We write in response to the original article by Rennie and Rudland published in the April 2003 edition of this journal.1 Current and former Dundee Medical School students are concerned at the media misinterpretation of the study and the consequences that this branding of “dishonesty” will have on Dundee Medical School’s reputation and also on individuals embarking on their ….

_This is a personal account based on many years experience as a medical writer. It considers aspects of medical writing with particular focus on the intellectual and ethical dilemmas it can raise. What makes medical writing both so interesting and so challenging is the fact that it often takes place at the border between different disciplines. For example, it straddles both science and art. Ethical issues also arise at the boundaries between academia and commerce. Until (...) recently there have been few guidelines to help navigate such potentially dangerous territory. I have been privileged to be involved in developing two such guidelines and I describe how I hope the Good Publication Practice guidelines for pharmaceutical companies and the European Medical Writers Association guidelines may improve the practice of this fascinating profession, Medical Writing._. (shrink)

"Medical writing tells us a great deal about how the language of science has developed in constructing and communicating knowledge in English. This volume provides a new perspective on the evolution of the special language of medicine, based on the electronic corpus of Early Modern English Medical Texts, containing over two million words of medical writing from 1500 to 1700. The book presents results from large-scale empirical research on the new materials and provides a more (...) detailed and diversified picture of domain-specific developments than any previous book. Three introductory chapters provide the sociohistorical, disciplinary and textual frame for nine empirical studies, which address a range of key issues in a wide variety of medical genres from fresh angles. The book is useful for researchers and students within several fields, including the development of special languages, genre and register analysis, (historical) corpus linguistics, historical pragmatics, and medical and cultural history"--. (shrink)

BackgroundMany authors choose to work with professional medical writers when reporting the results of clinical trials. We conducted a systematic review to examine the relationship between professional medical writing support (PMWS) and the quality, ethics and timeliness of publications reporting clinical trials.MethodsUsing terms related to ‘medical writer’ and ‘observational study’, we searched MEDLINE and Embase (no date limits), as well as abstracts and posters from meetings of the International Society for Medical Publication Professionals (ISMPP; 2014–2018). (...) We also hand-searched the journals Medical Writing and The Write Stuff (2014–2018) and the bibliographies of studies identified in the electronic searches. We screened the results to identify studies that compared the quality, ethics and timeliness of clinical trial publications written with and without declared PMWS.ResultsOur searches identified 97 potentially relevant studies, of which 89 were excluded during screening and full paper review. The remaining eight studies compared 849 publications with PMWS with 2073 articles developed without such support. In these eight studies, PMWS was shown to be associated with increased adherence to Consolidated Standards of Reporting Trials (CONSORT) guidelines (in 3/3 studies in which this was assessed), publication in journals with an impact factor (one study), a higher quality of written English (one study), and a lower likelihood of reporting non-pre-specified outcomes (one study). PMWS was not associated with increased adherence to CONSORT for Abstracts guidelines (one study) or with the impact of published articles (mean number of citations per year, mean number of article views per year and Altmetric score; one study). In studies that assessed timeliness of publication, PMWS was associated with a reduced time from last patient visit in clinical trials to primary publication (one study), whereas time from submission to acceptance showed inconsistent results (two studies).ConclusionsThis systematic review of eight observational studies suggests that PMWS is positively associated with measures of overall quality of reporting of clinical trials and may improve the timeliness of publication.Video abstract. (MP4 161000 kb). (shrink)

The reception of Avicenna by medieval Jewish readers presents an underappreciated enigma. Despite the philosophical and scientific stature of Avicenna, his philosophical writings were relatively little studied in Jewish milieus, be it in Arabic or in Hebrew. In particular, Avicenna's philosophical writings are not among the “Hebräische Übersetzungen des Mittelalters” – only very few of them were translated into Hebrew. As an author associated with a definite corpus of writings, Avicenna hardly existed in Jewish philosophy in Hebrew. Paradoxically, however, some (...) of Avicenna's most distinctive ideas were widely known and embraced by Jewish philosophers. This is the phenomenon that we dub Avicennian knowledge without Avicenna. In contrast with the philosophical treatises, Avicenna's medical writings were widely and intensively studied by Jews, especially in Hebrew, and remained influential until at least the seventeenth century. The present article presents a comprehensive picture of Avicenna's reception within medieval Jewish cultures in both Arabic and Hebrew and tries to explain the Jews’ complex attitude to Avicenna.La réception d'Avicenne par les érudits juifs médiévaux présente une énigme dont on n'a pas encore pris toute la mesure. Malgré la grande stature scientifique et philosophique d'Avicenne, ses écrits philosophiques ont été peu connus des savants juifs, que ce soit en arabe ou en hébreu. Ils n'ont guère fait partie des “Hebräische Übersetzungen des Mittelalters” – peu seulement ont été traduits en hébreu. En tant qu’auteur associé à un corpus de textes, Avicenne n'existe presque pas dans la philosophie juive en hébreu. Paradoxalement cependant, certaines des idées les plus caractéristiques d'Avicenne étaient bien connues et acceptées par des philosophes juifs. Nous appelons ce phénomène savoir avicennien sans Avicenne. Contrairement aux écrits philosophiques, les ouvrages médicaux d'Avicenne, eux, étaient lus et utilisés par les juifs, notamment en traductions hébraïques, et ce jusqu'au xviie siècle. Cet article présente un tableau général de la réception d'Avicenne, en arabe et en hébreu, dans les différentes cultures juives et il tente d'expliquer l'attitude complexe des savants juifs vis-à-vis d'Avicenne.Send article to KindleTo send this article to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle. Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply. Find out more about the Kindle Personal Document Service.AVICENNA AMONG MEDIEVAL JEWS THE RECEPTION OF AVICENNA'S PHILOSOPHICAL, SCIENTIFIC AND MEDICAL WRITINGS IN JEWISH CULTURES, EAST AND WESTVolume 22, Issue 2Gad Freudenthal and Mauro Zonta DOI: https://doi.org/10.1017/S0957423912000033Your Kindle email address Please provide your Kindle [email protected]@kindle.com Available formats PDF Please select a format to send. By using this service, you agree that you will only keep articles for personal use, and will not openly distribute them via Dropbox, Google Drive or other file sharing services. Please confirm that you accept the terms of use. Cancel Send ×Send article to Dropbox To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Dropbox. AVICENNA AMONG MEDIEVAL JEWS THE RECEPTION OF AVICENNA'S PHILOSOPHICAL, SCIENTIFIC AND MEDICAL WRITINGS IN JEWISH CULTURES, EAST AND WESTVolume 22, Issue 2Gad Freudenthal and Mauro Zonta DOI: https://doi.org/10.1017/S0957423912000033Available formats PDF Please select a format to send. By using this service, you agree that you will only keep articles for personal use, and will not openly distribute them via Dropbox, Google Drive or other file sharing services. Please confirm that you accept the terms of use. Cancel Send ×Send article to Google Drive To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Google Drive. AVICENNA AMONG MEDIEVAL JEWS THE RECEPTION OF AVICENNA'S PHILOSOPHICAL, SCIENTIFIC AND MEDICAL WRITINGS IN JEWISH CULTURES, EAST AND WESTVolume 22, Issue 2Gad Freudenthal and Mauro Zonta DOI: https://doi.org/10.1017/S0957423912000033Available formats PDF Please select a format to send. By using this service, you agree that you will only keep articles for personal use, and will not openly distribute them via Dropbox, Google Drive or other file sharing services. Please confirm that you accept the terms of use. Cancel Send ×Export citation Request permission. (shrink)

This article studies the function of the verbs seem and parecer with an evidential meaning in early medical writing in a time span of two centuries. The texts for analysis are excerpted from the Corpus of Early Modern English Medical Texts in the case of English and the Corpus diacrónico del español in the case of Spanish. My hypothesis is that the forms seem and parecer are mainly evidential rather than epistemic, as suggested in the works of (...) Johansson and Aijmer, since they primarily report on the speaker’s role in the formulation of predication. In this sense, the use of seem shows the way in which information has been obtained. Source of knowledge identification and attribution are important in medical prose because writers tend to make manifest that their information is based on demonstrable grounds, including inferential processes. My notion of evidentiality draws on the work of Cornillie and is essentially disjunctive. This means that the association of mode/source of knowledge with varying degrees of certainty and truth does not always take place. This study also allows for cross-cultural and cross-linguistic conclusions in terms of frequency, motivation and use of these evidential verbs in historical texts. (shrink)

Other than the historical writings, the edition of which has yet to begin, Series VIII of the Academy Edition of Leibniz’s writings, presenting his “natural-scientific, medical, and technical” contributions, has been, since the project began in 1923, consistently deemed to be of low priority, and it is only very recently that the project has got fully underway. Coming, as it does, nearer to the end of the edition of the complete works, Series VIII has the advantage of accumulating some (...) of the ‘run-off’ of the philosophical writings, that is, texts of philosophical import that for whatever reason were not initially deemed sufficiently philosophical to be included in Series II or VI. Currently in preparation are the writings on chemistry, hydrology, and other natural sciences. The medical and ‘biological’ manuscripts, identified as ‘LH III’, will be edited likely some years from now.2 On our reading of these manuscripts, all or most are of at least some interest to the scholar of Leibniz’s philosophy. (shrink)

It is better to exist than not to exist. That stage in the ontological argument can apply also to reference works: even if they display no more than a basic competence, their mere existence is extremely welcome. Of few scholarly fields can this be more true than of vernacular scientific writing in medieval England. Like their Latin counterparts, scientific and medical writings in Middle English are often anonymous or bear spurious attributions. They can be securely identified only by (...) incipits. Their sheer mutability defeats traditional editorial techniques. Hence the fundamental need for an approach to the corpus that focuses on individual manuscripts rather than on texts.Scholars of medieval Latin material have long enjoyed the benefits of “TK,” the Catalogue of Incipits of Mediaeval Scientific Writings in Latin , edited by Lynn Thorndike and Pearl Kibre . And they will soon enjoy the yet greater “searchability” of “eTK,” the revision in electronic form promised by its editor, Peter Murray Jones . No medieval vernacular has been comparably served. True, the relatively few scientific writings in Old English have each been studied intensively; and the Anglo‐Norman material has been rescued from oblivion almost single‐handedly by Tony Hunt. But apart from a few major translations from the Latin, the Middle English corpus—far more substantial than the Old English or the Anglo‐Norman—has remained, by comparison, poorly understood, largely because many of the manuscript witnesses have yet to be found and listed, let alone scrutinized.All this is about to change. If the editors of the work under review had merely scratched the surface in their cataloguing they would have earned our warmest thanks. But they have done much more than that. Since 1985, Linda Voigts and Patricia Kurtz have spent some ten years recording information on texts surviving in more than 1,200 manuscripts held in libraries and private collections in fifteen countries. Prologues and “embedded texts” are treated individually. The scope of the project is admirably broad and free of anachronism. To quote the editorial introduction: “We define medieval texts on medicine, science, and technology as those writings found in scientific and medical manuscripts. This is not a circular definition, for these books contain not only texts that are still judged to be medicine and science, but also many other writings considered science and medicine in the Middle Ages but not today [for example, computus and chiromancy].” The result is indexed by incipit, author, title, translator, TK equivalence, manuscript, and subject. Keyword searching of all these indexes, and of the bibliography, is of course easy. Invaluably, an “Index of Raw Data” allows the user to view incipits in the order in which they appear in the manuscripts. Even for a computer semiliterate such as myself, the database proved straightforward to install and navigate. Since it has been so many years in the compiling, its technology and design now seem a little primitive. But both are more than adequate to their task. Overall, this is a magnificent achievement; and, as the corrections and supplements pour in to the editorial office, “eVK” will become even more detailed and comprehensive. Its existence places the entire subject on a new footing. (shrink)

Listening and responding to patients’ stories for over 20 years as an emergency physician has strengthened my appreciation for the many ways that the skills and principles drawn from writing fiction double as necessary clinical skills. The best medicine doesn’t work on the wrong story, and the stories patients tell sometimes feel like first drafts—vital and fragile works-in-progress. Increasingly complex health challenges compounded by social, financial, and psychological burdens make for stories that are difficult to articulate and comprehend. In (...) this essay, I argue that healthcare providers need to think like creative writers and the skills and sensitivities necessary to story construction deserve a vital space in medical education. A thorough understanding of story anatomy and the imaginative flexibility to work stories into open spaces serve as antidotes to the reductive nature of clinical decision making and have implications as patient safety and risk management strategies. The examples that I have selected demonstrate how thinking like a creative writer functions at the bedside, providing tools for clinical excellence and empathy. This approach asks that we re-imagine the importance of story in clinical care: from a vehicle to a diagnosis to its place as a critical destination. (shrink)

This volume reprints in a scholar's edition the first English-language texts on bioethics, John Gregory's (1724-1773) Observations on the Duties and Offices of a Physician and on the Method of Prosecuting Enquiries in Philosophy (London, 1770) and Lectures on the Duties and Qualifications of a Physician (London, 1772). Five previously unpublished manuscripts of Gregory's lectures are also included. An introduction places Gregory's medical ethics and philosophy of medicine in their eighteenth-century contexts of Scottish Enlightenment history and culture, Baconian science (...) and philosophy of medicine, medical practice, the feminine and feminist philosophy of the Bluestocking Circle, and moral sense philosophy, particularly David Hume's concept of sympathy, and provides a bibliography of primary and secondary sources as an aid to teaching and future scholarship. The book's index provides access to Gregory's texts, by using both historical terms and current terminology of bioethics. A volume in the subseries Classics of Medical Ethics. (shrink)

_Any assistance an author receives with writing a scientific article that is not acknowledged in the article is described as ghost-writing. Articles ghost-written by medical writers engaged by pharmaceutical companies who have a vested interest in the content have caused concern after scandals revealed misleading content in some articles. A key criterion of authorship in medical journals is final approval of the article submitted for publication. Authors are responsible for the content of their articles and for (...) acknowledging any assistance they receive. Action taken by some journals and medical writer associations to encourage acknowledgement is an uphill task in the light of disinterest from the pharmaceutical industry and ignorance or similar lack of interest by those who agree to be named authors. However, acknowledgment alone is not sufficient to resolve medical ghost-writing; issues of how the acknowledgement is formulated, permission to acknowledge and access to raw data also need to be tackled._. (shrink)

Narrative analysis, creative writing, and interactive reflective writing have been identified as valuable for professional identity formation and resilience among medical and premedical students alike. This study proposes that medical student blogs are novel pedagogical tools for fostering peer-to-peer learning in academic medicine and are currently underutilized as a near-peer resource for premedical students to learn about the medical profession. To evaluate the pedagogical utility of medical student blogs for introducing core themes in the (...) medical humanities, the authors conducted qualitative analysis of one hundred seventy-six reflective essays by baccalaureate premedical students written in response to medical student-authored narrative blog posts. Using an iterative thematic approach, the authors identified common patterns in the reflective essays, distilled major themes, coded the essays, and conducted narrative analysis through close reading. Qualitative analysis identified three core themes and one overarching theme. The premedical students’ essays demonstrated significant self-reflection in response to near-peer works, discussed their perceptions of medical professionalism, and expressed concerns about their future progress through the medical education system. The essays consistently attributed the impact of the medical student narratives to the authors’ status as near-peers. The authors conclude that reading and engaging in reflective writing about near-peer blog posts encourages premedical students to develop an understanding of core concepts in the medical humanities and promotes their reflection on the profession of medicine. Thus, incorporating online blogs written by medical trainees as narrative works in medical humanities classrooms is a novel pedagogical method for fostering peer-to-peer learning in academic medicine. (shrink)

This paper focuses on sickle cell anemia and thalassemia as case studies of genetic disease in America. Before the 1950s, these two diseases were perceived by many physicians as closely related (indeed, by some, as indistinguishable). Sickle cell anemia was defined by most American physicians as a Mendelian dominant disorder specific to African-Americans. As such, it could be 'spread' by any individual parent 'carrier' through reproduction. This view of the disease fed into (and was supported by) prevalent social concerns about (...) miscegenation and, more generally, the dangers inherent in 'negro blood'. A particularly thorny problem for American physicians was how to explain cases of 'sickle cell anemia in white patients'. The paper examines how views about race, blood, and Mendelian genetics informed broader debates about the nature of hereditary disease and social relations in America from 1910 to 1950. (shrink)

Every healthcare organisation enacts a multitude of policies, but there has been no discussion as to what procedural and substantive requirements a policy writing process should meet in order to achieve good outcomes and to possess sufficient authority for those who are asked to follow it.Using, as an example, the controversy about patient’s refusal of blood transfusions, I argue that a hospital wide policy is preferable to individual decision making, because it ensures autonomy, quality, fairness, and efficiency.Policy writing (...) for morally controversial medical practices needs additional justification compared to policies on standard medical practices and secures legitimate authority for HCO members by meeting five requirements: all parties directed by the policy are represented; the deliberative process encompasses all of the HCO’s obligations; the rationales for the policy are made available; there is a mechanism for criticising, and for evaluating the policy. (shrink)

Purpose: Moral distress occurs when one identifies an ethically appropriate course of action but cannot carry it out. In this conceptualization, medical students may be particularly vulnerable to m...

El término competencias profesionales se define en la actualidad, como la posesión por parte del individuo de los conocimientos, destrezas y actitudes necesarias para realizar su actividad. El actual estudio tiene como objetivo profundizar en el análisis de la literatura sobre las competencias profesionales con un enfoque de formación y desarrollo de la expresión escrita en las universidades médicas. Con la revisión documental, se corroboró que en estas instituciones, el tratamiento de los contenidos de los programas de las asignaturas, no (...) garantizan el desarrollo de las competencias profesionales, atendiendo a que los currículos están diseñados por habilidades lo que trae como resultado que sus egresados no cuenten con el desarrollo adecuado de tales competencias, en particular las que garantizan la práctica afectiva de la expresión escrita. Professional competencies are currently defined as an individual's knowledge, skills and attitudes required to work in a specific profession. The current study aimed to further examine the literature related to professional skills with a focus on the development of writing in medical universities. Through document review, it was confirmed that in these institutions, the syllabi do not ensure the development of professional competencies since curricula are skills based. This in turn hinders the proper development of professional competencies, particularly those that guarantee strong writing practices. (shrink)

Michael Ryan (d. 1840) remains one of the most mysterious figures in the history of medical ethics, despite the fact that he was the only British physician during the middle years of the 19th century to write about ethics in a systematic way. Michael Ryan’s Writings on Medical Ethics offers both an annotated reprint of his key ethical writings, and an extensive introductory essay that fills in many previously unknown details of Ryan’s life, analyzes the significance of his (...) ethical works, and places him within the historical trajectory of the field of medical ethics. (shrink)

As English plays a significant role in most professions, improving the English for Specific Purpose writing competence allows individuals to participate in the global professional community, which makes ESP writing important for research. However, research on ESP writing is reported to be insufficient, and how factors such as emotions affect ESP writing is rarely and marginally studied. Therefore, this study aimed at investigating how induced emotions influence the learning outcome in ESP writing classes with an (...) emphasis on a particular rhetorical choice among medical university undergraduates. A total of 63 medical university undergraduates were recruited. After the emotional inducement, they were taught with materials selected and adopted from the BioCauses corpus and with an explicitly inductive teaching approach. Results revealed that positive emotions positively correlated with better learning outcomes, while negative emotions hindered participants in their learning. The results shed light on the impact of emotional states on ESP/medical research article writing, learning, and teaching. Further study implications were provided accordingly. (shrink)

Personal, creative writing as a process for reflection on patient care and socialization into medicine (“reflective writing”) has important potential uses in educating medical students and residents. Based on the authors’ experiences with a range of writing activities in academic medical settings, this article sets forth a conceptual model for considering the processes and effects of such writing. The first phase (writing) is individual and solitary, consisting of personal reflection and creation. Here, introspection (...) and imagination guide learners from loss of certainty to reclaiming a personal voice; identifying the patient’s voice; acknowledging simultaneously valid yet often conflicting perspectives; and recognizing and responding to the range of emotions triggered in patient care. The next phase (small-group reading and discussion) is public and communal, where sharing one’s writing results in acknowledging vulnerability, risk-taking, and self-disclosure. Listening to others’ writing becomes an exercise in mindfulness and presence, including witnessing suffering and confusion experienced by others. Specific pedagogical goals in three arenas-professional development, patient care and practitioner well-being – are linked to the writing/reading/listening process. The intent of presenting this model is to help frame future intellectual inquiry and investigation into this innovative pedagogical modality. (shrink)

Medical educators recognize the value of reflection for medical students and the role creative writing can play in fostering this. However, direct creative writing tasks can be challenging for many students, particularly those with limited experience in the arts and humanities. An alternative strategy is to utilize an indirect approach, engaging students with structured tasks that obliquely encourage reflection. This paper reports one such approach. We refer to this approach as in-verse reflection, playing on both the (...) structure of the writing and its novel approach to reflection. Students were invited to write, in verse-like structures, about their personal and clinical experiences as medical students. Thematic analysis of their creative outputs and reactions identified four principal themes: the challenges of life as a medical student, the emotional demands of the medical course, a sense of connectedness and solidarity with fellow students, and a sense of marginality within the hospital system. Students generally found the tasks highly engaging and conducive to reflection, producing texts representing significant insights into their experiences as medical students. The reported method offers a relatively simple, structured, and guided approach to reflective writing, adding to the repertoire of methods available to educators in the medical humanities. (shrink)

Star Trek scripts have often grappled with dilemmas of medical ethics. The most explicitly medical-ethics-oriented Star Trek episode is named, aptly enough, “Ethics.” The script was written by Sara Charno and Stuart Charno, authors of two other Star Trek episodes. “Ethics” first aired on 2 March 1992. In the fall of 1992, we began to use this “Ethics” episode to motivate discussions in our first-year medical students’ course on medical ethics and the doctor-patient relationship. We asked (...) students to write essays addressing one of the many ethical dilemmas posed by the episode. Over the years, the episode has become a tradition. Both students and instructors find the formulation of dilemmas in the context of a science-fiction story to be both liberating and stimulating. In this essay, we will discuss this particular episode in some detail and then provide a brief synopsis of other episodes that might be used in ethics courses in a similar way. (shrink)

In order to determine whether there is a significant difference between the medical literature and the surgical literature in terms of their bioethics content, we conducted a computerized search of the MEDLINE database. The journals searched were selected from the 'Medicine' and 'Surgery' sections of the 'Brandon-Hill List', and the search was limited to 1992 issues of these journals. Three hundred and seven bioethics bibliographic records (out of a total of 11,239 articles indexed) were retrieved from the 15 (...) class='Hi'>medical journals searched, while 17 bioethics bibliographic records (out of a total of 2,645 articles indexed) were retrieved from the 12 surgical journals searched. We conclude that there is a statistically significant (p < 0.001) difference between the medical literature and the surgical literature with respect to their quantitative bioethics content. (shrink)

This paper examines medical writing in Karl Philipp Moritz’ Journal of Empirical Psychology by looking at the alterations Moritz made to his sources. It shows how he rearranged the data in order to introduce a new type of text into psychology: the case or case study. He did so by altering the main parts of a report that had been published a few years earlier. In rewriting the report, Moritz introduced not only a new type of text but (...) also a style of reasoning; i.e. the casuistic form of thinking that became more widely acknowledged only later in the course of experiential psychology. The paper thus links writing techniques in psychology to the rise of a type of text and a new style of reasoning. (shrink)

Despite the expansive literature detailing various arguments for or against the use of MANH in caring for the dying and debilitated, the thesis of this paper is that a large part, if not the main thrust, of the debates over MANH have been inadequate and misguided on a number of different levels. The paper hopes to reorient and redirect the debate by attending to the medical history of MANH (part one) and recent medical developments with regard to MANH (...) (part five), examining and contextualizing the earliest debate (i.e. in the 1950s) over MANH among moral theologians (part two), a more recent debate over MANH involving numerous American Catholic bishops (part three), and critically evaluating the types of moral arguments that preoccupy many of those who currently write on the ethics of MANH (part four). (shrink)

ABSTRACTModern medical practice is becoming increasingly pluralistic and diverse. Hence, cultural competency and awareness are given more focus in physician training seminars and within medical school curricula. A renewed interest in describing the varied ethical constructs of specific populations has taken place within medical literature. This paper aims to provide an overview of Islamic Medical Ethics. Beginning with a definition of Islamic Medical Ethics, the reader will be introduced to the scope of Islamic Medical (...) Ethics literature, from that aimed at developing moral character to writings grounded in Islamic law. In the latter form, there is an attempt to derive an Islamic perspective on bioethical issues such as abortion, gender relations within the patient‐doctor relationship, end‐of‐life care and euthanasia. It is hoped that the insights gained will aid both clinicians and ethicists to better understand the Islamic paradigm of medical ethics and thereby positively affect patient care. (shrink)

Ghostwriting in its various forms has received critical scrutiny from medical ethicists, journal editors, and science studies scholars trying to explain where ghostwriting goes wrong and ascertain how to counter it. Recent analyses have characterized ghostwriting as plagiarism or fraud, and have urged that it be deterred through stricter compliance with journal submission requirements, conflict of interest disclosures, author-institutional censure, legal remedies, and journals' refusal to publish commercially sponsored articles. As a supplement to such efforts, this paper offers a (...) critical assessment of medical ghostwriting as contrary to good patient care, on the grounds that it contradicts established general principles guiding clinical ethics. Specifically, I argue that ghostwriting undermines trust relationships between authors and their readers, and between these readers and their trusting patients, and in so doing contradicts the duty of respect for patient autonomy by obstructing informed consent. For this reason, complicity in ghostwriting practices should be understood as a violation of the professional ethical duties of physicians and other healthcare workers. (shrink)

Objectives: After years of public discussion too little is still known about willingness to accept the idea of writing an advance directive among various groups of people in EU countries. We investigated knowledge about and willingness to accept such a directive in cancer patients, healthy controls, physicians, and nursing staff in Germany.Methods: Cancer patients, healthy controls, nursing staff, and physicians were surveyed by means of a structured questionnaire.Results: Only 18% and 19% of the patients and healthy controls respectively, and (...) 10% of the medical staff had written an advance directive. However, 50–81% of those surveyed indicated that they wished to write one. This intention was associated with deteriorating health . Only 29% of the healthy controls and 43% of the patients knew about the possibility of appointing a health care proxy. A majority in all groups believed that advance directives may influence the course of treatment , yet half of those surveyed in all groups fear that patients could be pressurised into writing an advance directive, and 38–65% thought that relatives could abuse such documents.Conclusions: Only a minority of the participants had written an advance directive and knew about the possibility of authorising a health care proxy. Deteriorating health was associated with increasing willingness to make a directive. Despite a majority belief that advance directives may influence treatment at the end of life, other factors limit their employment, such as fear of abuse. (shrink)

CATHOLIC PERSPECTIVES AND CONTEMPORARY MEDICAL MORALS A Catholic perspective on medical morals antedates the current world wide interest in medical and biomedical ethics by many centuries[5]. Discussions about the moral status of the fetus, abortion, contraception, and sterilization can be found in the writings of the Fathers and Doctors of the Church. Teachings on various aspects of medical morals were scattered throughout the penitential books of the early medieval church and later in more formal treatises when (...) moral theology became recog nized as a distinct discipline. Still later, medical morality was incorpor ated into the many pastoral works on medicine. Finally, in the contemporary period, works that strictly focus on medical ethics are produced by Catholic moral theologians who have special interests in matters medical. Moreover, this long tradition of teaching has been put into practice in the medical moral directives governing the operation of hospitals under Catholic sponsorship. Catholic hospitals were monitored by Ethics Committees long before such committees were recommended by the New Jersey Court in the Karen Ann Quinlan case or by the President's Commission in 1983 ([8, 9]). Underlying the Catholic moral tradition was the use of the casuistic method, which since the 17th and 18th centuries was employed by Catholic moralists to study and resolve concrete clinical ethical dilem mas. The history of casuistry is of renewed interest today when the case method has become so widely used in the current revival of interest in medical ethics[ll]. (shrink)

Available from UMI in association with The British Library. ;Typically we maintain two incompatible standards towards right action and good character, and the tension between these polarities creates the paradox of moral luck. In practice we regard actions as right or wrong, and character as good or bad, partly according to what happens as a result of the agent's decision. Yet we also think that people should not be held responsible for matters beyond their control. ;This split underpins Kant's assertion (...) that only the good will is securely good, that its goodness is impervious to outcome ill-luck. Some commentators, such as Martha Nussbaum and to some extent Bernard Williams, think that this simply writes off the paradox. Williams asserts that the paradox is insoluble, and that its inescapability threatens the notion of agent responsibility. In contrast Thomas Nagel argues that agents' most cherished projects may be indeed be subject to luck, but that does not mean that their deepest motivations are moral. This, I suggest, is one of several means whereby we might limit the effect of the paradox without denying that the tension exists. But I also argue that it is wrong to accuse Kant of ignoring the paradox. ;Ethical consequentialists, on the other hand, appear to have no problem with moral luck, because the paradox depends on a dichotomy between the outside world and the locus of moral worth in the individual agent. But this turns out not to be true. The problem of moral luck is not some strange Kantian fixation, but a general dilemma: a variant on what Nagel terms "the problem of excess objectivity" which cuts across all of ethics and metaphysics. ;Retaining a broadly Kantian notion of agent-responsibility, but limiting what agents are responsible for, requires us to delineate the realm of ethics more narrowly than has been done by those who believe that the rational and/or prudential are coterminous with the ethical. This strategy for minimising the paradox's impact is explored in two areas from medical ethics, the allocation of scarce medical resources and informed consent, and two from public policy, secrecy and nuclear deterrence. Throughout, the analysis seeks to test Nagel's maxim that the best we can hope for is to act in such a manner that we would not have to revise our opinion of how we should have acted once the consequences of our actions become apparent. (shrink)

This text explores the border between medical and social problems, the boundary between health and social change. The book studies the body as the mediator between individual and collective experience, finding that many health problems, for example the trauma of violence or depression in the course of chronic pain, are less individual medical problems than interpersonal experiences of social suffering. It argues for an ethnographic approach to moral practice in medicine, one that embraces the infrapolitical context of illness, (...) responses to it, the social institutions relating to it and the way it is configured in medical ethics. (shrink)

The medical record, as a managerial, historic, and legal document, serves many purposes. Although its form may be well established and many of the cases documented in it routine in medical experience, what is written in the medical record nevertheless records decisions and actions of individuals. Viewed as an interpretive text, it can itself become the object of interpretation. This essay applies literary theory and methodology to the structure, content, and writing style(s) of an actual (...) class='Hi'>medical record for the purpose of exploring the relationship between the forms and language of medical discourse and the daily decisions surrounding medical treatment. The medical record is shown to document not only the absence of a consistent treatment plan for the patient studied but also a breakdown in communication between different health professionals caring for that patient. The paper raises questions about the kind of education being given to house staff in this instance. The essay concludes with a consideration of how such situations might be more generally avoided. (shrink)

Looking Beneath the Surface explores Arab-Islamic and Western perspectives on medical ethical issues: genetic research and treatment, abortion, organ donation, and palliative sedation and euthanasia. The contributions in this volume discuss the state of the art, the role of laws, counseling, and spiritual counseling in the decision-making process. The different approaches to the ethical issues, ways of moral reasoning, become clear in these contributions, especially the role of tradition for Islam and the importance of autonomy for the West. Beneath (...) the differences, however, the reader will also discover common values, such as the role of dignity and the value of life, and similar practices. Some of the main differences are sociocultural in nature, rather than religious as such. Well-known experts in the fields of medicine and ethics have contributed to this volume from different religious and secular backgrounds. The book offers a carefully written introduction and final chapter on intercultural comparisons. Looking Beneath the Surface is more than a collection of writings on issues in medical ethics: it helps the reader to compare different paradigms of accountability and moral reasoning. (shrink)

The hematologist-historian author became interested in the nature 'medical miracles', following a request to write a report on a set of bone marrows that was sent to the Vatican as a possible miracle cure in a cause for canonization. She questioned the prevalence of medical miracles, their structure, and relationship to other 'official' miracles that are recognized by the Church. Evidence was drawn from a variety of sources: oral testimony of pilgrims at feast day celebrations, ex voto paintings, (...) and 160 miracle files in 67 canonization records of the Vatican Archives. Some changes can be detected through time, but the results also testify to remarkable longue durée in the healing experience: the patterns of suffering and despair, the gestures of pleading, the presence of beds and dreams, the astonishment of the caregivers, and above all the simultaneous recourse to medicine and religion both. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:John Gregory and the Invention of Professional Medical Ethics and the Profession of Medicine by Laurence B. McCullough, John Gregory’s Writings on Medical Ethics and Philosophy of Medicine ed. by Laurence B. McCullough, Medicine and Morals in the Enlightenment: John Gregory, Thomas Percival and Benjamin Rush by Lisbeth HaakonssenHeiner F. KlemmeLaurence B. McCullough. John Gregory and the Invention of Professional Medical Ethics and the Profession (...) of Medicine. Dordrecht, Boston, London: Kluwer Academic Publishers, 1998. Pp. xv + 347. Cloth, $140.00.Laurence B. McCullough, editor. John Gregory’s Writings on Medical Ethics and Philosophy of Medicine. Dordrecht, Boston, London: Kluwer Academic Publishers, 1998. Pp. xi + 254. Cloth, $105.00.Lisbeth Haakonssen. Medicine and Morals in the Enlightenment: John Gregory, Thomas Percival and Benjamin Rush. Amsterdam, Atlanta: Rodopi, 1997. Pp. x + 247. Paper, $20.50.The Scottish Enlightenment is widely appreciated for its contributions to philosophy, economics, sociology, law, chemistry, and medicine. The ideas and theories advanced by Hume, Smith, Millar, and Ferguson are still widely debated. John Gregory (1724–1773), important in his own time, is not as well known as some of his friends and colleagues. He was professor of medicine at the University of Edinburgh from 1766 to 1773, where he taught introductory lectures on the theory and practice of medicine. A set of extensive student notes from these lectures, entitled Observations on the Duties and Offices of a Physician, appeared anonymously in 1770. Two years later, Gregory himself published a revised version of his lectures under the title Lectures on the Duties and Qualifications of a Physician. These two books are said to mark the beginnings of professional medical ethics in the English-speaking world. They are also sometimes characterized as having anticipated bioethics.McCullough’s comprehensive John Gregory and the Invention of Professional Medical Ethics and the Profession of Medicine is the first modern intellectual biography of Gregory. Based on extensive research into eighteenth-century institutional context and the study of hitherto unknown manuscripts, he gives a full account of Gregory’s education at Edinburgh and Leiden, and his practice and teaching of medicine at Aberdeen, London, and Edinburgh. He stresses the importance of Gregory’s membership in the Aberdeen Philosophical Society and his close contact with Mrs. Montagu and her Circle for the understanding of his medical ethics. McCullough also shows that Bacon’s experimental method had a decisive influence on Gregory. Gregory took over Bacon’s three offices or ends of medicine: preservation of health, prolonging of life, and curing of diseases. In 1772, perhaps anticipating his premature death from hereditary gout, he added a fourth office, namely easing the pain of dying. Gregory referred mainly to Bacon (and Reid) in his Lectures to make clear how we can enlarge our medical knowledge by the method of experience and observation, pointing out that the progress of medicine had been seriously retarded by the way in which it was taught since Hippocrates. He also thought it was handicapped by the view that only professionals [End Page 535] should practice it, and claimed that even quacks have their advantages because their interest and reputation seldom suffer from the failure of the experiments necessary for the improvement of the medical profession.Gregory also argued that we should regard medicine not as a trade but as an art. In this context the principle of sympathy (or humanity) became important for him. Sympathy was the basis of the central duties in his Lectures. In a time of extreme instability of manners, when medicine was regarded more as a trade than an art, there was no physician-patient relationship based on the epistemological and moral authority of the physician. According to McCullough, it was Gregory who created “the physician-patient relationship as fiduciary. The virtues of the physician as fiduciary—openness to conviction, tenderness, and steadiness—provided for him the moral causes that would gather physicians together into a group worthy of the name, ‘profession,’ in its intellectual and moral senses” (265). The physician should no longer view his patients as moral strangers.McCullough claims that Gregory’s medical ethics is not just of historical interest, providing bioethics with its own history. It is also of... (shrink)

BackgroundFrance has long been a country of immigration and in some respects may be seen to have a generous policy with respect to asylum seekers and access to health care for migrants. The French state notably provides healthcare access for undocumented migrants, through state medical aid and since 1998 has had a humanitarian policy for granting temporary residence permits for medical reason (TRPMR) to migrants. Within a context of political debate, reform and tightening immigration control we will examine (...) this latter policy focusing especially on the dilemmas that arise for physicians of migrant patients when they are requested to write medical certificates as part of a TRPMR application. In a 2017 reform the key role of making recommendations on the granting or not of permits was handed over to Ministry of the Interior health inspectors. Recommendations are made after perusal of medical certificates established by the migrant’s physician and complementary evidence.Main bodyThe writing of medical certificates by a physician would seem straightforward. This is far from the case since it raises a number of ethical dilemmas. These occur within a physician-patient relationship embedded within a social contract between the State, the physician and the migrant patient. To clarify the ethical issues arising 3 vignettes based on practice within an infectious disease unit at a large Paris hospital have been developed. The vignettes highlight ethical dilemmas in the care for migrants with tuberculosis (dilemma in defining health and disease), chronic hepatitis (dilemma between beneficence and do not harm), and HIV / AIDS (issue of deservingness). We will go on to reflect on issues of social justice and responsibility for the health of migrants within a globalized world.ConclusionsCriteria for residence permit delivery appear less than clear-cut and are interpreted in a restrictive way. Neither are the consequences of refusing a residence permit taken into account. We call for an empirical transnational ethics study involving countries implementing similar TRPMR policies. We also call for inclusion of lobbying competences into the medical undergraduate curricula, in order to breed future generations of physicians skilled in defending social justice. (shrink)

“The City of the Hospital” is a creative nonfiction writing workshop for medical students, which the author has conducted annually since 2002. Part of the required preclinical Narrative Medicine curriculum at the Columbia University College of Physicians and Surgeons, this six-week intensive workshop includes close readings of literary works and in-class assignments that are then edited by fellow class members and rewritten for final submission. Over the years, students have produced a wide range of compelling essays and stories, (...) and they describe the class as having an effect that lasts throughout their further medical training. This special section includes selected works from class members. (shrink)