Volume 24, Issue 10, October 2024, Page 80-82.

Volume 24, Issue 10, October 2024, Page 80-82.

Dr. Henry Beecher, a renowned Harvard Medical School anesthesiologist, sent shock waves through the medical research community and the lay press when he described 22 examples of “unethical or questionably ethical studies” by reputable researchers at major institutions in his now well-known 1966 New England Journal of Medicine article. Beecher concluded this exposé by noting: “The ethical approach to experimentation in man has several components: two are more important than the others, the first being informed consent.... (...) Secondly, there is the more reliable safeguard provided by the presence of an intelligent, informed, conscientious, compassionate, responsible investigator”. Beecher’s... (shrink)

This book about philosophical and methodological problems in psychoanalytic theory is surely one of the best pieces of literature on this subject of recent vintage. The author, a psychiatrist on the faculty of Harvard Medical School, displays considerable logical skill and philosophical sophistication, in addition to the expected familiarity with the psychoanalytic literature. The major purport of the book is a logical and philosophical defense of the claim that psychoanalytic explanations of human behavior--if constructed with proper and (...) adequate regard for relevant clinical data--are methodologically sound and genuinely scientific. One useful and novel feature of Sherwood's argument is the particular type of illustrative case material which he employs: instead of mustering various bits and instances of behavior from large numbers and varieties of cases, Sherwood considers the psychiatric explanation actually given by Freud in one of his recorded clinical case histories--the famous "Karl Lorenz" or "rat man" case. Sherwood devotes two chapters to a detailed description of this case, and an analysis of the logic of Freud's explanations of the behavior presented therein. From the point of view of logical and methodological considerations, there is an obvious advantage in such an approach, for it enables the critic to avoid leveling charges against the theory which might originate simply from extracting portions of explanatory material from their proper context. Sherwood also includes a chapter of criticism of what he calls "the thesis of the separate domain"--the view that there are fundamental differences in the logic of explanations of human behavior, cognition, and other phenomena involving reasons and intentions on the one hand, and other forms of explanation characteristic of the physical sciences, on the other. Philosophically, this is the most mature chapter of the book, and will be of interest to philosophers of mind, as well as philosophers of science, particularly for its criticism of the views of R. S. Peters. Unfortunately, however, Sherwood's argument is not unmarred by serious flaws and deficiencies. These include a highly psychologistic analysis of the logic and structure of explanation whose subsequent use repeatedly involves the author in context-of-discovery vs. context-of-justification confusions. Moreover, an apparent lapse into a non-Humean account of causality in the second section of the fifth chapter leads Sherwood to an unfortunate petitio principii on the issue of causes vs. reasons. Sherwood's critical discussion of the classical "covering-law" model of scientific explanation in the penultimate chapter exhibits numerous failures to come to grips with the essential aspects of the Braithwaite-Hempel-Oppenheim theory. Finally, an important sin of omission: Sherwood completely ignores the highly germane and decisive issues raised by authors such as Nagel and Arthur Pap, who charge the theoretical concepts of psychoanalysis with lack of cognitive and empirical significance. In sum, this is a flawed but eminently worthwhile book in the philosophy of behavioral science.--H. P. K. (shrink)

The Dead Donor Rule is intended to protect the public and patients, but it remains contentious. Here, I argue that we can abandon the Dead Donor Rule. Using Joel Feinberg’s account of harm, I argue that, in most cases, particularly when patients consent to being organ donors, death does not harm permanently unconscious (PUC) patients. In these cases, then, causing the death of PUC patients is not morally wrong. This undermines the strongest argument for the Dead Donor Rule—that doctors ought (...) not kill their patients. Thus, there is nothing wrong with abandoning the Dead Donor Rule with regard to PUC patients. Importantly, the harm-based argument defended here allows us to sidestep the thorny debate surrounding definitions of death. What matters is not when a patient dies but whether their death constitutes some further harm. (shrink)

Over the past 50 years, academic-industrial collaborations and technology transfer have played an increasingly prominent role in the biomedical sciences. These relationships can speed the delivery of innovative drugs and medical technologies to clinical practice, creating important public health benefits as well as income for universities and their faculty. At the same time, they raise ethical concerns, particularly when research involves human subjects in clinical trials. Lapses in oversight of industry sponsored clinical trials at universities, and especially patient deaths (...) in a number of trials, have brought these issues into the public spotlight and have led the federal government to intensify its oversight of clinical research. The leadership of Harvard Medical School convened a group of leaders in academic medicine to formulate guidelines on individual financial conflicts of interest. They and other groups are working to formulate a national consensus on this issue. (shrink)

Medical students' professional identity formation is an adaptive, developmental process. PIF is shaped by values implicit in educational practices and in the culture of the learning environment. In 2003, educational leaders at Harvard Medical School created the Cambridge Integrated Clerkship as a new model of clinical education to support PIF intentionally. The CIC, a longitudinal integrated clerkship, differs in structure, processes, and venues from traditional block rotations, while...

A robust body of literature analyzes the shift of academic science toward more business-oriented models. This paper presents the findings of an empirical study investigating basic scientists’ attitudes toward publicly funded basic research at the Harvard Medical School and affiliated institutions. The study finds that scientists at the Harvard Medical School construe publicly funded basic research as inquiries that, whether use oriented or not, must be governed by the cognitive and social norms of the (...) traditional mode of knowledge production. They recognize that academic science is vulnerable to access by external capital but maintain that it remains distinct from research done in the private sector. Overall, the study demonstrates that important segments of academia have preserved a traditional approach to knowledge production, which is yet to be transformed by the entrepreneurial turn. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Incoherence of Determining Death by Neurological Criteria: A Commentary on Controversies in the Determination of Death, A White Paper by the President’s Council on Bioethics*Franklin G. Miller** (bio) and Robert D. Truog (bio)Traditionally the cessation of breathing and heart beat has marked the passage from life to death. Shortly after death was determined, the body became a cold corpse, suitable for burial or cremation. Two technological changes in (...) the second half of the twentieth century prompted calls for a new, or at least expanded, definition of death: the development of intensive care medicine, especially the use of mechanical ventilators, and the advent of successful transplantation of vital organs. Patients with profound neurological damage, leaving them incapable of breathing on their own and in an irreversible coma, could be maintained for some period of time with the aid of mechanical ventilation. The situation of these patients posed two ethical questions. Is it appropriate to stop life-sustaining treatment? If so, is it acceptable to retrieve vital organs for transplantation to save the lives of others before stopping treatment?In 1968, the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death proposed that death could be determined on the basis of neurological criteria, thus providing a positive answer to these two questions (Ad Hoc Committee 1968). According to the position of this committee, patients diagnosed with the cessation of brain function are dead, despite the fact that they breathe and circulate blood with the aid of mechanical ventilation. [End Page 185] Because they are dead, it is appropriate, indeed imperative, to stop mechanical ventilation. And because they are dead, it becomes ethical to procure vital organs for transplantation before stopping what otherwise would be life-sustaining treatment. Remarkably, this innovative neurological determination of death became, with little debate or controversy, the established position in medical ethics and the law throughout the United States.The Harvard Committee articulated the diagnosis of “irreversible coma,” but merely asserted that this condition constituted death. No explanatory rationale was provided. It fell to the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research to provide an authoritative rationale in its 1981 report, Defining Death. The second paragraph of the report set the stage as follows: “The question addressed here is not inherently difficult or complicated. Simply, it is whether the law ought to recognize new means for establishing that the death of a human being has occurred” (President’s Commission 1981, p. 3). The Commission claimed that “death is a unitary phenomenon” (p. 7) and that the determination of death by neurological criteria, in terms of the absence of all brain function, is consistent with the traditional conception of death as the cessation of vital functioning of the organism as a whole. The key issue is the integrative functioning of the human organism, which ceases to exist, according to the Commission, when the whole brain, including higher cortical areas and the brain stem, fails to function. Although “brain-dead” patients do not appear to be dead—i.e., the reality of their death is “masked” by the activity of mechanical ventilation—the patient’s body has irreversibly lost all capacity for integrative functioning. In the words of the Commission: “When artificial means of support mask this loss of integration as measured by the old methods [cessation of respiration and heart beat], brain-oriented criteria and tests provide a new window on the same phenomenon” (p. 33). The President’s Commission was instrumental in developing and establishing “The Uniform Definition of Death Act”: “An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead” (p. 2).Although the question posed by the President’s Commission was easy to articulate, the answer, over time, has proved complicated and controversial. The coherence and cogency of determining death by neurological criteria has been challenged. Various experts have demonstrated that “brain-dead” patients maintained on mechanical ventilation display a range of vital, integrative, functioning, which conflicts with the judgment that they are dead (Truog and... (shrink)

Background Few studies have been conducted to assess the quality of orientation practices for ethics advisory committees that conduct ethics consultation. This survey study focused on several Harvard teaching hospitals, exploring orientation quality and committee members’ self-evaluation in the American Society of Bioethics and Humanities ethics consultation competencies. Methods We conducted a survey study that involved 116 members and 16 chairs of ethics advisory committees, respectively. Predictor variables included professional demographics, duration on committees and level of training. Outcome variables (...) included familiarity with and preparedness in the ASBH competencies and satisfaction with orientations. We hypothesised that responses would be associated with both the aforementioned predictors and whether or not participants had encountered the ASBH competencies in training. Results A majority of respondents found their orientation curricula to be helpful, although a significant portion of respondents did not receive any orientation or were unsatisfied with their orientation. Familiarity with ASBH competencies was a statistically significant predictor of respondents’ self-evaluation in particular categories. Standard educational materials were reported as offered during orientation, such as readings and case studies ; different medium resources were less evidenced such as videos on ethics consultation. Conclusions Institutions should re-evaluate orientation practices for ethics committee members that perform ethics consultation. Integrating ASBH competencies and useful methods into a resourceful pedagogy will help improve both member satisfaction with orientation and preparation in consultation. (shrink)

When Flexner wrote about medical education at the beginning of the 20th century, he articulated and amplified the emerging view that medical education and the practice of medicine should be grounded in scientific method and that medical education belonged in the province of the university, an environment dedicated to original scholarship and investigation (Cooke et al. 2006; Flexner 1910; Ludmerer 2010). To learn to treat medical uncertainty the way a scientist frames hypotheses, medical students, he (...) argued, required participatory, hands-on experience, as well as a focus on the development of independent problem-solving and critical-thinking skills. The intimate linkage between research (which moves the frontier .. (shrink)

Getting a graduate education is one of the most important parts of a professional in a field. It allows them to climb higher in the professional rankings or even get higher pay for their academic work. All graduate students are adults and self-directed due to their past experiences in work or practice. However, when the pandemic hit the world, these self-directed learners were not spared from shutting of schools. In the Philippines, most graduate schools deliver their lessons through the traditional (...) mode or face-to-face until the pandemic that they shifted in the emerging online learning modality. Using the mixed method of quantitative and qualitative type of study the researchers were able to gather 419 graduate students from various regions of the archipelago to take part in the study. The researchers found out that upon experiencing the benefits of online learning, graduate students want to continue this modality even in the future. More than a third of the respondents also claimed that they want the blended or hybrid type of graduate studies as opposed to going back to the more traditional face-to-face classes. The reasons for these can vary on each learner’s situation. (shrink)

A novel method of teaching military medical ethics, medical ethics and military ethics in the Israel Defense Force (IDF) Medical Corps, essential topics for all military medical personnel, is discussed. Very little time is devoted to medical ethics in medical curricula, and even less to military medical ethics. Ninety-five per cent of American students in eight medical schools had less than 1 h of military medical ethics teaching and few knew the (...) basic tenets of the Geneva Convention. Medical ethics differs from military medical ethics: the former deals with the relationship between medical professional and patient, while in the latter military physicians have to balance between military necessity and their traditional priorities to their patients. The underlying principles, however, are the same in both: the right to life, autonomy, dignity and utility. The IDF maintains high moral and ethical standards. This stems from the preciousness of human life in Jewish history, tradition and religious law. Emphasis is placed on these qualities within the Israeli education system; the IDF teaches and enforces moral and ethical standards in all of its training programmes and units. One such programme is ‘Witnesses in Uniform’ in which the IDF takes groups of officers to visit Holocaust memorial sites and Nazi death camps. During these visits daily discussions touch on intricate medical and military ethical issues, and contemporary ethical dilemmas relevant to IDF officers during active missions. (shrink)

_In _Broader, Bolder, Better_, authors Elaine Weiss, of the Broader, Bolder Approach to Education campaign, and Paul Reville, former Massachusetts secretary of education, make a compelling case for a fundamental change in the way we view education._ The authors argue for a large-scale expansion of community-school partnerships in order to provide holistic, integrated student supports (ISS) from cradle to career, including traditional wraparound services like health, mental health, nutrition, and family supports, as well as expanded access to opportunities (...) such as early childhood education, afterschool activities, and summer enrichment programs. The book builds on nearly a decade of research by the Broader, Bolder Approach to Education, a national initiative endorsed by more than sixty policy experts and leaders from across the country, and draws on the work of Harvard’s Education Redesign Lab. It pulls from case studies of effective ISS efforts in twelve diverse communities to illustrate the variety of strategies that can be adopted locally. A call to action that also provides examples of communities that are successfully leveling the playing field for poor children, this book offers a detailed vision for building—through field work, mobilization, and financing—comprehensive systems to prepare all children for success. (shrink)

A survey of 106 medical students assessing their interest in and attitudes to medical ethics in the curriculum is reported by the authors. Results indicate that 64 per cent of the students rated the importance of medical ethics to good medical care as high or critical and 66 per cent desired to learn more about the topic. However, in reports of patient encounters identifying ethical issues, less than six per cent of the students reported a frequency (...) of more than one such patient encounter per week. The students also demonstrated a greater awareness of more obvious ethical issues than of more subtle, less publicised issues. When asked how medical ethics should be taught, the students clearly affirmed a desire for an integrated exposure to the subject throughout the medical curriculum. Possible implications of these findings for medical education are discussed. (shrink)

Evidence‐based medicine has become both the mantra of clinical practice and the dominant contemporary approach to patient care. Gordon Guyatt et al. first proposed applying the concept to medical education in the early 1990s, arguing for training that “de‐emphasizes intuition, unsystematic clinical experience, and pathophysiologic rationale” in favor of “examination of evidence from clinical research”; over the following twenty‐five years, nearly every medical school and residency program in the United States incorporated these methods into its training. During (...) this same period, admissions requirements and protocols have continued to rely on subjective, non‐evidence‐based ideals largely developed a century earlier. In light of the continued underrepresentation of certain demographic groups among matriculants, as well as the national controversy surrounding admissions standards at undergraduate institutions—most notably embodied in the lawsuit by Students for Fair Admissions against Harvard University—the moment may be ripe for a radical reexamination of those requirements. (shrink)

A report of a problem-based learning project on the ethics of terminal care, offered as one of the options available to first year MB ChB students in Edinburgh University Medical School. The project formed part of the 'clinical correlation course' in the new curriculum. Six students took part under the supervision of two clinical tutors and a moral philosopher. The course was case-based and practical with students being given the opportunity over a period of eight weeks to meet (...) patients, relatives and hospital staff at a local geriatrics hospital and terminal care home. The main issue studied was the degree of choice available to patients electing to be treated at home, in hospital or in a hospice. Other issues included: pre-death, disposal of the dead, certification of death, communication with relatives and follow-up bereavement services. (shrink)

An instrument to assess 'ethical sensitivity' has been developed. The instrument presents four clinical vignettes and the respondent is asked to list the ethical issues related to each vignette. The responses are classified, post hoc, into the domains of autonomy, beneficence and justice. This instrument was used in 1990 to assess the ethical sensitivity of students in all four medical classes at the University of Toronto. Ethical sensitivity, as measured by this instrument, is not related to age or grade-point (...) average. Sensitivity increases between the 1st and 2nd year and then decreases throughout the rest of undergraduate medical training, such that the 4th-year students identify fewer issues than those entering medical school. Students expressing a career choice of family medicine identify more issues than their peers. Several problems with the use of the instrument and the interpretation of the data were found. Nonetheless, these findings, if reproducible, are important and their meaning needs further discussion. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Emperor’s Daughter, the Wise Rabbi, and the Realtor’s FaceliftJohn Davidson and Ruhama WeissFour decades ago during the clinical years of medical school, my (JD) first patient–care efforts included serendipitous contacts with three non–physician mentors. Each a rabbi. Each a Texan. Each of a different generation. Each acting in a pastoral care role in Houston’s Texas Medical Center. By sharing with all–comers their command of the (...) two–millennia–old rabbinic literary corpus, especially its aggadic, or nonlegal texts, they changed me forever. Theological dogma was not their passion. Caregiving for their hospitalized congregants was. And in so doing, they opened gates of discovery to rabbinic stories (aggadot) as articles of faith to be put into action for patients, staff, students, and doctors alike. These unexpected gifts have catalyzed and sustained my medical career and personal life ever since.The most influential of those stories was the famous Talmudic tale of the eminent Rabbi Eliezer (Babylonian Talmud, Bava Metzia 59b) using every conceivable means to support his view in a dispute, including miracles and a voice of approval from Heaven. His colleagues refused to assent to the singularity of his methods or arrival. They insisted on reasoning their way through to a majority decision based on consideration of the evidence at hand with the tools available. The tale ends with a joyous, proud, yet defeated parental deity declaring, “My children have bested Me, my children have bested Me.”The legend empowered me as a student to speak my mind in seeking to value the methodical, collaborative process of clinical decision–making over the sometimes ferocious voices of “the experts.” It continues to resurface decades later in daily efforts at finding common ground with both patients and other clinicians as we try to figure out, “what to do.” For more on this topic see my article, “Empathy and Integrative Thinking: Talmudic Paradigms for the Essentials of a Medical Interview” found in Medical Humanities.Just as those rabbis in the 1970’s told their stories in order to make sense of worldly and spiritual matters, so have I come now to appreciate the value of similar narratives for my patients and myself. Sometimes stories are shared in a near prescriptive fashion. Sometimes they are recalled silently as a compass suggesting the next step in an interview or treatment process. These rabbinic tales come to mind during clinical encounters after years of personal reflection on favorite texts and even more often in the midst of weekly if not daily textual study as a central element of my Jewish religious life. This practice has led to a realization that recalling rabbinic texts in contemporary clinical contexts is neither far–fetched nor irrelevant. At times it is uncannily helpful. Two millennia are not so long ago.During the past year, an Israeli colleague (RW) and I have revisited various Talmudic passages on a regular basis. Unlike Texas four decades ago, now I have learned with a pastoral care clinician who is a “hevruta,” or study partner, from the same Hebrew root as “haver,” meaning “friend.” Ours is a centuries–old way of study consisting of a pair of learners conversing freely on equal footing as they wrestle with interpreting a chosen, often familiar, text in a new way. My hevruta and I parse verbs. We examine articles. We question redundancy and grammatical reversals. We search for allusions. We read closely. We do all of this for its sake alone. It is part of our spiritual journey. It is one way we search for God. We engage the words on the page or screen and talk to each other.It is also a dyadic effort whose process and content bear a likeness to that of a doctor and a patient as they try to dialogue together regarding a patient’s concerns and the doctor’s capacity to help. Here, too, there is give and take, an attention to details, a reinterpretation of the past, and a reconsidering of the present. It is not surprising that the fruits of an ongoing dialogue on one stage with a hevruta, related to rabbinic stories and grammatical puzzlements, is of use on another... (shrink)

The teaching of ethics in UK medical schools has recently been reviewed, from the perspective of the teachers themselves. A questionnaire survey of medical undergraduates at King’s College London School of Medicine provides useful insight into the students’ perception of ethics education, what they consider to be the value of learning ethics and law, and how engaged they feel with the subject.

The study examined the influence of the Pond Report on the teaching of medical ethics in the London medical schools. A questionnaire was given to both medical students and college officers. All medical colleges reported that ethics was included in the curriculum. However, from students' replies, it seems that attendance of optional courses is low and that not all current final year medical students have had any formal teaching in medical ethics. Stronger guidelines are (...) necessary to ensure appropriate ethical training in London medical schools. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Foundation of Ethical Theory in the ClinicJohn Collins Harvey (bio)William Osler has had a very profound and lasting effect on American medical education and medical practice. He set the pattern, still followed today, for the clinical training of medical students at the patient’s bedside and in the clinical laboratory. In such settings Osler was able to demonstrate to his pupils the principles, ethics, and standards (...) of medical practice that he espoused and thought fundamental to the profession of medicine. His monumental text book, The Principles and Practice of Medicine, first published in 1892, transformed the medical profession and remained a standard text for more than four decades (Leon 1995, p. 13). Renowned medical historians, such as Pedro Laín Entralgo, Henry Sigerist, and Richard Shyrock, recognize him as the greatest clinician that North America has ever produced.Osler, who had observed bedside teaching in his post-graduate studies, recognized that this method had much to offer in the instruction of medical students. Opportunity to introduce this method of teaching into the medical school curriculum came in 1888 when he was called to serve as Professor of Medicine and Physician-in-Chief at the newly established Johns Hopkins Medical School and Hospital. Bedside teaching proved to be very successful especially in demonstrating to students the standards and ethics of medical practice that he espoused.Osler’s teaching method was immediately adopted by many of the university medical schools in the United States, including Harvard, Columbia, the University of Pennsylvania, and Stanford, all of whom appreciated the success of the Hopkins medical educational experiment. Graduates of the Hopkins Medical School quickly became a major source of faculty in medical schools in the United States. Many of Osler’s immediate pupils became outstanding clinicians and leaders in American academic medicine and served as faculty members at Hopkins or in established or newly founded schools. Osler’s disciples taught students in the wards the “art” of medicine according to his principles, ethics, and standards. The second and third generation faculty members, who were trained by Osler’s immediate pupils, continue to this day to teach the “art” by employing this method of teaching. Consequently, the practice of medicine in the United States continues to be influenced by the ethics held by Osler. To find [End Page 343] the theories behind Osler’s teaching, we must look at Osler’s background, education, and writings.The Religio Medici: Background For Osler’S Medical EthicsOsler received a very solid traditional classical education at the small, excellent Anglican secondary school in Weston, Ontario run by the Reverend James Johnson, with whom Osler developed a life long friendship. Johnson’s avocation was natural science. He first aroused Osler’s interest in nature and science. Osler was taught Scripture well at Weston. He committed much of the Bible to memory and often quoted it in his speeches. He also studied both Greek and Latin, and was exposed to the writings of Plato, Aristotle, Cicero, and other classical authors, particularly the stoics.While a student at Weston, Osler first came to know Sir Thomas Browne’s remarkable text Religio Medici (The Religion of the Physician), which was to become a lifelong favorite. In his first address as the new Regius Professor of Medicine at Oxford in 1905, which was given to the Guy’s Hospital Physical Society, he vigorously recommended the Religio Medici to the students.The Religio is a deeply reflective personal inquiry into the paradoxical nature of one man as a microcosm of all men (Browne 1940, pp. 40, 53–54, 61–62). Browne participated in the Baconian program for the advancement of knowledge and the rise of “science.” As a defense of the physician’s faith, the Religio shows how neatly the scientist and the Christian united in the single figure of the inspired reader of God’s two books, nature and Scripture, can defend an attitude that is both scientific and yet reverent. The central theme in the first and much longer part of the Religio is the relation between faith and reason. The second part of the Religio is about charity: Man’s love of God and his neighbors, commanded as... (shrink)

BackgroundBurnout is being experienced by medical students, residents, and practicing physicians at significant rates. Higher levels of Hardiness and Emotional Intelligence may protect individuals against burnout symptoms. Previous studies have shown both Hardiness and Emotional IntelIigence protect against detrimental effects of stress and can be adapted through training; however, there is limited research on how training programs affect both simultaneously. Therefore, the objective of this study was to define the association of Hardiness and Emotional Intelligence and their potential improvement (...) through hyper realistic immersion simulation training in military medical students.MethodsParticipants in this study consisted of 68 second year medical students representing five medical schools who were concurrently enrolled in the United States military scholarship program. During a six day hyper-realistic surgical simulation training course, students rotated through different roles of a medical team and responded to several mass-casualty scenarios. Hardiness and Emotional Intelligence were assessed using the Hardiness Resilience Gauge (HRG) and the Emotional Quotient Inventory (EQ-I 2.0) respectively, at two time points: on arrival (pre-event) and after completion of the course (post-event).ResultsHardiness and Emotional Intelligence scores and sub scores consistently improved from pre-event to post-event assessments. No difference in training benefit was observed between genders but differences were observed by age where age was more often associated with Emotional Intelligence. In addition, factor analysis indicated that the HRG and EQ-I 2.0 assessment tools measured predominately different traits although they share some commonalities in some components.ConclusionThis study indicates that Hardiness and Emotional Intelligence scores can be improved through immersion training in military medical students. Results from this study support the use of training course interventions and prompt the need for long term evaluation of improvement strategies on mitigating burnout symptoms. (shrink)

This article discusses what level of consent is needed from a child or parent before a primary-school medical can take place . It also considers whether there are occasions when a doctor can see a child if the parents have failed to give consent or have explicitly refused consent.Primary-school children are considered incompetent to make decisions about their own medical treatment and so their consent does not need to be gained before a medical takes place, (...) although it is highly desirable to obtain it. However, a doctor cannot justify a decision to see a child purely in terms of the benefit conferred on the child. Parents can be wronged if their wishes are ignored and usually those wishes should be considered overriding. Normally, general consent, which need not be fully informed, is needed before a school medical. However, if a child is considered to be in danger of being harmed significantly or suspected to have a major medical condition, a medical should go ahead regardless of the level of consent obtained from the parent, so that a reasonable standard of health is maintained for the child. (shrink)

On May 24, 1999, the Cabinet of Ministers of Ukraine adopted a decree # 883 on the assignment of the Kremenetsky Medical College named after Arsen Riainsky, which states "To accept the proposal of the Ministry of Health, agreed with the Ministry of Education and the Ternopil Regional Administration and the Archbishop of Kremenets The school is named after Arseniy Rychinskiy Kremenets Medical School.

In lieu of an abstract, here is a brief excerpt of the content:Priming and Narrative Habits in the Phenomenological InterviewReflections on a Study of Tourette SyndromeThe author reports no conflicts of interest.In "Dimensions, Not Types: On the Phenomenology of Premonitory Urges in Tourette Syndrome," Lisa Curtis-Wendlandt and Jack Reynolds provide new insights into some of the experiences characteristic of Tourette syndrome (TS). Their study is an excellent example of applied phenomenology (Burch, 2021), combining philosophy and qualitative research methods to illuminate (...) experiences that have often been mischaracterized in the existing literature. In their study, they focus on what is commonly referred to as a "premonitory urge" (PU): the "anticipatory urge that is often thought to precede the onset of the motor and phonic tics that are part of Tourette Syndrome" (Curtis-Wendlandt & Reynolds, 2024, p. 26). They ask not only whether PU is a necessary feature of TS, but also whether the very concept of PU accurately portrays the experiences and behaviors that it's intended to refer to. They point out that existing scales used to assess PU, for example, seem to implicitly narrow the relevant experiences by assuming that they are a) always negative and b) always internal, or inwardly focused (Curtis-Wendlandt & Reynolds, 2024, 26). Curtis-Wendlandt and Reynolds question these in-built assumptions about PU, suggesting that they may provide an overly narrow depiction that misses the genuine diversity of experiences that precede the onset of a motor or phonic tic.To explore these phenomena in more detail, they conducted a study intended to elicit fresh descriptions of these experiences. They interviewed 12 teenagers with a diagnosis of TS about their experiences of ticcing and tic suppression. Using the micro-phenomenological method (Petitmengin, 2006), they asked participants to reflect on a specific tic or tic suppression event and to recall the event in detail. Throughout the interview, [End Page 43] they asked open-ended questions about sensory, cognitive, or affective experiences surrounding the event. Through these interviews, they were able to generate rich descriptions of these experiences and investigate how these descriptions differed from standard accounts in the existing literature.Curtis-Wendlandt and Reynolds provide a detailed account of how they designed their phenomenological study, both philosophically and empirically. However, there is an important aspect of their method that they discuss only in a cursory or implicit way, which is what I want to focus on here. Throughout their study, they were concerned that participants might simply parrot back well-worn medicalized characterizations of PU. Such characterizations risk simplifying or even occluding key aspects of the participants' experiences that might be difficult to reflect upon or describe. However, despite stressing the importance of eliciting fresh descriptions, Curtis-Wendlandt and Reynolds provide only glimpses of how the interviews actually unfolded and what kinds of techniques they used to elicit these descriptions.In my experience, it is quite common to hear phenomenological psychologists and psychiatrists express concern that people may simply repeat common psychiatric or medicalized characterizations of their condition, rather than genuinely reflect upon and describe their first-person experiences. The philosophical assumption is that we all fall back on culturally sedimented language and terminology when describing our experiences. Someone who has spent extended periods of time interacting with psychiatrists and other healthcare professionals, for example, is likely to have picked up common ways of describing their condition—ways that may have helped them receive a diagnosis or obtain treatment. There is nothing inherently wrong with falling into these culturally sedimented characterizations. They facilitate everyday communication through a shared language and terminology. But phenomenologists are often concerned that this kind of culturally sedimented language covers over or obscures the phenomenon or experience they are trying to investigate. For example, if a psychiatrist has often described their patient's depressed mood as "sadness," then that patient may be likely to self-describe their mood as sadness in an interview setting. It might, in fact, be the case that their mood is best described as sadness. But it could also be the case that their mood would be more accurately described as, for instance, a sense of emptiness or feeling deep despair. The challenge is therefore to know whether someone's self-description is... (shrink)

The following text explores performative art works commissioned within a specific “arts and health” cultural setting, namely that of a medical school within a British university. It examines the degree to which the professional autonomy of the artists was “instrumentalized” and diminished as a result of having to fit into normative frames set by institutional agendas. We ask to what extent do such “entanglements,” feel more like “enstranglements,” suffocating the artist’s capacity to envision the world afresh or any (...) differently? What kinds of pressures allow for certain kinds of “evidence” to be read and made visible,? Are You Feeling Better? was a 2016 programme curated by Frances Williams, challenging simplistic expectations that the arts hold any automatic power of their own to make “things better” in healthcare. It included two performative projects – The Secret Society of Imperfect Nurses, by Anthony Schrag with student nurses at Kings College London, and Hiding in Plain Sight by Becky Shaw with doctoral researchers in nursing and midwifery. These projects were situated in a climate of United Kingdom National Health Service cuts and austerity measures where the advancement of social prescribing looks dangerously like the government abnegating responsibility and offering art as amelioration. The text therefore examines the critical “stage” on which these arts-health projects were performed and the extent to which critical reflection is welcomed within institutional contexts, how learning is framed, expressed aesthetically, as well as understood as art practice. It further examines how artistic projects might offer sites of resistance, rejection and mechanisms of support against constricting institutional norms and practices that seek to instrumentalise artistic works to their own ends. (shrink)

Medical ethics has been described as a thread woven into the fabric of the Nottingham curriculum. There exist a wide variety of relevant learning experiences, occurring at intervals throughout each of the five years of the course. The introduction of the students to clinical method from the start creates the need for early consideration of ethical aspects of professional behaviour and this in turn stimulates spontaneous discussion and inquiry amongst the students. The school has chosen to rely on (...) having a sufficient number of medical teachers from various disciplines willing to discuss in all the necessary detail their own clinical decisions. (shrink)

pThis paper examines Nishida Kitarō’s (1870–1945) late essay, “Life,” which develops the process of “world-expression” (世界表現) to situate human and nonhuman agency in ways drawing his thought closer to concerns of posthuman ideals of inter-species commensurability and biosemiotics today. Here he extends his philosophy of a site-specific matrix or basho (場所) so as to incorporate arguments from J. S. Haldane’s emThe Philosophical Basis of Biology/em (1931), which poses questions concerning the coordination of organisms and environments. Nishida finds in Haldane support (...) for his own situating of selves, even engaging questions concerning how animals count as selves./p. (shrink)

Knight has shown how the moral growth of medical students involves a spiritual journey. He may, however, present too sanguine a portrayal of the extent to which the medical education environment promotes this moral and spiritual growth. Medical school may indeed be more abusive than supportive. Admitting more women to medical school and teaching more humanities courses, while worthwhile, will not necessarily promote the goals that Knight appropriately advocates.

IntroductionExtended decision -making through the use of proxy decision -makers has been enshrined in a range of International Codes, Professional Guidance and Statute,For example, the UK Mental Capacity Act section 9.1; The General Medical Council ; the US National Guardianship Association ; Nuffield Council on Bioethics ; CIOMS-WHO section 6. Court cases such as Re Quinlan in the US have also contributed to establishing the groundings for the legal status of the proxy, albeit in terms of who might be (...) suitable as a proxy in cases where there was no clear appointment of them by a still competent individual. and is now widely seen as a useful means through which we can exercise control over decisions that affect our lives when we have lost capacity to make these decisions for ourselves.I will here limit myself to discussion of proxy consent for adults appointed prior to the loss of competence by the person they are acting as proxy for. The issue of p. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Personal Narratives: Parenting Children With Autism Spectrum Disorders Through the Transition to AdulthoodCatherine Cornell, Julie Herren, Susan Osborne, and Kelly WeissTransition years: From Learning, Living and Loving to Maintenance and MediocrityCatherine CornellWhat does every parent of an autistic child worry about the most? For those of us with severely affected children, the answer to that question is: “Who will care for my child and keep her safe when I (...) am gone?”I drove my daughter back to her “group home” for a scheduled drop off on Saturday. There was only one car in the driveway and the house van was gone. Lily was not happy about returning “home.” Agitated, she opened the door to the car, almost before it was stopped, ran to the back of the house, and up the fire escape stairs to the door of her third floor bathroom, as if she was avoiding going through the main living rooms of the house. I called up to her that there was no one at home and she came back down and pushed through the unlocked door. Racing ahead of me, she was already shed of her clothes and in the shower: her self–calming method that she used whenever returning to the house. Thirty minutes later, after three attempts to leave the shower and throwing up in the shower, she dressed and ran back out to our car. I played her favorite music, attempting to calm her anxiety. This transition, from home to “group home,” was increasingly difficult due to recent changes in staff and housemates. Having no one there to greet her was ratcheting up the anxiety level for both of us.When the on–call manager came, Lily was so distraught that I asked for her medications and took her back home with me. Two days later she was calm enough and I was reassured enough to return her to the house. Somehow the house manager made the incident my fault. Perhaps I did react strongly, but on reflection, what triggered the strong reaction in me was the insecurity I felt at finding no one home. It seemed like a breach of trust. Like we were left, abandoned, our plans shattered and at the mercy of fate. Strong emotions for a little mix–up in communications (if that is what it was) but, nevertheless, there it is—how I felt and more to the point how my daughter felt.I relate this story because it illustrates what has changed the most about our lives since Lily left her school and entered the world of adult services: missing is the feeling of trust and security that responsible caring people would keep Lily safe when my husband and I cannot.My 25–year–old daughter Lily has severe autism. She was the most beautiful and easy baby imaginable and appeared to develop normally until she began to lose speech and have night terrors at 15 months of age. She was diagnosed initially with atypical autism, then pervasive developmental disorder not otherwise specified, and finally with autism at age four.From age four to twenty–two, she attended a specialized school for autism where she received age level academics, therapies for speech, and training in self–care and independent living. She did not do well in academics nor did she regain her lost speech. She did learn to care for herself with assistance and, as important, she gained social and behavioral skills and learned to live with others in a social way. She [End Page E1] also learned recreational and vocational skills that would be transferrable to the community, such as bicycle riding, rollerblading, swimming and jogging. The philosophy of her school was to build self–esteem and confidence by teaching music, art and physical skills—in small steps, ensuring success, and then building on those skills.In her last year at school, Lily was a happy and well–adjusted member of her small group of five young women living in a town house with support from trained school staff. She participated in job programs, earning money by recycling and working for Meals–On–Wheels. She went out into the community with her group... (shrink)

This article considers the issues of adaptation and organization of the educational process, barrier-free environment and readiness for professional activity of students with disabilities in inclusive education in conditions of inclusive education in a medical university. The relevance of this work is determined by one of the priority areas of state policy in the field of higher education – access to higher education for people with disabilities in inclusive education. Inclusive education at the university is designed to ensure not (...) only the realization of the right of students with disabilities in inclusive education to higher education, but also to solve the problems of socialization and professional demand for such people. In order to improve the process of introducing inclusive education at the Ryazan State Medical University named after Academician I.P. Pavlov, a study was conducted, the main problems and ways of solving them were identified, related to the organization of the educational process, the conditions of the barrier-free environment and the readiness for professional activity of students with disabilities in inclusive education. An increase in the proportion of university teachers who have undergone advanced training in inclusive education also contributes to solving problems. Adaptation of educational programs and educational and methodological support for persons with disabilities includes psychological, pedagogical and tutor support etc. The organization of the educational process using distance education technologies is one of the priority conditions for teaching students with disabilities and/or HIA. The use of this technology makes it possible to significant-ly expand and modify some educational standards for students with disabilities in inclusive education, namely, to create an individual way for each student with disabilities in inclusive education in a medical university. It is proposed to use training techniques such as: online consultation of teachers; VR technologies; availability of training materials 24/7; online webinars that facilitate the inclusion of such students in the educational and research activities of the university. The professionally organized educational space and educational process of the university provide not only a high level of mastery of professional competencies, but also contribute to the formation of personal qualities of students with disabilities in inclusive education, necessary for their successful socialization, life and activity in society. (shrink)

Spanish influence in the New World was particularly acute in the areas of medicine and medical education. From the time of Columbus forward prominent medical experts journeyed to Latin America establishing medical schools and research centers. This essay chronicles the history of Latin America with a strong focus on the physicians and scientists who brought modern scientific medicine, as it wag then known in Western Europe, to the Americas.

The Toronto experience suggests that there may be several general lessons for academic health sciences complexes to learn from the Olivieri/Apotex affair regarding the ethics, independence, and integrity of clinical research sponsored by for profit enterprises. From a local perspective, the OAA occurred when there already was a focus on the complex and changing relationships among the University of Toronto, its medical school, the fully affiliated teaching hospitals, and off campus faculty because of intertwined interests and responsibilities. The (...) OAA became a catalyst that accelerated various systemic reforms, particularly concerning academic/industry relations. In this article, the evolving governance framework for the Toronto academic health sciences complex is reviewed and these policy and process reforms discussed. These reforms have created collaborative activity among research ethics boards and contract research offices of the partner institutions, and allowed the joint university/hospital ethics centre to play a role in governance and policy, while respecting the missions and mandates of the involved institutions. Although few of the policies are dramatically innovative, what is arguably novel is the elaboration of an overarching governance framework that aims to move ethics to a central focus in the academic complex. Time alone will tell how sustainable and effective these changes are. (shrink)

_What is psychotherapy about?_ _What are the similarities and differences of its many forms?_ _What are the most recent developments in the field?_ _Introduction to Psychotherapy_ has been an essential reference book since its publication in 1979, and is regularly included in reading lists for trainee psychotherapists, psychiatrists and other professionals. It is often recommended to interested lay people and prospective patients. This third edition takes into account recent changes in psychotherapy theory, practice and research. The authors are all psychoanalysts. (...) The first edition arose from the experiences of Dennis Brown and Jonathan Pedder working and teaching together as Consultant Psychotherapists at St Mary's Hospital and Medical School, London. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 11.2 (2004) 165-173 [Access article in PDF] Professional Judgment, Critical Realism, Real People, and, Yes, Two Wrongs Can Make a Right! K.W.M. Fulford Anthony Colombo Keywords values, values-based practice, models of disorder, concept of mental illness, user-centred practice, patient-centred practice, multidisciplinary teamwork We are grateful to our four commentators for putting much-needed conceptual air and space around the models project. Published originally as an (...) empirical study of the different implicit models of disorder, held by users of services, carers, nurses, psychiatrists, and social workers (Colombo et al. 2003), our paper outlined the philosophical roots of the models project in linguistic analytic philosophy of the "Oxford school" (Fulford and Colombo 2004). Our four commentators provide extra dimensions of understanding, respectively from professional education (Williams 2004), sociology (Bendelow 2004), Heideggerian phenomenology (Heginbotham 2004), and mental health policy and practice (Williamson 2004).Since the original study, the models project has been taken forward as a key contribution to a range of philosophy-into-practice initiatives called, collectively, Values-Based Practice. In this brief response, we outline the key features of Values-Based Practice and indicate how these connect with some of the many thoughtful points about models made by our commentators. Values-Based Practice Values-Based Practice, then, is the theory and skills-base for effective health care decision making where different, and hence potentially conflicting, values are in play (Fulford 2004). Premised on the democratic meta-value of equal respect for all voices, Values-Based Practice relies, much as a political democracy relies, on good process rather than preset outcomes for its practical effectiveness. The ten pointers to good process in Values-Based Practice are summarized in Figure 1. We return to the implications of these for the work on models below.Relying on good process may be thought to be a recipe more for relativism and indecision in clinical decision making than for practical effectiveness. To the contrary, however, the 'values democracy' of Values-Based Practice, again like a political democracy, carries a number of clear and coherent implications for policy and practice in health care. [End Page 165] Click for larger viewFigure 1 10 Pointers to Good Process in VBP [End Page 166]Examples of the implications of Values-Based Practice for policy and practice are given in the Values Framework shown in Figure 2. This is a policy framework for the development of Values-Based Practice in mental health produced by a project group in the National Institute for Mental Health in England (NIMHE), the section of the UK's National Health Service (NHS) responsible for implementing government policy on mental health as embodied in the National Service Framework for Mental Health (Department of Health 1999) and subsequent policies. The framework gives three key principles of Values-Based Practice (the three Rs of recognition, raising awareness, and respect) and then summarizes some of the specific implications of the approach. Racism, for example, is incompatible with Values-Based Practice because racism is by definition intolerant of diversity. Again, we indicate some of the policy implications of Values-Based Practice for the points about models made by our commentators below.Training for mental health practitioners in Values-Based Practice will be rolled out from April 2005, through both voluntary and statutory bodies, in each of the eight regions of the National Health Service of England and Wales. This roll out will be supported by training methods developed and piloted in a unique joint venture between Warwick University's Department of Philosophy and Medical School, and an in-service training provider, the Sainsbury Centre for Mental Health (Fulford, Williamson, and Woodbridge 2002; Woodbridge and Fulford 2003). These training methods are the basis of a detailed workbook for Values-Based Practice (Woodbridge and Fulford 2004). The workbook will be launched in July 2004 at a conference in London by the Minister of State with responsibility for mental health, Rosie Winterton. Professional Training and Professional Judgment The models project has been central to the development of... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Philosophy of George Engel and the Philosophy of MedicineJeffrey P. Spike (bio)KeywordsGeorge Engel, psychosocial medicine, medical education, medical humanities, interviewing skills, philosophy of medicine, scientific methodDoctor Brad Lewis has encouraged us to consider George Engel’s philosophy with his excellent essay on Engel and Pragmatism. As a philosopher teaching full time in a medical school, it is refreshing to have an opportunity to analyze the (...) work of two physicians at this level of reflection and abstraction. It is even more of a pleasure because I knew Dr. Engel personally while I was teaching at the University of Rochester School of Medicine. I will make some observations of the philosophy behind Dr. Engel’s work, both published and practical, that is, as reflected in his writing but also in his influence in the medical curriculum at the institution that he called home for some thirty years (as seems appropriate when considering someone’s bona fides as a pragmatist).Engel’s Philosophy and Medicine’s PhilosophyGeorge Engel’s primary philosophical concern was to fight the powerful belief (or perhaps delusion) that medicine was evolving into a pure physical science, an extension of biochemistry and cell biology, or as we would now call them, proteomics and genomics. There is little evidence that he espoused any one methodology for basic science, so much as he opposed any one methodology for medicine. So to say he was a pragmatist seems underdetermined by his words, if that is taken to mean he advocated for changing the methodological model for scientific research. Rather the question is whether his preferred medical methodology is best characterized as pragmatic, or by some other description. On that score I agree with Lewis wholeheartedly.Of course, it might be that the claim of pragmatism is not meant to suggest a change in method for basic science, but to advocate for retaining an appreciation for the whole range of approaches to knowledge, from experimental science to epidemiology, and from epidemiology to acculturation. By that definition of pragmatism, Engel was indeed a pragmatist. Interpreted this way, he wanted medicine to stop worshipping the scientific method and appreciate that there are many paths to knowledge besides through the wet lab.It might be said that there are different scientific methods for different sciences, and Engel wanted us to appreciate that the reductionist methods [End Page 315] appropriate to the sciences of the small are not necessarily methods that can be applied to all sizes of objects we study, or all levels of reality (like the psychological and social). This is the truth about the world, although I am not sure that this is what Engel meant. As Lewis notes, Engel’s writing does sometimes sound as if he worshipped at the alter of science, as if all subjects of importance can be studied scientifically. But if he believed that, he was not correct. It might be, if all the subjects of the university that Lewis mentions are important, that some will turn out to be able to be studied in academically rigorous methods that are not scientific in any of the usual meanings of the word. Consider philosophy itself, for example.To the degree that it may stretch the evidence to say that Engel would have advocated for a pragmatic scientific method, it is still the case that pragmatism as outlined by Lewis and Engel’s biopsychosocial model can both be used to help medicine understand itself and overcome the temptation to idolize science. Medicine is not a science, or at least it is not just a science; in fact, I would suggest that it never was a science, and it will never be a science. Medicine is about health and illness, and uses whatever science it can to promote health and to treat (ameliorate or cure) illness.None of this should necessarily lead us to idolize pragmatism either. If each subject has its own ideal methodology for study, then it may be that pragmatism is the preferred method for, say, clinical judgment, whereas the scientific method is the best for the ‘hard’ sciences, and logic for philosophy. Or perhaps pragmatism and inductive logic are competing models for clinical... (shrink)

Immunisation is offered to all age groups in the UK, but is mainly given to infants and school-age children. Such immunisation is not compulsory, in contrast to other countries, such as the United States. Levels of immunisation are generally very high in the UK, but the rates of immunisation vary with the public perception of the risk of side effects. This article discusses whether compulsory vaccination is acceptable by considering individual cases where parents have failed to give consent or (...) have explicitly refused consent for their children to be immunised. In particular, the rights of: a parent to rear his/her child according to his/her own standards; the child to receive health care, and the community to be protected from vaccine-preventable infectious disease are considered. The conclusion of the article is that compulsory vaccination cannot, with very few exceptions, be justified in the UK, in view of the high levels of population immunity which currently exist. (shrink)

Recent explorations into Sigmund Freud's intellectual development by Frank Sulloway and Lucille Ritvo have directed attention to the significance of evolutionary theory for psychoanalysis. In this paper I shall pursue the exploration by showing how Darwin was received by members of the so-called Helmholtz circle and certain of Freud's teachers in the University of Vienna medical school. I will make the point that the Leibniz–Kant background of these several scientists was important for this reception. I will argue that (...) the Leibniz–Kant tradition came forward to Freud by two roads, Helmholtz's unconscious inference as foundation for a physiology of the senses, and Arthur Schopenhauer's not unrelated uses of the principle of sufficient reason to explain the possibility of lawlikeness in a universe of lawless energies. Finally, I will suggest ways in which Freud received and used the tradition. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:A Report from the Front Lines: Conversations on Public Theology. A Festschrift in Honor of Robert Benne, and: Explorations in Christian Theology and Ethics: Essays in Conversation with Paul L. LehmannJeffrey P. GreenmanA Report from the Front Lines: Conversations on Public Theology. A Festschrift in Honor of Robert Benne Edited by Michael Shahan Grand Rapids, Mich.: Eerdmans, 2009. 184 pp. $30.00.Explorations in Christian Theology and Ethics: Essays in (...) Conversation with Paul L. Lehmann Edited by Philip G. Ziegler and Michelle J. Bartel Farnham, Surrey, UK: Ashgate, 2009. 206 pp. $99.95.The volumes reviewed here each recognize an important thinker in Christian social ethics in America: Robert Benne, emeritus professor of religion at Roanoke College, a Lutheran social ethicist; and Paul L. Lehmann (1906–94), a Presbyterian who was an influential teacher associated with Princeton Theological Seminary, Harvard University Divinity School, and Union Theological Seminary in New York.The first volume honors Benne’s seventieth birthday. His major writings include The Ethic of Democratic Capitalism: A Moral Reassessment (1981), Ordinary Saints: An Introduction to the Christian Life (1988), The Paradoxical Vision: A Public Theology for the Twenty-First Century (1995), Quality with Soul: How Six Premier Colleges and Universities Keep Faith with Their Religious Traditions (2001), and most recently, Good and Bad Ways to Think about Religion and Politics (2010). Since Benne is known for his traditionalist moral views, some unmistakably conservative voices, including a number of prominent Lutherans and neoconservative political thinkers, are represented in this book. The broad theme is public theology, working from Benne’s definition of public theology as “the engagement of a living religious tradition with its public environment—the economic, political, and cultural spheres of our common life.”The book has three parts. The first section, “The Imperative of a Public Theology,” includes essays by editor Michael Shahan, Carl Braaten, Jean Bethke Elshtain, and Richard John Neuhaus. Shahan’s essay provides a helpful exposition of Benne’s intellectual trajectory. Braaten offers a defense of the historic, bodily resurrection of Jesus as the “crux of Christianity’s case.” Elshtain takes [End Page 206] up C. S. Lewis’s concerns in his Abolition of Man (1944) as she diagnoses the “cultural disorder” reflected in current debates about euthanasia and abortion. Neuhaus’s wistful essay looks back over his efforts in the public square, stating that he and Benne have shared a common concern: “A renewal of Christian confidence in providing a morally informed philosophy for a more just and virtuous society in the tradition of liberal democracy” (47). Taken together, these four chapters sketch the assumed intellectual and cultural landscape that sets the context for the volume as a whole.The second section, “The Lutheran Necessity in Public Theology,” begins with a largely autobiographical essay by James Nuechterlein about his journey in Lutheranism and the value of its theological distinctives, especially the famous simul. Next is Gilbert Meilaender’s account (exploring an insight from Kierkegaard) of the place for a Lutheran “corrective” within the wider normative tradition, then Mark Noll’s chapter that underscores the value of robust Lutheran social thinking against the backdrop of the more revivalist and pietist tendencies of Protestant evangelicalism.The final section, “Contested Issues in Public Theology,” includes chapters by Paul Hinlicky, Ronald Thiemann, Gerald McDermott, Donald Schmeltekopf and Michael Beaty, and Joseph Swanson. The chapters by Hinlicky on Luther’s relation to liberal political theory, and by Thiemann on the idea of the public theologian’s prophetic role as “connected critic,” are the most densely argued material in the book. These two essays will probably be of the most interest for scholars in theological ethics. The chapter by McDermott deals with Lutheran church-related colleges. A coauthored essay by Schmeltekopf and Beaty champions the vocation of Christian university education. Swanson situates Benne’s economic writings within neo-conservative thought.The book takes up some of Benne’s favorite themes and interest areas, but only rarely do the authors engage Benne’s own thought. Virtually nowhere do they prod Benne to become clearer, to strengthen his arguments, or to modify his conclusions. I would have preferred a deeper engagement with Benne’s ideas; in several... (shrink)