE has been very successful in illustrating new ways of teaching medicine and training health professionals, and has positioned itself around the notion that “critical appraisal skills” are yet another set of essential abilities which—in addition to the interpersonal, diagnostic, and prognostic skills—a good doctor should master. An important by product of CE was documentation which showed that much of the available evidence on diagnosis, prognosis, and treatment of diseases was of poor methodological quality and quite often of dubious transferability to everyday clinical practice.This led to a strong call for improving the scientific basis of clinical practice, which was seen as too often dominated by practices of unproven effectiveness. This was the background for the 1992 Journal of the American Medical Association article that first used the term “evidence based medicine”.2In essence, proponents of EBM said that “all medical action of diagnosis, prognosis, and therapy should rely on solid quantitative evidence based on the best of …. (shrink)

In order to conquer and subjugate Africans, at the 1884 Berlin Conference, European countries dismembered Africa by carving her up into pieces and sharing her among themselves. European colonialists also antagonised Africans by setting up one ethnic African community against the other, thus promoting ethnic consciousness to undermine Pan-African consciousness. European powers also imposed their own “ethnic” languages, making them not only “official”, but also “international”. Consequently, as the Kenyan philosopher, Ngũgῖ wa Thiong’o, persuasively argues, through their ethnic languages, European (...) colonialists planted their memory wherever they went, while simultaneously uprooting the memory of the colonised. Cognisant of efforts in some South African institutions of higher learning to promote African languages for the purpose of promoting literacy in African languages, this article argues that while this exercise is commendable, ethnic African languages should be deliberately taught to “re-member” Africa and rediscover Pan-African consciousness. By doing this, African scholarship would be aiding Africans’ perennial and elusive quest for Pan-Africanism and the African Renaissance. Keywords: African Renaissance, Ethnic African Languages, Ethnic European Languages, European Colonialism, Pan-African Consciousness, Pan-Africanism. (shrink)

This grounded study investigated the negotiation of authorship by faculty members, graduate student mentors, and their undergraduate protégés in undergraduate research experiences at a private research university in the northeastern United States. Semi-structured interviews using complementary scripts were conducted separately with 42 participants over a 3 year period to probe their knowledge and understanding of responsible authorship and publication practices and learn how faculty and students entered into authorship decision-making intended to lead to the publication of peer-reviewed technical papers. (...) Herein the theoretical model for the negotiation of authorship developed through the analysis of these interviews is reported. The model identifies critical causal and intervening conditions responsible for the coping strategies faculty and students employ, which, in our study, appear to often produce unfortunate consequences for all involved. The undergraduate student researchers and their graduate student mentors interviewed in this study exhibited a limited understanding of authorship and the requirements for authorship in their research groups. The power differential between faculty and students, the students’ limited epistemic development, the busy-ness of the faculty, and the faculty’s failure to prioritize authorship have been identified as key factors inhibiting both undergraduate and graduate students from developing a deeper understanding of responsible authorship and publication practices. Implications for graduate education and undergraduate research are discussed, and strategies for helping all students to develop a deeper understanding of authorship are identified. (shrink)

This volume in the King's College (London) Studies in Medical Law and Ethics series covers a wide range of issues (euthanasia, abortion, embryo research and fetal transplantation, the teaching of medical ethics, AIDS and sex selection) while focusing on a series of related themes. Contributors to this collection of essays include doctors, lawyers, theologians and philosophers and their viewpoints will be of immense interest to a wide range of professionals in related fields and/or students of medicine, philosophy and (...) nursing. (shrink)

In a time marked by the development of innovative treatments in healthcare and the need for health professionals to deal with resulting ethical dilemmas in clinical practice, this study was developed to determine the influence of the bioethics teaching on the moral competence of medical and nursing students. The authors conduct a longitudinal study using the Moral Competence Test extended version before and after attending the ethics curricular unit, in three nursing schools and three medical schools of (...) Portugal. In this questionnaire the participant is confronted with three ethical dilemmas and asked to evaluate arguments for and against the attitude of the main character. For both nursing and medical students, C-score was lower after the attendance of the ethics curricular units, with a statistically significant decrease in the total score for nursing students and a decrease not statistically significant for medical students. A multivariate analysis did not find any association between this decrease and gender, course, or age. The phenomenon of moral segmentation was observed, with better performance in the worker and judge dilemma, than in the doctor dilemma. These results highlight the need to reflect on the curricular strategies that can be implemented for health professionals to better develop moral competence and decision-making, allowing for the provision of humanized health care. (shrink)

The importance and relevance of philosophy has come to be recognized more today than ever before in recent history. In many colleges and universities philosophy is now an essential component of interdisciplinary studies. The public interest in philosophy is increasing. UNESCO’s initiatives to promote philosophy are laudable. All these call for reimagining the study and teaching of philosophy for our contemporary time − a task worthwhile for philosophy studies in ecclesiastical institutes as well.

Los estudios de ciencia, tecnología y sociedad revelan las interrelaciones entre la ciencia y la tecnología como procesos sociales. Este artículo persigue como objetivo: valorar la significación social de un entorno virtual en la enseñanza aprendizaje de la Estadística descriptiva en la carrera de Medicina. El diagnóstico preliminar mediante de la observación, la encuesta y el análisis documental, mostró que existen insuficiencias en el uso de las tecnologías de la información y las comunicaciones en el proceso de enseñanza aprendizaje de (...) la Estadística. Se diseñó un entorno virtual constituido por cinco módulos que incluyen contenidos de Estadística descriptiva, ejercicios, bibliografía y ayuda. Con la validación a partir del criterio de especialistas y la sistematización con la introducción en la práctica, se evaluó el mismo como muy adecuado, fue considerado útil, necesario y aplicable al contexto objeto de estudio, lo que contribuye a la formación científica de los estudiantes desde una posición materialista. Science, technology and society studies reveal the interrelations between science and technology as social processes. This article pursues the following objectives: to assess the social significance of a virtual environment in the teaching and learning of descriptive Statistics in Medicine degree course. The preliminary diagnosis through the observation, opinion poll and documentary analysis, showed that there are insufficiencies in the use of Information and Communication technologies in teaching and learning Statistics. It was designed a virtual environment with five modules that include contents of descriptive Statistics, exercises, bibliography and help. With the validation of specialists and the systematization after putting it in practice, the virtual environment was assessed as adequate, useful, necessary and applicable to the context being studied, which contributes to the scientific training of students from a materialistic position. (shrink)

ProblemThe question of what factors drive the effectiveness of ethics teaching in medicine has remained largely unanswered in German-speaking countries. Due to the lack of scientifically sound evaluation studies, it is sometimes only possible to assume how effective certain teaching formats and methods actually are in ethics courses. The selection of teaching formats and methods that ethics lecturers use to achieve a specified learning objective is often not made according to evidence-based criteria, but on the basis (...) of positive or negative teaching experiences and direct feedback from students.Methods and argumentsIn this article, after a brief overview of evaluation procedures of ethical competences, findings from selected international effectiveness studies are presented and discussed in terms of their relevance for teaching medical ethics.Results and conclusionAlthough the findings from these evaluation and meta-studies come from other, related fields such as research ethics and other teaching contexts, they can serve as an impetus for discussion and contribute to defining cornerstones in order to design effective ways to teach ethics in medicine in the German-speaking countries. (shrink)

Upshot: This response focuses on the following issues, which summarize the points made by the commentaries: (i) further reflection on and details of the methodological framework that was applied to studying the proposed design of our innovation course, (ii) the issue of generalizability of the findings for teaching innovation (in this context the question of generic or transferable skills will become central), and (iii) finally, more precise explanation of what we mean by “learning from the future as it emerges.”.

Background This study used a scenario- and discussion-based approach to teach preclinical medical students the socio-philosophical aspects of psychiatry and qualitatively evaluated the learning outcomes in a medical humanities course in Taiwan. Methods The seminar session focused on three hypothetical psychiatry cases. Students discussed the cases in groups and were guided by facilitators from multiple disciplines and professions. At the end of the semester, students submitted a narrative report comprising their reflections on the cases and discussions. The authors utilized (...) content analysis to categorize students’ narratives into three facets, namely, the philosophical, social and individual. Results In total 163 preclinical medical students participated in the class; 150 of them mentioned the scenario-based lesson in their reports; 33.3% of these reports discussed the case at the philosophical dimension (n = 50), 45.3% at the social dimension (n = 68), and 26.6% at the individual dimension (n = 40). Four major themes emerged: (1) a psychiatric diagnosis has far-reaching consequences for an individual’s life, (2) the social structure affects how patients experience psychiatric disorders, (3) students related personal experience or those of friends and family to understand psychiatric disorders, and (4) medical humanities are of particular importance in psychiatric education. Conclusions This study demonstrated that the scenario-based discussions led by a multidisciplinary team of facilitators can benefit medical students with limited clinical experience to contemplate the socio-philosophical aspects of psychiatry. The authors suggest that this pedagogical model during preclinical education should be encouraged. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Laying Medicine Open: Innovative Interaction Between Medicine and the HumanitiesLaurence B. McCullough and Warren Thomas ReichThe past three decades have witnessed the emergence and remarkable success of the fields of bioethics and medical humanities. The intellectual landscape of medicine and that of the humanities have been remarkably altered in the process. Twenty-five to 30 years ago in the United States there existed but a few courses (...) in what came to be called “bioethics” in departments of philosophy, religious studies, and theology in colleges and universities, a handful of programs of teaching in medical schools such as the University of Texas Medical Branch at Galveston and Pennsylvania State University School of Medicine at Hershey, and but one independent research center (the Hastings Center) and one university-based research center (the Kennedy Institute of Ethics at Georgetown University). Articles on bioethics began to appear in the peer-reviewed medical, nursing, and humanities literature and some books were published. There was only one journal in bioethics, The Hastings Center Report (which consolidated two previously separate journals from the Hastings Center). Graduate programs in bioethics and medical humanities in colleges and universities and fellowship training in bioethics and medical humanities in medical schools did not exist. Very little existed in colleges, universities, and medical schools in other countries. Now, of course, everything is different.Teachers, scholars, and students of bioethics and medical humanities should not take these remarkable changes for granted, for they represent a sustained and innovative interaction between medicine and the humanities. We have chosen the metaphor of “laying medicine open” to characterize the history of bioethics and medical humanities of the past three decades. This surgical metaphor was used in eighteenth-century Britain by a number of writers who wanted to make medical science and practice more accessible to the sick and to the lay public more generally (Lawrence 1975). We use the metaphor to characterize the efforts of teachers and [End Page 1] scholars over the past three decades and more to make the value-laden dimensions of biomedical science and practice and of health care policy more accessible to patients and to the lay public more generally. The result of this laying open of medicine has gone a long way toward bringing closer together the two cultures of science and the humanities that had, as C. P. Snow famously described, become significantly isolated from each otherAlbert Jonsen (1998) has recently contributed the first book-length history of what he calls the “birth” of bioethics, adding to the work of other scholars such as Warren Reich (1994; 1995) and Robert Baker (1993) and, before them, Corrado Viafora (1990) and David Rothman (1991). The articles in this issue of the Kennedy Institute of Ethics Journal make additional contributions to the developing understanding of the history of the past thirty years of interaction between medicine and the humanities.Laurence McCullough provides an historical context for the three accounts of the recent laying open of medicine that follow. McCullough examines two times in the history of medicine when it has been laid open to accountability (in addition to its being laid open to and by bioethics and medical humanities). The first laying open occurred in the work of the eighteenth-century Scottish physician and philosopher John Gregory, who set out to create a profession of medicine in a true moral sense of a fiduciary profession by making medicine accountable for its scientific and moral quality. The second occurred in the late twentieth century in which the managed practice of medicine in general, and managed care in particular, have begun to lay medicine open to accountability for its scientific and moral quality, as well as its cost and, at least in the public sector, its accessibility. McCullough argues that, just as Gregory responded to the ethical challenges of medicine laid open more than two centuries ago, bioethics should respond to the ethical challenges in the current laying open of medicine.Warren Reich provides an account of André Hellegers, whose premature death left an enormous gap in the field that will never be filled. Reich claims that Hellegers was engaged substantially in much more than the laying open of medicine: he... (shrink)

This superb account of the development of scientific research in the state of Baden places the growth of science in nineteenth century Germany within a broad social and economic context. The book analyses the progress of scientific research and its institutionalization in the state university system. Focusing on the experimental sciences, the book explores the introduction of the research ethic into the university medical curriculum, and the process by which laboratory science came to be an essential pedagogical tool in the (...) education of future citizens of the state. The social and economic changes that ultimately transformed Germany into a modern industrial state are also considered. It was within this setting that laboratory training, once considered inappropriate for university studies, grew in status, and that dissatisfaction with the overly theoretical education traditionally offered by the universities began to increase. Thus, much like computers today, the scientific method in the nineteenth century came to represent an instrument for teaching not only specific skills but also a particular way of approaching, analyzing, and solving the problems of an industrializing economy. This compelling volume will be of interest to historians of science, medicine, and European studies. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:John Gregory and the Invention of Professional Medical Ethics and the Profession of Medicine by Laurence B. McCullough, John Gregory’s Writings on Medical Ethics and Philosophy of Medicine ed. by Laurence B. McCullough, Medicine and Morals in the Enlightenment: John Gregory, Thomas Percival and Benjamin Rush by Lisbeth HaakonssenHeiner F. KlemmeLaurence B. McCullough. John Gregory and the Invention of Professional Medical Ethics and the Profession (...) of Medicine. Dordrecht, Boston, London: Kluwer Academic Publishers, 1998. Pp. xv + 347. Cloth, $140.00.Laurence B. McCullough, editor. John Gregory’s Writings on Medical Ethics and Philosophy of Medicine. Dordrecht, Boston, London: Kluwer Academic Publishers, 1998. Pp. xi + 254. Cloth, $105.00.Lisbeth Haakonssen. Medicine and Morals in the Enlightenment: John Gregory, Thomas Percival and Benjamin Rush. Amsterdam, Atlanta: Rodopi, 1997. Pp. x + 247. Paper, $20.50.The Scottish Enlightenment is widely appreciated for its contributions to philosophy, economics, sociology, law, chemistry, and medicine. The ideas and theories advanced by Hume, Smith, Millar, and Ferguson are still widely debated. John Gregory (1724–1773), important in his own time, is not as well known as some of his friends and colleagues. He was professor of medicine at the University of Edinburgh from 1766 to 1773, where he taught introductory lectures on the theory and practice of medicine. A set of extensive student notes from these lectures, entitled Observations on the Duties and Offices of a Physician, appeared anonymously in 1770. Two years later, Gregory himself published a revised version of his lectures under the title Lectures on the Duties and Qualifications of a Physician. These two books are said to mark the beginnings of professional medical ethics in the English-speaking world. They are also sometimes characterized as having anticipated bioethics.McCullough’s comprehensive John Gregory and the Invention of Professional Medical Ethics and the Profession of Medicine is the first modern intellectual biography of Gregory. Based on extensive research into eighteenth-century institutional context and the study of hitherto unknown manuscripts, he gives a full account of Gregory’s education at Edinburgh and Leiden, and his practice and teaching of medicine at Aberdeen, London, and Edinburgh. He stresses the importance of Gregory’s membership in the Aberdeen Philosophical Society and his close contact with Mrs. Montagu and her Circle for the understanding of his medical ethics. McCullough also shows that Bacon’s experimental method had a decisive influence on Gregory. Gregory took over Bacon’s three offices or ends of medicine: preservation of health, prolonging of life, and curing of diseases. In 1772, perhaps anticipating his premature death from hereditary gout, he added a fourth office, namely easing the pain of dying. Gregory referred mainly to Bacon (and Reid) in his Lectures to make clear how we can enlarge our medical knowledge by the method of experience and observation, pointing out that the progress of medicine had been seriously retarded by the way in which it was taught since Hippocrates. He also thought it was handicapped by the view that only professionals [End Page 535] should practice it, and claimed that even quacks have their advantages because their interest and reputation seldom suffer from the failure of the experiments necessary for the improvement of the medical profession.Gregory also argued that we should regard medicine not as a trade but as an art. In this context the principle of sympathy (or humanity) became important for him. Sympathy was the basis of the central duties in his Lectures. In a time of extreme instability of manners, when medicine was regarded more as a trade than an art, there was no physician-patient relationship based on the epistemological and moral authority of the physician. According to McCullough, it was Gregory who created “the physician-patient relationship as fiduciary. The virtues of the physician as fiduciary—openness to conviction, tenderness, and steadiness—provided for him the moral causes that would gather physicians together into a group worthy of the name, ‘profession,’ in its intellectual and moral senses” (265). The physician should no longer view his patients as moral strangers.McCullough claims that Gregory’s medical ethics is not just of historical interest, providing bioethics with its own history. It is also of... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:John Gregory and the Invention of Professional Medical Ethics and the Profession of Medicine by Laurence B. McCullough, John Gregory’s Writings on Medical Ethics and Philosophy of Medicine ed. by Laurence B. McCullough, Medicine and Morals in the Enlightenment: John Gregory, Thomas Percival and Benjamin Rush by Lisbeth HaakonssenHeiner F. KlemmeLaurence B. McCullough. John Gregory and the Invention of Professional Medical Ethics and the Profession (...) of Medicine. Dordrecht, Boston, London: Kluwer Academic Publishers, 1998. Pp. xv + 347. Cloth, $140.00.Laurence B. McCullough, editor. John Gregory’s Writings on Medical Ethics and Philosophy of Medicine. Dordrecht, Boston, London: Kluwer Academic Publishers, 1998. Pp. xi + 254. Cloth, $105.00.Lisbeth Haakonssen. Medicine and Morals in the Enlightenment: John Gregory, Thomas Percival and Benjamin Rush. Amsterdam, Atlanta: Rodopi, 1997. Pp. x + 247. Paper, $20.50.The Scottish Enlightenment is widely appreciated for its contributions to philosophy, economics, sociology, law, chemistry, and medicine. The ideas and theories advanced by Hume, Smith, Millar, and Ferguson are still widely debated. John Gregory (1724–1773), important in his own time, is not as well known as some of his friends and colleagues. He was professor of medicine at the University of Edinburgh from 1766 to 1773, where he taught introductory lectures on the theory and practice of medicine. A set of extensive student notes from these lectures, entitled Observations on the Duties and Offices of a Physician, appeared anonymously in 1770. Two years later, Gregory himself published a revised version of his lectures under the title Lectures on the Duties and Qualifications of a Physician. These two books are said to mark the beginnings of professional medical ethics in the English-speaking world. They are also sometimes characterized as having anticipated bioethics.McCullough’s comprehensive John Gregory and the Invention of Professional Medical Ethics and the Profession of Medicine is the first modern intellectual biography of Gregory. Based on extensive research into eighteenth-century institutional context and the study of hitherto unknown manuscripts, he gives a full account of Gregory’s education at Edinburgh and Leiden, and his practice and teaching of medicine at Aberdeen, London, and Edinburgh. He stresses the importance of Gregory’s membership in the Aberdeen Philosophical Society and his close contact with Mrs. Montagu and her Circle for the understanding of his medical ethics. McCullough also shows that Bacon’s experimental method had a decisive influence on Gregory. Gregory took over Bacon’s three offices or ends of medicine: preservation of health, prolonging of life, and curing of diseases. In 1772, perhaps anticipating his premature death from hereditary gout, he added a fourth office, namely easing the pain of dying. Gregory referred mainly to Bacon (and Reid) in his Lectures to make clear how we can enlarge our medical knowledge by the method of experience and observation, pointing out that the progress of medicine had been seriously retarded by the way in which it was taught since Hippocrates. He also thought it was handicapped by the view that only professionals [End Page 535] should practice it, and claimed that even quacks have their advantages because their interest and reputation seldom suffer from the failure of the experiments necessary for the improvement of the medical profession.Gregory also argued that we should regard medicine not as a trade but as an art. In this context the principle of sympathy (or humanity) became important for him. Sympathy was the basis of the central duties in his Lectures. In a time of extreme instability of manners, when medicine was regarded more as a trade than an art, there was no physician-patient relationship based on the epistemological and moral authority of the physician. According to McCullough, it was Gregory who created “the physician-patient relationship as fiduciary. The virtues of the physician as fiduciary—openness to conviction, tenderness, and steadiness—provided for him the moral causes that would gather physicians together into a group worthy of the name, ‘profession,’ in its intellectual and moral senses” (265). The physician should no longer view his patients as moral strangers.McCullough claims that Gregory’s medical ethics is not just of historical interest, providing bioethics with its own history. It is also of... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:John Gregory and the Invention of Professional Medical Ethics and the Profession of Medicine by Laurence B. McCullough, John Gregory’s Writings on Medical Ethics and Philosophy of Medicine ed. by Laurence B. McCullough, Medicine and Morals in the Enlightenment: John Gregory, Thomas Percival and Benjamin Rush by Lisbeth HaakonssenHeiner F. KlemmeLaurence B. McCullough. John Gregory and the Invention of Professional Medical Ethics and the Profession (...) of Medicine. Dordrecht, Boston, London: Kluwer Academic Publishers, 1998. Pp. xv + 347. Cloth, $140.00.Laurence B. McCullough, editor. John Gregory’s Writings on Medical Ethics and Philosophy of Medicine. Dordrecht, Boston, London: Kluwer Academic Publishers, 1998. Pp. xi + 254. Cloth, $105.00.Lisbeth Haakonssen. Medicine and Morals in the Enlightenment: John Gregory, Thomas Percival and Benjamin Rush. Amsterdam, Atlanta: Rodopi, 1997. Pp. x + 247. Paper, $20.50.The Scottish Enlightenment is widely appreciated for its contributions to philosophy, economics, sociology, law, chemistry, and medicine. The ideas and theories advanced by Hume, Smith, Millar, and Ferguson are still widely debated. John Gregory (1724–1773), important in his own time, is not as well known as some of his friends and colleagues. He was professor of medicine at the University of Edinburgh from 1766 to 1773, where he taught introductory lectures on the theory and practice of medicine. A set of extensive student notes from these lectures, entitled Observations on the Duties and Offices of a Physician, appeared anonymously in 1770. Two years later, Gregory himself published a revised version of his lectures under the title Lectures on the Duties and Qualifications of a Physician. These two books are said to mark the beginnings of professional medical ethics in the English-speaking world. They are also sometimes characterized as having anticipated bioethics.McCullough’s comprehensive John Gregory and the Invention of Professional Medical Ethics and the Profession of Medicine is the first modern intellectual biography of Gregory. Based on extensive research into eighteenth-century institutional context and the study of hitherto unknown manuscripts, he gives a full account of Gregory’s education at Edinburgh and Leiden, and his practice and teaching of medicine at Aberdeen, London, and Edinburgh. He stresses the importance of Gregory’s membership in the Aberdeen Philosophical Society and his close contact with Mrs. Montagu and her Circle for the understanding of his medical ethics. McCullough also shows that Bacon’s experimental method had a decisive influence on Gregory. Gregory took over Bacon’s three offices or ends of medicine: preservation of health, prolonging of life, and curing of diseases. In 1772, perhaps anticipating his premature death from hereditary gout, he added a fourth office, namely easing the pain of dying. Gregory referred mainly to Bacon (and Reid) in his Lectures to make clear how we can enlarge our medical knowledge by the method of experience and observation, pointing out that the progress of medicine had been seriously retarded by the way in which it was taught since Hippocrates. He also thought it was handicapped by the view that only professionals [End Page 535] should practice it, and claimed that even quacks have their advantages because their interest and reputation seldom suffer from the failure of the experiments necessary for the improvement of the medical profession.Gregory also argued that we should regard medicine not as a trade but as an art. In this context the principle of sympathy (or humanity) became important for him. Sympathy was the basis of the central duties in his Lectures. In a time of extreme instability of manners, when medicine was regarded more as a trade than an art, there was no physician-patient relationship based on the epistemological and moral authority of the physician. According to McCullough, it was Gregory who created “the physician-patient relationship as fiduciary. The virtues of the physician as fiduciary—openness to conviction, tenderness, and steadiness—provided for him the moral causes that would gather physicians together into a group worthy of the name, ‘profession,’ in its intellectual and moral senses” (265). The physician should no longer view his patients as moral strangers.McCullough claims that Gregory’s medical ethics is not just of historical interest, providing bioethics with its own history. It is also of... (shrink)

This guide accompanies the following article(s): ‘Full Disclosure of the “Raw Data” of Research on Humans: Citizens’ Rights, Product Manufacturer’s Obligations and the Quality of the Scientific Database.’Philosophy Compass 6/2 (2011): 90–99. doi: 10.1111/j.1747‐9991.2010.00376.x Author’s Introduction Securing consent (and informed consent) from patients and research study participants is a key concern in patient care and research on humans. Yet, the legal doctrines of consent and informed consent differ in their applications. In patient care, the judicial doctrines of consent and (...) informed consent are disclosure doctrines based on the obligation of physicians to inform their patients of the following types of information: the nature of the procedure the physician is recommending in the patent’s care (P), the alternatives to the physician‐recommendation (A), and the risks of procedure and its alternatives (R). In addition, the physician must provide truthful answers to the patient’s questions (Q) to the best of the physician’s abilities. In research on humans, the onus of disclosure by study sponsors and principal investigators is much greater than in patient care precisely because the purpose of research is not patient care. The purpose of research is the identification and development of new generalizable knowledge. Thus, participation in a research study or trial may not benefit the study volunteer at all. In addition, the participant may carry a heavy risk burden in relationship to any testing of a newly designed drug or device as part of their experiences in the research study. Presently, despite the risks borne by the research study participant, the raw data collected from volunteers in research trials are treated by courts as if they were the private property of the study sponsor rather than generally owed to the public as would be expected by an effort like research participation aimed at contributing to the development of generalizable knowledge. This paper reviews the obligations that study sponsors owe to their study participants based on the very definition of research as a systematic activity whose purpose is to develop generalizable knowledge to help all humans. Author Recommends Court cases Canterbury v. Spence, United States Court of Appeals, District of Columbia Circuit 464 F.2d 772 (1972). (Federal appellate decision heard in the District of Columbia, USA) Reibl v. Hughes, 2 S.C.R. 880 (1980). (Supreme Court of Canada) Rogers v. Whitaker, 175 C.L. R. 479 (1992). (High Court of Australia) Sidaway v. Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital and Others. 1 A.C. 871 (1985) (House of Lords) Canterbury v. Spence is the landmark Federal informed consent case in the United States heard in the District of Columbia. In this case, Judge Spottswood Robinson articulated the reasonable person standard of informed consent. This standard was subsequently adopted by the Supreme Court of Canada (Reibl v. Hughes, 2 S.C.R. 880 (1980)) and the High Court of Australia (Rogers v. Whitaker, 175 C.L. R. 479 (1992)). The House of Lords rejected the reasonable person standard in England in Sidaway v. Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital and Others. 1 A.C. 871 (1985). Book Mazur, Dennis J. The Science and Ethics of Research on Humans. Baltimore, MD: Johns Hopkins University Press, 2007. This book is a detailed guide for the review of scientific and ethical aspects of research on humans contained in the research study protocols and research informed consent forms which need to be submitted by study sponsors and principal investigators to institutional review boards (IRBs) for IRB review before a research study can receive approval to be conducted within a human study population in those institutions over which the IRB has authority. It also presents basic definitions in the area of research on humans and basic approaches to help conduct a deep review of the underlying scientific and ethical issues that are present within a research study protocol and its accompanying research informed consent form. Report National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The Belmont Report: Ethical Guidelines for the Protection of Human Subjects of Research. Washington, DC: DHEW Publications, 1978 (78‐0012). This U.S. National Commission in the Belmont Report argued for the necessity of a reasonable volunteer standard in research on humans in the United States. Arguing that the professional standard and the reasonable person standard of consent and informed consent were insufficient to base a disclosure standard in research on humans, this National Commission developed the reasonable volunteer standard where a study participant is to be approached in research informed consent with that information that a reasonable volunteer would want to know. Online Materials Belmont Report: Syllabus Topics for Lecture and Discussion Week I: Introduction and Overview Readings: Rogers v. Whitaker, 175 C.L.R. 479 (1992). (High Court of Australia) Sidaway v. Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital and Others. 1 A.C. 871 (1985) (House of Lords) Week II: The Different Standards of Consent and Informed Consent Readings: Canterbury v. Spence, 464 F.2d 772 (1972). (Federal appellate opinion heard in the District of Columbia) Sidaway v. Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital and Others. 1 A.C. 871 (1985) (House of Lords) Week III: Definition of Research Reading: Mazur, Dennis J. The Science and Ethics of Research on Humans. Baltimore, MD: Johns Hopkins University Press, 2007. (Especially Chapters 2 and 3) Week IV: How to Review a Research Study Protocol and Research Informed Consent Form Reading: Mazur, Dennis J. The Science and Ethics of Research on Humans. Baltimore, MD: Johns Hopkins University Press, 2007. (Especially Chapters 4–6, 10, and 12–14) Week V: Obligations in Research of Humans Versus Patient Care Reading: National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The Belmont Report: Ethical Guidelines for the Protection of Human Subjects of Research. Washington, DC: DHEW Publications, 1978 (78‐0012). Focus Questions • How do the judicial doctrines of consent in England and Australia compare to the judicial doctrines of informed consent in the United States and Canada? • How does a professional standard of disclosure differ from a reasonable person standard of disclosure? • What is the definition of research? • How is a research study (study proposal and research informed consent form) reviewed from scientific and ethical bases for considerations of approval by an IRB? • How do the obligations of a study sponsor, a principal investigator, and a research team conducting a research trial on human study participants differ from the obligations of a physician caring for a patient? • Should all raw data of research derived from humans be made available to the public for use in developing generalizable knowledge to help others, or should raw data be considered the private property of the study sponsors (for example, prescription drug manufacturers), who fund the research trials? Seminar/project Idea Draw a timeline of the development of the basic concepts of consent and informed consent in patient care and in patient research. On this timeline, first place the dates of the key court cases in England, the United States, Canada, and Australia on consent and informed consent. Then place the date of the development of the Belmont Report. Why do differences exist between these four countries in terms of the legal requirements of informedness of a patient (in medical care) and a study participant (in medical research)? What roles if any do the concepts of self‐determination and self‐decision have in consent and informed consent in patient care and in informed consent in research on humans among the four countries of interest? What are the realities of research on human participants that require a new standard of informed consent, the reasonable volunteer standard, to be developed beyond the two standards in patient care, the professional standard, and the reasonable person standard? Counterpoint Arguments The following are counterpoint arguments that need to be appreciated to more fully understand the concepts that impact the thesis that ‘raw data’ should be open to the public to allow the opportunity of checking of the results of its associated scientific paper and for further analysis. De‐Identified (Anonymized) Raw Data A current approach to identifying (anonymizinig) raw data is based on the Health Insurance Portability and Accountability Act (HIPAA) of 1996 (P.L.104‐191). HIPAA was enacted by the U.S. Congress in 1996 to keep a person’s medical information private. In a research study, a person’s private medical information can become research data. HIPAA’s Privacy Rule allows a covered entity to de‐identify data by removing all 18 elements that could be used to identify the individual or the individual’s relatives, employers, or household members; these elements are enumerated in the Privacy Rule. The covered entity must also have no actual knowledge that the remaining information could be used alone or in combination with other information to identify the individual who is the subject of the information. Under this method, the identifiers that must be removed are the following: 1 Names. 2 All geographic subdivisions smaller than a state, including street address, city, county, precinct, ZIP Code, and their equivalent geographical codes, except for the initial three digits of a ZIP Code if, according to the current publicly available data from the Bureau of the Census: 2a. The geographic unit formed by combining all ZIP Codes with the same three initial digits contains more than 20,000 people. 2b. The initial three digits of a ZIP Code for all such geographic units containing 20,000 or fewer people are changed to 000. 3 All elements of dates (except year) for dates directly related to an individual, including birth date, admission date, discharge date, and date of death, and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older. 4 Telephone numbers. 5 Facsimile numbers. 6 Electronic mail addresses. 7 Social security numbers. 8 Medical record numbers. 9 Health plan beneficiary numbers. 10 Account numbers. 11 Certificate/license numbers. 12 Vehicle identifiers and serial numbers, including license plate numbers. 13 Device identifiers and serial numbers. 14 Web universal resource locators (URLs). 15 Internet protocol (IP) address numbers. 16 Biometric identifiers, including fingerprints and voiceprints. 17 Full‐face photographic images and any comparable images. 18 Any other unique identifying number, characteristic, or code, unless otherwise permitted by the Privacy Rule for re‐identification. Even though ‘raw data’ can be de‐identified (anonymized) so that there is no way to trace back the data to the study participant from which it was drawn, there are still questions whether the ‘de‐identified raw data’ can be given to other researchers or made public without the original study participant’s approval. It may be the case that this approval could be done at the start of any research study where the individual considering study participation would be counseled on what the process of de‐identification consists of and would be asked whether the participant would allow use of the data by other researchers or made available to the public in a de‐identified state. However, there may be questions of the study participants as to whether the data are truly de‐identified and untraceable back to the study participant since the participant would not be able to see the process actually being carried out in detail in all relevant circumstances. Using Raw Data in Context Simply being in possession of raw data is never enough to build on that data from a research perspective. Researchers need to understand the context of the scientific research study in which the data were collected. This research context includes (but is not limited to): (i) the scientific hypothesis of the research study, (ii) the inclusion and exclusion criteria selected by the research designers of the study to determine which study participants were included and which were excluded from the study, (iii) the methods used to collect the data and possibilities of errors in the data collection processes, and (iv) answers to questions regarding whether any data were excluded from the study data and why these data were excluded. Ownership Rights Over Data There are ownership rights over data. Ownership rights include court decision making related to the question which parties are to be considered as the owners of the data. Possible owners here include (but are not limited to) (i) the study sponsor whose only role was to fund that study, (ii) the principal investigator(s) who developed the scientific hypothesis, and (iii) individual study participants through special contracts made by individual participants who negotiate such contracts with study sponsors and principal investigators to share in the ownership of data. Examples of such data are participant sources of unique gene lines or unique cell lines to be used in future research. Objections to Data Sharing Finally, individual researchers may simply object to sharing data. A researcher’s arguments here may be simply stating that he or she has a right to fully analyze the data since the collection of the data was the researchers’ idea in the first place. These researchers may argue that they have the right to mine the data as fully as they can before deciding to make the data open to the public for others to analyze. Works Cited 1 Kaiser, J. ‘Making Clinical Data Widely Available.’Science 322.5899 (10 Oct. 2008): 217–8. 2 de Lusignan, S., J.F. Metsemakers, P. Houwink, V. Gunnarsdottir, and J. van der Lei. ‘Routinely Collected General Practice Data: Goldmines for Research? A Report of the European Federation for Medical Informatics Primary Care Informatics Working Group (EFMI PCIWG) from MIE2006, Maastricht, The Netherlands.’Informatics in Primary Care 14.3 (2006): 203–9. 3 Sim, I. ‘Human Studies Database Project’, CTSA Data Repositories Symposium (17 Oct. 2008). 23 Nov. 2010. 4 Sim, I., C.G. Chute, H. Lehmann, R. Nagarajan, M. Nahm, and R.H. Scheuermann. ‘Keeping Raw Data in Context.’Science 323.5915 (6 Feb. 2009): 713. 5 U.S. Department of Health and Human Services, National Institutes of Health, HIPAA Privacy Rule, Information for Researchers. 13 Nov. 2010. 6 Wilczynski, N.L., R.B. Haynes, and Hedges Team. ‘EMBASE Search Strategies for Identifying Methodologically Sound Diagnostic Studies for Use by Clinicians and Researchers.’BMC Medicine 29.3 (March 2005): 7. (shrink)

This book provides a richly documented account of the historical, cultural, philosophical and practical dimensions of feng shui. It argues that where feng shui is entrenched educational systems have a responsibility to examine its claims, and that this examination provides opportunities for students to better learn about the key features of the nature of science, the demarcation of science and non-science, the characteristics of pseudoscience, and the engagement of science with culture and worldviews. The arguments presented for feng shui being (...) a pseudoscience can be marshalled when considering a whole range of comparable beliefs and the educational benefit of their appraisal. Feng shui is a deeply-entrenched, three-millennia-old system of Asian beliefs and practices about nature, architecture, health, and divination that has garnered a growing presence outside of Asia. It is part of a comprehensive and ancient worldview built around belief in chi the putative universal energy or life-force that animates all existence, the cosmos, the solar system, the earth, and human bodies. Harmonious living requires building in accord with local chi streams; good health requires replenishment and manipulation of internal chi flow; and a beneficent afterlife is enhanced when buried in conformity with chi directions. Traditional Chinese Medicine is based on the proper manipulation of internal chi by acupuncture, tai-chi and qigong exercise, and herbal dietary supplements. Matthews has produced another tour de force that will repay close study by students, scientists, and all those concerned to understand science, culture, and the science/culture nexus. Harvey Siegel, Philosophy, University of Miami, USA With great erudition and even greater fluidity of style, Matthews introduces us to this now-world-wide belief system. Michael Ruse, Philosophy, Florida State University, USA The book is one of the best research works published on Feng Shui. Wang Youjun, Philosophy, Shanghai Normal University, China The history is fascinating. The analysis makes an important contribution to science literature. James Alcock, Psychology, York University, Canada This book provides an in-depth study of Feng Shui in different periods, considering its philosophical, historical and educational dimensions; especially from a perspective of the ‘demarcation problem’ between science and pseudoscience. Yao Dazhi, Chinese Academy of Sciences, China. (shrink)

Teacher emotion has become an important issue in English language teaching as it is a crucial construct in understanding teachers' responses to institutional policies. The study explored teachers' emotion labor and its impact on teachers' pedagogical decision-making in English for Specific Purposes teaching in a university of Traditional Chinese Medicine in China. Drawing on a poststructural perspective, the study examined data from two rounds of semi-structured interviews, policy documents and teaching artifacts. The analysis of (...) data revealed that the major emotion labor facing the participants revolved around students' disengagement in class. Teachers experienced mixed feelings of anticipation, disappointment, anger, and empathy toward students and distanced themselves from institutional feeling rules enforcing objective assessment of students' performance and punishing students for lack of engagement in class. The study found that teacher emotion labor served as the site for their pedagogical modifications. ESP teachers' beliefs in the importance of attending to students' needs become a powerful discourse in supporting teachers to strategically subvert institutional feeling rules and critically reflect on the dysfunctions of curriculum, orienting teachers' agentic actions in modifying pedagogical practices. We thus underscore this empowering discourse as the bridge to connect teachers' policy negotiation and their actual classroom practices. We also highlight teachers' pedagogical decision-making as a process of the interactions of teacher emotion, teachers' reflexive practices, and power relations. The study ended by suggesting more longitudinal research where teachers' beliefs as previously appropriated discourses could be examined comprehensively as they were both the construct of emotion labor and the potential subverting power in supporting teachers' pedagogical decision-making in policy negotiation. (shrink)

Our present day knowledge in the area of medicine in Ancient Egypt has been severally sourced from medical papyri several of which have been deduced and analyzed by different scholars. For educational purposes it is always imperative to consult different literature or sources in the teaching of ancient Egypt and medicine in particular. To avoid subjectivity the author has found the need to re-engage the efforts made by several scholars in adducing evidences from medical papyri. In the (...) quest to re-engage the efforts of earlier writers and commentaries on the medical papyri, we are afforded the opportunity to be informed about the need to ask further questions to enable us to construct or reconstruct both past and modern views on ancient Egyptian medical knowledge. It is this vocation the author sought to pursue in the interim, through a preliminary review, to highlight, comment and reinvigorate in the reader or researcher the need for a continuous engagement of some pertinent documentary sources on Ancient Egyptian medical knowledge for educational and research purposes. The study is based on qualitative review of published literature. The selection of those articles as sources was based on the focus of the review, in order to purposively select and comment on articles that were published based either on information from a medical papyrus or focused on medical specialization among the ancient Egyptians as well as ancient Egyptian knowledge on diseases and medicine. It was found that the Egyptians developed relatively sophisticated medical practices covering significant medical fields such as herbal medicine, gynecology and obstetrics, anatomy and physiology, mummification and even the preliminary form of surgery. These practices, perhaps, were developed as remedies for the prevailing diseases and the accidents that might have occurred during the construction of their giant pyramids. It must be stated that they were not without flaws. Also, the key issues raised from these literatures are but a few among the Egyptian medical corpus across the academic and publishing world. It should therefore afford researchers, students and readers the opportunity to continue the educational dialogue on the medical practices of the Ancient Egyptians. (shrink)

BackgroundThe issue of stigma is very important in the battle against HIV/aids in Africa since it may affect patient attendance at healthcare centres for obtaining antiretroviral medications and regular medical check-ups. Stigmatization creates an unnecessary culture of secrecy and silence based on ignorance and fear of victimization. This study was designed to determine if there is external stigmatization of people living with HIV and AIDS by health care workers at a tertiary hospital in KwaZulu-Natal province, South Africa. The (...) class='Hi'>study investigated the impact of knowledge of HIV/aids by HCWs on treatment of patients, as well as the comfort level and attitude of HCWs when rendering care to PLWHA.MethodsA descriptive cross sectional study was designed to collect data using an anonymous self-administered structured questionnaire from 334 HCWs. The study was conducted in clinical departments of a large multidisciplinary 922-bed tertiary care teaching hospital in Durban, KZN.ResultsOverall HCWs had an above average knowledge about HIV/aids although some gaps in knowledge were identified. Tests of statistical significance showed that there was association between level of education and knowledge of HIV/aids ; occupation and knowledge of HIV/aids ; and gender and knowledge of HIV/aids. Test for comfort level was only significant for gender, with males showing more comfort and empathy when dealing with PLWHA. The study also revealed that patients were sometimes tested for HIV without informed consent before surgery, due to fear of being infected, and there was some gossiping about patients' HIV status by HCWs, thereby compromising patient confidentiality. The majority of HCWs showed a willingness to report incidents of stigmatization and discrimination to higher authorities, for better monitoring and control.ConclusionsAlthough knowledge, attitude and comfort level of HCWs taking care of PLWHA was above average, enforcement of existing antidiscrimination laws and continuing education in medical ethics and healthcare law, would greatly improve the performance of HCWs taking care of PLWHAs. More psychological support and counselling should be provided to HCWs, to further reduce the impact of stigmatization and discrimination against PLWHA. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Health Care Ethics: Theological Foundations, Contemporary Issues, and Controversial Cases, revised edition by Michael R. Panicola, David M. Belde, John Paul Slosar, and Mark F. Repenshek, and: On Moral Medicine: Theological Perspectives in Medical Ethics, third edition ed. by M. Therese Lysaught and Joseph J. Kotva Jr. with Stephen E. Lammers and Allen VerheyLindsey EsbensenReview of Health Care Ethics: Theological Foundations, Contemporary Issues, and Controversial Cases, revised (...) edition MICHAEL R. PANICOLA, DAVID M. BELDE, JOHN PAUL SLOSAR, AND MARK F. REPENSHEK Winona, MN: Anselm Academic, 2011. 438 pp. $37.95Review of On Moral Medicine: Theological Perspectives in Medical Ethics, third edition EDITED BY M. THERESE LYSAUGHT AND JOSEPH J. KOTVA JR. WITH STEPHEN E. LAMMERS AND ALLEN VERHEY Grand Rapids, MI: Eerdmans, 2012. 1180 pp. $61.55Health Care Ethics and On Moral Medicine are excellent resources for those studying and teaching in the field of medical ethics. Each text on its own provides a very good initial evaluation of contemporary conversations in health care ethics. Together they provide a thorough foundation for the study of health care ethics that encourages further exploration of topics in the field. They both provide an excellent overview for undergraduate students as well as anyone interested in the field of medical morality.Health Care Ethics is especially helpful for those entering the field of ethics in general and the more particular realm of medical morality. User-friendly, [End Page 211] the book is accessible to beginners while also being relevant to those already well-versed in medical ethics. The book provides case studies culled from the experiences of the authors throughout their careers in the practice of medical ethics. Perhaps even more useful, however, are the other exercises in which readers are given the opportunity to actively engage the text in order to discover and more fully articulate their own moral stance. Although Health Care Ethics approaches the topic from a theological perspective, using scriptural passages as well as broader religious themes and contexts, the book is accessible to those outside of the religious arena as well.The first three chapters lay the framework for general theological and ethical inquiry while the later chapters discuss more specific topics in applied health care ethics. The opening chapters by Michael Panicola are thought-provoking, especially since they encourage readers to participate in exercises to determine how they would respond to particular scenarios in their personal decision making. For example, after laying out the classic ethical theories, readers are asked to take a “quiz” by responding to multiple-choice questions to determine how they would respond to various ethical situations. The exercise demonstrates that moral discernment that relies on one ethical theory alone or one single approach to ethics is too narrow and confining for authentic dialogue in ethics. Another exercise calls upon readers to examine their fundamental bases for personal decision making by asking them to create a list of what they think are the ten things that constitute human flourishing and then narrow that list down to the top two. In addition to being engaging, these exercises help readers establish their personal moral stance by asking them to appropriate foundational norms in the process of moral discernment to the case studies throughout the book. They also help readers apply these norms to the specific topics in health care ethics presented in the later chapters.The authors of Health Care Ethics clearly identify human flourishing as the center and goal for all ethical inquiry. Demonstrating that “human flourishing” has different connotations for different people, they also argue that certain norms can be agreed upon to establish a framework for all conversations regarding moral decision making in health care. They especially emphasize a concern for the optimization of human flourishing in final chapters of the text. Chapters 4–12 provide detailed examinations of current topics in medical ethics. Each chapter includes case studies that raise questions concerning social ethics as well as health care morality, employing sources from law, sociology, philosophy, and theology. Each case underscores the complexity of moral decision making in health care ethics as well as the point that there is no one, pure approach to medical ethics that... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:John Gregory and the Invention of Professional Medical Ethics and the Profession of Medicine by Laurence B. McCullough, John Gregory’s Writings on Medical Ethics and Philosophy of Medicine ed. by Laurence B. McCullough, Medicine and Morals in the Enlightenment: John Gregory, Thomas Percival and Benjamin Rush by Lisbeth HaakonssenHeiner F. KlemmeLaurence B. McCullough. John Gregory and the Invention of Professional Medical Ethics and the Profession (...) of Medicine. Dordrecht, Boston, London: Kluwer Academic Publishers, 1998. Pp. xv + 347. Cloth, $140.00.Laurence B. McCullough, editor. John Gregory’s Writings on Medical Ethics and Philosophy of Medicine. Dordrecht, Boston, London: Kluwer Academic Publishers, 1998. Pp. xi + 254. Cloth, $105.00.Lisbeth Haakonssen. Medicine and Morals in the Enlightenment: John Gregory, Thomas Percival and Benjamin Rush. Amsterdam, Atlanta: Rodopi, 1997. Pp. x + 247. Paper, $20.50.The Scottish Enlightenment is widely appreciated for its contributions to philosophy, economics, sociology, law, chemistry, and medicine. The ideas and theories advanced by Hume, Smith, Millar, and Ferguson are still widely debated. John Gregory (1724–1773), important in his own time, is not as well known as some of his friends and colleagues. He was professor of medicine at the University of Edinburgh from 1766 to 1773, where he taught introductory lectures on the theory and practice of medicine. A set of extensive student notes from these lectures, entitled Observations on the Duties and Offices of a Physician, appeared anonymously in 1770. Two years later, Gregory himself published a revised version of his lectures under the title Lectures on the Duties and Qualifications of a Physician. These two books are said to mark the beginnings of professional medical ethics in the English-speaking world. They are also sometimes characterized as having anticipated bioethics.McCullough’s comprehensive John Gregory and the Invention of Professional Medical Ethics and the Profession of Medicine is the first modern intellectual biography of Gregory. Based on extensive research into eighteenth-century institutional context and the study of hitherto unknown manuscripts, he gives a full account of Gregory’s education at Edinburgh and Leiden, and his practice and teaching of medicine at Aberdeen, London, and Edinburgh. He stresses the importance of Gregory’s membership in the Aberdeen Philosophical Society and his close contact with Mrs. Montagu and her Circle for the understanding of his medical ethics. McCullough also shows that Bacon’s experimental method had a decisive influence on Gregory. Gregory took over Bacon’s three offices or ends of medicine: preservation of health, prolonging of life, and curing of diseases. In 1772, perhaps anticipating his premature death from hereditary gout, he added a fourth office, namely easing the pain of dying. Gregory referred mainly to Bacon (and Reid) in his Lectures to make clear how we can enlarge our medical knowledge by the method of experience and observation, pointing out that the progress of medicine had been seriously retarded by the way in which it was taught since Hippocrates. He also thought it was handicapped by the view that only professionals [End Page 535] should practice it, and claimed that even quacks have their advantages because their interest and reputation seldom suffer from the failure of the experiments necessary for the improvement of the medical profession.Gregory also argued that we should regard medicine not as a trade but as an art. In this context the principle of sympathy (or humanity) became important for him. Sympathy was the basis of the central duties in his Lectures. In a time of extreme instability of manners, when medicine was regarded more as a trade than an art, there was no physician-patient relationship based on the epistemological and moral authority of the physician. According to McCullough, it was Gregory who created “the physician-patient relationship as fiduciary. The virtues of the physician as fiduciary—openness to conviction, tenderness, and steadiness—provided for him the moral causes that would gather physicians together into a group worthy of the name, ‘profession,’ in its intellectual and moral senses” (265). The physician should no longer view his patients as moral strangers.McCullough claims that Gregory’s medical ethics is not just of historical interest, providing bioethics with its own history. It is also of... (shrink)

Although the AAMC requires annual reporting of medical humanities teaching, most literature is based on single-school case reports and studies using information reported on schools’ websites. This study sought to discover what medical humanities is offered in North American allopathic and osteopathic undergraduate medical schools. An 18-question, semi-structured survey was distributed to all 146 member schools of the American Association of Medical Colleges and the American Association of Colleges of Osteopathic Medicine. The survey sought information on required (...) and elective humanities content, hours of humanities instruction, types of disciplines, participation rates, and humanities administrative structure. The survey was completed by 134 schools. 70.8% of schools offered required and 80.6% offered electives in humanities. Global health and writing were the most common disciplines. Schools required 43.9 mean and 30 median hours in humanities. In the first two years, most humanities are integrated into other course work; most electives are offered as stand-alone classes. 50.0% of schools report only 0-25% of students participating in humanities electives. Presence of a certificate, concentration or arts journal increased likelihood of humanities content but decreased mean hours. Schools with a medical humanities MA had a higher number of required humanities hours. Medical humanities content in undergraduate curriculum is lower than is indicated in the AAMC annual report. Schools with a formal structure have a greater humanities presence in the curriculum and are taken by more students. (shrink)

Over the past decade, teaching and learning in virtual worlds has been at the forefront of many higher education institutions around the world. The DEHub Virtual Worlds Working Group (VWWG) consisting of Australian and New Zealand higher education academics was formed in 2009. These educators are investigating the role that virtual worlds play in the future of education and actively changing the direction of their own teaching practice and curricula. 47 academics reporting on 28 Australian higher education institutions (...) present an overview of how they have changed directions through the effective use of virtual worlds for diverse teaching and learning activities such as business scenarios and virtual excursions, role-play simulations, experimentation and language development. The case studies offer insights into the ways in which institutions are continuing to change directions in their teaching to meet changing demands for innovative teaching, learning and research in virtual worlds. This paper highlights the ways in which the authors are using virtual worlds to create opportunities for rich, immersive and authentic activities that would be difficult or not possible to achieve through more traditional approaches. (shrink)

Most donated organs in the United States come from brain dead donors, while a small percentage come from patients who die in “controlled,” or expected, circumstances, typically after the family or surrogate makes a decision to withdraw life support. The number of organs available for transplant could be substantially if donations were permitted in “uncontrolled” circumstances–that is, from people who die unexpectedly, often outside the hospital. According to projections from the Institute of Medicine, establishing programs permitting “uncontrolled donation after (...) circulatory determination of death,” or uDCDD, throughout the United States has the potential to provide 22,000 more donation opportunities annually. In contrast, U.S. controlled donation after circulatory determination of death, or cDCDD, cases have increased progressively over the past decade from 87 to 848 donors, but currently account for only 10.6 percent of all deceased donors. Following the IOM recommendations, several projects exploring the feasibility of uDCDD were funded by the federal government, including a grant from the Health Resources and Services Administration that supported a pilot project in New York City in which the authors of this article participated.A key feature of our protocol, and indeed of many uDCDD protocols, is the initiation of preservation methods such as chest compressions and extracorporeal membrane oxygenation shortly after death in order to perfuse and preserve the donor's organs. Critics of uDCDD argue that the means of determining death deviates from generally ascribed principles. They assert that reinstituting circulation in order to preserve organs has the effect of “undoing” the prior determination of death. The result is that cDCDD is widely accepted and practiced routinely even though it only marginally increases the number of organs available for transplantation, and uDCDD is widely considered unacceptable despite being ethically embraced and proven to significantly increase organ donation opportunities in other countries. This article explores the evolution of this counterintuitive state of affairs and calls for a policy that, in line with the IOM report, allows for both cDCDD and uDCDD protocols. (shrink)

Contemporary psychiatry faces serious challenges because it has failed to incorporate accumulated knowledge from basic neuroscience, neurophilosophy, and brain–mind relation studies. As a consequence, it has limited explanatory power, and effective treatment options are hard to come by. A new conceptual framework for understanding mental health based on underlying neurobiological spatial-temporal mechanisms of mental disorders (already gained by the experimental studies) is beginning to emerge.

Taking into account how much modern medicine is a function of—and at the same time has a function in—science and technology, it is hardly surprising that both the approach of science studies and the idea of the social and cultural construction of health, disease, and bodies overlap, generally and specifically, in the realm of the novel field of MEDICINE STUDIES. The work already done in science and technology studies as well as in social studies of medicine, together (...) with the rich tradition of medical history and philosophy of medicine, may be considered a solid base and a good vantage point for further analysis. By exploring the shifts of knowledge production in medicine we may be able to see the driving forces behind the ongoing development of medicine and the associated transformation of its social functions in a new light. Based on historiographical reconstructions we may come up with a much more broadly contextualized understanding of the ways in which science, technology, medicine and society interact and in what regard their mutual interdependencies have been undergoing profound changes for a number of decades. By tracing the channels through which key concepts defining the relationship of medicine and its social context are negotiated, we may further explore how our notions of health, disease, and humanity are continuously morphing alongside the incessant transformations of medicine. This editorial explores the aims and scope of MEDICINE STUDIES as a truly transdisciplinary endeavor. (shrink)

Placebo effects raise some fundamental questions concerning the nature of clinical and medical research. This Element begins with an overview of the different roles placebos play, followed by a survey of significant studies and dominant views about placebo mechanisms. It then critically examines the concept of placebo and offers a new definition that avoids the pitfalls of other attempts. The main philosophical lesson is that background medical theories provide the ontology for clinical and medical research. Because these theories often contain (...) incoherent and arbitrary classifications, the concept of placebo inherits the same messiness. The Element concludes by highlighting some impending challenges for placebo studies. (shrink)

Two decades of research on euthanasia in the Netherlands have resulted into clear insights in the frequency and characteristics of euthanasia and other medical end-of-life decisions in the Netherlands. These empirical studies have contributed to the quality of the public debate, and to the regulating and public control of euthanasia and physician-assisted suicide. No slippery slope seems to have occurred. Physicians seem to adhere to the criteria for due care in the large majority of cases. Further, it has been shown (...) that the majority of physicians think that the euthanasia Act has improved their legal certainty and contributes to the carefulness of life-terminating acts. In 2005, eighty percent of the euthanasia cases were reported to the review committees. Thus, the transparency envisaged by the Act still does not extend to all cases. Unreported cases almost all involve the use of opioids, and are not considered to be euthanasia by physicians. More education and debate is needed to disentangle in these situations which acts should be regarded as euthanasia and which should not. Medical end-of-life decision-making is a crucial part of end-of-life care. It should therefore be given continuous attention in health care policy and medical training. Systematic periodic research is crucial for enhancing our understanding of end-of-life care in modern medicine, in which the pursuit of a good quality of dying is nowadays widely recognized as an important goal, in addition to the traditional goals such as curing diseases and prolonging life. (shrink)