Health professionals communicate with each other about medication information using different forms of documentation. This article explores knowledge and power relations surrounding medication information exchanged through documentation among nurses, doctors and pharmacists. Ethnographic fieldwork was conducted in 2010 in two medical wards of a metropolitan hospital in Australia. Data collection methods included participant observations, field interviews, video‐recordings, document retrieval and video reflexive focus groups. A critical discourse analytic framework was used to guide data analysis. The written medication (...) chart was the main means of communicating medication decisions from doctors to nurses as compared to verbal communication. Nurses positioned themselves as auditors of the medication chart and scrutinised medical prescribing to maintain the discourse of patient safety. Pharmacists utilised the discourse of scientific judgement to guide their decision‐making on the necessity of verbal communication with nurses and doctors. Targeted interdisciplinary meetings involving nurses, doctors and pharmacists should be organised in ward settings to discuss the importance of having documented medication information conveyed verbally across different disciplines. Health professionals should be encouraged to proactively seek out each other to relay changes in medication regimens and treatment goals. (shrink)

Access to clear and concise medication information is essential to support safe and effective use of prescription drugs. Patient misunderstanding of medication information is a common reason for non-adherence to medication regimens and a leading cause of outpatient medication errors and adverse drug events in the U.S. Medication errors are the most common source of risk to patient safety, leading to poor health outcomes, hospitalizations, and deaths. Over half a million adverse drug events occur in (...) the outpatient setting each year at a cost of approximately $1 billion annually.Nearly half of adults in the U.S. experience difficulty understanding and acting upon health information. Even individuals with high levels of general literacy may find medication information difficult to understand or use. The risk of misunderstanding medication information is compounded for patients with limited English proficiency who may not have access to this information in their own language. (shrink)

The COVID-19 pandemic has resulted in more than 524 million cases and 6 million deaths worldwide. Various drug interventions targeting multiple stages of COVID-19 pathogenesis can significantly reduce infection-related mortality. The current within-host mathematical modeling study addresses the optimal drug regimen and efficacy of combination therapies in the treatment of COVID-19. The drugs/interventions considered include Arbidol, Remdesivir, Interferon and Lopinavir/ritonavir. It is concluded that these drugs, when administered singly or in combination, reduce the number of infected cells and viral (...) load. Four scenarios dealing with the administration of a single drug, two drugs, three drugs and all four are discussed. In all these scenarios, the optimal drug regimen is proposed based on two methods. In the first method, these medical interventions are modeled as control interventions and a corresponding objective function and optimal control problem are formulated. In this framework, the optimal drug regimen is derived. Later, using the comparative effectiveness method, the optimal drug regimen is derived based on the basic reproduction number and viral load. The average number of infected cells and viral load decreased the most when all four drugs were used together. On the other hand, the average number of susceptible cells decreased the most when Arbidol was administered alone. The basic reproduction number and viral load decreased the most when all four interventions were used together, confirming the previously obtained finding of the optimal control problem. The results of this study can help physicians make decisions about the treatment of the life-threatening COVID-19 infection. (shrink)

As a study involving diabetes care demonstrates, children sometimes have a much more sophisticated capacity for taking charge of their own health care decisions than is usually recognized in bioethics. Protecting these children from their disease means involving them in their treatment as much as possible, helping them to understand it and take responsibility for it so that they can navigate the multitude of daily decisions that become part of the diabetes medical regimen.

Michel Senellart Cet article propose une réponse à la critique adressée par G. Agamben, dans Le Règne et la Gloire (2008), à la généalogie foucaldienne de la gouvernementalité. En cherchant dans la pensée chrétienne des premiers siècles la matrice d’une conception nouvelle du pouvoir comme gouvernement des hommes — « économie » ou conduite des âmes —, Foucault aurait méconnu la signification proprement théologique, au sein du dispositif trinitaire, du mot oikonomia. Nous voudrions montrer, à partir d’une relecture du 2e (...) Discours (362) de Grégoire de Nazianze (329-390), dont Foucault tire le concept d’une « économie des âmes », que cette idée ne présuppose nullement la référence au schéma trinitaire et renvoie bien davantage au modèle du « patronage » romain, couplé à la figure sacerdotale du bon berger. Cette analyse conduira, en outre, à rappeler le lien de la « direction des âmes » avec le paradigme médical. (shrink)

The discovery of dietetics -- Philosophy of the nature of man -- Therapy of body and soul -- The philosophical legacy of On regimen.

Hynek Bartos does the field of ancient philosophy a great service by detailing the influence of early Greek thinkers (such as Heraclitus, Empedocles, Anaxagoras, Democritus, and Diogenes of Apollonia) on the Hippocratic work On Regimen, and by demonstrating that work’s innovative engagement with contemporary scientific and philosophical concepts as well as its direct influence on Plato and Aristotle. His study usefully counteracts the lamentable tendency among ancient philosophers to ignore or downplay the influence of medical literature on philosophy in (...) general, and to heap scorn on this text in particular, which Kirk, Raven, and Schofield considered ‘an eclectic and very superficial quasi- philosophical treatise’ and Barnes famously called ‘a silly farrago of ill-digested Presocratic opinions’. (shrink)

Increasing ethical attention and debate is focusing on whether individuals who take part in clinical trials should be given access to post-trial care. However, the main focus of this debate has been upon drug trials undertaken in low-income settings. To broaden this debate, we report findings from interviews with individuals (n = 24) who participated in a clinical trial of a closed-loop system, which is a medical device under development for people with type 1 diabetes that automatically adjusts blood glucose (...) to help keep it within clinically recommended ranges. Individuals were recruited from UK sites and interviewed following trial close-out, at which point the closed-loop had been withdrawn. While individuals were stoical and accepting of the requirement to return the closed-loop, they also conveyed varying degrees of distress. Many described having relaxed diabetes management practices while using the closed-loop and having become deskilled as a consequence, which made reverting back to pre-trial regimens challenging. Participants also described unanticipated consequences arising from using a closed-loop. As well as deskilling, these included experiencing psychological and emotional benefits that could not be sustained after the closed-loop had been withdrawn and participants reevaluating their pre- and post-trial life in light of having used a closed-loop and now perceiving this life much more negatively. Participants also voiced frustrations about experiencing better blood glucose control using a closed-loop and then having to revert to using what they now saw as antiquated and imprecise self-management tools. We use these findings to argue that ethical debates about post-trial provisioning need to be broadened to consider potential psychological and emotional harms, and not just clinical harms, that may result from withdrawal of investigated treatments. We also suggest that individuals may benefit from information about potential nonclinical harms to help make informed decisions about trial participation. (shrink)

The paper provides an innovative interpretation of the treatise De Victu, showing that, though Heraclitean, Anaxagorean and Empedoclean borrowings in the work are certainly pervasive, the author also develops a sophisticated and multi-purpose explanatory framework, which, being based on an original conception of the nature of man, the cosmos and the relationship between the two, provides an effective foundation for the medical enterprise, allowing him to propose his dietetics as a ‘way of life’. At the core of this enterprise is (...) the relationship between microcosm and macrocosm: in virtue of this relationship, I submit, the cosmos becomes both an active factor to be taken into account for the maintenance of individual physical well-being and the normative standard to which a dietician and whoever cares about health must refer in order to live the healthiest possible life. (shrink)

This study analyzes the dissemination and readership of two medieval medical works in Catalan. Combining the use of diverse sources such as the manuscripts themselves, post-mortem inventories, and the prologues written by the translators, the study shows how the diffusion of these works exemplifies the two main audiences to which vernacular texts were addressed. These were, on the one hand, literate but not Latinate surgeons and other practitioners interested in the new medicine emanating from the emerging universities; and on the (...) other, nobles and burghers interested in issues of health and disease and in natural philosophy in general. The framework for the study is the general process of consolidation of the new medical system which developed in late medieval Latin Europe. (shrink)

Kwaku Marfo, Danielle Garcia, Saira Khalique, Karen Berger, Amy LuMontefiore Medical Center, Bronx, NY, USABackground: Medication errors are a prime concern for all in healthcare. As such the use of information technologies in drug prescribing and administration has received considerable attention in recent years, with the hope of improving patient safety. Because of the complexity of drug regimens in renal transplant patients, occurrence of medication errors is inevitable even with a well adopted computerized physician order entering system. Our (...) objective was to quantify medication error type and frequency in an inpatient renal transplant unit.Methods: Systemic evaluation of all medication errors during an initial 10-day audit and a 28-day follow-up audit in an inpatient renal transplant unit. Each error was concurrently evaluated for potential to result in adverse patient consequences, error type and associated medication class.Results: A total of 103 clinically significant medication errors were detected during the 10-day and 28-day audit time periods. The most common errors were wrong medication dose ordered and wrong time of drug administration. Thirty-six out of 66 prescribing/ordering errors reached the patient.Conclusions: Even with utilization of computerized physician order entry system in an inpatient renal transplant unit, post-kidney transplant patients are at risk for adverse outcomes due to medication errors. The risk factors may be multifactorial and will require both organizational and technical approaches to resolve.Keywords: medication errors, CPOE, inpatient, renal transplant patients. (shrink)

Biopower is a prominent force in mental health, with psychiatry having a strong influential grasp across the areas of definition of mental disorders, diagnosis, care, treatment, and legislation. One area that impacts upon the everyday lives of community mental health service users is treatment, largely dominated by medication. This paper will explore biopower in relation to the practices and management of mental health service users’ medication regimens. Michel Foucault’s insistence in his later work that power is the product (...) of bodily forces will be drawn upon in highlighting the importance of undertaking analysis of medication regimens. Taking examples from a project focused on service user experience, the concept of ‘somatic enactment’ is suggested as a means through which to open up biopower to the localised concerns of service users with regard to the issue of managing one’s body on a day to day basis, as affected by medication. In doing so, the author seeks to move towards a notion of biopower that does not only work on a ‘top down’ manner, and in which processes of embodied subjectification can be illuminated, without recourse to a straightforward power-resistance framework. (shrink)

BackgroundNational guidelines require programmes use subjective assessments of social support when determining transplant suitability, despite limited evidence linking it to outcomes. We examined how transplant providers weigh the importance of social support for kidney transplantation compared with other factors, and variation by clinical role and personal beliefs.MethodsThe National survey of the American Society of Transplant Surgeons and the Society of Transplant Social Work in 2016. Using a discrete choice approach, respondents compared two hypothetical patient profiles and selected one for transplantation. (...) Conditional logistic regression estimated the relative importance of each factor; results were stratified by clinical role and beliefs.ResultsFive hundred and eighy-four transplant providers completed the survey. Social support was the second most influential factor among transplant providers. Providers were most likely to choose a candidate who had social support, always adhered to a medical regimen, and had a 15 years life expectancy with transplant. Psychosocial providers were more influenced by adherence and quality of life compared with medical/surgical providers, who were more influenced by candidates' life expectancy with transplant. For providers concerned with avoiding organ waste, social support was the most influential factor, while it was the least influential for clinicians concerned with fairness.ConclusionsSocial support is highly influential in listing decisions and may exacerbate transplant disparities. Providers’ beliefs and reliance on social support in determining suitability vary considerably, raising concerns about transparency and justice. (shrink)

Relationships, jobs, and health behaviors-these are what New Year's resolutions are made of. Every year millions resolve to adopt a better diet, exercise more, become fit, or lose weight but few put into practice the health behaviors they aspire to. For those who successfully begin, the likelihood that they will maintain these habits is low. Healthcare professionals recognize the importance of these, and other, health behaviors but struggle to provide their patients with the tools necessary for successful maintenance of their (...) medical regimens. The thousands of research papers that exist on patient adherence and health behavior change can leave professionals overwhelmed. This book synthesizes the results from more than 50 years of empirical research, resulting in simple, powerful, and practical guidance for health professionals who want to know the most effective strategies for helping their clients to put long-term health-relevant behavior changes into practice. It advocates a straightforward 3-ingredient model: Before a person can change, they must know what change is necessary ; desire the change ; and then have the tools to achieve and maintain the change. This book is designed to be informative and compelling, but its numerous anecdotes and examples render it engaging and entertaining, as well. Written for a practitioners and students of medicine, chiropractic, osteopathy, nursing, health education, physician assistant programs, dentistry, clinical and health psychology, marriage and family counseling, social work, school psychology, and care administrators -- and for lay persons who wish to take an active role in their health, this book brings together major empirically-based findings within the field and provides succinct, evidence-based recommendations and strategies for using these findings to make real changes. (shrink)

The Common Health problems that plague Americans today are often the result of people’s choices and behaviors: obesity, cigarette smoking, accidental pediatric head trauma owing to failure to properly restrain children, and failure to adhere to medication regimens. For each problem, there is a well-studied effective behavioral intervention: a healthy diet and exercise for obesity, smoking cessation programs to overcome cigarette addiction, appropriate car restraints to prevent accidental head trauma, and direct observation of treatment and simplification of medical regimens (...) to improve drug adherence. Traditionally, the physician defined the problem and told the patient what she needed to do. In the modern era of .. (shrink)

Reconstructive allografts using Vascularized Composite Allotransplantation are providing individuals living with upper limb loss and facial disfigurement with new opportunities for a sensate, esthetically acceptable, and functional alternative to current treatment strategies. Important research attention is being paid to how best to assess and screen candidates for VCA, measure optimal patient outcomes, and support patient adherence to lifelong behaviors and medical regimens. Far less attention, however, has been dedicated to the team science required for these complex VCA teams to form, (...) prepare, and provide the highest quality clinical and psychosocial care to those receiving VCA. VCA teams are unique in that they require specialized team members whose scope of practice may not otherwise overlap. The team also needs to constantly negotiate balancing patient safety with multiple risks throughout the transplant process. This study aimed to elucidate the team science needed for this highly innovative and complex area of medicine. Using in-depth qualitative interviews with 14 VCA team members and observations at team meetings, we found that careful consideration of team composition, team structure, and organizational commitment influences team performance and patient outcomes, but that to be efficient and truly effective, teams need to commit to developing processes that foster collaboration. These processes are action-oriented, strategic and interpersonal. Dedication and commitment to team science allows teams to manage conflict under stress and exercise ways to leverage strengths to provide optimal performance or patient psychosocial and clinical outcomes. This study can provide insight into quality improvement efforts for VCA teams and guidance for other transplant programs that wish to consider expansion into VCA. (shrink)

There are broadly five interconnected meanings of the noun ‘discipline’. Disciplinawere instructions to disciples, and hence a branch of instruction or department of knowledge. This religious context provided the modern educational notion of a ‘body of knowledge’, or a discipline such as sociology or economics. We can define discipline as a body of knowledge and knowledge for the body, because the training of the mind has inevitably involved a training of the body. Second, it signified a method of training or (...) instruction in a body of knowledge. Discipline had an important military connection involving drill, practice in the use of weapons. Third, there is an ecclesiastical meaning referring to a system of rules by which order is maintained in a church. It included the use of penal methods to achieve obedience. To discipline is to chastise. Fourth, to discipline is to bring about obedience through various forms of punishment; it is a means of correction. Finally there is a rare use of the term to describe a medical regimen in which ‘doctor's orders’ brings about a discipline of the patient. In contemporary society, there is, following the work of Michel Foucault, the notion of increasing personal regulation resulting in a ‘disciplinary society’ or a society based upon carceral institutions. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:When Is Enough, Enough?Megan HomsyThis was a case that stuck with many members of our transplant team for a long time. The patient was a 44-year-old Caucasian male evaluated for a liver transplant with a diagnosis of hepatitis C virus (HCV), originally diagnosed 11 years before the transplant evaluation. The patient met the criteria for the following substance use diagnoses: alcohol use disorder moderate in sustained remission, in a (...) controlled environment, opioid use disorder, severe, in sustained remission, on maintenance therapy, in a controlled environment, stimulant use disorder, amphetamine-type, severe, in early remission, in a controlled environment and stimulant use disorder, cocaine-type, severe in early remission, in a controlled environment.The patient had been living in a sober living housing program for approximately ten months prior to his transplant evaluation with me, his social worker. He had also been diagnosed with depression and bipolar disorder. He had been intermittently linked with mental health services and had participated in numerous detox and substance abuse programs over the last ten years, with varying degrees of success. He was in dual diagnosis treatment (i.e., treatment for co-occurring substance use and mental health disorders) through his Suboxone clinic and was completing toxicology screenings on a biweekly basis.After concluding the minimum three months of drug and alcohol treatment set forth by the state's Organ Transplantation Consortium, the patient graduated from his sober living program, moved in with his sister, and was listed for a liver transplant.The patient was transplanted five months after his clinic evaluation. At the time of the surgery, the patient's Suboxone was abruptly discontinued and replaced with IV Dilaudid. Within days of his transplant, the patient frequently expressed concerns about his pain. Several medical services attempted to manage the pain medications, resulting in his pain management plan being changed repeatedly and much confusion over his current medication regimen. During his liver transplant hospitalization, the RN found the patient with a needle in his arm, and after a search of the patient's hospital room, the hospital police found drug paraphernalia and illicit substances. The patient was eventually discharged to an inpatient substance abuse program, which he left before completing the program and against medical advice.During his first year post-transplant, I attempted to arrange other various treatment programs for him (most of which he did not follow through with) and to find housing for him (as he had been forced to leave his sister's home after his relapse). Eventually, the patient was incarcerated on drug-related charges. Numerous times, the patient missed completing his labs and his post-transplant appointments. He did not refill his immunosuppressant medications, and for lengthy periods of time, he was unreachable by the transplant care team, which resulted in my team members and I calling the patient's family, other providers, and the police for safety checks.In the aftermath of these issues, my colleagues and I had to reckon with the realization that we had failed the patient. As a team, our transplant center created a task force to review this case and what to do in the future to prevent such breakdowns in patient care. We created protocols for managing patients who, at the time of their transplant, are on Medication Assisted Treatment (MAT) such as Suboxone and methadone. Staff across the multidisciplinary team attended trainings regarding addiction, pain management, and best practices for MAT services. Additionally, our transplant center collaborated with our hospital's addiction treatment program for a streamlined referral process for transplant patients to addiction services.This patient's case and its sensational nature resulted in many conversations, both professional and unprofessional. Members of the social worker department became aware that personnel within transplant, though not involved in patient care, were inappropriately discussing this patient's case and engaging in unprofessional behavior. Said actions led to the termination of a member of the transplant team. I was placed in the unenviable [End Page E3] position of having to report this behavior to hospital management and legal teams to protect a vulnerable patient.The ethical challenge behind this case really stems from the transplant team attempting to balance two... (shrink)

Athenaeus of Attalia distinguishes two types of exercise or training (γυμνασία) that are required at each stage of life: training of the body and training of the soul. He says that training of the body includes activities like physical exercises, eating, drinking, bathing and sleep. Training of the soul, on the other hand, consists of thinking, education, and emotional regulation (in other words, 'philosophy'). The notion of 'training of the soul' and the contrast between 'bodily' and 'psychic' exercise is common (...) in the Academic and Stoic traditions Athenaeus is drawing from; however, he is the earliest extant medical author to distinguish these kinds of training and to treat them as equally important aspects of regimen. In this paper, I propose some reasons why he found this distinction useful, and I examine how he justified incorporating it into his writings on regimen, namely by attributing Plato's beliefs about regimen to Hippocrates, a strategy Galen would adopt well over a century later. (shrink)

Modern medical technology has made it possible for babies to survive with conditions that would have ended their lives only half a century ago. But complex health care interventions and regimens are not enough. These children require support, caregiving, and constant vigilance from their families, especially their parents. Sometimes referred to as children with "special needs," their dependency and vulnerability may stem from genetic disorders, premature births, serious accidents, or illness. This includes conditions such as severe autism spectrum disorder, Down (...) syndrome, hypoxic ischemic encephalopathy, Trisomy 13, Trisomy 18, Fragile X Syndrome, spina bifida, and brain damage... (shrink)

The author reviews various conceptions of autonomy to show that humans are actually not autonomous, strictly speaking. He argues for a need to rethink the personal autonomy approaches to HIV testing in sub-Saharan Africa (SSA) countries. HIV/AIDS has remained a leading cause of disease burden in SSA. It is important to bring this disease burden under control, especially given the availability of current effective antiretroviral regimens in low- and middle-income countries. In most SSA countries the ethic or value of personal (...) autonomy or self-determination is promoted as primary in HIV testing decision-making. SSA policymakers have an ontological and moral duty to adopt HIV testing policies that reflect human and medical realities, relationships, local contexts, and respect human rights for both individuals and others who are affected by HIV in society. Without rethinking the value of autonomy in HIV testing decision-making, the article cautions that attainment of the Sustainable Development Goal (SDG) 3 and the UNAIDS fast-track strategy that explicitly call to end the epidemic by 2030 will not be feasible for SSA. (shrink)

For individuals pursuing medically assisted gender transition, gender-affirming surgical treatments, such as oophorectomy (removal of the ovaries) and orchiectomy (removal of the testicles), cause sterility, and gender-affirming hormone treatment with medications (i.e., testosterone and estrogen) may negatively impact infertility. The major United States (US) medical associations already endorse fertility preservation (FP) through cryopreservation (i.e., “freezing” egg and sperm) for transgender individuals. Despite these endorsements from the relevant medical societies, medical insurance coverage for FP remains very limited in the US. Given (...) the high out-of-pocket costs for FP services, fertility preservation remains financially out of reach for many transgender individuals who may desire it. We present an ethical justification for universal FP coverage for all transgender and gender diverse (TGD) individuals who request this option during medically assisted gender transition. First, we argue that gender-affirming medical care is analogous to other medical interventions and treatment regimens that compromise fertility, such as cancer care, and that both types of interventions need to be afforded the same medical benefits and assistance in pursuing fertility goals. Second, we argue that the lack of FP for transgender individuals contributes to the ongoing and profound transphobia and anti-trans bias that has been exacerbated in the past several years across the healthcare landscape in the United States. We argue that the provision of FP coverage for transgender individuals is necessary for clinicians and third-party payers to state their unequivocal support for TGD patients and their healthcare needs. (shrink)

In this essay, we consider questions arising from cases in which people request medical assistance in dying (MAiD) in unjust social circumstances. We develop our argument by asking two questions. First, can decisions made in the context of unjust social circumstance be meaningfully autonomous? We understand ‘unjust social circumstances’ to be circumstances in which people do not have meaningful access to the range of options to which they are entitled and ‘autonomy’ as self-governance in the service of personally meaningful goals, (...) values and commitments. People in these circumstances would choose otherwise, were conditions more just. We consider and reject arguments that the autonomy of people choosing death in the context of injustice is necessarily reduced, either by restricting their options for self-determination, through their internalisation of oppressive attitudes or by undermining their hope to the point that they despair.Second, should MAiD be available to people in such circumstances, even when a sound argument can be made that the agents in question are autonomous? In response, we use a harm reduction approach, arguing that even though such decisions are tragic, MAiD should be available. Our argument engages with relational theories of autonomy as well as recent criticism raised against them and is intended to be general in application, although it emerges in response to the Canadian legal regimen around MAiD, with a focus on recent changes in Canada’s eligibility criteria to qualify for MAiD. (shrink)

This paper explores Jean‐Luc Nancy's philosophical reflection on surviving his own heart transplant. In ‘The Intruder’, he raises central questions concerning the relations between what he refers to as a ‘proper’ life, that is, a life that is thought to be one's own singular ‘lived experience’, and medical techniques, shaped at this particular historical juncture by cyclosporine or immuno‐suppresssion. He describes the temporal nature of an ever‐increasing sense of strangeness and fragmentation which accompanies his heart transplant. In doing so, Nancy (...) opens up the concealed of transplantation in terms of the problematic ‘gift’ of a ‘foreign’ organ, the unremitting suffering intrusiveness of the treatment regimen, and the living of life as ‘bare life’. He uncovers and exposes the relentless uncanniness that pervades the post‐transplant experience, which for him is an example of our humanistic, never‐ending impulse, to alter ourselves. Nevertheless, Nancy offers no answer to this dilemma, but instead calls us to think about the meaning or ‘sense’ of the prolonging of life and deferring of death, which currently drives our medical interventions. (shrink)

Mr. F. is a fifty‐year‐old father of two school‐aged daughters. Six years ago, he received a double lung transplant because he was suffering from interstitial lung disease, a fatal illness that causes suffocation by progressive scarring of the lungs. He is now experiencing chronic rejection of the transplant and is being considered to receive another. Without it, he is expected to survive only a year and a half. With it, his prognosis will improve, but the numbers are still not good. (...) Three years after his lung transplant, Mr. F. stopped attending his office visits. For a period of sixteen months he went without the studies and attention essential to posttransplant care. He stopped performing the required daily self‐monitoring of his lung function about eight months after his transplant, but he has maintained a regular exercise regimen. While lost to follow‐up, he continued to take his immunosuppressant medications, but he stopped taking medicine to control his high blood pressure because of its expense. (shrink)

Moshe ben Maimon, or Moses Maimonides, remains one of the most celebrated rabbis in this history of Judaism; his numerous writings include philosophical and medical treatises in Arabic, two of history's most important works on Jewish law, and, most notably, efforts to reconcile Aristotelian philosophy with biblical teaching. The _Complete Medical Works_, edited by Gerrit Bos of the Martin-Buber-Institut fur Judaistik at the University of Cologne, collects the entirety of Maimonides's medical writings. Notwithstanding its title, _On Asthma_ is in fact (...) a complete regimen of health, designed for the needs of a high-ranking patient whose identity is not stated. In true Galenic fashion, Maimonides stresses that a healthy lifestyle and diet are the most important preventative measures against chronic illness such as asthma. Good and bad foods are described in detail, and many recipes for beneficial dishes and drugs are included, with Maimonides adapting Galenic regimens to the needs of his Muslim patient. (shrink)

It seems uncontroversial that Buddhism is therapeutic in intent. The word ‘therapy’ is often used, however, to denote methods of treating medically defined mental illnesses, while in the Buddhist context it refers to the treatment of deep-seated dissatisfaction and confusion that, it is claimed, afflict us all. The Buddha is likened to a doctor who offers a medicine to cure the spiritual ills of the suffering world. In the Pāli scriptures, one of the epithets of the Buddha is ‘the Great (...) Physician’ and the therapeutic regimen or healing treatment is his teaching, theDhamma. This metaphor is continued in later literature, most famously in theSaddharmapuṇḍarīka Sūtra, where the Buddha is said to be like a benevolent doctor who attempts to administer appropriate medicine to his sons. In the Mahāyāna pantheon, one of the most popular of the celestial Buddhas is Bhaiṣajyaguru, the master of healing, who is believed to offer cures for both the spiritual and more mundane ailments of sentient beings. The four truths, possibly the most pervasive of all Buddhist teachings, are expressed in the form of a medical diagnosis. The first truth, that there is suffering (dukkha), is the diagnosis of the disease. The second truth, that suffering arises from a cause (or causes), seeks to identify the root source of the disease. The third truth, that suffering can be ended, is a prognosis that the disease is curable. The fourth truth describes the path to end suffering, and is the prescription of treatment. (shrink)

The COVID-19 pandemic crisis has necessitated widespread adaptation of revised treatment regimens for both urgent and routine medical problems in patients with and without COVID-19. Some of these alternative treatments maybe second-best. Treatments that are known to be superior might not be appropriate to deliver during a pandemic when consideration must be given to distributive justice and protection of patients and their medical teams as well the importance given to individual benefit and autonomy. What is required of the doctor discussing (...) these alternative, potentially inferior treatments and seeking consent to proceed? Should doctors share information about unavailable but standard treatment alternatives when seeking consent? There are arguments in defence of non-disclosure; information about unavailable treatments may not aid a patient to weigh up options that are available to them. There might be justified concern about distress for patients who are informed that they are receiving second-best therapies. However, we argue that doctors should tailor information according to the needs of the individual patient. For most patients that will include a nuanced discussion about treatments that would be considered in other times but currently unavailable. That will sometimes be a difficult conversation, and require clinicians to be frank about limited resources and necessary rationing. However, transparency and honesty will usually be the best policy. (shrink)

Scientific authority and physician authority are both challenged by Thomas Kuhn's concept of incommensurability. If competing “paradigms” or “world views” cannot rationally be compared, we have no means to judge the truth of any particular view. However, the notion of local or partial incommensurability might provide a framework for understanding the implications of contemporary philosophy of science for medicine. We distinguish four steps in the process of translating medical science into clinical decisions: the doing of the science, the appropriation of (...) the scientific findings by the clinician, the transfer of the findings from the clinician to the patient, and the choice of a treatment regimen. Incommensurability can play a role in each stage. There is at least some theory- and value-ladenness in science that is dependent on the world view of those who construct the scientific theories. Clinicians who must use the results of scientific research will inevitably interpret the research from the standpoint of their own world view. There may be further incommensurability when these data are communicated to the patient. Finally, clinician and patient values must come into play in any decision about choice of treatment. No stage of medical research or practice is value-free. This position does not imply relativism; some scientific accounts are better than others. However, the challenge of the incommensurabilists shows that further analysis is needed to establish how particular accounts are better or worse. (shrink)

Mr. M is an eighty-five-year-old who presented to the hospital with congestive heart failure exacerbation, pneumonia, altered mental status, and sepsis. A physician determines that he lacks capacity, and the team in the intensive care unit looks to the patient's daughter, Celia, as his surrogate decision-maker because she is named as an agent in his medical power of attorney form. While in the ICU, Mr. M suffers acute respiratory distress secondary to pneumonia and thus requires intubation. Celia accepts several life-sustaining (...) interventions, but she sporadically refuses other medically indicated therapies. Although providers explain the importance of the ICU insulin regimen for glucose control, she either refuses the insulin or requests a lower dose. The health care team believes that it is providing substandard care and that Celia's medical decisions are not in the patient's best interests, so they request an ethics consultation. When the clinical ethicist attempts to talk with Celia, she refuses to speak with him, saying flatly, “I am not interested in talking with you.” The clinical ethicist meets with Celia on a couple of occasions, but she consistently refuses to have a conversation with him. He wonders if the patient's surrogate decision-maker can refuse a clinical ethics consultation and is unsure what his next steps should be. (shrink)

It is widely acknowledged that the HIV and AIDS pandemic is a global emergency and that cheap, effective treatment should be provided for as many people as possible worldwide. But there are many challenges to rolling out antiretroviral treatment in resource-poor settings. These include the cost of drugs, sustaining their supply and distribution, the complexity of treatment regimens, selection of patients for treatment, shortage of medical and nursing personnel, inadequacy of healthcare facilities, the need for uninterrupted, lifelong treatment, and monitoring (...) for drug resistance. Great efforts, nationally and internationally, are required to meet these challenges. (shrink)

BackgroundSocial support plays an important role for health outcomes. Support for those living with chronic conditions may be particularly important for their health, and even for their survival. The role of support for the survival of cancer patients after receiving an allogeneic hematopoietic cell transplant is understudied. To better understand the link between survival and support, as well as different sources and functions of support, we conducted two studies in alloHCT patients. First, we examined whether social support is related to (...) survival. Second, we examined who provides which support and which specific support-related functions and tasks are fulfilled by lay caregivers and healthcare professionals.MethodsIn Study 1, we conducted a retrospective chart review of alloHCT patients and registered availability of a dedicated lay caregiver and survival. In Study 2, we prospectively followed patients after alloHCT from the same hospital, partly overlapping from Study 1, who shared their experiences of support from lay caregivers and healthcare providers in semi-structured in-depth interviews 3 to 6 months after their first hospital discharge.ResultsPatients with a dedicated caregiver had a higher probability of surviving to 100 days than patients without a caregiver, OR = 2.84, p = 0.042. Study 2 demonstrated the importance of post-transplant support due to patients’ emotional needs and complex self-care regimen. The role of lay caregivers extended to many areas of patients’ daily lives, including support for attending doctor’s appointments, managing medications and financial tasks, physical distancing, and maintaining strict dietary requirements. Healthcare providers mainly fulfilled medical needs and provided informational support, while lay caregivers were the main source of emotional and practical support.ConclusionThe findings highlight the importance of studying support from lay caregivers as well as healthcare providers, to better understand how they work together to support patients’ adherence to recommended self-care and survival. (shrink)

A self-confessed hypochondriac, Immanuel Kant was prolific on the topic of his own corporeality, diligently recording the details of his ‘Di‰tetik’–a physical regimen intended to ensure long life. The ‘Di‰tetik’ reveals a Kantian body in which the orifices–the ways in and out of the body–are problematized, and exchange with the world of objects via these orifices is strictly regulated. The Kantian body is a ‘classic’ body in Bakhtinian terms; its ‘grotesque’ counterpart–the feminine body–is explored in a range of Enlightenment (...) and Romantic texts–philosophical, medical, sociological. The Enlightenment is a turning point in the history of gender difference, when the naturalness of incommensurable sexual difference is asserted. The Kantian body is part of this project. The motif of bodily fluids, and their transgression of corporeal boundaries, is considered within the context of an emerging consumer economy, and the changes being wrought on the ‘body politic’. (shrink)

Mr. F. is a fifty‐year‐old father of two school‐aged daughters. Six years ago, he received a double lung transplant because he was suffering from interstitial lung disease, a fatal illness that causes suffocation by progressive scarring of the lungs. He is now experiencing chronic rejection of the transplant and is being considered to receive another. Without it, he is expected to survive only a year and a half. With it, his prognosis will improve, but the numbers are still not good. (...) Three years after his lung transplant, Mr. F. stopped attending his office visits. For a period of sixteen months he went without the studies and attention essential to posttransplant care. He stopped performing the required daily self‐monitoring of his lung function about eight months after his transplant, but he has maintained a regular exercise regimen. While lost to follow‐up, he continued to take his immunosuppressant medications, but he stopped taking medicine to control his high blood pressure because of its expense. (shrink)

The transplant coordinator scheduled a meeting that included numerous members of the multidisciplinary team, among them the transplant surgeon, a social worker, a psychologist, and an ethics consultant. The ethics consultant outlined the ethical issues and made a recommendation. The consultant argued that the question whether the patient should again be listed as a transplant candidate really came down to the kind of environment that could be provided during aftercare. That is, if a rather structured living environmentcould be found for (...) the patient, then retransplantation might be warranted. But without such an environment, the patient would again probably fail to adhere to the medical and psychological treatment regimen necessary for a successful life as a transplant recipient. The psychologist, who had been working closely with the ethics consultant, concurred in this opinion. (shrink)

This paper aims at analysing the ancient Greek notions of catharsis (clearing up, cleaning), to holon (the whole) and therapeia (therapy, treatment, healing) to assess whether they may be of help in addressing a set of questions concerning the didactics of medical ethics: What do medical students actually experience and learn when they attend classes of medical ethics? How should teachers of medical ethics proceed didactically to make students benefit morally from their teaching? And finally, to what extent and in (...) what forms and formats can the kind of cathartic treatment envisaged by Plato still be considered a necessary preliminary to moral learning? The three questions will be addressed by means of a reconstructive analysis and assessment of the Platonic notions of catharsis and holistic therapy present in the Charmides and the Sophist. Besides, the didactic potential of Plato’s dialogue form and moral regimen will be tried out. The ultimate aim is to investigate the possibilities of developing a therapeutic conception of medical ethics. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Standing at the Intersections: Navigating Life as a Black Intersex ManSean Saifa WallAs I sit down to write this narrative, my mind is reflecting on the past year. This year has seen numerous protests against state–sanctioned violence with the declaration that “Black Lives Matter”. As a Black intersex man, I have witnessed the impact of state–sanctioned violence on my family and my community, both from the police state and (...) medical community. I charge the police state and the medical community with state– sanctioned violence: Each targets non–normative bodies—the former through incarceration and execution, and the latter by means of surgical and hormonal intervention. As a Black intersex man, I stand at the intersection bearing witness to how this violence has incarcerated my friends and loved ones as well as being subjected to medically unnecessary surgical intervention. Although this is where I stand now, both socially and politically, I have not always existed here.I was born in the winter of 1978 at Columbia–Presbyterian Hospital in New York City. I was the youngest of five children and one of three children in my family who were born with an intersex trait now known as androgen insensitivity syndrome (AIS). At the time, AIS was referred to as “testicular [End Page 117] feminization syndrome.” Upon receiving my medical records years later at the age of twenty–five, I noticed scribbling and a barrage of notes indicating the process by which the doctors assigned my gender as female. Although I had ambiguous genitalia, which caused some initial confusion among the doctors, XY chromosomes were not enough for me to be raised as male. My mother was told I would be raised as a girl and, according to the medical records, “function as such.”Unlike my sisters who were also born with AIS, my mom was not swayed by the surgical recommendations doctors made about my body. As a matter of protocol, my sisters’ gonads were removed in infancy, however, my mom made the decision that my testes would remain with me until they had to be removed.Because of intense pain in my groin area, my testicles were removed when I was thirteen years old. The pain that I felt following the surgery was perhaps the worst pain that I have experienced in my entire life. After surgery, my pediatrician prescribed estrogen and Provera as a hormonal replacement regimen. Fatty deposits changed the shape and contours of my face. Once robust and chiseled thighs now harbored cellulite. The beginnings of facial hair and prominent body hair became wispy and nonexistent. What was hard and defined became soft.At no point did anyone ask me what I wanted to do with my body.I actually missed the effects of my natural testosterone such as a deepening voice, increased hair and muscle mass; when I asked if I could take both testosterone and estrogen after surgery, my mother remarked, “You would look too weird.”The hormone therapy was coupled with intense social conditioning. I feel as if the social conditioning for young women raised with AIS is suffocating. When doctors prescribed hormones for me to take, my mother constantly reminded me how “beautiful” the little yellow pills would make me. As a means of reassurance, my pediatrician told my mom that “a lot of fashion models” have AIS and that I would most certainly be beautiful. In our dominant US culture, gender norms can already be oppressive, but for women with AIS, there is the impact of gender norms and the underlying fear that women with AIS are not really women since they have XY chromosomes. I did not succumb to the pressure to be more feminine, but actually gravitated toward masculinity. Before transitioning to live as a man, I considered myself a butch woman. When I came out of the closet at fourteen years old and presented as a masculine young woman, I never felt safe. Because I dated women who were more feminine than I, my relationship with these women seemed threatening to men who repeatedly reminded me through harassment and threats that “I was not a man.” Of course, I wasn’t trying to be a... (shrink)

Clear guidelines addressing the ethically appropriate use of anti-infectives in the setting of hospice care do not exist. There is lack of understanding about key treatment decisions related to infection treatment for patients who are eligible for hospice care. Ethical concerns about anti-infective use at the end of life include: (1) delaying transition to hospice, (2) prolonging a dying process, (3) prescribing regimens incongruent with a short life expectancy and goals of care, (4) increasing the reservoir of potential resistant pathogens, (...) (5) placing unreasonable costs on a capitated hospice system. Although anti-infectives are thought to be relatively safe, they can place a burden on patients and be inconsistent to particular care plans. The current complex, and at times fragmented, medical care often fails to address these issues in decision-making. In many ways, the ethics governing the end of life decisions related to dialysis, hydration/nutrition, and hypercalcemia parallel those of anti-infectives. In this article we articulate important elements in ethical decision-making in the application of anti-infectives for patients who are eligible for hospice care, and we point to the need for prospective studies to help refine particular guidelines in these cases. (shrink)

Background: Recent research demonstrates that people sometimes make different medical decisions for others than they would make for themselves. This finding is particularly relevant to end-of-life decisions, which are often made by surrogates and require a trade-off between prolonging life and maintaining quality of life. We examine the impact of decision role, patient age, decision maker age and multiple individual differences on these treatment decisions. Methods: Participants read a scenario about a terminally ill cancer patient faced with a choice between (...) an aggressive chemotherapy regimen that will extend life by two years and palliative treatments to control discomfort for one remaining month. Participants were randomly assigned to one of three decision roles (patient, physician, or an abstract other) and the scenario randomly varied whether the patient was described as 25 or 65-years old. Results: When deciding for a 65-year old patient, approximately 60% of participants selected aggressive chemotherapy regardless of decision role. When deciding for a 25-year old patient, however, participants were more likely to select chemotherapy for a patient (physician role) or another person (abstract other) than for themselves (70%, 67%, and 59%, respectively). In addition, confidence that powerful others (eg, physicians) control one’s health, as well as respondents’ age and race, consistently predicted treatment choices. Conclusions: Patient age appears to influence medical decisions made for others but not those that we make for ourselves. These findings may help to explain the discord that often occurs when younger cancer patients refuse life-extending treatments. (shrink)

Is a painful experience less bad for you if you will not remember it? Do you have less reason to fear it? These questions bear on how we think about medical procedures and surgeries that use an anesthesia regimen that leaves patients conscious – and potentially in pain – but results in complete ‘drug-induced amnesia’ after the fact. I argue that drug-induced amnesia does not render a painful medical procedure a less fitting object of fear, and thus the prospect (...) of amnesia does not give patients a reason not to fear it. I expose three mistakes in reasoning that might explain our tendency to view pain or discomfort as less fearful in virtue of expected amnesia: a mistaken view of personal identity; a mistaken view of the target of anticipation; and a mistaken method of incorporating past evidence into calculations about future experiences. Ultimately my argument has implications for whether particular procedures are justified and how medical professionals should speak with anxious patients about the prospect of drug-induced amnesia. (shrink)

Marion Lee Sanders,1 Anthony James Langone2 1Department of Medicine, Division of Nephrology and Hypertension, University of Iowa, Iowa City, IA, 2Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN, USA: Transplantation is the preferred treatment option for individuals with end-stage renal disease. Individuals who undergo transplantation must chronically be maintained on an immunosuppression regimen for rejection prophylaxis to help ensure graft survival. Current rejection prophylaxis consists of using a combination of calcineurin inhibitors, mTOR inhibitors, (...) antimetabolite agents, and/or corticosteroids. These agents have collectively improved the short-term outcomes of renal transplantation, but improvements in late/chronic graft loss and recipient survival have lagged significantly behind challenging the field of transplantation to develop novel prophylactic agents. There have been several clinical trials conducted within the last 5 years in an attempt to bring such novel agents to the commercial market. These trials have resulted in the US Food and Drug Administration approval of extended-release tacrolimus, as well as belatacept, which has the potential to replace calcineurin inhibitors for rejection prophylaxis. Other trials have focused on the development of novel calcineurin inhibitors, costimulation blockade, kinase inhibitors, and inhibitors of leukocyte migration. While these later agents have not been FDA-approved for use in transplantation, they remain noteworthy, as these agents explore pathways not previously targeted for allograft-rejection prophylaxis. The purpose of this review was to consolidate available clinical trial data with regard to the recent developments in rejection prophylaxis in kidney transplantation. Keywords: rejection, prophylaxis, immunosuppression, transplantation. (shrink)

Foucault’s vocabulary of arts of existence might be helpful to problematize the entwinement of humans and technology and to search for new types of hybrid selves. However, to be a serious new ethical vocabulary for technology, this art of existence should be supplemented with an ongoing critical discourse of technologies, including a critical analysis of the subjectivities imposed by technologies, and should be supplemented with new medical and philosophical regimens for an appropriate use of technologies.

Placebos are often used by clinicians, usually deceptively and with little rationale or evidence of benefit, making their use ethically problematic. In contrast with their typical current use, a provocative line of research suggests that placebos can be intentionally exploited to extend analgesic therapeutic effects. Is it possible to extend the effects of drug treatments by interspersing placebos? We reviewed a database of placebo studies, searching for studies that indicate that placebos given after repeated administration of active treatments acquire (...) class='Hi'>medication-like effects. We found a total of 22studies in both animals and humans hinting of evidence that placebos may work as a sort of dose extender of active painkillers. Wherever effective in relieving clinical pain, such placebo use would offer several advantages. First, extending the effects of a painkiller through the use of placebos may reduce total drug intake and side effects. Second, dose-extending placebos may decrease patient dependence. Third, using placebos along with active medication, for part of the course of treatment, should limit dose escalation and lower costs. Importantly, provided that nondisclosure is pre-authorized in the informed consent process and that robust evidence indicates therapeutic benefit comparable to that of standard full-dose therapeutic regimens, introducing dose-extending placebos into the clinical arsenal should be considered. This novel prospect of placebo use has the potential to change our general thinking about painkiller treatments, the typical regimens of painkiller applications, and the ways in which treatments are evaluated. (shrink)

While the movement to ensure patient’s rights to information and informed consent spreads throughout the world, patient rights of this kind have yet to be introduced in mainland China. Nonetheless, China is no different from other parts of the world in that nurses are expected to shoulder the responsibility of safeguarding patients’ best interests and at the same time to uphold their right to information. This paper expounds on the principle of protectiveness grounded in traditional Chinese medical ethics concerning the (...) practice of informed consent. Nurses in China have a moral obligation to treat patients with sincerity. This notion carries a strong sense of parental protectiveness. As far as information-giving is concerned, nurses in China are ambivalent about the notion of truthfulness. The findings of an empirical study undertaken in seven Chinese cities reveal that nurses in China experience similar difficulties related to the disclosure of information as their counterparts in other parts of the world. A nurse’s narrative, the Chan case, is used to illustrate the typical difficult situation that nurses in China often encounter in looking after vulnerable patients who would like to learn more about their therapeutic regimens. The moral tension embedded in nursing practice is analysed. It is found that most nurses would prefer to tell the truth to patients, but their primary ethical justification is not that of respect for patients’ autonomy or safeguarding patients’ right to self-determination. Rather, it is basically beneficent in nature; that is, they base their decision to reveal the truth on whether or not patients will receive more relevant treatment and better nursing care. (shrink)

Four of the works attributed to Arnau de Vilanova may be considered consilia, which is the name of the genre of texts that expound medical treatments for illnesses suffered by specific individuals. In this paper, I first address the problem of their authenticity within the framework of the so-called "Arnaldian question". The evidence presented here confirms that Arnau de Vilanova was the author of the Regimen podagre and the Epistola ad Bremundum Montisferrarii, while the question regarding the authorship of (...) the Regimen quartane and the Cura febris ethice remains unresolved. This article furthermore documents the degree to which the actual cures prescribed by the physician in the consilia agreed with the doctrinal works of the Galenic tradition. It is explained how medieval university-trained physician had to compete with other practitioners and how they tried to outrival them by applying the doctrines of learned medicine to the individual cases at hand. (shrink)

During the process of in vitro fertilization (IVF), hormonal drugs are used to stimulate the woman's ovaries to produce multiple eggs. The injecting of the drugs is often performed by the women themselves outside of the clinical context, constituting a gendered burden of work that is rendered invisible by the dominant representations of treatment as undergone by couples and performed by doctors. Based on a series of interviews with women and couples who have undergone IVF unsuccessfully and who have ended (...) treatment at least two years previously, this paper focuses on two aspects of the self-injection of hormonal drugs that emerged from the participants accounts: firstly, the gendered ways in which the drug regimen was experienced as compromising privacy and secondly, the strategic use of images of both illicit and medical drug use in the accounts. The paper argues that in spite of the dominant representation of IVF as a couples’ technology, the IVF process is profoundly gendered, both in terms of bodily intervention and in the distribution of labour in the implementation of treatment; that the invisibility of the drug regimens from dominant representations of IVF can leave those undergoing treatment unprepared for some of the problems that the self-administration of the drugs can raise, particularly in terms of maintaining privacy; and finally, that images of the drug injection are mobilized strategically in the accounts to locate themselves within normative social reproductive standards. This highlights the extent to which the enduring ideological construction of proper womanhood as defined by motherhood continues to pose a dilemma for those who are involuntarily childless. (shrink)