Over the course of the last century, physicians have written a number of articles about suicide among their own. These articles reveal how physicians have fundamentally conceived of themselves, how they have addressed vulnerability among their own, and how their self-identification has changed over time, due, in part, to larger historical changes in the profession, psychiatry, and suicidology. The suicidal physician of the Golden Age (1900–1970), an expendable deviant, represents the antithesis of that era’s image of strength and (...) invincibility. In contrast, the suicidal physician of the modern era (1970 onwards), a vulnerable human being deserving of support, reflects that era’s frustration with bearing these unattainable ideals and its growing emphasis on physician health and well-being. Despite this key transition, specifically the acknowledgment of physicians’ limitations, more recent articles about physician suicide indicate that Golden Age values have endured. These persistent emphases on perfection and discomfort with vulnerability have hindered a comprehensive consideration of physician suicide, despite one hundred years of dialogue in the medical literature. (shrink)

This book presents essays by eminent scholars from across the history of medicine, early science and European history, including those expert on the history of the book. The volume honors Professor Nancy Siraisi and reflects the impact that Siraisi's scholarship has had on a range of fields. Contributions address several topics ranging from the medical provenance of biblical commentary to the early modern emergence of pathological medicine. Along the way, readers may learn of the purchasing habits of physician-book collectors, the (...) writing of history and the development of natural history. Modeling the interdisciplinary approaches championed by Siraisi, this volume attests to the enduring value of her scholarship while also highlighting critical areas of future research. Those with an interest in the history of science, the history of medicine and all related fields will find this work a stimulating and rewarding read. (shrink)

While some seventeenth-century scholars promoted natural history as the basis of natural philosophy, they continued to debate how it should be written, about what and by whom. This look into the studios of two Amsterdam physicians, Jan Swammerdam (1637–80) and Steven Blankaart (1650–1705), explores natural history as a project in the making during the second half of the seventeenth century. Swammerdam and Blankaart approached natural history very differently, with different objectives, and relying on different traditions of handling specimens and (...) organizing knowledge on paper, especially with regard to the way that individual observations might be generalized. These traditions varied from collating individual dissections into histories, writing both general and particular histories of plants and animals, collecting medical observations and applying inductive reasoning. Swammerdam identified the essential changes that insects underwent during their life cycle, described four orders based on these ‘general characteristics’ and presented his findings in specific histories that exemplified the ‘general rule’ of each order. Blankaart looked to the collective observations of amateurs to support his reputation as a man of medicine, but this was not supposed to lead to any kind of generalization. Their work alerts us to the variety of observational practices that were available to them, and with what purposes they made these their own. (shrink)

Hesyre was a high court official in ancient Egypt and lived about 2650 bc during the reign of King Djoser. He managed to combine religious as well as secular posts, and has the distinction of being the first recorded physician and firstknown dentist in history. Healthcare developed at an early period in ancient Egyptian history as is supported by the evidence from the skeletal and mummified remains, from the artistic record, as well as from inscriptional and textual sources. These textual (...) sources, the medical papyri, provide details of medical procedures undertaken, drugs employed and treatments provided - some of which have influenced modern medical practice. What we know about Hesyre comes from his impressive tomb at Saqqara, the walls of which are brightly decorated with items of daily life. Additionally, the tomb contained six fine wooden panels listing Hesyres titles, among them those relating to his practice of medicine and dentistry. (shrink)

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

ABSTRACTIn a paper presented to the American Historical Association annual meeting in 1934, entitled “The Predicament of History,” Eugen Rosenstock-Huessy argued that professional (or “...

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

The history of physician involvement in capital proceedings is longstanding and ripe with controversy and conflicts of ethical concerns. Previously one of us has written that the controversy is more appropriately characterized as a conflict of moral position rather than one of ethical dilemma.In hindsight, we believe that analysis, while true, does not capture the depth or complexity of the issue.Forensic psychiatric evaluations, including competency to be executed evaluations, are done with a clear understanding that no physician-patient relationship exists. Treatment, (...) however, is not so neatly re-categorized in large measure because it involves the physician’s active provision of the healing arts. (shrink)

He notes that parallel to this phenomenon have been developments in the common law of malpractice that give patients a better chance than ever of winning compensation. While these developments benefit patients, Dr. Chapman describes how they have also pointed out a major flaw in malpractice law: the enormous amounts of time and money it takes to bring such cases to court. To overcome these difficulties, Dr. Chapman maintains, the medical profession needs to reconsider the basic concepts on which its (...) ethics rest. No less important is a revision of malpractice law so that it finally begins to serve, fairly and equitably, the purposes for which it originally came into being. Literate, thoughtful, and thought-provoking, Physicians, Law, and Ethics is an important contribution to today's medical care debate. (shrink)

After 40 years of attributing high rates of physician career dissatisfaction, attrition, alcoholism, divorce and suicide to ‘burnout’, there is growing recognition that these outcomes may instead be caused by moral injury. This has led to a debate about the relative diagnostic merits of these two terms, a recognition that interventions designed to treat burnout may be ineffective, and much perplexity about how—if at all—this changes anything. The current research seeks to develop the construct of moral injury outside military contexts, (...) generate more robust validity tests and more fully describe and measure the experiences of persons exposed to moral harms. Absent from the literature is a mechanism through which to move from the collective moral injury experience of physicians to a systematic change in the structure of medical practice. To address this, after providing a brief history, definitions and contrasts between burnout, moral distress and moral injury, we review the interplay of moral and ethical codes in the context of moral injury. We conclude by suggesting that professional associations can potentially prevent moral injury by providing protections for physicians within their codes of ethics. There are no data in this work. (shrink)

"Consists basically of medical prayers, oaths, pledges, ethical aphorisms and codes, and covenants of physicians throughout the ages, in various civilizations."--Intro. Published 1973.

Brussen, Kerri Anne This paper is a brief history of suicide, euthanasia, and physician assisted suicide in the United States of America which aims to provide an understanding of the continued and persistent effort in the USA to legalise physician assisted suicide. Oregon and Washington State Dying with Dignity Laws are reviewed as examples of legalised physician assisted suicide.

This essay highlights an argument for the moral impermissibility of physician-assisted death based on the prohibition of killing innocents that unfolds in four phases. First, I identify the operative moral principle and then develop a moral argument based upon it. Second, I raise challenges to such an argument designed to mitigate the force of the conclusion. Third, I sketch out a potential defense of the argument in light of these counter-responses for those who want to maintain moral opposition to physician-assisted (...) death based upon the prohibition of killing innocents. Finally, I conclude with a brief postscript that highlights the limits of the philosophical approach taken in this essay in conversation with the role of moral psychology in moral judgment. (shrink)

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

The vignette described in the introduction of this symposium raises a number of ethical and legal problems for physicians who work for correctional institutions and death row inmates. They are not confined to correctional physicians, however, as states have requested aid from practicing physicians in the community, and even from other states, when conflicts have arisen in the treatment of death row inmates as they near the date of execution. As outlined, the case involves a 48-year-old man (...) with a long history of schizophrenia, initially diagnosed at age 19. Compliant with medication, he remained generally free from positive symptoms-delusions and hallucinations. Nonetheless, he committed two murders during a robbery and was sentenced to death. Since his incarceration, the defendant has consistently refused psychotropic medications and has been forcibly medicated on several occasions when he exhibited violent outbursts and was overtly psychotic. (shrink)

In an age of rapid advances inlife-prolonging treatment, patients and caregivers areincreasingly facing tensions in making end-of-lifedecisions. An examination of the history of healthcare in the United States reveals technological,economic, and medical factors that have contributed tothe problems of terminal care and consequently to themovement of assisted suicide. The movement has itsroots in at least two fundamental perceptions andexpectations. In the age of technological medicineenergized by the profit motive, dying comes at a highprice in suffering and in personal economic loss. (...) Thefailure to provide affordable resources for terminalcare is the result of the marketplace in health care. The medical profession has been painfully slow inresponding to the challenges of terminal care, mainlybecause of the pressures of the marketplace and lackof adequate training. This has occurred at a time ofrapid advances in life-sustaining treatment and ofexpanding public awareness of personal rights underthe law. Overly aggressive treatment in the finalstages of terminal illness has enhanced anxieties overa painfully prolonged and expensive dying. Thesefactors have promoted the movement to assistedsuicide. In the U.S. debate of the issues, ethiciststend to argue abstractly without examiningadequately the context of terminal care that is thehealth care system. It is a system in dire need of areform that will remove it from the marketplace. (shrink)

It is often said that because physicians and other healthcare professionals frequently play a critical role in determining the fate of their patients, they ought if at all possible to be their patient's friend. The relationship of necessity is intimate: physicians have knowledge of their patients' histories and of their bodies which under other circumstances would be reserved to the most intimate of friends, and physicians and patients meet under more or less critical situations. In this paper, (...) I briefly examine the role of the physician as “friend,” an Issue to be much more extensively explored In a book In preparation. (shrink)

Peter Pereira is a family physician and a poet. I weave excerpts from Dr. Pereira's poems into a brief history of medicine's mythological and historical roots, beginning with the Egyptian god Thoth, and the Greek physician Hippocrates. Along the way, I touch on the European Middle Ages and the Islamic World. Finally, I quote poet-critic T.S. Eliot, who was an early influence on Dr. Pereira's decision to become a poet, and contemporary physician-poets Rafael Campo and William Carlos Williams. I end (...) by placing Dr. Pereira, whose practice is oriented toward immigrant families, in his indigenous Pacific Northwest, arguing that being both physician and poet helps Pereira to live in a world that is both intimately human and naturally impersonal. (shrink)

As a bioethical and social issue, euthanasia has become in the 1990s what abor- tion was in the 1960s. Around the world, a de facto taboo on open discussion of the practice is seemingly falling by the wayside, as recognition increases that “active” euthanasia is taking place in spite of social and legal prohibitions. Euthanasia, or more specifically physician-assisted suicide, has become the most visible bioethical issue of the present era; and in the United States the debate has taken on (...) a prominence and urgency unprecedented in our nation's history. (shrink)

When physicians today appeal to “conscience,” it has been alleged such exercises pejoratively reflect “conscience without consequence” as contemporary practitioners are said to be insulated from the consequences of such decisions. It has also been implied these physicians avoid traditional professional responsibilities—including providing charity care and making house or night calls. The assertions demand clarification. Fundamentally, what traits constitute an integrated professionalism specific to Christian physicians? Historical evidence verifies sanctity-of-life affirmations by Christian physicians throughout Church history. (...) However, surveying Christian medical practices in the initial centuries of the Common Era, and more recently in the United States, supports integration of conscience with philanthropy and a rigorous definition of a medical vocation. These suggest there may be deterioration in a holistic commitment to medicine in the United States. Reclaiming an integrated professional paradigm—wherein conscience, philanthropia, and vocation are combined—is essential to an authentic contemporary witness. (shrink)

Medical ethics changed dramatically in the past 30 years because physicians and humanists actively engaged each other in discussions that sometimes led to confrontation and controversy, but usually have improved the quality of medical decision-making. Before then medical ethics had been isolated for almost two centuries from the larger philosophical, social, and religious controversies of the time. There was, however, an earlier period where leaders in medicine and in the humanities worked closely together and both fields were richer for (...) it. This volume begins with the 18th century Scottish Enlightenment when professors of medicine such as John Gregory, Edward Percival, and the American, Benjamin Rush, were close friends of philosophers like David Hume, Adam Smith, and Thomas Reid. They continually exchanged views on matters of ethics with each other in print, at meetings of elite intellectual groups, and at the dinner table. Then something happened, physicians and humanists quit talking with each other. In searching for the causes of the collapse, this book identifies shifts in the social class of physicians, developments in medical science, and changes in the patterns of medical education. Only in the past three decades has the dialogue resumed as physicians turned to humanists for help just when humanists wanted their work to be relevant to real-life social problems. Again, the book asks why, finding answers in the shift from acute to chronic disease as the dominant pattern of illness, the social rights revolution of the 1960's, and the increasing dissonance between physician ethics and ethics outside medicine. The book tells the critical story of how the breakdown in communication between physicians and humanists occurred and how it was repaired when new developments in medicine together with a social revolution forced the leaders of these two fields to resume their dialogue. (shrink)

This is a multi-disciplinary exploration of the history of understanding of the human mind or soul and its relationship to the body, through the course of more than two thousand years. Thirteen specially commissioned chapters, each written by a recognized expert, discuss such figures as the doctors Hippocrates and Galen, the theologians St Paul, Augustine, and Aquinas, and philosophers from Plato to Leibniz.

Psyche and Soma is a multi-disciplinary exploration of the conceptions of the human soul or mind and body, through the course of more than two thousand years of Western history. Thirteen specially commissioned chapters, each written by a recogized expert, discuss figures such as the physicians Hippocrates, Galen, Stahl, and Cabanis; theologians St Paul, Augustine, and Aquinas; and philosophers from Plato and Aristotle to Descartes, Leibniz, and La Mettrie. The chapters explore in chronlogical sequence the views of these writers (...) on such questions as the soul's immortality, the control it exerts over the body, how mental disturbances arise out of bodily imbalances, and the roles of the priest and the physician in promoting spiritual and mental health. Psyche and Soma will be a key point of reference and a rich source of illumination in this central area of human inquiry. (shrink)

Psyche and Soma is a multi-disciplinary exploration of the history of understanding of the human mind or soul and its relationship to the body, through the course of more than two thousand years. Thirteen specially commissioned chapters, each written by a recognized expert, discuss such figures as the doctors Hippocrates and Galen, the theologians St Paul, Augustine, and Aquinas, and philosophers from Plato to Leibniz.

Even with the passage of time, the misguided motivations of highly educated, physician-participants in the genocide known as the Holocaust remain inexplicable and opaque. Typically, the physician-patient relationship inherent within the practice of medicine, has been rooted in the partnership between individuals. However, under the Third Reich, this covenant between a physician and patient was displaced by a public health agenda that was grounded in the scientific theory of eugenics and which served the needs of a polarized political system that (...) relied on this hypothesis to justify society’s racial hygiene laws. As part of the National Socialist propaganda, Adolf Hitler ominously argued that the cultural decline of Germany after World War I could largely be based on interbreeding and a “resultant drop in the racial level.” This foundational premise defined those who could be ostracized, labeled and persecuted by society, including those who were assimilated. The indoctrination and implementation of this distorted social policy required the early and sustained cooperation and leadership of the medical profession. Because National Socialism promised it could restore Germany’s power, honor and dignity, physicians embraced their special role in the repair of the state. This article will explore the imperative role, moral risks and deliberate actions of physicians who participated in the amplification process from “euthanasia” to systemic murder to medically-sanctioned genocide. A goal of this analysis will be to explore what perils today’s physicians would face if they were to experience the transitional and collective behaviors of a corrupted medical profession, or if they would, instead, have the fortitude and courage necessary to protect themselves against this collaboration. Our premise is that an awareness of history can serve as a safeguard to the conceit of political ascendency and discrimination. (shrink)

The Care of the Self is the third and possibly final volume of Michel Foucault’s widely acclaimed examination of "the experience of sexuality in Western society." Foucault takes us into the first two centuries of our own era, into the Golden Age of Rome, to reveal a subtle but decisive break from the classical Greek vision of sexual pleasure. He skillfully explores the whole corpus of moral reflection among philosophers and physicians of the era, and uncovers an increasing mistrust (...) of pleasure and growing anxiety over sexual activity and its consequences. (shrink)

A physician says, "I have an ethical obligation never to cause the death of a patient," another responds, "My ethical obligation is to relieve pain even if the patient dies." The current argument over the role of physicians in assisting patients to die constantly refers to the ethical duties of the profession. References to the Hippocratic Oath are often heard. Many modern problems, from assisted suicide to accessible health care, raise questions about the traditional ethics of medicine and the (...) medical profession. However, few know what the traditional ethics are and how they came into being. This book provides a brief tour of the complex story of medical ethics evolved over centuries in both Western and Eastern culture. It sets this story in the social and cultural contexts in which the work of healing was practiced and suggests that, behind the many different perceptions about the ethical duties of physicians, certain themes appear constantly, and may be relevant to modern debates. The book begins with the Hippocratic medicine of ancient Greece, moves through the Middle Ages, Renaissance and Enlightenment in Europe, and the long history of Indian and Chinese medicine, ending as the problems raised modern medical science and technology challenge the settled ethics of the long tradition. (shrink)

The first history of American medical ethics published in more than a half century, Before Bioethics tracks the evolution of American medical ethics from colonial midwives and physicians' oaths to current bioethical controversies over abortion, AIDS, animal rights, and physician-assisted suicide.

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Philosophy 39.1 (2001) 142-143 [Access article in PDF] Wright, John P. and Paul Potter, editors. Psyche and Soma: Physicians and Metaphysicians on the Mind-Body Problem from Antiquity to Enlightenment. New York: Oxford University Press, 2000. Pp. xii + 298. Cloth, $72.00. The mind-body problem has a long history that begins well before Descartes made it extreme by presenting mind as unextended active thinking (...) and matter as unthinking passive extension. This absolute division was motivated in some part by the desire to present the soul as an entity that can survive the death of the body. This is difficult to maintain if the soul is merely the form or the vital force motivating a human body. But the advance of physiology has led more and more to the conclusion that the functions often attributed to the soul are actually carried out by the brain. Thinking may be as natural (and perhaps as determined) a function of the body as is digestion. And if digestion does not survive the death of the body, maybe thinking does not either.This collection of studies provides a detailed introduction to both medical and metaphysical views and theories concerning the relation of mind to body. In particular, the first article by Beate Gundert on Hippocratic Medicine sets the stage by showing that "mind and body in the Hippocratic writings, while distinguished empirically by being related to different types of phenomena, are both ultimately accounted for by the same explanatory model: Human nature (physis), which embraces the totality of bodily structures, physiological processes, and psychic events" (35). T. M. Robinson shows that Plato admits of no solution as to how mind and body interact, and Philip J. van der Eijk argues that "to detach the essence of man completely from his physical make-up would run counter to Aristotle's biological approach to man as a natural living being, the ultimate implication of his view on the divinity of nous is that the fullest realization of what it is to be a human being is to go beyond the limits of corporeality and mortality, and to become, if only temporarily, a god" (77). Heinrich von Staden covers Epicurus, Herophilus, Erasistratus, the Stoics, and Galen, concluding that "The discovery of the nerves entailed the first significant erosion of the vast territory ruled by the soul in Platonic and Aristotelian philosophy, an erosion accompanied by an expansion of the rule of 'nature,' visible not only in medicine, but also in philosophy" (116). Theo K. Heckel discusses Saint Paul's insistence upon the whole person, and Gareth Matthews shows that, prior to Descartes, Augustine presents "a radically new argument for mind-body dualism... an internalist argument... that proceeds from what, allegedly, the mind can know concerning itself to the conclusion that the mind is incorporeal" (145). Emily Michael discusses Pomponazzi's view that we know the immortality of the soul only by faith and the scholastic attempts to show that the soul is a substantial form. Guillaume Lamy, for example, criticized Descartes for having a soul only of thinking, whereas the soul must be of life. Steven Voss shows how at the end of his life, Descartes did discuss in detail how thinking affects the body, particularly in the management of health and the curing of disease. But Descartes does not solve the problem of how this interaction takes place. Thomas Lennon discusses the views of Bayle on Leibniz's monadic forces and Locke's fideism. And Francois Duchesneu continues the discussion of Stahl and Leibniz, to [End Page 142] conclude that "Leibniz attempts to discover the formal foundation of the organism, which he locates in the capacity of perception-appetition proper to the dominant monad" (235).John P. Wright gives an exposition of a very important distinction between Cartesian dualism and the functional dualism that came to dominate medical thought, that is, the question of how the brain and vital organs interact. Roselyn Rey carries this discussion on to the development of theories... (shrink)

The American Medical Association enacted its Code of Ethics in 1847, the first such national codification. In this volume, a distinguished group of experts from the fields of medicine, bioethics, and history of medicine reflect on the development of medical ethics in the United States, using historical analyses as a springboard for discussions of the problems of the present, including what the editors call "a sense of moral crisis precipitated by the shift from a system of fee-for-service medicine to a (...) system of fee-for-system medicine, better known as 'managed care.'" The authors begin with a look at how the medical profession began to consider ethical issues in the 1800s and subsequent developments in the 1900s. They then address the sociological, historical, ethical, and legal aspects of the practice of medicine. Later chapters discuss current and future challenges to medical ethics and professional values. Appendixes display various versions of the AMA's Code of Ethics as it has evolved over time. Contributors: George J. Annas, J.D., M.P.H., Arthur Isak Applbaum, Ph.D., Robert B. Baker, Ph.D., Chester R. Burns, M.D., Ph.D., Arthur L. Caplan, Ph.D., Alexander Morgan Capron, J.D., Christine K. Cassel, M.D., Linda L. Emanuel, M.D., Ph.D., Eliot L. Freidson, Ph.D., Albert R. Jonsen, Ph.D., Stephen R. Latham, J.D., Ph.D., Susan E. Lederer, Ph.D., Florencia Luna, Ph.D., Edmund D. Pellegrino, M.D., Charles E. Rosenberg, Ph.D., Mark Siegler, M.D., Rosemary A. Stevens, Ph.D., Robert M. Tenery, Jr., M.D., Robert M. Veatch, Ph.D., John Harley Warner, Ph.D., Paul Root Wolpe, Ph.D. (shrink)

This paper argues that our modern concept of biological heredity was first clearly introduced in a theoretical and practical setting by the generation of French physicians that were active between 1810 and 1830. It describes how from a traditional focus on hereditary transmission of disease, influential French medical men like Esquirol, Fodéré, Piorry, Lévy, moved towards considering heredity a central concept for the conception of the human bodily frame, and its set of physical and moral dispositions. The notion of (...) heredity as a natural force, with a wide ranging capabilities of transmitting differentially both fundamental and accidental characters was generalized by that generation of physicians with the help of contemporary naturalists and physiologists. By 1830 the term hérédité was widespread, and it shared the explanatory and semantic qualities of traditional medical concepts like constitution and temperament. An analysis is given of the main developments that led to the conception of biological (including human) bodies as consisting of a layered, hierarchical organization of characters, differentially affected by the laws of conservation (Heredity) and change (Inneity, Variation). The mid-century work of the French physician Prosper Lucas, Traité Philosophique et Physiologique de L'Hérédité Naturelle, is shown to be the culmination of the efforts of several generations of French physicians towards having a feasible, complexly structured notion of how heredity works. (shrink)

During the mid-twentieth century, Soviet scientists developed the “natural focus” theory–practice framework to explain outbreaks of diseases endemic to wild animals and transmitted to humans. Focusing on parasitologist-physician Evgeny N. Pavlovsky and other field scientists’ work in the Soviet borderlands, this article explores how the natural focus framework’s concepts and practices were entangled in political as well as material ecologies of knowledge and practice. We argue that the very definition of endemic plague incorporated both hands-on materialist experience and ideological concepts (...) that supported Soviet colonization. Theorizing and fighting plague assisted with the goals of controlling and improving landscapes and peoples in southern Russia and Central Asia. The history of the natural focus framework illustrates how Soviet disease ecology co-developed with the needs of local and central political powers in the Soviet borderlands. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hume Studies Volume 29, Number 1, April 2003, pp. 125-141 Dr. George Cheyne, Chevalier Ramsay, and Hume's Letter to a Physician JOHN P. WRIGHT The publication of a new intellectual biography of George Cheyne1 provides a "propitious" occasion for "a thoroughly skeptical review"2 of the question which has long exercised Hume scholars, whether Cheyne was the intended recipient of David Hume's fascinating pie-Treatise Letter to a Physician,3 the letter (...) which describes his own hypochondriacal physical and mental symptoms and gives an account of his early philosophical development.4 Hume's nineteenth-century biographer, John Hill Burton, argued that Hume was probably writing to Cheyne,5 while Ernest Mossner claimed to definitively refute that hypothesis in an article entitled "Hume's Epistle to Dr. Arbuthnot," published in 1944.6 Anita Guerrini's intellectual biography does not discuss Cheyne as a possible recipient of Hume's letter, but she does present a well-rounded picture of this interesting eighteenth-century physician from which we can judge his appropriateness as its addressee. In the following discussion I will make use of the biographical material found in this new biography of Cheyne, as well as other sources, to show that Mossner's arguments are less than definitive, and that it would be wrong to dismiss the possibility that the letter was sent to George Cheyne.7 This is a possibility that, for reasons that I will make clear, makes good biographical and philosophical sense. At the same time, it is important to keep a proper suspense of judgment as Burton did, for the evidence that the letter was either intended for or actually sent to Cheyne is not definitive. John P. Wright is Professor of Philosophy, Central Michigan University, Mt. Pleasant, MI 48859, USA. e-mail: [email protected] 126 John P. Wright Burton, who first published the autobiographical letter of the 22-yearold Hume in 1846, narrowed down the possible addressees of Hume's letter to either Cheyne or John Arbuthnot. He also pointed out that it is possible that the letter was never sent, and that the ten and a half page manuscript is only a neatly written draft, rather than a fair copy of an actual letter. Nevertheless, Burton thought he could identify the unnamed addressee on the basis of the internal evidence of the manuscript and the records of Scottish physicians practicing in England at the time. In the letter, Hume refers to the intended recipient as his "Countryman, a Scotchman [,]... a skilful Physician, a man of Letters, of Wit, of Good Sense, & of great Humanity."8 Further he writes that he is consulting him because he is a person "of great Learning beyond [his]... own Profession" who is acquainted with the "Motions of the Mind" he has described in his letter, and that "Fame pointed [him]... out as the properest person to resolve my Doubts..." about the cure of his disorder.9 Burton tells us that "the first name that suggested itself... was Arbuthnot, whose fine genius was just then flickering in the socket."10 (John Arbuthnot had been ill for some time, and died a year later.) But he then added that "a more full consideration showed to my satisfaction that it must have been destined for Dr. George Cheyne." His main reason for settling on Cheyne was that Cheyne's immensely popular The English Malady (1733) had recently been published, and that "there is a certain unison of tone between Hume's letter and this book." Burton quotes a portion of Cheyne's own long autobiographical account of his own disease in The English Malady. Cheyne's autobiography begins with the claim that "I passed my Youth in close study, and almost constant Application to the abstracted Sciences, (wherein my chief pleasure consisted) and consequently in great Temperance and a Sedentary Life"; it is followed by the reflection that any overindulgence in food or drink led to physical and psychological problems.11 He goes on to describe these in great detail for 39 pages, along with a history of his life. Burton also quotes a section of the book in which Cheyne describes how a studious and sedentary life causes the symptoms... (shrink)

Experts in medical informatics have argued for the incorporation of ever more machine-learning algorithms into medical care. As artificial intelligence research advances, such technologies raise the possibility of an “iDoctor,” a machine theoretically capable of replacing the judgment of primary care physicians. In this article, I draw on Martin Heidegger’s critique of technology to show how an algorithmic approach to medicine distorts the physician–patient relationship. Among other problems, AI cannot adapt guidelines according to the individual patient’s needs. In response (...) to the objection that AI could develop this capacity, I use Hubert Dreyfus’s analysis of AI to argue that attention to the needs of each patient requires the physician to attune his or her perception to the patient’s history and physical exam, an ability that seems uniquely human. Human physician judgment will remain better suited to the practice of primary care despite anticipated advances in AI technology. (shrink)

One of the best-known principles of halakha is that Shabbat is violated to save a life. Who does this saving and how do we know that a life is in danger? What categories of illness violate Shabbat and who decides? A historical-sociological analysis of the roles played by Jew, non-Jew, and physician according to the approach of “medical cosmology” can help us understand the differences in the approach of the Shulchan Aruch compared to later decisors (e.g., the Mishnah Berurah). Such (...) differences illuminate how premodern medical triage coexisted with a different halakhic understanding than that of the biomedical age. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Moral Responsibility in a Context of Scarcity:the Journey of a Haitian PhysicianPaul PierreAlmost all Haitian physicians have been involved in some sort of "social movement" at one point in their professional life. In a country characterized by a natural inclination to question authority, fighting the status quo of the ineffective, corrupt and disorganized [End Page 89] Haitian health system often appears to be the right thing to do.In (...) 2002, I played an active role in a large protest movement for better working conditions at the largest health facility in Port-au-Prince: the General Hospital (GH). Port-au-Prince is the capital and economic center of Haiti. It is home to close to a third of Haiti's ten million people. At that time, the situation at the GH facility was dire. All of the 400 beds at the GH were dirty. The staff was underpaid and unhappy. Drug and medical supply stock-outs were routine. Medical equipment was rarely maintained and only one of the six operating theatres in the surgery block was working. Unsupervised physicians in training (like me) were the main health care providers. Attending physicians were busy running their own private clinics, and most of them would come to the hospital solely to "recruit" the less poor patients for their clinics. As physicians-in-training, we had the responsibility of caring for the poor, but we had no means. We grew frustrated and angry witnessing our powerless patients losing legs, arms and their lives for lack of care. On many occasions, I had the parents of my patients buy the gloves that I would use to examine their sick relatives. I've seen patients fighting for the inheritance of medications left by others who had just passed away. There was no way for this hospital to fulfill its mission, and no way for its staff to deliver anything other than mediocre care. We could not accept that situation at such an early stage in our medical development, and so we refused to continue to work. We went on a strike, which completely paralyzed the delivery of care at the hospital for nearly two months. After intense negotiation, the strike ended with a signed agreement with the Minister of Health that addressed, more or less, the reasons of our movement. However, the implementation of the agreement was permanently delayed by other competing "state emergencies" including a general insurrection.At the time of our movement, I thought we were making history. After witnessing 11 "social movements" that similarly paralyzed the GH in the following decade for reasons identical to ours, I am now convinced that we were not. We were temporary actors performing in the cynical play of scarcity on permanent display in Port-au-Prince. The social movement that we started ended up hurting the very same people that we were trying to help.Extending access to heath care to poor people seemed to me at that time to be too complicated and too expensive for an unorganized state like Haiti. I realized that local protests could, at best, influence the allocation of local resources. But so-called local resources are so limited in "resource-limited" countries. Haiti spends only $40 U.S. dollars per capita for health care. This is not enough for good care. The options we were provided were not real ones—since all of them would end in more suffering. The case of providing health care to poor people needed to be approached differently.I was born in Port-au-Prince at the same general hospital in which I would later work. I am the third of four children, and the first male child in my family. My father made me understand very clearly that my first responsibility was for my siblings. My sisters made me understand equally clearly that I had no authority over any of them. I ended up with a lot of responsibility but with very little authority. The few of us who completed school, entered university, studied abroad and "emerged" were considered, to some extent, responsible for the others—the ones who couldn't go to school, university, or abroad, the ones who had "sunk... (shrink)