Novel Medicine: Healing, Literature, and Popular Knowledge in Early Modern China. By Andrew Schonebaum. Seattle: University of Washington Press, 2016. Pp. viii + 283. $50.

This article presents a brief general view of the recent literature and the scholarly activity in the field of philosophy of medicine in Scandinavia. The focus of attention is not on medical ethics, but on studies on topics like decision theory, medical classification, causality, causal explanations, concept formation, and on analyses of different ideals of medical science and clinical practice. A few principal works on medical ethics are mentioned by way of introduction and a brief account of a (...) highly topical debate on the legislation on artificial insemination in Sweden is given at the end. (shrink)

This essay is an attempt to plumb the conventions which exist at a specific historical moment in both the aesthetic and scientific spheres. I will assume the existence of a web of conventions within the world of the aesthetic—conventions which have elsewhere been admirably illustrated—but will depart from the norm by examining the synchronic existence of another series of conventions, those of medicine. I do not mean in any way to accord special status to medical conventions. Indeed, the world (...) is full of overlapping and intertwined systems of conventions, of which the medical and the aesthetic are but two. Medicine offers an especially interesting source of conventions since we do tend to give medical conventions special “scientific” status as opposed to the “subjective” status of the aesthetic conventions. But medical icons are no more “real” than “aesthetic” ones. Like aesthetic icons, medical icons may iconographic in that they represent these realities in a manner determined by the historical position of the observers, their relationship to their own time, and to the history of the conventions which they employ. Medicine uses its categories to structure an image of the diversity of mankind; it is as much at the mercy of the needs of any age to comprehend this infinite diversity as any other system which organizes our perception of the world. The power of medicine, at least in the nineteenth century, lies in the rise of the status of science. He conventions of medicine infiltrate other seemingly closed iconographic systems precisely because of this status. In examining the conventions of medicine employed in other areas, we must not forget this power.One excellent example of the conventions of human diversity captured in the iconography of the nineteenth century is the linkage of two seemingly unrelated female images—the icon of the Hottentot female and the icon of the prostitute. In the course of the nineteenth century, the female Hottentot comes to represent the black female in nuce, and the prostitute to represent the sexualized woman. Both of these categories represent the creation of classes which correspondingly represent very specific qualities. While the number of terms describing the various categories of the prostitute expanded substantially during the nineteenth century, all were used to label the sexualized woman. Likewise, while many groups of African blacks were known to Europeans in the nineteenth century, the Hottentot remained representative of the essence of the black, especially the black female. Both concepts fulfilled an iconographic function in the perception and the representation of the world. How these two concepts were associated provides a case study for the investigation of patterns of conventions, without any limitation on the “value” of one pattern over another. Sander L. Gilman is professor of Humane Studies in the Department of German Literature and Near Eastern Studies and professor of Psychiatry in the Cornell Medical College, Cornell University. He is the author or editor of numerous studies of European cultural history with a focus on the history of stereotypes. In addition, he has coedited Degeneration with J. E. Chamberlin. His study Jewish Self-Hatred is forthcoming. (shrink)

This report explores the relationship between philosophy and medicine in the Netherlands. In Section 1 we outline the ups and downs of medico-philosophical research in our country: pre-war flourishing, post-war decline, and modern renaissance. In Section 2 we review recent Dutch literature in the philosophy of medicine. The topics dealt with include methodology of medical science, alternative medicine, the basic concepts of medicine, anthropological medicine, medicalization, medicine and culture, and health care ethics.

There has been a move in medicine towards patient-centred care, leading to more demands from patients for particular therapies and treatments, and for wish-fulfilling medicine: the use of medical services according to the patient's wishes to enhance their subjective functioning, appearance or health. In contrast to conventional medicine, this use of medical services is not needed from a medical point of view. Boundaries in wish-fulfilling medicine are partly set by a physician's decision to fulfil or decline (...) a patient's wish in practice. In order to develop a better understanding of how wish-fulfilling medicine occurs in practice in The Netherlands, a qualitative study (15 semistructured interviews and 1 focus group) was undertaken. The aim was to investigate the range and kind of arguments used by general practitioners and plastic surgeons in wish-fulfilling medicine. These groups represent the public funded realm of medicine as well as privately paid for services. Moreover, GPs and plastic surgeons can both be approached directly by patients in The Netherlands. The physicians studied raised many arguments that were expected: they used patient autonomy, risks and benefits, normality and justice to limit wish-fulfilling medicine. In addition, arguments new to this debate were uncovered, which were frequently used to justify compliance with a patient's request. Such arguments seem familiar from conventional medicine, including empathy, the patient–doctor relationship and reassurance. Moreover, certain arguments that play a significant role in the literature on wish-fulfilling medicine and enhancement were not mentioned, such as concepts of disease and the enhancement–treatment dichotomy and ‘suspect norms’. (shrink)

Cette étude s’intéresse à la période 1760-1800. Elle porte sur les rapports entre d’une part les représentations médicales et littéraires de la sexualité féminine post-pubertaire, et d’autre part le sentiment de « dégradation culturelle » nourri par de nombreux lettrés de l’époque – un sentiment qui recoupe à la fois l’idée d’une dégénérescence de la race et celle d’une décadence des mœurs entraînées par les raffinements excessifs de la société contemporaine. Mary McAlpin défend la thèse selo...

I recently taught an upper-division Honors class in Medicine and Literature with students ranging from a pre-physician’s assistant student and nursing student to English, French, History, and Technical Writing majors. The common thread connecting these students initially was their self-described fear of and helplessness with poetry. However, as the semester drew to a close, their class discussion and journals revealed not only increased comfort with poetry but also a preference for it. The information and insight they got from (...) poetry, they said, were the reason they took a medical humanities course in the first place and commented that the poetry we read provoked more substantial “medicine and literature” discussions than prose. Poetry provides a good starting place to analyze complex human relationships, and the focus on language and form levels the intellectual playing field: students are all unfamiliar with how to do it and are learning a new skill together. This could be accomplished, of course, with a literary short story, but for the diverse population of students in this class, the brevity of poetry made it all the more appealing. (shrink)

From governments to the general public, one may ask about the possible contributions of historians, if any, to the understanding and management of global disasters, as e.g. the ongoing coronavirus disease 2019. Given the confuse situation at the onset of the pandemic in terms of diagnosis, treatment, and prevention, a look into past experience with nonconventional medicine seemed relevant. In the present study I surveyed secondary literature on the role of Chinese medicine, Āyurveda, and homeopathy over time. (...) The quantitative results were disappointing: nothing on Āyurveda, and one single study each on Chinese medicine and homeopathy. The quality of the former compensates for the numerical short age. The case of homeopathy is rather sui generis, since this medical system was born and blossomed during epidemics and pandemics. I conclude with a short comment on reference sources, which might serve as point of departure for future studies of Āyurveda in epidemics. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 10.2 (2000) 175-188 [Access article in PDF] Scope Note 38 Bioethics Resources on the Web * Once described as an "enormous used book store with volumes stacked on shelves and tables and overflowing onto the floor" (Pool, Robert. 1994. Turning an Info-Glut into a Library. Science 266 (7 October): 20-22, p. 20), Internet resources now receive numerous levels of organization, from basic directory listings (...) to elaborate "links" (cross-references to other Internet documents) that flash and glow in the dark. In many ways, the Internet functions as a direct extension of the traditional library. Following linked references across various sites is an electronic version of browsing library stacks, and the serendipitous discoveries made while "surfing the Net" recall the wonders of physically going "book-to-book." Although many of the Internet's best aspects augment library strengths by eliminating physical distance from sources, Net resources pose unique problems for researchers. It is not always clear who is responsible for the content of Web documents, when the document was produced, or how often (if ever) it is updated. Internet resource tools, then, must enable researchers to identify appropriate resources and to evaluate what they find when they get there. Web Research as Taking "Snapshots" Given the Internet's visual nature and fluid content, the process of conducting research on the Web has been likened to taking an informal picture of information on a specific date at a particular time. This metaphor also conveys the "zoom-in" aspect of searching through Web pages by going from general to specific categories. In the first section of this Scope Note, National Reference Center for Bioethics Literature (NRCBL) staff present a snapshot of bioethics resources taken during the spring months of 2000. Entries are divided into the categories of directories, electronic journals, full-text documents, news/current awareness, and teaching resources. In the two subsequent sections, this series of categories is repeated for entries on a specific topic within bioethics-genetics-and again for general search and evaluation tools. Where a Web site may contain pages applicable [End Page 175] to more than one category, multiple entries are made for that site with appropriate information for each category.Much as telecommunication advances have strengthened the relationship of patients and providers as partners, the dynamic nature of the Internet acknowledges that the researcher functions as a librarian whenever accessing the Web. It is our hope that BIOETHICSLINE and the other NRCBL databases not only will enable researchers to search the Web more efficiently, but also will help them to evaluate what they find when they get there. Bioethicsline on the Web: An International Plan in Progress Once only available through libraries, the U.S. National Library of Medicine (NLM), the funding agency for the ongoing development of the BIOETHICS LINE® database from the Kennedy Institute, has provided free Web access to that database of 63,000 citations since September 1998 through Internet Grateful Med. Plans are now underway to eliminate such specialty databases and incorporate all citations into PubMed (for journal articles) or LOCATORplus (for book-like materials and chapters in books). Both of these databases are likewise available at no cost on the Web. In the transition to PubMed and LOCATORplus some features of BIOETHICSLINE that presently are available may be lost. Researchers are encouraged to contact the National Reference Center for Bioethics Literature with search requests or for search strategy assistance with either the current or the future system ([email protected]).The inclusion of bioethics citations in PubMed and LOCATORplus will have several advantages. First, unique keywords from the Bioethics Thesaurus will be considered for inclusion in Medical Subject Headings (MeSH), the indexing vocabulary for PubMed and LOCATORplus, thereby enhancing retrieval of relevant clinical literature by offering more precise terminology covering ethical issues. Second, it will be easier to identify foreign-language materials, which are not currently included in the scope of BIOETHICSLINE. Third, the updating schedule will become more frequent. On the other hand, there may be some loss of searching precision because certain specialized features... (shrink)

The volume examines the interrelationships between the history of medicine and literature from the 17th until the 19th centuries. The papers in the volume analyse these interrelationships using the styles of medical and literary texts, which show how the dimensions of knowledge and of representation determine each other – for example in the case of narrative structures in medical case histories or a diagnostic narrative stance in a novel.

The medical literature in Rome firstly lives on Greek scientific works, because Latin language, inappropriate for speculative matters, couldn’t be succeeded to express the grandiosity and precision of the subject. So, Roman medicine assimilates the Greek medical culture. Roman doctors dedicate themselves to a public hygiene, prudently systematizing practice and concrete knowledge of other cultures. Pliny, the elder writes a work untitled Natural History, composed in thirty seven books, and interests us most those dedicated to medicine, its (...) history and dissemination among ancient people, up to its arrival and reception in Rome, at the first century. (shrink)

Evidence-Based Medicine (EBM) developed from the work of clinical epidemiologists at McMaster University and Oxford University in the 1970s and 1980s and self-consciously presented itself as a "new paradigm" called "evidence-based medicine" in the early 1990s. The techniques of the randomized controlled trial, systematic review and meta-analysis have produced an extensive and powerful body of research. They have also generated a critical literature that raises general concerns about its methods. This paper is a systematic review of the (...) critical literature. It finds the description of EBM as a Kuhnian paradigm helpful and worth taking further. Three kinds of criticism are evaluated in detail: criticisms of procedural aspects of EBM (especially from Cartwright, Worrall and Howick), data showing the greater than expected fallibility of EBM (Ioaanidis and others), and concerns that EBM is incomplete as a philosophy of science (Ashcroft and others). The paper recommends a more instrumental or pragmatic approach to EBM, in which any ranking of evidence is done by reference to the actual, rather than the theoretically expected, reliability of results. Emphasis on EBM has eclipsed other necessary research methods in medicine. With the recent emphasis on translational medicine, we are seeing a restoration of the recognition that clinical research requires an engagement with basic theory (e.g. physiological, genetic, biochemical) and a range of empirical techniques such as bedside observation, laboratory and animal studies. EBM works best when used in this context. (shrink)

Ayahuasca is a psychoactive traditional plant medicine preparation used by the indigenous tribes of the Upper Amazon in their shamanic traditions. Its use has become popular amongst Westerners seeking alternative means of healing, and the medicine has now spread across the globe via syncretic spiritual healing traditions such as the Santo Daime Church. Despite the increased use of the medicine, little research exists on its effectiveness for healing depression. The existing literature does not contain a detailed (...) self-reported phenomenological account of ayahuasca healing a case of depression. The aim of this paper is to share a personal account of healing depression using ayahuasca in a Santo Daime ritual in Johannesburg, South Africa. This experience was unplanned and unexpected and resulted in a profoundly transformative healing process. Based on my experience, I describe ayahuasca’s ingestion as having created a powerful mind-body-spirit connection that resulted in what appeared and felt like a profound reconfiguration of the bio-electrical energy system in my body and a powerful anti-depressant action on my mind. These effects were catalyzed by a strong intention to heal and trust in and take responsibility for myself. Other South African Santo Daime members have reported healing of depression with ayahuasca, although in longer and different processes. It appears that the medicine engages the individual’s unique collective self (life-history, physical and mental disposition, beliefs and intents) resulting in different outcomes for different individuals. Thus, from my own and others’ experience, I describe ayahuasca as a spiritual medicine; one that promotes enhanced awareness and deeper connection to one’s core self, to others and the greater universe, while facilitating the manifestation of one’s intentions and beliefs. This encounter with ayahuasca provided me a first-hand experience of learning and healing from the medicine, making real to me the indigenous Amazonian description of plants as being teachers and doctors. (shrink)

This essay examines historical and contemporary connections between Buddhist and medical traditions through a study of the Accomplishing Medicine ( sman sgrub ) practice and the Yuthok Heart Essence ( G.yu thog snying thig ) anthology. Accomplishing Medicine is an esoteric Buddhist yogic and contemplative exercise focused on several levels of “alchemical” transformation. The article will trace the acquisition of this practice from India by Tibetan medical figures and its assimilation into medical practice. It will propose that this (...) alchemical practice forms the central nexus of connection between Tibetan medicine and the Buddhist Nyingma tradition, and that this little-studied link is not a marginal feature of Tibetan medicine but rather one that has had a significant shaping factor on each tradition throughout history. (shrink)

The use of metaphors and analogies was widespread in English political literature during the sixteenth and early seventeenth centuries, and for contemporary readers they were more than merely rhetorical artifices – they were used to illustrate and, in some cases, even to provide evidence. In this regard, none was more apt than the most prominent of these analogies: that between the human body and the state. The political thought of the time established an unshakeable connection between the two, building (...) an argument for how their structures and ways of functioning mirrored each other. This paper examines one of the most extensive and thorough examples of corporal analogies in early modern English political literature – that of Edward Forset’s A Comparative Discourse of the Bodies Natural and Politique (1606) – and shows how such corporal analogies were used to construct an absolutist political model wherein the king was depicted as the soul, the head and the heart of the body politic. The paper integrates Forset’s A Comparative Discourse within the context of the ideological struggles from the end of the sixteenth century and the beginning of the seventeenth, while its place within the larger picture of the medieval and early modern metaphor of the body politic is also examined, in order to assess the lineage and originality of Forset’s ideas and point out how the same kind of analogies could be used to provide significantly different political interpretations. (shrink)

This is a review of the literature in the philosophy of medicine published in China from 1930 to 1980. The topics dealt with include the relationship between medicine and philosophy, the basic concepts of medicine, etiology and causality, the bearing of psychology on physiology and pathology, epistemology in diagnostics, methodology of medical sciences, philosophical and methological problems in traditional Chinese medicine, philosophical problems in health policy, and medical ethics.

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

This article presents the results of a rigorous critical interpretive review that maps the current literature on phronesis in medicine. The literature in this area involves varied disciplines, centuries, and conceptions and is extensive, but through a focused review, this study seeks to clarify definitions and key distinctions. It thereby aims to elucidate a depth of meaning and understanding regarding phronesis in medicine to inform future work on the topic. Specifically, 12 themes are inductively identified and (...) analyzed from the literature, and organized into three chronological categories of past, present, and future. A narrative summation of the literature to date is then offered, assessing the varied conceptual applications of phronesis to medical practice, the emerging literature on its applicability to organizations, prospects for empirical work on the concept, and its application in medical education. (shrink)

There are various ways in which medicine and literature interact, but this paper concentrates on the contribution which literature can make to 'whole person understanding'. Scientific understanding is concerned with seeing events and actions in terms of patterns or similarities. But 'whole person understanding' is concerned with uniqueness or with what it is for a given person to have an illness. Literature can in various ways develop this kind of understanding.

This book contains the results of two European/American preparatory workshops for the First World Conference on Ethics Codes in Medicine and Biotechnology (October 1997, Freiburg, Germany) supported by the leading national institutions in the field. It aims to stimulate research about codes, the effects of codification and other forms of implementing ethics. It breaks new ground with interdisciplinary and international discourse on the subject, emphasising the need for a complete collection of codes for systematic research and evaluation and filling (...) the gap in literature on the subject to date. (shrink)

BackgroundDefensive medicine (DM) practice refers to the ordering or prescription of unnecessary treatments or tests while avoiding risky procedures for critically ill patients with the aim to alleviate the physician’s legal responsibility and preserve reputation. Although DM practice is recognized, its dimensions are still uncertain. The subject has been highly investigated in developed countries, but unfortunately, many developing countries are unable to investigate it properly. DM has many serious ramifications, exemplified by the increase in treatment costs for patients and (...) health systems, patients’ exposure to risks, and negative effects on the psychological health of both health providers and recipients. Ultimately, the most serious consequence is the ethical consequences.MethodsThis work is based on a review of the literature related to DM worldwide and a comparison with the available knowledge found in Jordan. It is qualitative with a descriptive nature, aiming to diagnose the current DM practice in Jordan.ResultsThis is the first published article that discusses DM in Jordan by diagnosing its ethical and economic consequences for the health system as well as for patients. Despite the knowledge of the reasons that support its practice, little is being done to solve this issue. The absence of agreeable medical malpractice law, the dearth of unified medical protocols, the overwhelming pressure imposed by patients on medical staff, and the deteriorating patient-physician relationship are some of the causes of DM practice. Surely, the solution to these issues is to focus on fortifying the ethical and humanitarian aspects on the side of both the physician and the patient to ensure positive collaboration. The ethical aim of the physician to treat the patient faithfully and do what is possible to help combined with the appreciation of the physician’s efforts and the choice to not take advantage of the physician through litigation could be the most reasonable solution in the near future.ConclusionJordan is suffering from DM due to the limited financial expenditure on the health sector and the impracticality of medical malpractice law. The authors highlight that the cardinal step in solving this dilemma is restoring the ethical dimension of the patient-physician relationship. (shrink)

In this paper I have not, of course, presented all the embryological data that can be collected from the Talmudic and Midrashic literature. More details can be found in Julius Preuss' classical work on biblical and talmudic medicine, now available in Fred Rosner's English translation and in a French M.D. thesis by Martine Michel.75 I also did not present any data on teratology, and did not deal with the very rich Jewish mystical lore, the Cabbala. But a few (...) comments are in order here about the material on embryology.There are very few original ideas in the Talmudic corpus on embryology, but it is obvious that the Sages were well aware of the Greek and Roman theories on embryology.The fact that the Talmud is a compilation that was built up slowly, during several centuries, explains why the information recorded in it cannot be ascribed solely to one school of thought or one clear-cut influence.When a definite problem was difficult to solve because there were many different theories about it, the Sages based their opinion on a famous experiment that seemed to offer guarantees of validity. This was the case with the controversial problem of the formation of the embryo and its sexual differentiation, where the Sages made use of an experiment allegedly initiated by Cleopatra.The Sages were ready to discuss scientific problems with non-Jewish scholars and even to accept their arguments. This was the case with the important topic of the time of the entry of the soul into the embryo. But the legal conclusions drawn from the Sages' opinion were not consistent with those declared by Churth Fathers such as Tertullian. Embryotomy, for instance, was permitted by Jewish law.Wide interest, scholarly discussions, suggestive descriptions and readiness to inquire and to obtain detailed information characterized the Talmudic discussions of embryology.In conclusion, I quote a Talmudic text that reviews the whole process of embryological development through the sequence of prayers of a faithful Jew who learns that his wife is expecting a baby.The first three days, [he should pray to the Lord] that the seed should not putrefy.From the third to the fortieth day: that the child should be a male.From the fortieth day to the third month: that there should not occur any superfetation, which could lead the first embryo to be a fetus compressus.From the third to the sixth month: that an abortion should not occur.From the sixth to the ninth month: that the birth should be without problems.76. (shrink)

Mark Geller is well known to everyone in his field and, unsurprisingly, his Festschrift is a bulging volume of contributions—from thirty-four scholars in a variety of different specialties. Like most Festschriften, it is of uneven quality, but there are some very fine articles, including useful text editions and offerings that raise interesting scholarly questions. Although there is nothing here on economics, there are articles that engage historical and/or anthropological questions, exegetical issues, and matters of composition of literary texts, including one (...) offering on Akkadian grammar. None of these would be expected from a volume entitled Mesopotamian Medicine and Magic, but their presence is a testimony to the very broad interests of the honoree. (shrink)

Collection of essays on the connection between medicine and literature and how novelists and physicians are both, in a sense, diagnosticians; the book focuses, in particular, on Walker Percy, a writer who had trained as a pathologist.

The aim of this paper is to situate Addison’s aesthetics within the diverse, transdisciplinary aesthetic communication of the early eighteenth century, through which the new anthropology of sensibility took shape. Like many of his contemporaries, Addison draws on the medico-physiological literature of his time. Aesthetic pleasure is explained as consisting in or being produced by neurophysiological processes described in terms of iatromechanism and animal spirit physiology. These processes, he argues, are beneficial to the health and well-being of the human (...) body and mind, and can prevent and even cure mental diseases such as melancholy, which were thought to be caused by the disordered movement of the animal spirits. This means that aesthetic pleasure functions as a kind of therapeutic in Addison’s aesthetics. A comparison with his essays on therapeutic somatic practices reveals that Addison describes the neurophysiological processes involved in aesthetic pleasure in much the same way as those involved in physical exercise. When he refers to the pleasures of the imagination as “gentle exercise” (Spectator 411), Addison is drawing on the medico-physiological literature on exercise, especially Francis Fuller’s Medicina Gymnastica. For Addison, both physical exercise and the “gentle exercise” offered by aesthetic pleasure share the same normative goal: a “cheerful” mind, i.e. the lively movement and the proper distribution of animal spirits. Exercise, both physical and aesthetic, can achieve this by rearranging the movement of the animal spirits: exercise distracts the solitary, constricted and inert melancholic mind, releases the animal spirits from their confused and disordered movements by communicating to them a Motion contrary to theirs. In a way, both physical exercise and aesthetic pleasure re-connect or synchronise us with our environment: they lead the melancholic mind back to the beauty, novelty and greatness of nature, the delights of social life and the bounties of the providential order itself. For Addison, cheerfulness is much more than optimal neurophysiological functioning: it is a virtuous, sociable and pious “habit of mind” (Spectator 387) that makes us feel at home in our natural, social and providential world. Thus, due to its medical and physiological underpinnings, Addison’s aesthetics takes its place in the tradition of the “care of the self”, still reverberating in the eighteenth century, fusing medicine, aesthetics, morality and piety in the normative goal of the Addisonian quest for self-transformation: cheerfulness. (shrink)

Medicine and the humanities have been exploring new ways to improve the quality of healthcare. One such collaboration is the practice of narrative medicine which uses literature to teach physicians to better meet their patients’ needs. Narrative medicine, however, draws primarily from Anglophone literature, yet post-war French literature, philosophy and criticism have much to add to the theoretical and practical underpinnings of narrative medicine. As well, such scholarship provokes a number of questions that (...) expose certain weaknesses in narrative medicine as it is practiced currently. As this paper demonstrates, drawing post-war French literature into narrative medicine opens new ways to think about life, narrative and the place of the patient in the modern healthcare system. (shrink)

In this essay, I look back at some of the earliest attempts by the first generation of literature-and-medicine scholars to answer the question: Why teach literature and medicine? Reviewing the development of the field in its early years, I examine statements by practitioners to see whether their answers have held up over time and to consider how the rationales they articulated have expanded or changed in the following years and why. Greater emphasis on literary criticism, narrative (...) ethics, narrative theory, and reflective writing has influenced current work in the field in ways that could not have been foreseen in the 1970s. The extraordinary growth of interest and work in the field nationally and, especially since 1996, internationally has included practitioners in many additional areas such as disability studies, film studies, therapeutic writing, and trauma studies. Along with the emergence of narrative medicine, this diverse community of scholars and practitioners—affiliated more through their use of narrative methodologies than the teaching of literature—makes the perennial challenge of evaluation and assessment even more complicated. (shrink)

Placebos are much discussed in both the medical and philosophy of medicine literatures. Once narrowly defined as inert “sugar pills,”, they now are now most often taken to be “treatments that appear similar to experimental treatments, but that lack their characteristic components”. In addition to their use in the control groups of many clinical trials, placebos are also now widely recognized by medical practitioners to be powerful therapies in themselves, often outperforming conventional drug therapies in these studies.Given this, I (...) find Haller’s book, which is divided into six chapters, “Evidence Based Medicine,” “Postmodernist Medicine,” “The Powerful Placebo,” “Politics of... (shrink)

Contrary to accepted ideas, questions of gender started to be raised around the end of the 19th century. The characters of problematic sex and sexuality who abounded in literature at that time had the function of emblems of the fears aroused by the erasure and divorce between the sexes in a civilization in disarray. The figure of the androgyne was used to name and depict those condemned to indecision. But its closeness to the invert led to the decline of (...) the myth, which in the meantime was taken over by turn-of-the-century clinical medicine. Just like homosexuality, hermaphroditism became an anomaly, and those affected by it were depicted as deviant, incomplete beings. However, it was from the explosive superimposition of those two denigrated figures – the homosexual and the androgyne – that the concept of gender emerged in its true nature, that is, as a mental construction as much as an anatomical destiny. (shrink)

The importance of bioethics education as a valuable tool to be responsive to medicine’s complexities is affirmed by graduate medical education accreditation bodies and professional organizations alike. The Accreditation Council for Graduate Medical Education, the body that accredits the majority of medical residency and fellowship programs in the United States, affirms the importance of ethics training for physicians in training. How this is accomplished is largely left to the prerogative of individual programs to manage, as benchmarks or milestones to (...) ascertain this are not firmly in place. However, there is doubt that significant education in bioethics is being accomplished by individual residency programs. This review searched the PubMed database for relevant articles on the scope and objectives of ethics education in US and Canadian family medicine residency programs. (shrink)

The fundamental problem of Jan Srzednicki’s new epistemology is the question: how thoughts surpass the resistance of that what is ontologically present, how this process is possible? In Srzednicki’s opinion, thinking is a process of distancing from the pressure of ontological presence. His ideas offer a splendid inspiration for philosophy of medicine which attempts to answer the question “whether (and how) a disease is cognizable?” This question refers directly to and is translated into the question of the capacity to (...) diagnose particular diseases. Answering to the above stated question whether disease is cognizable we should answer in the affirmative, however, in a “modified” form that its pre-cognitive resistance to reality is formed at the articulated level. Somewhat intuitively we feel the presence of a disease before we express it in words as a disease according to our scientific or informal thought style. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Laying Medicine Open: Understanding Major Turning Points in the History of Medical EthicsLaurence B. McCullough (bio)AbstractAt different times during its history medicine has been laid open to accountability for its scientific and moral quality. This phenomenon of laying medicine open has sometimes resulted in major turning points in the history medical ethics. In this paper, I examine two examples of when the laying open of (...) class='Hi'>medicine has generated such turning points: eighteenth-century British medicine and late twentieth-century American medicine. In the eighteenth century, the Scottish physician-philosopher, John Gregory (1724–1773), concerned with the unscientific, entrepreneurial, self-interested nature of then current medical practice, laid medicine open to accountability using the tools of ethics and philosophy of medicine. In the process, Gregory wrote the first professional ethics of medicine in the English-language literature, based on the physician’s fiduciary responsibility to the patient. In the late twentieth century, the managed practice of medicine has laid medicine open to accountability for its scientific quality and economic cost. This current laying open of medicine creates the challenge of developing medical ethics and bioethics for population-based medical science and practice.Reading the Histories of Medicine, Bioethics, and Medical EthicsThere are many ways in which to read the history of medi-cine and therefore of medical ethics and bioethics. For example, the history of medicine can be usefully understood in terms of successive advances or revolutions in biomedical science and its clinical applications, with medical ethics understood as a moral response to scientific and technological change. On this reading, which has been common in the history of bioethics for the past three decades, moral response is required to address scientific and technological changes that are unprecedented and therefore threaten to outstrip society’s moral capacities [End Page 7] to understand and manage those changes well. Much recent work on the ethical, legal, and social issues raised by the genome project appeals to this reading. The history of medicine can also be read in social terms, with medicine understood as a major social institution shaped by various factors, not limited to science. In this perspective, medicine and society are understood in terms of a complex and dynamic synergy. Bioethics and medical ethics become part of this synergy and are to be explained—perhaps even explained away—by social historical factors. There are, of course, other ways to read the history of medicine and therefore of bio-ethics and medical ethics—e.g., in terms of key figures and movements that are thought to have shaped developments in crucial ways.I want to suggest another way to read these histories, namely, the successive laying open of medicine to accountability that sometimes results in key turning points in the development of medical ethics and bioethics. On this reading, ethics is understood as an intellectual and practical discipline that makes medicine as a social institution and its practitioners, physicians, morally accountable for their clinical judgment, decision making, and behavior. This differs from Robert Veatch’s (1981) reading of the history of medical ethics either as particular—informed by intellectual, moral, and experiential resources thought to be available only to physicians—or universal—informed by intellectual, moral, and experiential resources generally available in the culture (present and past). Veatch sees medical ethics as open when it is universal and closed, and unacceptable, when it is particular. I read the history of medical ethics as always universal and medicine as a social institution and practice as sometimes closed—i.e, not accountable for its scientific and moral integrity—and sometimes as open, accountable for such integrity. When medicine is “laid open,” medical ethics itself is sometimes transformed. The same may well be the case for the other health care professions. The histories of medical ethics and bioethics, therefore, can be usefully read as responses to the laying open of medicine and the health care professions generally at various times in their histories. In what follows, I examine two important examples of laying medicine open that create key turning points in the history of medical ethics—Scottish medicine from the eighteenth century and American medicine from the end of the twentieth century.The... (shrink)

ABSTRACTThe early history of anthropology in eighteenth-century Germany wove together contributions from medicine, metaphysics, and a host of other disciplines in an attempt to develop a holistic ‘science of man.’ This paper examines a literary text written by prominent figure in that movement, Johann Gottlob Krüger’s Dreams. The collection of parables staged as dreams in this book presents specifically literary cases against the sufficiency of either philosophy or physiology for the study of human life as a whole. Through close (...) readings of a number of these dreams and related texts, this paper shows how Krüger’s Dreams advocates an approach to anthropology that recognizes the importance of literature for an interdisciplinary study of human life. More than simply recognising literary writing as another means of studying human life, the vision of a new anthropology implied in this book draws on literary devices to counter the overconfidence and partisanship of existing philosophical and medical theories of human nature. (shrink)

We are more used to thinking of medicine in relation to the ways that it alleviates the effects of violence. Yet an important thread in the academic literature acknowledges that medicine can also be responsible for perpetuating violence, albeit unintentionally, against the very individuals it intends to help. In this essay, I discuss definitions of violence, emphasizing the importance of understanding the term not only as a physical perpetration but as an act of power of one person (...) over another. I next explore the paradox of a healing profession that is permeated with violence sometimes necessary, often unintentional, and almost always unrecognized. Identifying the construct of “physician arrogance” as contributory to violence, I go on to identify different manifestations of violence in a medical context, including violence to the body; structural violence; metaphoric violence; and the practice of speaking to or about patients (and others in the healthcare system in ways that minimize or disrespect their full humanity. I further suggest possible explanations for the origins of these kinds of violence in physicians, including the fear of suffering and death in relation to vicarious trauma and the consequent concept of “killing suffering”; as well as why patients might be willing to accept such violence directed toward them. I conclude with brief recommendations for attending to root causes of violence, both within societal and institutional structures, and within ourselves, offering the model of the wounded healer. (shrink)

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

In lieu of an abstract, here is a brief excerpt of the content:Moral Distress in Academic Medicine: My Brother’s Keeper?Lauren B. SmithAs a member of the hospital ethics committee, I’ve become the go–to person for any ethical issues that arise in our Department. Being a pathologist who is interested in ethics, I’m a rare bird. In this role, I get the occasional curbside consult when anyone has a question or concern. Shortly after an ethics lecture to our trainees, one (...) of the junior residents approached me and asked to speak privately. We headed to the cafeteria and found a private table where we could talk. She hesitated, running her fingers through her hair and gazing around the room before speaking.She told me that the trainees were concerned because they had noticed that the pathologists at another institution were not grading one type of cancer the way that they had learned to do this at our hospital. This type of cancer grading is a surrogate for aggressiveness, and, while somewhat flawed, it often determines the staging and adjuvant therapy that the patient will receive. The resident argued that at this hospital, patients were getting assigned cancer grades that were higher than the ones they would receive at our institution. Therefore, a cancer presenting at the other hospital would be considered more aggressive by the clinicians treating the patient.The resident and many of her colleagues had tried to broach this subject with the pathologists. [End Page E18] Many had been brave enough to voice their confusion and concern over the practices. Their efforts, she explained, had been rebuffed. The pathologists assured the residents that they were grading their cases correctly and cited a reference that they used for this purpose. Due to the hierarchical nature of medicine, it is understandably difficult for trainees to confront attending physicians when they have concerns about their clinical cases and diagnostic acumen. Residents and fellows often do not express their concerns for fear of overstepping their roles. In spite of this, many trainees felt that their concerns for the patient made them set aside their own best interest and they spoke up. Moral distress and genuine concern trumped self–interest in this case, which was admirable.At the time of our meeting, I wondered what I could do to help. I am a hematopathologist who specializes in diagnosing leukemias and lymphomas. I know very little about solid tumor diagnosis and treatment. I have not looked at many solid tumors since I was a trainee six years ago. I do not read the literature in that area and I’m not up–to–date on any controversies regarding grading. In summary, I am far from an expert.However, the problem, on a broader scale, was familiar. As pathologists, we may disagree with or question the diagnoses of our colleagues. What is the appropriate course of action when this occurs? This question is an interesting and infinitely complex issue in the realm of pathological diagnosis. If you aren’t a pathologist or a physician, it may be difficult to grasp why there isn’t a right answer in every case. Diagnosing cancer, in many ways, is truly an art as much as a science. Many intersecting variables are at play, including the size and quality of the sample, the experience and training of the pathologist, and the clinical information available at the time of the diagnosis. Some areas are fraught with subjectivity and inter–observer reliability. Some pathologists are more skilled than others. These are realities that no one wishes to freely admit.It is important, however, to differentiate between systematic and random errors. There are many errors that are difficult to predict or avoid. However, systematic errors are the ones that we most want to uncover as they can be fixed with education and awareness. This case appeared to represent a systematic error in which the pathologists at the other hospital were all performing grading in a way that differed from usual practice.I wondered if it would be overstepping my role to speak to the pathologists. I ran the situation by some of the senior pathologists that I know. Many understood my concern but subtly discouraged any action. Many felt... (shrink)

Written by a leading proponent of the philosophy and ethics of healthcare, this volume, filled with thought-provoking and frequently controversial ideas and arguments provides readers with a contribution to the literature on medical ethics.