In this case-study, I examine examples which fall within the five categories of the re-use of texts in the Nyāya Sūtra, Nyāya Bhāṣya, and Nyāya Vārttika and note the form of quoting and embedment. It is found that the re-use of texts is prominent and that the category and method of embedding the re-used passages varies from author to author. Gautama embeds the most interlanguage quotations without acknowledging his sources and Uddyotakara re-uses the most quotations and paraphrases while acknowledging his (...) sources. Vātsyāyana re-uses the most direct quotations but only acknowledges his sources about half the time. Each author re-uses textual material for two reasons: to demonstrate his authority in this field; and to support his own arguments and to critique objections and opposing theories. Differences crop up in the methodologies of Gautama, Vātsyāyana, and Uddyotakara as the concept of an authority shifts over time, as the body of literature grows, and as new objections and opponents arise. (shrink)

Doctoral programs at U.S. universities play a critical role in the development of human resources both in the United States and abroad. This volume reports the results of an extensive study of U.S. research-doctorate programs in five broad fields: physical sciences and mathematics, engineering, social and behavioral sciences, biological sciences, and the humanities. Research-Doctorate Programs in the United States documents changes that have taken place in the size, structure, and quality of doctoral education since the widely used 1982 editions. This (...) update provides selected information on nearly 4,000 doctoral programs in 41 subdisciplines at 274 doctorate-granting institutions. This volume also reports the results of the National Survey of Graduate Faculty, which polled a sample of faculty for their views on the scholarly quality of program faculty and the effectiveness of doctoral programs in preparing research scholars/scientists. This much-anticipated update of such an essential reference will be useful to education administrators, university faculty, and students seeking authoritative information on doctoral programs. (shrink)

This chapter suggests that Sellars' account of subjectivity as socially constructed, and hence conceptual at its illusory roots, presents a crisp and compelling perspective on cognitive life that captures Buddhist conceptions of transformative non-duality.

In the acquisition of verbal knowledge, the Nyāya school outlines four conditions of a linguistic utterance that must be met: āsatti (temporal proximity), ākāṅkṣā (syntactic expectancy), tātparya (speaker intention), and yogyatā (semantic fitness). I will follow the traditional Nyāya view that is it one of the four necessary conditions that enable a hearer to gain verbal knowledge. The reasoning behind retaining tātparya as a condition (or cause) of verbal knowledge, is that it provides a resource with which to clarify ambiguity (...) when contextual factors cannot. It also provides a context for a hearer so that the primary (abhidhā) or secondary (lakṣaṇā) meaning of the word, or sentence is understood. In this sense, tātparya imparts the meaning of a work. Examples such as “Bring saindhava” or “Hari” make the case for the importance of tātparya in that the meanings of these terms are ambiguous unless the context is provided or the speaker intends to mean one referent rather than another. In this paper, I present the case that tātparya is the most important component of an accurate paraphrase, and it must be retained in order to preserve the original intention of the work. In other words, tātparya should be the primary constraint of an acceptable paraphrase. As a side comment to my aim, I discuss the notion of why paraphrase only needs to be sufficiently similar to the original work. (shrink)

In the Nyāya school of Classical Indian Philosophy, the concept of word meaning is described in detail; however, the theory of metaphor seems to clash with the theory of word meaning. This paper explores the theory of meaning in the early Nyāya theory and whether metaphor is compatible with it. The Nyāya theory of meaning is a 'basis for application' (pravrttinimitta) model: words pick out references because of the conventions and practices of use. Yet, these words can come to refer (...) to something completely different by pushing off its conventional usage and taking on a metaphorical meaning. If the referent is determined on the basis of the properties it possesses, how it is possible that only some properties are applied to a referent in metaphorical cases when, conventionally, a referent must possess all of the properties before the word is applied to it? This paper will investigate three main questions: 1) what is the nature of a referent according to the Nyāya?; 2) what is the mechanism for metaphorical transfer that allow some properties to transfer and not others?; and 3) what are the philosophical implications of the Naiyāyikas understanding of meaning? (shrink)

Best known for his contributions to the development of contemporary intersubjectivity theory, Bernard Brandchaft has dedicated a career to the advancement of psychoanalytic theory and practice. Continually searching for a theoretical viewpoint that would satisfactorily explain the clinical phenomena he was encountering, his curiosity eventually led him to the work of Heinz Kohut and the then-emerging school of self psychology. However, seemingly always one step ahead of the crowd, Brandchaft constantly reformulated his ideas about and investigations into the intersubjective nature (...) of human experiences. Many of the chapters in this volume have never before been published. Together, they articulate the evolution of Brandchaft's thinking along the road toward an emancipatory psychoanalysis. Moreover, commentary from Shelley Doctors and Dorienne Sorter – in addition to Bernard Brandchaft himself – examines the clinical implications of the theoretical shifts that he advocated and provides a contemporary context for the case material and conclusions each paper presents. These theoretical shifts, both clear and subtle, are thereby elucidated to form the grand narrative of a truly visionary psychoanalytic thinker. (shrink)

Star Wars Episode VII: The Force Awakens is not the hero’s journey as George Lucas previously conceptualized it. Instead, the story line of The Force Awakens leads me to believe that it creates a new iteration of the hero myth. It follows the contemporary heroine’s journey while conforming to the essential construct of the hero monomyth. First, the contemporary heroine’s journey focuses primarily on the greater good and secondarily on her own personal journey, which is the converse of the traditional (...) hero’s journey. Second, the contemporary heroine’s self is awakened and called to adventure in a different way than the traditional hero. Third, the traditional hero receives guidance on his journey, while the contemporary heroine pushes ahead alone, striving to save her society from despair. (shrink)

As a Madhyamaka philosopher, Taktsang Lotsawa Sherab Rinchen 1 is perhaps most widely known for his claim to have identified eighteen major contradictions in the thought of Tsongkhapa Losang Drakpa, a polemic discussion that appears in the Madhyamaka chapter of his encyclopedic Freedom from Extremes through Comprehensive Knowledge of Philosophy.2 In this article we will not pursue this critique, both renowned and infamous, but instead focus on Taktsang Lotsawa's own pragmatic hermeneutics of emptiness in context. Taktsang Lotsawa argues that *Svātantrika (...) 3 Mādhyamikas, in their drive to furnish the two... (shrink)

Based on newly discovered texts, this book explores the barely known but tremendously influential thought of the Tibetan Buddhist teacher, Mabja Jangchub Tsöndrü.This Tibetan Buddhist master exercised significant influence on the interpretation of Madhyamaka thinking in Tibet during the formative phase of Tibetan Buddhism and plays a key role in the religious thought of his day and beyond. The book studies the framework of Mabja’s philosophical project, holding it up against the works of both his own Madhyamaka teachers as well (...) as those of central authors of the later "classical period". The emerging account of the evolution of Madhyamaka in Tibet reveals a striking pattern of transformative appropriations. This, in turn, affords us insights into the nature and function of tradition in Tibetan religious culture and Mahāyāna Buddhism at large. Innovation is demanded for both the advancement and consolidation of tradition. This ground-breaking book is an invaluable contribution to the study of Tibetan philosophy. It is of great interest to Buddhist practitioners, specialists in Buddhist philosophy and Tibetan Buddhism. (shrink)

Objective: To evaluate one ethics rounds model by describing nurses’ and doctors’ experiences of the rounds. Methods: Philosopher-ethicist-led interprofessional team ethics rounds concerning dialysis patient care problems were applied at three Swedish hospitals. The philosophers were instructed to promote mutual understanding and stimulate ethical reflection, without giving any recommendations or solutions. Interviews with seven doctors and 11 nurses were conducted regarding their experiences from the rounds, which were then analysed using content analysis. Findings: The goal of the rounds (...) was partly fulfilled. Participants described both positive and negative experiences. Good rounds included stimulation to broadened thinking, a sense of connecting, strengthened confidence to act, insight into moral responsibility and emotional relief. Negative experiences were associated with a sense of unconcern and alienation, as well as frustration with the lack of solutions and a sense of resignation that change is not possible. The findings suggest that the ethics rounds above all met the need of a forum for crossing over professional boundaries. The philosophers seemed to play an important role in structuring and stimulating reasoned arguments. The nurses’ expectation that solutions to the ethical problems would be sought despite explicit instructions to the contrary was conspicuous. Conclusion: When assisting healthcare professionals to learn a way through ethical problems in patient care, a balance should be found between ethical analyses, conflict resolution and problem solving. A model based on the findings is presented. (shrink)

BackgroundMedical ethics has recently seen a drive away from multiple prescriptive approaches, where physicians are inundated with guidelines and principles, towards alternative, less deontological perspectives. This represents a clear call for theory building that does not produce more guidelines. Phronesis (practical wisdom) offers an alternative approach for ethical decision-making based on an application of accumulated wisdom gained through previous practice dilemmas and decisions experienced by practitioners. Phronesis, as an ‘executive virtue’, offers a way to navigate the practice virtues for any (...) given case to reach a final decision on the way forward. However, very limited empirical data exist to support the theory of phronesis-based medical decision-making, and what does exist tends to focus on individual practitioners rather than practice-based communities of physicians.MethodsThe primary research question was: What does it mean to medical practitioners to make ethically wise decisions for patients and their communities? A three-year ethnographic study explored the practical wisdom of doctors (n = 131) and used their narratives to develop theoretical understanding of the concepts of ethical decision-making. Data collection included narrative interviews and observations with hospital doctors and General Practitioners at all stages in career progression. The analysis draws on neo-Aristotelian, MacIntyrean concepts of practice- based virtue ethics and was supported by an arts-based film production process.ResultsWe found that individually doctors conveyed many different practice virtues and those were consolidated into fifteen virtue continua that convey the participants’ ‘collective practical wisdom’, including the phronesis virtue. This study advances the existing theory and practice on phronesis as a decision-making approach due to the availability of these continua.ConclusionGiven the arguments that doctors feel professionally and personally vulnerable in the context of ethical decision-making, the continua in the form of a video series and app based moral debating resource can support before, during and after decision-making reflection. The potential implications are that these theoretical findings can be used by educators and practitioners as a non-prescriptive alternative to improve ethical decision-making, thereby addressing the call in the literature, and benefit patients and their communities, as well. (shrink)

Background Based on the principle of informed consent, doctors are required to fully inform patients and respect their medical decisions. In China, however, family members usually play a special role in the patient’s informed consent, which creates a unique “doctor-family-patient” model of the physician-patient relationship. Our study targets young doctors to investigate the ethical dilemmas they may encounter in such a model, as well as their attitudes to the family roles in informed consent. Methods A questionnaire was developed (...) including general demographic characteristics, the fulfillment of the obligation to fully inform, who will be informed, and the ethical dilemmas in decision-making. We recruited a total of 421 doctors to complete this questionnaire, of which 368 met the age requirements for this study. Cross tabulation and Pearson’s chi-squared test were used to analyze the differences between types of patients for categorical variables, and a p-value < 0.05 was considered statistically significant. Results Our data shows that only 20 doctors (5.40%) stated “informing the patient alone is sufficient” when it comes to informing patients of their serious conditions. The rest of the participants would ensure that the family was informed. When facing elderly patients with decision-making capacity, the data was statistically different (3.8%; P < 0.001) The primary reason for ensuring that family members be informed differs among the participants. In addition, when family members asked doctors to conceal the patient’s medical condition for the best interests of patients, 270 doctors (73.4%) would agree and cooperate with the family. A similar proportion (79.6%) would do so when it comes to elderly patients. Conclusions (1) Chinese doctors pay extra attention to informing the patient’s family, which may not be in the patient’s best interests. (2) Chinese doctors treat adult (but not elderly) patients and elderly patients differently when it comes to informing family members. (3) When family members request that doctors withhold information from patients “in the best interest of the patient,” the majority choose to comply with the request, although this may cause them distress. (shrink)

This important new work surveys the source and ramifications of the famed Nuremburg Code -- recognized around the world as one of the cornerstones of modern bioethics.

As a global and profuse fact, all professions are more or less affected by the rapid penetration of technology in their domain of practice. As the technological capacity progresses, we observe a gradual replacement of human skills by machine-guided procedures. Although such a gradual passage undeniably reduces the human presence in the practice of a profession, the transfer seems not to be a linear process. It has rather a pivoting character, comprising a series of ambivalences and contradictions. Consequently, professionals tend (...) to keep their already acquired knowledge and ability through education and practice, and instead submissively abandon their place to technological tools. From such a perspective, we discuss in this article the strategies of resistance adopted and developed by professionals for keeping their professional power. Among a variety of professions, we choose to focus on medicine and aviation, due to their two fundamental distinctive characteristics: Both have a high degree of technological determination, and accomplishing vital functions. For this purpose, we discuss the strategies of resistance towards technology by professionals, throughout data we gathered from some field research conducted with doctors and pilots. (shrink)

Background Medical ethics deals with the ethical obligations of doctors to their patients, colleagues and society. The annual reports of Sri Lanka Medical Council indicate that the number of complaints against doctors has increased over the years. We aimed to assess the level of knowledge, attitude and practice regarding medical ethics among doctors in three teaching hospitals in Sri Lanka. Methods A hospital-based cross-sectional study was conducted among doctors using a pre-tested self-administered, anonymous questionnaire. Chi Squared (...) test, and ANOVA test were used to identify the significance of association between level of knowledge and selected factors. Results Most doctors had a poor level of knowledge on medical ethics, with postgraduate trainees showing significantly higher level of knowledge. The average knowledge on medical ethics among doctors was significantly different between the three hospitals. Over 95% had a favourable attitude towards gaining knowledge and advocated the need for training. The majority indicated awareness of unethical practices. 24.6% of respondents stated that they get a chaperone ‘sometimes’ during patient examination while 3.5% never do. The majority responded that they never accept gifts from pharmaceutical companies in recognition of their prescribing pattern. 12–41% of doctors participated in the study acknowledged that they ‘sometime’ engaged in unethical practices related to prescribing drugs, accepting gifts from pharmaceutical companies and when obtaining leave. Conclusion Most doctors had a poor level of knowledge of medical ethics. Postgraduate trainees had a higher level of knowledge than other doctors. The majority showed a favourable attitude towards gaining knowledge and the need of training. Regular in-service training on medical ethics for doctors would help to improve their knowledge on medical ethics, as well as attitudes and ethical conduct. (shrink)

Background: Ethics support services are growing in Europe to help doctors in dealing with ethical difficulties. Currently, insufficient attention has been focused on the experiences of doctors who have faced ethical difficulties in these countries to provide an evidence base for the development of these services.Methods: A survey instrument was adapted to explore the types of ethical dilemma faced by European doctors, how they ranked the difficulty of these dilemmas, their satisfaction with the resolution of a recent (...) ethically difficult case and the types of help they would consider useful. The questionnaire was translated and given to general internists in Norway, Switzerland, Italy and the UK.Results: Survey respondents ranged in age from 28 to 82 years, and averaged 25 years in practice. Only a minority reported having access to ethics consultation in individual cases. The ethical difficulties most often reported as being encountered were uncertain or impaired decision-making capacity , disagreement among caregivers and limitation of treatment at the end of life . The frequency of most ethical difficulties varied among countries, as did the type of issue considered most difficult. The types of help most often identified as potentially useful were professional reassurance about the decision being correct , someone capable of providing specific advice , help in weighing outcomes and clarification of the issues . Few of the types of help expected to be useful varied among countries.Conclusion: Cultural differences may indeed influence how doctors perceive ethical difficulties. The type of help needed, however, did not vary markedly. The general structure of ethics support services would not have to be radically altered to suit cultural variations among the surveyed countries. (shrink)

Dealing with situations where parents’ views about treatment for their child are strongly opposed to doctors’ views is one major area of ethical challenge in paediatric health care. The traditional approach focuses on the child’s best interests, but this is problematic for a number of reasons. The Harm Principle test is regarded by many ethicists as more appropriate than the best interests test. Despite this, use of the best interests test for intervening in parental decisions is still very common (...) in clinical settings and can lead to confusion. In this paper, I propose the Zone of Parental Discretion as a means of putting into practice the key ideas of the Harm Principle, in a clear, step-by-step process. The Zone of Parental Discretion provides a tool for ethical deliberation by clinicians and ethicists about all situations in which parents and doctors disagree about treatment of a child, whether parents are refusing medically recommended treatment, or requesting non-recommended treatment. (shrink)

Background We present and discuss the results of a Norwegian survey of medical doctors' views on potential ethical dilemmas in professional practice. Methods The study was conducted in 2015 as a postal questionnaire to a representative sample of 1612 doctors, among which 1261 responded. We provided a list of 41 potential ethical dilemmas and asked whether each was considered a dilemma, and whether the doctor would perform the task, if in a position to do so. Conceptually, dilemmas arise (...) because of tensions between two or more of four doctor roles: the patient’s advocate, a steward of societal interests, a member of a profession and a private individual. Results 27 of the potential dilemmas were considered dilemmas by at least 50% of the respondents. For more than half of the dilemmas, the anticipated course of action varied substantially within the professional group, with at least 20% choosing a different course than their colleagues, indicating low consensus in the profession. Conclusions Doctors experience a large range of ethical dilemmas, of which many have been given little attention by academic medical ethics. The less-discussed dilemmas are characterised by a low degree of consensus in the profession about how to handle them. There is a need for medical ethicists, medical education, postgraduate courses and clinical ethics support to address common dilemmas in clinical practice. Viewing dilemmas as role conflicts can be a fruitful approach to these discussions. (shrink)

How can we ensure that players in the National Football League receive excellent health care they can trust from providers who are as free from conflicts of interest as realistically possible? NFL players typically receive care from the club's own medical staff. Club doctors are clearly important stakeholders in player health. They diagnose and treat players for a variety of ailments, physical and mental, while making recommendations to the player concerning those ailments. At the same time, club doctors (...) have obligations to the club, namely to inform and advise clubs about the health status of players. While players and clubs share an interest in player health—both of them want players to be healthy so they can play at peak performance—there are several areas where their interests can diverge, and the divergence presents legal and ethical challenges. The current structure forces club doctors to have obligations to two parties—the club and the player—and to make difficult judgments about when one party's interests must yield to another's. None of the three parties involved should prefer this conflicted approach. We propose to resolve the problem of dual loyalty by largely severing the club doctor's ties with the club and refashioning that role into one of singular loyalty to the player-patient. The main idea is to separate the roles of serving the player and serving the club and replace them with two distinct sets of medical professionals: the Players' Medical Staff and the Club Evaluation Doctor. We begin by explaining the broad ethical principles that guide us and that help shape our recommendation. We then provide a description of the role of the club doctor in the current system. After explaining the concern about the current NFL player health care structure, we provide a recommendation for improving this structure. We then discuss how the club medical staff fits into the broader microenvironment affecting player health. (shrink)

The use of medical stimulants to sustain attention, augment memory and enhance intellectual capacity is increasing in society. The use of Methylphenidate for cognitive enhancement is a subject that has received much attention in the literature and academic circles in recent times globally. Medical doctors and medical students appear to be equally involved in the off-label use of Methylphenidate. This presents a potential harm to society and the individual as the long-term side effect profile of this medication is unknown.

To be human is to be autonomous, yet this is a trait that most of us lack. We are subject to forces external to our being. We are workers; we are citizens; we are needful creatures. Humanity-proper in these times of neoliberal omnipotence is defined differently. The key terms are familiar: personal betterment, personal responsibility, productivity, pleasantness. A forked tongue slithers in our conscience, tells us that these are the traits of the human condition. Through Bataille, this paper argues the (...) substrate of these oft repeated familiar mantras are other. Neoliberal subjects, propelled by need, understand themselves along the axis of the useful choice. The paper turns to myth to understand the interdependence of need and choice, and how this interdependence posits being as always in desire but never in pleasure. Revisiting Don Giovanni, a character central to Acéphalic thought, and the commentary of Søren Kierkegaard, we think in terms of non-abstraction, of pleasurably floating in change, rather than toiling in desire. For it is by grace in the form of chance, that at the very time of transgression, that we – in and for an instant – become human, become as the sacred in the flesh. (shrink)

Objectives: Young people who are concerned that consultations may not remain confidential are reluctant to consult their doctors, especially about sensitive issues. This study sought to identify issues and concerns of adolescents, and their parents, in relation to confidentiality and teenagers’ personal health information.Setting: Recruitment was conducted in paediatric dermatology and general surgery outpatient clinics, and on general surgery paediatric wards. Interviews were conducted in subjects’ own homes.Methods: Semistructured interviews were used for this exploratory qualitative study. Interviews were carried (...) out with 11 young women and nine young men aged 14–17. Parents of 18 of the young people were interviewed separately. Transcripts of tape recorded interviews provided the basis for a framework analysis.Results: Young women were more concerned than young men, and older teenagers more concerned than younger teenagers, about people other than their general practitioner having access to their health information. Young people with little experience of the healthcare system were less happy than those with greater knowledge of the National Health Service for non-medical staff to access their health information. As they grow older, adolescents become increasingly concerned that their health information should remain confidential.Conclusion: Young people’s willingness to be open in consultations could be enhanced by doctors taking time to explain to them that their discussion is completely confidential. Alternatively, if for any reason confidentiality cannot be assured, doctors should explain why. (shrink)

Artificial intelligent (AI) systems used in medicine are often very reliable and accurate, but at the price of their being increasingly opaque. This raises the question whether a system’s opacity undermines the ability of medical doctors to acquire knowledge on the basis of its outputs. We investigate this question by focusing on a case in which a patient’s risk of recurring breast cancer is predicted by an opaque AI system. We argue that, given the system’s opacity, as well as (...) the possibility of malfunctioning AI systems, practitioners’ inability to check the correctness of their outputs, and the high stakes of such cases, the knowledge of medical practitioners is indeed undermined. They are lucky to form true beliefs based on the AI systems’ outputs, and knowledge is incompatible with luck. We supplement this claim with a specific version of the safety condition on knowledge, Safety*. We argue that, relative to the perspective of the medical doctor in our example case, his relevant beliefs could easily be false, and this despite his evidence that the AI system functions reliably. Assuming that Safety* is necessary for knowledge, the practitioner therefore doesn’t know. We address three objections to our proposal before turning to practical suggestions for improving the epistemic situation of medical doctors. (shrink)

Objectives: To analyse and compare the surveys on German doctors and judges on end of life decision making regarding their attitudes on the advance directive and on the dying process.Design: The respondents were to indicate their agreement or disagreement to eight statements on the advance directive and to specify their personal view on the beginning of the dying process.Participants: 727 doctors in three federal states and 469 judges dealing with guardianship matters all over Germany.Main measurements: Comparisons of means, (...) analyses of variance, pivot tables and factor analyses .Results: Three attitude groups on advance directive were disclosed by the analysis: the decision model, which emphasises the binding character of a situational advance directive; the deliberation model, which puts more emphasis on the communicative aspect; and the delegation model, which regards the advance directive as a legal instrument. The answers regarding the beginning of the dying process were broadly distributed, but no marked difference was observed between the responding professions. The dying process was assumed by most participants to begin with a life expectancy of only a few days.Conclusions: A high degree of valuation for advance directive was seen in both German doctors and judges; most agreed to the binding character of the situational directive. Regarding the different individual concepts of the dying process, a cross-professional discourse on the contents of this term seems to be overdue. (shrink)

Nietzschean Psychology and Psychotherapy describes Nietzsche as an unacknowledged critic of psychology and mental health, bringing out and integrating his teachings about wise living, coping with pain and suffering, and effecting self-change and self-cultivation.

This paper investigates the medical law and ethics learning needs of Foundation doctors by means of a national survey developed in association with key stakeholders including the General Medical Council and Health Education England. Four hundred sevnty-nine doctors completed the survey. The average self-reported level of preparation in MEL was 63%. When asked to rate how confident they felt in approaching three cases of increasing ethical complexity, more FYs were fully confident in the more complex cases than in (...) the more standard case. There was no apparent relationship with confidence and reported teaching at medical school. The less confident doctors were no more likely to ask for further teaching on the topic than the confident doctors. This suggests that FYs can be vulnerable when facing ethical decisions by being underprepared, not recognising their lack of ability to make a reasoned decision or by being overconfident. Educators need to be aware of this and provide practical MEL training based on trainee experiences and real-world ethics and challenge learners’ views. Given the complexities of many ethical decisions, preparedness should not be seen as the ability to make a difficult decision but rather a recognition that such cases are difficult, that doubt is permissible and the solution may well be beyond the relatively inexperienced doctor. Educators and supervisors should therefore be ensuring that this is clear to their trainees. This necessitates an environment in which questions can be asked and uncertainty raised with the expectation of a supportive response. (shrink)

BackgroundThe Mental Capacity Act was enacted in 2007 in England and Wales, but the assessment of mental capacity still remains an area of professional concern. Doctors’ compliance with legal and professional standards is inconsistent, but the reasons for poor compliance are not well understood. This preliminary study investigates doctors’ experiences of and attitudes toward mental capacity assessment.MethodsThis is a descriptive, cross-sectional study where a two-domain, study-specific structured questionnaire was developed, piloted and digitally disseminated to doctors at differing (...) career stages employed in a large, multi-site National Health Service Trust in London over 4 months in 2018. Descriptive statistics and frequency tables adjusted for missing data were generated and secondary analysis was conducted.ResultsParticipants were predominantly UK trained, female and between the ages of 30 and 44 years. Less than half of the participants reported receiving formal MCAx training. Only one-third of the participants self-rated themselves as very competent or extremely competent. Self-reported MCA confidence was significantly affected by career stage with Consultants with over 10 years of experience reporting lowest confidence.ConclusionsThis study describes significant variation in practice by doctors and low self-confidence in the practice of MCAx. These results raise concerns that MCAx continues to be inconsistently performed by doctors despite appropriate awareness of the law and professional guidance on best practice. (shrink)

Defensive medicine is defined as a doctor’s deviation from standard practice to reduce or prevent complaints or criticism. The objectives of this study were to assess the prevalence of the practice of defensive medicine in the UK among hospital doctors and the factors affecting it.

Background The aim of the study is to assess the knowledge, attitudes and practices among healthcare professionals in Barbados in relation to healthcare ethics and law in an attempt to assist in guiding their professional conduct and aid in curriculum development. Methods A self-administered structured questionnaire about knowledge of healthcare ethics, law and the role of an Ethics Committee in the healthcare system was devised, tested and distributed to all levels of staff at the Queen Elizabeth Hospital in Barbados (a (...) tertiary care teaching hospital) during April and May 2003. Results The paper analyses 159 responses from doctors and nurses comprising junior doctors, consultants, staff nurses and sisters-in-charge. The frequency with which the respondents encountered ethical or legal problems varied widely from 'daily' to 'yearly'. 52% of senior medical staff and 20% of senior nursing staff knew little of the law pertinent to their work. 11% of the doctors did not know the contents of the Hippocratic Oath whilst a quarter of nurses did not know the Nurses Code. Nuremberg Code and Helsinki Code were known only to a few individuals. 29% of doctors and 37% of nurses had no knowledge of an existing hospital ethics committee. Physicians had a stronger opinion than nurses regarding practice of ethics such as adherence to patients' wishes, confidentiality, paternalism, consent for procedures and treating violent/non-compliant patients (p = 0.01) Conclusion The study highlights the need to identify professionals in the workforce who appear to be indifferent to ethical and legal issues, to devise means to sensitize them to these issues and appropriately training them. (shrink)

Through an analysis of two sets of writing in the British Medical Journal from the 1980s, this article explores relationships between unemployment and health. “Unemployment in My Practice,” published in 1981, was a series of nine short essays by general practitioners from across the United Kingdom. This was followed by “Occupationless Health” in 1985, made up of fourteen essays, composed by the assistant editor of the journal, Dr. Richard Smith. Both series demonstrate how deeply frustrating it was for doctors (...) to confront mass unemployment in light of the policy decisions of the Thatcher government. They present a call to medical practitioners to be aware of the health dimensions of unemployment and a growing sensitivity to the lives of working-class patients. Rich with perceptions about the relationships among work, gender, class, age, and health, these essays argue that unemployment was not just an economic problem, but one doctors needed to monitor. Doctors found their professional identities shaped in new ways by their broader economic and cultural contexts. (shrink)

Glenn Cohen, Holly Fernandez Lynch, and Christopher Deubert are right in their article “A Proposal to Address NFL Club Doctors’ Conflicts of Interest and to Promote Player Trust” that the problem with the medical care rendered to National Football League players is not that the doctors are bad, but that the system in which they provide care is structured badly. We saw some of the problems this system causes last season in what happened to Case Kenum, a quarterback (...) for the Los Angeles Rams who, despite having a possible concussion from a game injury, was allowed to continue to play, with a concussion spotter in the booth and coaches, teammates, seven game officials, and two full training staffs present. From my experience playing in the league from 1989 to 1999, I do not believe that you can eliminate the conflict of interest completely, but I think it can be limited to the point that it does not harm the player. As the structure is now, with the team paying the club doctor, it is impossible to put the players’ health and well-being before the team's on-field priorities. (shrink)

OBJECTIVES: To study empirically whether ethical theory (from the mainstream principles-based, virtue-based, and feminist schools) usefully describes the approaches doctors and nurses take in everyday patient care. DESIGN: Ethnographic methods: participant observation and interviews, the transcripts of which were analysed to identify themes in ethical approaches. SETTING: A British old-age psychiatry ward. PARTICIPANTS: The more than 20 doctors and nurses on the ward. RESULTS: Doctors and nurses on the ward differed in their conceptions of the principles of (...) beneficence and respect for patient autonomy. Nurses shared with doctors a commitment to liberal and utilitarian conceptions of these principles, but also placed much greater weight on relationships and character virtues when expressing the same principles. Nurses also emphasised patient autonomy, while doctors were more likely to advocate beneficence, when the two principles conflicted. CONCLUSION: The study indicates that ethical theory can, contrary to the charges of certain critics, be relevant to everyday health care-if it (a) attends to social context and (b) is flexible enough to draw on various schools of theory. (shrink)

Nurses need to adapt to various interactional situations and design their talk for different recipients. One essential communicative task for nurses is to transmit information on test and measurement results both to the patient and to the physician. This article examines how nurses design their talk on numerical values according to the recipient and the activity. The nurse can deliver the information either plainly through numbers or by formulating some type of qualitative description of the value. The data consist of (...) 7.5 hours of video-recorded interaction in a Finnish hospital. Using conversation analysis, we demonstrate how the institutional roles and the ongoing activity sequence affect how nurses formulate their talk. When nurses discuss results with their patients, they typically use qualitative descriptions, whereas when they talk with doctors, the typical turn involves numeric information. It will be demonstrated that nurses construct their professional identity involving both care and medical expertise through their linguistic-interactional choices. (shrink)

There is an extensive ethical debate regarding the justifiability of doctors nudging towards healthy behaviour and better health-related choices. One line of argument in favour of nudging is based on empirical findings, according to which a healthy majority among the public support nudges. In this paper, we show, based on an experiment we conducted, that, in health-related choices, people’s ethical attitudes to nudging are strongly affected by the point of view from which the nudge is considered. Significant differences have (...) been found between doctors’ ethical attitude to clinical nudging and that of patients. We show how these differences weaken the argument for nudging from public support. Moreover, our findings raise concerns regarding doctors’ ability to nudge ethically according to their own standards, as they may underestimate the degree of harm medical nudges can cause to informed consent, doctor–patient trust and other important ethically relevant features of health-related choices. (shrink)

When a patient could be offered one of multiple established treatments, doctors should be able to offer treatment only if the patient agrees to participate in research aimed at determining which of the treatments is most effective. Making treatment conditional on research participation will help researchers complete badly needed studies.