This book situates biomedicine within American culture and argues that the very organization and practice of medicine are themselves cultural. It demonstrates the symbolic construction of clinical reality within American biomedicine and shows how biomedicine never leaves the realm of the personal.

Even in the increasingly individualized American medical system, advocates of 'personalized medicine' claim that healthcare isn't individualized enough. With the additional glamour of new biotechnologies such as genetic testing and pharmacogenetics behind it, 'Me Medicine'-- personalized or stratified medicine-- appears to its advocates as the inevitable and desirable way of the future. Drawing on an extensive evidence base, this book examines whether these claims are justified. It goes on to examine an alternative tradition rooted in communitarian ideals, (...) that of the common good as a goal in medicine. (shrink)

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

Where Medicine Went Wrong explores how the idea of an average value has been misapplied to medical phenomena, distorted understanding and lead to flawed medical ...

Fredrik Svenaeus' book is a delight to read. Not only does he exhibit keen understanding of a wide range of topics and figures in both medicine and philosophy, but he manages to bring them together in an innovative manner that convincingly demonstrates how deeply these two significant fields can be and, in the end, must be mutually enlightening. Medicine, Svenaeus suggests, reveals deep but rarely explicit themes whose proper comprehension invites a careful phenomenological and hermeneutical explication. Certain philosophical (...) approaches, on the other hand - specifically, Heidegger's phenomenology and Gadamer's hermeneutics - are shown to have a hitherto unrealized potential for making sense of those themes long buried within Western medicine. Richard M. Zaner, Ann Geddes Stahlman Professor of Medical Ethics, Vanderbilt University. (shrink)

In Wrong Medicine, Lawrence J. Schneiderman, M.D., and Nancy S. Jecker, Ph.D., address issues that have occupied the media and the courts since the time of Karen Ann Quinlan. The authors examine the ethics of cases in which medical treatment is offered--or mandated--even if a patient lacks the capacity to appreciate its benefit or if the treatment will still leave a patient totally dependent on intensive medical care. In exploring these timely issues Schneiderman and Jecker reexamine the doctor-patient relationship (...) and call for a restoration of common sense and reality to what we expect from medicine. They discuss economic, historical, and demographic factors that affect medical care and offer clear definitions of what constitutes futile medical treatment. And they address such topics as the limits on unwanted treatment, the shift from the "Age of Physician Paternalism" to the "Age of Patient Autonomy," health care rationing, and the adoption of new ethical standards. (shrink)

Recent criticisms of medicine converge on fundamental questions about the aim of medicine. The main task of this paper is to propose an account of the aim of medicine. Discussing and rejecting the initially plausible proposal according to which medicine is pathocentric, the paper presents and defends the Autonomy Thesis, which holds that medicine is not pathocentric, but sanocentric, aiming to promote health with the final aim to enhance autonomy. The paper closes by considering the (...) objection that the Autonomy Thesis is overly permissive and allows many highly controversial procedures as legitimate parts of medicine. (shrink)

This work brings together Philip van der Eijk's previously published essays on the close connections that existed between medicine and philosophy throughout antiquity. Medical authors such as the Hippocratic writers, Diocles, Galen, Soranus and Caelius Aurelianus elaborated on philosophical methods such as causal explanation, definition and division and applied key concepts such as the notion of nature to their understanding of the human body. Similarly, philosophers such as Plato and Aristotle were highly valued for their contributions to medicine. (...) This interaction was particularly striking in the study of the human soul in its relation to the body, as illustrated by approaches to specific topics such as intellect, sleep and dreams, and diet and drugs. With a detailed introduction surveying the subject as a whole and an essay on Aristotle's treatment of sleep, this wide-ranging and accessible collection is essential reading for the student of ancient philosophy and science. (shrink)

Medicine, Power, and the Law demonstrates that criminal and civil justice interact with medicine and public health more than is presently understood. The book focuses on the role of healthcare practitioners and an array of other professionals across industries in identifying wrongdoers, reporting behavior, and testifying on behalf of the state or government agencies. It also covers circumstances in which law enforcement relies on medicine for evidence or support in ways that compromise medical ethics. By reporting or (...) testifying as experts, a range of people, from specialist pediatricians to flight attendants, can have a life-changing impact on individuals in the name of public health or medicine. People who work in hospitals, social work settings, and even airlines, often contribute to wrongful and aggressive criminal and civil actions against society's most vulnerable people, including parents, older adults, and people living with poverty. The book explores a number of examples, including police use of medicine as a restraint or the collection of blood as evidence and the risks of opting out of certain scientific discoveries, such as pharmaceuticals. It describes the harms that may come to those who engage in suboptimal but generally heretofore legal child-raising behaviors, and people opting to live independently as older adults. These can lead to civil and criminal charges when noticed by those in a position of power. Medicine, Power, and the Law is an important contribution for researchers and practitioners in medicine, the law, and the expanding field of bioethics. (shrink)

To practice medicine and ethics, physicians need wisdom and integrity to integrate scientific knowledge, patient preferences, their own moral commitments, and society's expectations. This work of integration requires a physician to pursue certain goals of care, determine moral priorities, and understand that conscience or integrity require harmony among a person's beliefs, values, reasoning, actions, and identity. But the moral and religious pluralism of contemporary society makes this integration challenging and uncertain. How physicians treat patients will depend on the particular (...) beliefs and values they and other health professionals bring to each instance of shared decision making. This book offers a framework for practical wisdom in medicine that addresses the need for integrity in the life of each health professional. In doing so, it acknowledges the challenge of moral pluralism and the need for moral dialogue and humility as professionals fulfil their obligations to patients, themselves, and society. (shrink)

This is a volume of twelve essays concerning the fundamental tension in personalised medicine between individual choice and the common good.

Medicine and morality in rural Haiti are shaped both by different local religious traditions and by biomedical and folk medicine practices. People who become ill may seek treatment from Western doctors, but also from herbalists and religious leaders. This study examines the decisions guiding such choices, and considers moral issues arising in a society where suffering is associated with guilt but where different, sometimes conflicting, ethical systems coexist. It also reveals how in the crisis of illness people rework (...) religious identities and are forced to address fundamental social and political problems. (shrink)

Medicine at the Crossroads is a collection of essays based a column originally published in the Waco-Tribune Herald by renowned cardiologist Dr. Michael Attas of Baylor University. It touches on three perspectives - the physician, the patient, and the healthcare system - and addresses some of the most pressing questions in medicine today.

Padela and his contributors address a hitherto unexplored dimension of Islamic bioethics: the dynamics and tensions between Muslim medical doctors and Islamic jurists. What happens, and what should happen, when ancient faith and modern medicine both make claims on care for the ill? What, at the end of the day, constitutes true 'Islamic bioethics?' Includes a foreword and a chapter by Ebrahim Moosa.

En este texto se presenta un espacio de intercambio de conocimientos desde una perspectiva científica, técnica y jurídica, para contribuir a la protección de los recursos naturales. Debido a la importancia de establecer mecanismos para proteger la biodiversidad y posibilitar la preservación de los conocimientos asociados especialmente al uso de la flora medicinal, la Línea de Investigación en Política y Legislación, del Grupo de Estudios en Sistemas Tradicionales de Salud de la Facultad de Medicina, y la Línea de Derecho Ambiental (...) y Grupos Étnicos, del Grupo de Derechos Humanos de Jurisprudencia de la Universidad del Rosario, desarrollaron este libro a través del cual la Universidad se propone profundizar en el panorama actual de la reglamentación y política –Internacional, nacional y local—respecto a la flora medicinal y al patrimonio cultural inmaterial asociado a ésta. (shrink)

The connections between medicine and well-being are myriad. This paper focuses on the place of well-being in clinical medicine. It is here that different views of well-being, and their connection to concepts like “autonomy” and “authenticity”, both illuminate and are illuminated by looking closely at the kinds of interactions that routinely take place between clinicians, patients, and family members. -/- In the first part of the paper, I explore the place of well-being in a paradigmatic clinical encounter, one (...) where a competent patient interacts with a clinician. The main question here is how, or even whether, the pursuit of patient well-being – however we construe it – figures into a paradigmatic clinical encounter. In the second part of the paper, I consider what I will call a marginal clinical encounter – one where the patient is, as Agnieska Jaworska (1999) puts it, at the “margins of agency” – to theorize about the nature of well-being and to show how different theories of well-being can have dramatic consequences for clinical decision-making. (shrink)

In the Caribbean as in many other areas costly biomedical resources and personnel are limited, and more and more people are turning to alternative medicine and folk practitioners for health care. To meet the goal of providing health care for all, research on nonbiomedical therapies is needed, along with legal recognition of folk practitioners to establish standards of practice.

How compatible is a medical training with a future role in public office? Potentially very compatible and advantageous, particularly with regard to public policy issues, argues Dr Michael L Riordan.

Sustainable Medicine is based on the premise that twenty-first century Western medicine--driven by vested interests--is failing to address the root causes of disease. Symptom-suppressing medication and "polypharmacy" have resulted in an escalation of disease and a system of so-called "health care," which more closely resembles "disease care." In this essential book, Dr. Sarah Myhill aims to empower people to heal themselves by addressing the underlying causes of their illness. She presents a logical progression from identifying symptoms, to understanding (...) the underlying mechanisms, to relevant interventions and tests and tools with which to tackle the root causes. As Myhill writes, "It's all about asking the question 'why?'" Sustainable Medicine covers a wide range of symptoms including inflammation (infection, allergy, autoimmunity), fatigue, pain, toxic symptoms, deficiency symptoms, and hormonal symptoms. And Dr. Myhill includes a toolbox of treatments for specific illnesses and ailments, as well as a general approach to avoiding and treating all disease. Finally, she offers a series of case histories to show how people have successfully taken control of their health and healed even in the face of the most discouraging symptoms--all without the harmful interventions of 21st century Western medicine. (shrink)

Advances in medicine have brought us the stethoscope, artificial kidneys, and computerized health records. They have also changed the doctor-patient relationship. This book explores how the technologies of medicine are created and how we respond to the problems and successes of their use. Stanley Joel Reiser, MD, walks us through the ways medical innovations exert their influence by discussing a number of selected technologies, including the X-ray, ultrasound, and respirator. Reiser creates a new understanding of thinking about how (...) health care is practiced in the United States and thereby suggests new methods to effectively meet the challenges of living with technological medicine. As healthcare reform continues to be an intensely debated topic in America, Technological Medicine shows us the pros and cons of applying technological solutions health and illness. (shrink)

Is medicine still good for us? sets out the facts about our medical establishments in a clear, engaging style, interrogating the ethics of modern practices and the impact they have on all our lives.

Philosophy of Medicine provides a fresh and comprehensive treatment of the topic. It offers a novel theory of the nature of medicine, and proposes a new attitude to medicine, aimed at improving the quality of debates between medical traditions and facilitating medicine's decolonization.

An interactive DVD-ROM that examines the doctor-patient relationship, changing nature of illness, ethics and practice of everyday medicine, and the goals of medical pedagogy; it also features interviews with prominent physicians, caretakers, writers, researchers, and philosophers, and is used at the University of Oklahoma in its continuing education for physicians.

Proponents of the emerging field of P4 medicine argue that computational integration and analysis of patient-specific “big data” will revolutionize our health care systems, in particular primary care-based disease prevention. While many ambitions remain visionary, steps to personalize medicine are already taken via personalized genomics, mobile health technologies and pilot projects. An important aim of P4 medicine is to enable disease prevention among healthy persons through detection of risk factors. In this paper, we examine the current status (...) of P4 medicine in light of historical and current challenges to predictive and preventive medicine, including overdiagnosis and overtreatment. Moreover, we ask whether it is likely that in silico integration of patient-specific data will be able to better deal such challenges and to turn risk predictions into disease-preventive actions in a wider social context. Given the lack of evidence that P4 medicine can tip the balance between benefits and harms in preventive medicine, we raise concerns about the current promotion of P4 medicine as a solution to the current challenges in public health. (shrink)

Much has been written about medicine and the market in recent years. This book is the first to include an assessment of market influence in both developed and developing countries, and among the very few that have tried to evaluate the actual health and economic impact of market theory and practices in a wide range of national settings. Tracing the path that market practices have taken from Adam Smith in the eighteenth century into twenty-first-century health care, Daniel Callahan and (...) Angela A. Wasunna add a fresh dimension: they compare the different approaches taken in the market debate by health care economists, conservative market advocates, and liberal supporters of single-payer or government-regulated systems. In addition to laying out the market-versus-government struggle around the world -- from Canada and the United States to Western Europe, Latin America, and many African and Asian countries -- they assess the leading market practices, such as competition, physician incentives, and co-payments, for their economic and health efficacy to determine whether they work as advertised. This timely and necessary book engages new dimensions of a development that has urgent consequences for the delivery of health care worldwide. (shrink)

In Medicine, Society, and Faith in the Ancient and Medieval Worlds Darrel Amundsen explores the disputed boundaries of medicine and Christianity by focusing on the principle of the sanctity of human life, including the duty to treat or attempt to sustain the life of the ill. As he examines his themes and moves from text to context, Amundsen clarifies a number of Christian principles in relation to bioethical issues that are hotly debated today. In his examination of the (...) moral stance of the earliest syphilographers, for example, he finds insights into the ethical issues surrounding the treatment of AIDS, which he believes has its closest historical antecedent not in plague but in syphilis. He also shows that the belief that all healing comes from God, whether directly, through prayer, or through the use of medicine -- a sentiment commonly held by contemporary Christians -- cannot be accurately attributed to any extant source from the patristic period. Indeed, all the Church Fathers were convinced that healing sometimes came from evil sources: Satan and his demons were able to heal, for example, and Asclepius was a demon "to be taken very seriously indeed.". (shrink)

This book offers a multidisciplinary look at the much-debated concept of “personalized medicine”. By combining a humanistic and a scientific approach, the book builds up a multidimensional way to understand the limits and potentialities of a personalized approach in medicine and healthcare. The book reflects on personalized medicine and complex diseases, the relationship between personalized medicine and the new bio-technologies, personalized medicine and personalized nutrition, and on some ethical, political, economic, and social implications of personalized (...) medicine. This volume is of interest to researchers from several disciplines including philosophy, bio-medicine, and the social sciences. (shrink)

In this profoundly theological reflection on illness, healing, and the doctor-patient relationship, pediatrician Margaret Mohrmann bridges the sometimes disparate worlds of medicine and faith, of high technology and ultimate concern. Drawing on her two decades of experience treating children who suffer from disease and dysfunction, Mohrmann movingly reveals the temptations of idolatry that beset our understanding of health and life, the intrinsic connectedness underlying all medical encounters, and the difficulties and riches of using scripture as a moral resource. In (...) clear, accessible language Mohrmann emphasizes the importance of interpreting the lives of the suffering as meaningful and ongoing stories - stories that require all of us to respond in healing ways. Uncovering insights from such diverse sources as the apostle Paul, Alasdair MacIntyre and Flannery O'Connor, she suggests that what is required for a truly human life is not the absence of pain, but the presence of others. Both pastoral and prophetic, Medicine as Ministry is a challenge to rethink the purposes of health care - and to better discern the human condition. (shrink)

Because medicine can preserve and restore health and function, it is widely acknowledged as a basic good that a just society owes its members. Yet there is controversy over the scope of what should be provided, to whom, how, when and why. This comprehensive and authoritative book - by well-known philosophers, doctors, lawyers, political scientists, and economists - lays a theoretical foundation for understanding the debate, assesses how health care is distributed in different countries and to various social groups, (...) and analyzes practical issues in constructing a socially just health care system. (shrink)

Narrative Medicine in Hospice Care argues that the models of selfhood and care found in the work of Paul Ricoeur can serve as a framework for clinicians, caregivers, and end-of-life patients regardless of the patients’ verbal and cognitive capabilities.

This book presents a straightforward account of disease, the problems of practice, and the moral, legal and financial questions in the field.

This is the first textbook on osteopathic medicine to complement the dominant 'medical' model of education.

This book presents an interpretation of pharmaceutical, surgical and psychotherapeutic interventions based on a univalent metalanguage: biosemiotics. It proposes that a metalanguage for the physical, mental, social, and cultural aspects of health and medicine could bring all parts and aspects of human life together and thus shape a picture of the human being as a whole, made up from the heterogeneous images of the vast variety of sciences and technologies in medicine discourse. The book adopts a biosemiotics clinical (...) model of thinking because, similar to the ancient principle of alchemy, tam ethice quam physice, everything in this model is physical as much as it is mental. Signs in the forms of vibrations, molecules, cells, words, images, reflections and rites conform cultural, mental, physical, and social phenomena. The book decodes healing, dealing with health, illness and therapy by emphasizing the first-person experience as well as objective events. It allows readers to follow the energy-information flows through and between embodied minds and to see how they form physiological functions such as our emotions and narratives. (shrink)

Medicine and Ethics in Black Women's Speculative Fiction engages the complex nexus of black women's health, the fraught history of medicine as it relates to black women, and the problems with the inconsistent application of medical ethics that should concern us all through the lens of black women's literary speculation.

Cover -- Title -- Copyright -- Contents -- List of figures -- Contributors -- Acknowledgements -- 1 Introduction -- 2 Philip Melanchthon and his significance for natural philosophy -- 3 Daniel Sennert and the chymico-atomical reform of medicine -- 4 The changing face of Lutheranism in post-Reformation Denmark -- 5 After Tycho: Philippist astronomy and cosmology in the work of Brahe's Scandinavian assistants -- 6 The Book of Nature and the Word of God: Lutheran natural philosophy and medicine (...) in early-seventeenth-century Denmark and Norway -- 7 Holger Rosenkrantz, 'the Learned' (1574-1642). (shrink)

The success of precision medicine depends on obtaining large amounts of information about at-risk populations. However, getting consent is often difficult. Why? In this commentary I point to the differentials in social status involved. These differentials are inevitable once personal information is surrendered, but are particularly intense when the studied populations are socioeconomically or socioculturally disadvantaged and/or ethnically stigmatized groups. I suggest how the deep distrust of the latter groups can be partially justified as a lack of confidence that (...) their core values or interests will sufficiently be taken into account. Hence, the ethical challenge here lies not in avoiding status differentials, but in dealing with them appropriately. Scientists should not assume trust from others but adopt a norm of “demonstrating trustworthiness”. (shrink)

First Published in 1998. Routledge is an imprint of Taylor & Francis, an informa company.

Rudolf Steiner, the often undervalued, multifaceted genius of modern times, contributed much to the regeneration of culture. In addition to his philosophical teachings, he provided ideas for the development of many practical activities including education--both general and special--agriculture, medicine, economics, architecture, science, religion, and the arts. Today there are thousands of schools, clinics, farms, and many other organizations based on his ideas. Steiner's original contribution to human knowledge was based on his ability to conduct spiritual research, the investigation of (...) metaphysical dimensions of existence. With his scientific and philosophical training, he brought a new systematic discipline to the field, allowing for conscious methods and comprehensive results. A natural seer from childhood, he cultivated his spiritual vision to a high degree, enabling him to speak with authority on previously veiled mysteries of life. Topics include: true human nature as a basis for medical practice; the science of knowing; the mission of reverence; the four temperaments; the bridge between universal spirituality and the physical; the constellation of the supersensible bodies; the invisible human within us: the pathology underlying therapy; cancer and mistletoe, and aspects of psychiatry; case history questions: diagnosis and therapy; anthroposophic medicine in practice: and three case histories. (shrink)

Much has been written about medicine and the market in recent years. This book is the first to include an assessment of market influence in both developed and developing countries, and among the very few that have tried to evaluate the actual health and economic impact of market theory and practices in a wide range of national settings. Tracing the path that market practices have taken from Adam Smith in the eighteenth century into twenty-first-century health care, Daniel Callahan and (...) Angela A. Wasunna add a fresh dimension: they compare the different approaches taken in the market debate by health care economists, conservative market advocates, and liberal supporters of single-payer or government-regulated systems. In addition to laying out the market-versus-government struggle around the world -- from Canada and the United States to Western Europe, Latin America, and many African and Asian countries -- they assess the leading market practices, such as competition, physician incentives, and co-payments, for their economic and health efficacy to determine whether they work as advertised. This timely and necessary book engages new dimensions of a development that has urgent consequences for the delivery of health care worldwide. (shrink)

Regulation of Regenerative Medicines: A Global Perspective covers regenerative medicine regulations globally where frameworks have been or are being established. Chapters by discipline include manufacturing, supply chain, pharmacology, pharmacokinetics, toxicology, and combination product.

In the late twentieth century the impressive achievements of modern medicine are obvious, yet medicine seems to have failed to satisfy public expectation. Government regulation of hospitals and doctors is tightening in most Western countries and health funding is a divisive political issue. Medical complaints departments are increasingly busy. In the United States medical litigation has reached alarming levels, and a similar trend can be seen in other developed countries. Is there something wrong with medical research and practice? (...) This book, written by a surgeon with more than thirty years experience of clinical medicine, examines what it is that doctors do, and what it is that patients expect of them. It finds that in the face of uncertainty, expectation and reality ofen often diverge. Starting from the communication difficulties that exist between doctors and patients, Humane Medicine explores the roles of science, ethics and the humanities in medical practice. It forcefully argues that more science cannot heal this rift, nor can better education in ethics. To foster better communication, medical teachers must change their philosophy and methods, so that value-laden issues in clinical medicine are interwoven with the necessary science. Professor Little outlines some possible ways to achieve this. This important book will be of interest to medical students and their teachers, clinicians, health policy planners and other readers concerned about the direction of the medical profession. (shrink)

Medicine and Money explores the role of beneficence and cost control in health-care systems. The book's primary concern of morally improving medicine is achieved by dividing the argument into two parts. The first defines the crisis in health-care and justifies beneficence. The second part offers practical suggestions on implementing beneficence into the system. Medicine and Money is one of the few books to provide concrete suggestions on improving the health-care system from the micro level for addressing cost (...) concerns in a morally acceptable manner. (shrink)

The world is in the midst of a medical revolution which is challenging basic assumptions about science and the practice of medicine. Dramatic scientific progress promises better health and longer life, but also creates profound problems.

This book offers cutting edge research on the modifications and disruptions of bodily experience in the context of anxiety, depression, trauma, chronic illness, pain, and aging. It presents original contributions in applied phenomenology, biomedical ethics, and the use of medical technologies.

Modern medical ethics in the English-speaking world is commonly thought to derive from the medical philosophy of the Scotsman John Gregory (1725-1773) and his younger associates, the English Dissenter Thomas Percival (1740-1804) and the American Benjamin Rush (1745-1813). This book is the first extensive study of this suggestion. Dr Haakonssen shows how the three thinkers combined Francis Bacon's and the Scottish Enlightenment's ideas of the science of morals and the morals of science. She demonstrates how their medical ethics was a (...) successful adaptation of traditional moral ideas to the dramatically changing medical world especially the voluntary hospital. In accounting for the dynamics of this process, she rejects the anachronism that modern medical ethics was a new paradigm. (shrink)