The medical profession is observing a rising number of calls to action considering the threat that climate change poses to global human health. Theory-led bioethical analyses of the scope and weight of physicians’ normative duty towards climate protection and its conflict with individual patient care are currently scarce. This article offers an analysis of the normative issues at stake by using Korsgaard’s neo-Kantian moral account of practical identities. We begin by showing the case of physicians’ duty to climate protection, before (...) we succinctly introduce Korsgaard’s account. We subsequently show how the duty to climate protection can follow from physicians’ identity of being a healthcare professional. We structure conflicts between individual patient care and climate protection, and show how a transformation in physicians’ professional ethos is possible and what mechanisms could be used for doing so. An important limit of our analysis is that we mainly address the level of individual physicians and their practical identities, leaving out important measures to respond to climate change at the mesolevels and macrolevels of healthcare institutions and systems, respectively. (shrink)

In their article, van Gils Schmidt and Salloch defend the claim that physicians have a duty to protect the climate. The logic of the argument in broad terms is that (i) there is a relationship between climate change and the burden of disease, (ii) the healthcare sector is a significant emitter of global greenhouse gasses, thereby enhancing the burden of disease and (iii) since doctors are advocates of health and stakeholders in the healthcare sector, they have a duty to respond (...) to climate change. The authors recognise the ‘ethical basis for the claim of healthcare professionals having a special responsibility in climate change is far from being obvious’. The theoretical framework they choose for making this tentative link more apparent is Korsgaard’s theory of practical identities. The main argument of the authors seems to be that practical identities are pluralistic—a person can identify as a physician and environmentalist simultaneously—and the normative positions attributable to these identities may come into conflict. More than that, they claim that being an environmentalist is increasingly becoming …. (shrink)

The non-identity problem arises when an intervention or behavior changes the identity of those affected. Delaying pregnancy is an example of such a behavior. The problem is whether and in what ways such changes in identity affect moral considerations. While a great deal has been written about the non-identity problem, relatively little has been written about the implications for physicians and how they should understand their duties. We argue that the non-identity problem can make a (...) crucial moral difference in some circumstances, and that it has some interesting implications for when it is or is not right for a physician to refuse to accede to a patient's request. If a physician is asked to provide an intervention (identity preserving) that makes a person worse off, then such harm provides a good reason for the physician to refuse to provide the intervention. However, in cases where different (identity-altering) interventions result in different people having a better or worse life, physicians should normally respect patient choice. (shrink)

Physicians frequently encounter situations in which their professional practice is intermingled with moral affordances stemming from other domains of the physician’s lifeworld, such as family and friends, or from general morality pertaining to all humans. This article offers a typology of moral conflicts ‘at the margins of professionalism’ as well as a new theoretical framework for dealing with them. We start out by arguing that established theories of professional ethics do not offer sufficient guidance in situations where professional ethics (...) overlaps with moral duties of other origins. Therefore, we introduce the moral theory developed by Christine M. Korsgaard, that centres around the concept of practical identity. We show how Korsgaard’s account offers a framework for interpreting different types of moral conflicts ‘at the margins of professionalism’ to provide either orientation for solving the conflict or an explanation for the emotional and moral burden involved in moral dilemmas. (shrink)

Physicians frequently encounter situations in which their professional practice is intermingled with moral affordances stemming from other domains of the physician’s lifeworld, such as family and friends, or from general morality pertaining to all humans. This article offers a typology of moral conflicts ‘at the margins of professionalism’ as well as a new theoretical framework for dealing with them. We start out by arguing that established theories of professional ethics do not offer sufficient guidance in situations where professional ethics (...) overlaps with moral duties of other origins. Therefore, we introduce the moral theory developed by Christine M. Korsgaard, that centres around the concept of practical identity. We show how Korsgaard’s account offers a framework for interpreting different types of moral conflicts ‘at the margins of professionalism’ to provide either orientation for solving the conflict or an explanation for the emotional and moral burden involved in moral dilemmas. (shrink)

In depicting five “spheres of morality” occupied by physicians Doernberg and Troug provide an impressive analysis on physicians’ various commitments and role conflicts which are excellently illustr...

The American Journal of Bioethics, Volume 12, Issue 8, Page 38-39, August 2012.

By the late nineteenth century, there were large numbers of women physicians in the United States. Three Realist novels of the time,Dr. Breen's Practice, by William Dean Howells,Dr. Zay, by Elizabeth Stuart Phelps andA Country Doctor, by Sarah Orne Jewett, feature women doctors as protagonists. The issues in these novels mirrored current issues in medicine and society. By contrasting the lives of these fictional women doctors to their historical counterparts, it is seen that, while the novels are good attempts to (...) he truthful treatments of women physicians' struggles, in certain areas they do not accurately address the concerns of women physicians. (shrink)

The point of departure is the empirical research by Marwijk, Haverkate, Van Royen and The. Starting from qualitative interviews, the act of euthanasia seems to be for the physician problematic and even traumatic, also in countries where euthanasia is a legal option. This emotional contrast-experience is an important locus for the ethical reflection. I will discuss one topic of the conclusion of the research: what is the place, meaning and limit of the moral integrity of the practitioner? In the (...) act of euthanasia, a relation of many years based on trust is often presupposed by the physician in order to legitimate morally his involvement in the act of euthanasia. At the same time, physicians experience an inconsistent relation between their acting and their personal emotional and moral experience. The legal possibility to refuse the involvement in the euthanasia, doesn’t take away the ethical unrest and physicians can experience to leave their patients to fend for themselves. Can the responsibility and the loyalty towards the patient implicate that one passes over his own moral integrity? A one-sided interpretation of the ethics of Levinas could suggest a positive answer to this question. A choice for the concrete goodness happens in the face-to-face relation with the other. The other’s interest and not the own existing values are decisive. This could lead to the suggestion of an absolute presence for the other. The own moral integrity is subordinated towards the ethical responsibility for the other. To this kind of reasoning, we put two questions: Every form of responsibility presupposes a moral integrity. The autonomy and the conscience of the physician is presupposed for taking up the responsibility towards the patient. It cannot be annihilated by the faithfulness and responsibility. The physician is not only responsible for the patient who is asking euthanasia, but also for his other patients. The act of euthanasia has consequences for his moral attitudes towards the third parties. The problem will be elaborated in a discussion with the concept of responsibility as developed by Emmanuel Levinas and Cathérine Chalier. The argument is based on a critical-philosophical reading of some biblical texts. The conclusion is relevant for the evaluation of the moral integrity of the physician as well as for the application of Levinas’ concept of responsibility in the field of biomedical ethics. (shrink)

Over the course of the last century, physicians have written a number of articles about suicide among their own. These articles reveal how physicians have fundamentally conceived of themselves, how they have addressed vulnerability among their own, and how their self-identification has changed over time, due, in part, to larger historical changes in the profession, psychiatry, and suicidology. The suicidal physician of the Golden Age (1900–1970), an expendable deviant, represents the antithesis of that era’s image of strength and invincibility. (...) In contrast, the suicidal physician of the modern era (1970 onwards), a vulnerable human being deserving of support, reflects that era’s frustration with bearing these unattainable ideals and its growing emphasis on physician health and well-being. Despite this key transition, specifically the acknowledgment of physicians’ limitations, more recent articles about physician suicide indicate that Golden Age values have endured. These persistent emphases on perfection and discomfort with vulnerability have hindered a comprehensive consideration of physician suicide, despite one hundred years of dialogue in the medical literature. (shrink)

This paper examines the role of the physician in a pluralistic community. A personal and communal sense of identity must resolve a vast array of often conflicting backgrounds and contexts in order to function smoothly. Physicians are neither entitled to impose their own moral views on their patients nor expected to surrender their own moral agency. Several illustrative cases are given. The solution of inevitable conflicts is embodied within the context of the situation, but since irreconcilable differences remain, (...) a resolution is not always possible. Tolerance for such differences and ways of dealing with them allows the integrity of both parties to remain intact. (shrink)

This paper experimentally investigates the altruistic behavior of physicians and whether this behavior is affected by payment system and uncertainty in health outcome. Subjects in the experiment take on the role of physicians and decide on the provision of medical care for different types of patients, who are identical in all respects other than the degree to which a given level of medical treatment affects their health. We investigate physician altruism from the perspective of ethical principles, by categorizing physicians (...) according to how well their treatment decisions align with different principles for priority setting. The experiment shows that many physicians are altruistic toward their patients but also that the degree of altruism varies across patients with different medical needs. We find a strong effect of payment system that is overall unaffected by the introduction of risk and ambiguity in patients health outcomes. There is, however, substantial heterogeneity across individuals, in particular under the capitation payment system where physicians responses to the introduction of uncertainty in patient health are modulated by their own generic risk and ambiguity preferences. (shrink)

The discovery of the molecular structure of deoxyribonucleic acid and the science of molecular biology have profoundly changed medicine’s diagnostic capability and promise to transform the therapeutic realm. When some genetic disorders are diagnosed, physicians can intervene for prevention or treatment. While the basic structure of DNA is the same for all human beings, no two individuals, other than identical twins, have the same DNA sequence. This discovery has had important repercussions in the criminal justice system, where DNA can serve (...) as an identification tool.At the crossroads of these different uses of DNA, there are great concerns about potential misuses of genetic information. Preventing disease, curing illness, and convicting criminals are all seen as worthwhile uses of the technology, but concerns of potential misuse in medicine or in the criminal justice system are not unfounded. A 1998 American Medical Association study showed that 68 percent of patients had fears that their genetic test results would be used against them by their employers or insurers. Others, pointing to racial profiling, have suggested that we may now face genetic profiling. (shrink)

Cultural forces such as film create and reinforce rigidly-defined images of a doctor's identity for both the public and for medical students. The authoritarian and hierarchical institution of medical school also encourages students to adopt rigidly-defined professional identities. This restrictive identity helps to perpetuate the power of the patriarchy, limits uniqueness, squelches inquisitiveness, and damages one's self-confidence. This paper explores the construction of a physician's identity using cultural theorists' psychoanalytic analyses of gender and race as a (...) framework of analysis. Cultural theorists' politically-motivated work provides an excellent point of departure for destabilizing parts of the authoritarian medical hierarchy that can damage a student's professional development. Drawing on such discourse, this paper examines the processes by which a doctor's identity becomes rigidly defined and fixed by daily training. It finally proposes a way for a medical student to extrapolate himself from the current definitions of this identity and create a broader, more malleable concept of professional identity by defining himself from outside of, rather than through, difference. (shrink)

The term body integrity identity disorder (BIID) describes the extremely rare phenomenon of persons who desire the amputation of one or more healthy limbs or who desire a paralysis. Some of these persons mutilate themselves; others ask surgeons for an amputation or for the transection of their spinal cord. Psychologists and physicians explain this phenomenon in quite different ways; but a successful psychotherapeutic or pharmaceutical therapy is not known. Lobbies of persons suffering from BIID explain the desire for amputation (...) in analogy to the desire of transsexuals for surgical sex reassignment. Medical ethicists discuss the controversy about elective amputations of healthy limbs: on the one hand the principle of autonomy is used to deduce the right for body modifications; on the other hand the autonomy of BIID patients is doubted. Neurological results suggest that BIID is a brain disorder producing a disruption of the body image, for which parallels for stroke patients are known. If BIID were a neuropsychological disturbance, which includes missing insight into the illness and a specific lack of autonomy, then amputations would be contraindicated and must be evaluated as bodily injuries of mentally disordered patients. Instead of only curing the symptom, a causal therapy should be developed to integrate the alien limb into the body image. (shrink)

Gils-Schmidt and Salloch recognise that human and climate health are inextricably linked, and that mitigating healthcare-associated climate harms is essential for protecting human health.1 They argue that physicians have a duty to consider how their own practices contribute to climate change, including during their interactions with patients. Acknowledging the potential for conflicts between this duty and the provision of individual patient care, they propose the application of Korsgaard’s neo-Kantian account of practical identities to help navigate such scenarios. In this commentary, (...) we argue that by focusing attention on this physician–patient level, the authors overlook the complexity of climate change, both within the healthcare sector and beyond. We recognise the importance of individual agency in tackling this issue, and we also recognise that the authors do briefly acknowledge the importance of considering these broader complexities; however, we emphasise the need for climate and health discussions/action to be situated in a wider framework of systemic change. Our concern is that overemphasis on patient-level interactions risks normalising the prioritisation of individual-level approaches to addressing climate change, detracting from such a broader approach. Physician training emphasises the need for trust, confidentiality and shared decision-making in the doctor–patient relationship. …. (shrink)

Definition of the problem: The question whether a prohibition of physician-assisted suicide is justifiable plays a prominent role in recent debate about this practice. Many authors argue that assisted suicide is an issue of individual choice, that a prohibition would base on particular conceptions of the good and that such a justification is not acceptable in a liberal society. Arguments: Within the frame of a communitarian approach the article demonstrates that the handling of dying and what physicians are allowed (...) to do is central for society and the professional identity of physicians and that every ethical position within this debate unavoidably rests upon certain conceptions of the good. Conclusion: Therefore it is necessary to deal with these conceptions in a transparent way and it is justifiable to impose a prohibition of physician-assisted suicide based on a conception of the common good that does not consult supposed social consequences. (shrink)

There has been increasing emphasis on professionalism in medical education over the past several decades, initially focusing on bioethical principles, communication skills, and behaviors of medical students and practitioners. Authors have begun to discuss professional identity formation (PIF), distinguishing it as the foundational process one experiences during the transformation from lay person to physician. This integrative developmental process involves the establishment of core values, moral principles, and self-awareness. The literature has approached PIF from various paradigms—professionalism, psychological ego development, (...) social interactions, and various learning theories. Similarities have been identified between the formation process of clergy and that of physicians. PIF reflects a very complex process, or series of processes, best understood by applying aspects of overlapping domains: professionalism, psychosocial identity development, and formation. In this study, the authors review essential elements of these three domains, identify features relevant to medical PIF, and describe strategies reported in the medical education literature that may influence PIF. (shrink)

Patients in Quebec can legally obtain medical assistance in dying (MAID) if they are able to give informed consent, have a serious and incurable illness, are at the end of their lives and are in a situation of unbearable suffering. Since the Supreme Court of Canada’s 2015 Carter decision, access to MAID, under certain conditions, has become a constitutional right. Quebec physicians are now likely to receive requests for MAID from their patients. The Quebec and Canadian laws recognize a (...) class='Hi'>physician’s right to conscientious objection, but this right is contested both in the medical ethics literature and in the public sphere. This paper presents the results of a qualitative study conducted with twenty Quebec physicians who did not integrate MAID into their medical practice, either because they were opposed to or deeply ambivalent about MAID. The interviews aimed to explore the reasons – religious and secular – for opposition to or ambivalence towards MAID. The secular reasons given by participants were grouped into four main categories: 1) the ends of medicine and professional identity, 2) the philosophy of palliative medicine and resource allocation in palliative care, 3) benevolent paternalism, the “good death”, and the interests of future selves, 4) the risk of a slippery slope and the protection of vulnerable people. (shrink)

Losing the sense of oneself is no trivial matter regardless of the reasons. But when these reasons have to do with the doubly-marginalizing circumstances of serious physical illness and subsequent hospitalization, the loss can be devastating in ways that extend beyond the patient’s release. Because the hierarchical practices and juridical moral theories that govern physician-patient hospital relationships in the United States largely disregard such losses by paying insufficient attention to power differentials and to the unique dilemmas presented by individual (...) cases, patient care calls for better, nonideal approaches to the well-being of this vulnerable population. Specifically, the medical and administrative norms that pervade patient care both harm and alienate those subject to their power by damaging whatever sense of personal identity that an otherwise seriously ill patient might still have. By stripping away not only patient self-trust and voice, but also any semblance of agency itself, the current normative models of hospital care mark those already burdened by illness as mere bodies—not as morally equal participants in the pursuit of healing. Moving toward any semblance of change requires a fundamental re-assessment of the relationship between the patient and the institutional arrangements and priorities. For such a reevaluation to take place, nothing less than an institutional shift toward nonideal, narratively-grounded approaches to the overall well-being of the patient is required. Only then might the status of the patient as a person begin to matter as an essential part of meaningful practices of hospital care. (shrink)

This paper offers a novel, qualitative approach to evaluating the outcomes of integrating humanities and ethics into a newly revised pre-clerkship medical education curriculum. The authors set out to evaluate medical students’ perceptions, learning outcomes, and growth in identity development. Led by a team of interdisciplinary scholars, this qualitative project examines multiple sources of student experience and perception data, including student essays, end-of-year surveys, and semi-structured interviews with students. Data were analyzed using deductive and inductive processes to identify key (...) categories and recurring themes. Results suggest that students not only engaged with the curricular content and met the stated learning objectives but also acknowledged their experience in the humanities and ethics curriculum as an opportunity to reflect, expand their perceptions of medicine (and what it means to be “in” medicine), connect with their classmates, and further cultivate their personal and professional identities. Results of this qualitative study show how and in what ways the ethics and humanities curriculum motivates students past surface-level memorization of factual knowledge and encourages thoughtful analysis and evaluation about how the course material relates to and influences their thinking and how they see themselves as future doctors. The comprehensive qualitative approach reflects a holistic model for evaluating the integration of humanities and ethics into the pre-clerkship medical education curriculum. Future research should examine if this approach provides a protective factor against the demonstrated ethical erosion and empathy decrease during clinical training. (shrink)

I respond to David Shoemaker's arguments for the conclusion that personal identity is irrelevant for death. I contend that we can accept Shoemaker's claim that loss of personal identity is not sufficient for death while nonetheless maintaining that there is an important theoretical relationship between death and personal identity. I argue that this relationship is also of practical importance for physicians' decisions about organ reallocation.

In this article, by professional immunity we refer to limitation of liability to the specific pandemic context, respectively to the concrete possibilities of diagnosis, treatment, care and too few degrees of professional freedom still available. The relevance of one or another of the limitation measures of professional liability depends on the specific legal context of each community. Our thesis is that, regardless of the form of transposition into practice, a form of health professionals protection, such as professional immunity is necessary. (...) From the multitude of possible protection measures, each state can select the appropriate ones. The need for specific measures for professional immunity is not identical in each state, depending on the specifics of the legal system, social values, measures characteristics taken to combat the pandemic, the degree of transparency of each healthcare system, the level of bioethical principles influence. However, this need doesn`t start from "no measure", the appropriate minimum level of protection seemingly to constitute a patient compensation no-fault model, plus the characteristics of the professional immunity, designed to adapt liability to specific conditions. The main problem in the absence of professional immunity is the risk of transferring the cost of ignorance, visible, in the inadequate expectations of medical science, on healthcare professionals, the limits of scientific knowledge risking to be reinterpreted as medical fault. The COVID-19 pandemic has somehow forced an additional step towards broadening discussions on universal human rights, being forced to consider ways of putting them into practice in the context of limited resources. Assuming that the increase in social complexity increases the risks of such events, we approach these problems from the perspective of creating rapid mechanisms to adapt to such changes, the lessons learned now being applied in the future to other similar cases. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Identity, Ritual and State in Tibetan Buddhism: The Foundations of Authority in Gelukpa MonasticismChristian P. B. HaskettIdentity, Ritual and State in Tibetan Buddhism: The Foundations of Authority in Gelukpa Monasticism. By Martin A. Mills. London: RoutledgeCurzon, 2003. 404 + xxi pp. with 12 black and white plates.In Tibetan Buddhism, there is a type of teaching called a dmar khrid, a "red instruction," wherein the lama brings students (...) through a teaching as a physician might dissect a corpse, pointing out and explaining the various parts and organs and their places and functions. In Identity, Ritual and State in Tibetan Buddhism, Martin Mills has done very much the same thing, with the exception that the body he examines is still very much alive, and emerges, to my eyes at least, as a new and wholly vital entity. Mills exposes the subcutaneous and sanguine body of Tibetan Buddhism, the bones and muscles that make up its structure, the blood that flows through it, and the organs that keep it alive, in "a plain and open manner," just as in a dmar khrid.1 The value of such a presentation truly cannot be overstated. An attempt to catalog the contents of each chapter would be both impossible and counterproductive, as the wealth of theoretical material and ethnographic detail is a large part of what makes this book so powerful. Instead, I will identify several topics, several of the vital organs alluded to, that are either not commonly noticed in the academic study of Buddhism, or that are given fresh perspective by Mills's anthropological and sociological methodology, and that are so crucial to understanding how it is that Buddhism lives in a typical Himalayan village. The latter portion of this review explains why I place such high value on this book and its potential place in Buddhist-Christian studies.Identity, Ritual and State is an ethnography of Kumbum Monastery in Lingshed, Ladakh (the eastern half of the Kashmir valley, located in Jammu and Kashmir, India), but its concerns are much more far-reaching than a single remote Himalayan village. The central question of the work is "how we are to understand the nature of religious authority in Tibetan Buddhist monasticism" (p. xiii), although it might more properly be the religious authority of Tibetan [End Page 187] Buddhist monastics. This answer is worked out in three overlapping areas of analysis: local ritual activity, ecclesiastical structure of the monastery, and the ritual foundations of Tibetan political thought (p. xvii).Mills convincingly asserts that there is a framework within which Buddhism happens in the Himalayas. The starting point of this framework is birth itself, which establishes the embodied person. The very physicality of personhood has several implications. First, the body is embedded in a very specific local space and place, and personhood is thus not only embodied, but also chthonic—intimately bound up with the earth or soil onto which it is born. At birth, persons are injected into a complex matrix of relations between people and various spirits, such as household gods and protectors, nāga, and itinerant demons. For example, Lingshed is divided into seven subterritories, each under the jurisdiction of a local deity whose physical abode and reign are well known to all in the village.2 These deities are associated with features of the local geography, and they regulate and influence local agricultural and social production, so birth in one area or another signifies a relation with the deity presiding over it. The land itself is imbued with a notion of personhood and agency. The human body is also the repository for pollution (sgrib), which comes about as a result of violating the established hierarchy of space and place and from bringing about changes to the local matrix of embodied persons. Both bodily pollution concerns and the need for proper relations with local spirit numina mandate definite, ongoing ritual attention. Rituals are occasioned in response to births, deaths, spirit possession, unintentional pollution of places or household objects, and movements within the monastic ecclesiastical structure, or happen regularly according to an astrologically and agriculturally influenced calendar.Rituals are performed by monks not only because they are trained specialists, but because... (shrink)

Physicians often express frustration with the ‘system’ in which they work. Over time, this frustration may put them at risk of burnout and disengagement, which may impact patient care. In this study, we aimed to understand the nature of the system flaws that physicians identified in their published narratives and to explore their self-representation as agents of change. We reviewed all reflective narratives published in four medical journals between January 2015 and December 2017. By consensus, we identified those that addressed (...) system flaws. Using content and narrative analysis, we analyzed the types of flaws and the physicians’ orientation to the flawed system. We identified seven recurring system flaws—five related to medical culture: failures of communication, erosive impact of the hidden curriculum, inadequate health advocacy, frenzied pace of work, and experience of stigma. Less frequently, physicians’ narratives also exposed limited and disparate healthcare resources and restrictive institutional practices as impeding patient-centered care. Physicians expressed agency to create change foremost when writing about flaws related to medical culture. While physicians are challenged by system flaws, they strive to practice in ways that do not succumb to them. We saw tension between the elements outside the physician’s control and those within it. This tension becomes a source of distress when the compromises that emerge from system flaws move physicians away from the values that define their professional identity. (shrink)

Giving Voice to Values as a Professional Physician provides students with the theoretical background and practical applications for acting on their values in situations of ethical conflict. It is the first medical ethics book that utilizes the Giving Voice to Values methodology to instruct students in medical ethics and professionalism. In doing so, it shifts the focus of ethics education from intellectually examining ethical theories and conflicts to emphasizing moral action. Each section of the book explains how moral decision-making (...) and action can be implemented in the healthcare arena. Medical ethics cases are provided throughout in order to assist students in giving voice to their values and developing skills for professional action. The Giving Voice to Values methodology, and the cases in this book, do not focus on the big questions of academic ethics, but rather on the ethics of the everyday, even if the challenges presented are difficult. In other words, the ethical questions students will have to face, in this book and in medical education and practice, are about how to interact with others, whether they be patients or colleagues, who might have different ethical positions. The book provides a unique guide for professional identity formation and the teaching of ethics in medical schools. (shrink)

As a consequence of recent changes, health research policies in the United States mandate the inclusion of women and members of racial and ethnic minority groups as experimental subjects in biomedical research. This article analyzes debates that underlie these policies and that concern the medical management of bodies, groups, identities and differences. Much of the uncertainty surrounding these new policies reflects the fact that researchers, physicians, policy makers and health advocates have adopted competing, and often murky, understandings of the nature (...) of sex, gender, racial and ethnic differences, and of the relation of the biological to the social in the manifestation of bodily illness. (shrink)

Martin Davies draws parallels between Herz's personal life and Prussian politics and culture to make sense of the end of the eighteenth century when Enlightenment tradition and Romantic thought coincided.

What marks the traditional privacy torts of disclosure, intrusion, false light, and appropriation is that they require an invasion, an intrinsic harm caused by someone doing something to us without our consent. But we are now voluntarily giving up information about ourselves--to our physicians, for instance--that is being gathered into databases that are brought and sold and that can be appropriated by those who wish to assume our identities. The way in which our privacy is put at risk is different, (...) and this leads to a new understanding of the concept of privacy. Others appropriate our identities, treating us as objects; by doing so, our standing as autonomous moral agents, controlling how we present ourselves to the world, is thus denied. (shrink)

ABSTRACT Through an interdisciplinary literature review, this propositional paper explores the emergence and unfolding of professionals’ moral identity conflicts involving important but contrasting values. Building on the exemplary case of physicians’ professional-religious dilemmas in End-of-Life circumstances, we develop a multilevel model of professional-personal identity conflict dynamics in ethically-charged situations in which we integrate individual-level mechanisms with organizational-level boundary conditions, namely peer social support and ethical climate, in relation to psychological well-being. Our conceptual model contributes to the ethics, (...) class='Hi'>identity and human behavior literature by advancing suggestions of how professionals may prevent or/and resolve moral conflicts concerning also other identities and contexts. (shrink)

BackgroundDefensive practice occurs when physicians provide services, such as tests, treatments and referrals, mainly to reduce their perceived legal or reputational risks, rather than to advance patient care. This behaviour is counter to physicians’ ethical responsibilities, yet is widely reported in surveys of doctors in various countries. There is a lack of qualitative research on the drivers of defensive practice, which is needed to inform strategies to prevent this ethically problematic behaviour.MethodsA qualitative interview study investigated the views and experiences of (...) physicians in Australia on defensive practice and its contribution to low value care. Interviewees were recruited based on interest in medico-legal issues or experience in a health service involved in ‘Choosing Wisely’ initiatives. Semi-structured interviews averaged 60 min in length. Data were coded using the Theoretical Domains Framework, which encapsulates theories of behaviour and behaviour change.ResultsAll participants (n = 17) perceived defensive practice as a problem and a contributor to low value care. Behavioural drivers of defensive practice spanned seven domains in the TDF: knowledge, focused on inadequate knowledge of the law and the risks of low value care; skills, emphasising patient communication and clinical decision-making skills; professional role and identity, particularly clinicians’ perception of patient expectations and concern for their professional reputation; beliefs about consequences, especially perceptions of the beneficial and harmful consequences of defensive practice; environmental context and resources, including processes for handling patient complaints; social influences, focused on group norms that encourage or discourage defensive behaviour; and emotions, especially fear of missing a diagnosis. Overall, defensive practice is motivated by physicians’ desire to avoid criticism or scrutiny from a range of sources, and censure from their professional peers can be a more potent driver than perceived legal consequences.ConclusionsThe findings call for strengthening knowledge and skills, for example, to improve clinicians’ understanding of the law and their awareness of the risks of low value care and using effective communication strategies with patients. Importantly, supportive cultures of practice and organisational environments are needed to create conditions in which clinicians feel confident in avoiding defensive practice and other forms of low value care. (shrink)

IntroductionFrontline healthcare workers have faced significant plight during the ongoing Coronavirus disease 2019 pandemic. Studies have shown their vulnerabilities to depression, anxiety disorders, post-traumatic stress, and insomnia. In a developing country like India, with a rising caseload, resource limitations, and stigma, the adversities faced by the physicians are more significant. We attempted to hear their “voices” to understand their adversities and conceptualize their resilience framework.MethodsA qualitative approach was used with a constructivist paradigm. After an initial pilot, a socio-demographically heterogeneous population (...) of 172 physicians working in COVID-designated centers were purposively sampled from all over India. Following in-depth virtual interviews using a pre-formed semi-structured guide, the data was transcribed and translated verbatim. The interview was focused on their challenges, needs, and processes of coping and support. Charmaz’s grounded theory was used for analysis supplemented by NVivo 10 software.ResultsFear of infection, uncertainty, stigma, guilt, and social isolation emerged as the main challenges. Simultaneously, their “unmet needs” were flexible work policies, administrative measures for better medical protection, the sensitivity of media toward the image of HCW, effective risk communication for their health, and finally, social inclusion. Their resilience “framework” emerged as a process while navigating these adversities and consisted of three facets: forming a “resilient identity,” managing the resilience, and working through the socio-occupational distress. The role of mental well-being, social network, peer support, problem negotiation, and self-care emerged as the key coping strategies.ConclusionThe study findings support the global call for better psychosocial health and quality of life of the frontline HCWs. Their “unheard voices” explored in the study can anchor subsequent resilience-enhancing interventions and policies. Guidelines focusing on the psychological wellbeing of frontline HCWs need to be grounded in their unmet needs and lived experiences. (shrink)

Background and objectives: Physicians are exposed to matters of existential character at work, but little is known about the personal impact of such issues. Methods: To explore how physicians experience and cope with existential aspects of their clinical work and how such experiences affect their professional identities, a qualitative study using individual semistructured interviews has analysed accounts of their experiences related to coping with such challenges. Analysis was by systematic text condensation. The purposeful sample comprised 10 physicians (including three women), (...) aged 33–66 years, residents or specialists in cardiology or cardiothoracic surgery, working in a university hospital with 24-hour emergency service and one general practitioner. Results: Participants described a process by which they were able to develop a capacity for coping with the existential challenges at work. After episodes perceived as shocking or horrible earlier in their career, they at present said that they could deal with death and mostly keep it at a distance. Vulnerability was closely linked to professional responsibility and identity, perceived as a burden to be handled. These demands were balanced by an experience of meaning related to their job, connected to making a difference in their patients’ lives. Belonging to a community of their fellows was a presupposition for coping with the loneliness and powerlessness related to their vulnerable professional position. Conclusions: Physicians’ vulnerability facing life and death has been underestimated. Belonging to caring communities may assist growth and coping on exposure to existential aspects of clinical work and developing a professional identity. (shrink)

There are increasing calls for coverage of medicine during the Holocaust in medical school curricula. This article describes outcomes from a Holocaust and medicine educational program featuring a study trip to Poland, which focused on physician complicity during the Holocaust, as well as moral courage in health professionals who demonstrated various forms of resistance in the ghettos and concentration camps. The trip included tours of key sites in Krakow, Oswiecim, and the Auschwitz-Birkenau concentration camps, as well as meeting with (...) survivors, lectures, reflective writings, and discussions. In-depth interviews and reflective writings were qualitatively analyzed. Resulting themes centered on greater understanding of the relationship between bioethics and the Holocaust, recognizing the need for moral courage and social awareness, deeper appreciation for the historical roles played by dehumanization and medical power and their contemporary manifestations, and the power of presence and experiential learning for bioethics education and professional identity formation. These findings evidence the significant impact of the experience and suggest broader adoption of pedagogies that include place-based and experiential learning coupled with critical reflection can amplify the impact of bioethics and humanism education as well as the process of professional identity formation of medical students. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Moral Responsibility in a Context of Scarcity:the Journey of a Haitian PhysicianPaul PierreAlmost all Haitian physicians have been involved in some sort of "social movement" at one point in their professional life. In a country characterized by a natural inclination to question authority, fighting the status quo of the ineffective, corrupt and disorganized [End Page 89] Haitian health system often appears to be the right thing to do.In 2002, (...) I played an active role in a large protest movement for better working conditions at the largest health facility in Port-au-Prince: the General Hospital (GH). Port-au-Prince is the capital and economic center of Haiti. It is home to close to a third of Haiti's ten million people. At that time, the situation at the GH facility was dire. All of the 400 beds at the GH were dirty. The staff was underpaid and unhappy. Drug and medical supply stock-outs were routine. Medical equipment was rarely maintained and only one of the six operating theatres in the surgery block was working. Unsupervised physicians in training (like me) were the main health care providers. Attending physicians were busy running their own private clinics, and most of them would come to the hospital solely to "recruit" the less poor patients for their clinics. As physicians-in-training, we had the responsibility of caring for the poor, but we had no means. We grew frustrated and angry witnessing our powerless patients losing legs, arms and their lives for lack of care. On many occasions, I had the parents of my patients buy the gloves that I would use to examine their sick relatives. I've seen patients fighting for the inheritance of medications left by others who had just passed away. There was no way for this hospital to fulfill its mission, and no way for its staff to deliver anything other than mediocre care. We could not accept that situation at such an early stage in our medical development, and so we refused to continue to work. We went on a strike, which completely paralyzed the delivery of care at the hospital for nearly two months. After intense negotiation, the strike ended with a signed agreement with the Minister of Health that addressed, more or less, the reasons of our movement. However, the implementation of the agreement was permanently delayed by other competing "state emergencies" including a general insurrection.At the time of our movement, I thought we were making history. After witnessing 11 "social movements" that similarly paralyzed the GH in the following decade for reasons identical to ours, I am now convinced that we were not. We were temporary actors performing in the cynical play of scarcity on permanent display in Port-au-Prince. The social movement that we started ended up hurting the very same people that we were trying to help.Extending access to heath care to poor people seemed to me at that time to be too complicated and too expensive for an unorganized state like Haiti. I realized that local protests could, at best, influence the allocation of local resources. But so-called local resources are so limited in "resource-limited" countries. Haiti spends only $40 U.S. dollars per capita for health care. This is not enough for good care. The options we were provided were not real ones—since all of them would end in more suffering. The case of providing health care to poor people needed to be approached differently.I was born in Port-au-Prince at the same general hospital in which I would later work. I am the third of four children, and the first male child in my family. My father made me understand very clearly that my first responsibility was for my siblings. My sisters made me understand equally clearly that I had no authority over any of them. I ended up with a lot of responsibility but with very little authority. The few of us who completed school, entered university, studied abroad and "emerged" were considered, to some extent, responsible for the others—the ones who couldn't go to school, university, or abroad, the ones who had "sunk... (shrink)

The term body integrity identity disorder (BIID) describes the extremely rare phenomenon of persons who desire the amputation of one or more healthy limbs or who desire a paralysis. Some of these persons mutilate themselves; others ask surgeons for an amputation or for the transection of their spinal cord. Psychologists and physicians explain this phenomenon in quite different ways; but a successful psychotherapeutic or pharmaceutical therapy is not known. Lobbies of persons suffering from BIID explain the desire for amputation (...) in analogy to the desire of transsexuals for surgical sex reassignment. Medical ethicists discuss the controversy about elective amputations of healthy limbs: on the one hand the principle of autonomy is used to deduce the right for body modifications; on the other hand the autonomy of BIID patients is doubted. Neurological results suggest that BIID is a brain disorder producing a disruption of the body image, for which parallels for stroke patients are known. If BIID were a neuropsychological disturbance, which includes missing insight into the illness and a specific lack of autonomy, then amputations would be contraindicated and must be evaluated as bodily injuries of mentally disordered patients. Instead of only curing the symptom, a causal therapy should be developed to integrate the alien limb into the body image. (shrink)

Burnout has been recognized as a serious health problem. In Portugal, before COVID-19 Pandemic, there were strong indicators of high prevalence of burnout in physicians and nurses. However, the Portuguese Health Care Service was able to efficiently respond to the increased demands. This study intends to understand how psychosocial variables might have been protective factors for burnout in physicians and nurses in Portugal. Specifically, we considered several psychosocial variables that have been found to be protective factors for burnout in previous (...) research and we compared their predictive and unique impact in the prediction of burnout. These variables are perceptions of justice (distributive, procedural, justice from colleagues, justice from patients, and their families), professional identification, meaningful work and empathy. We also included workload, as a risk factor, and controlled other variables that can be confounds for burnout, such as socio-demographic variables, ideological variables (religiosity, political orientation), and specific variables related with COVID-19 pandemic. The sample of the present study is composed by 229 physicians (aged between 23 and 70 years old,M= 36.54;SD= 10.72; 48% male and 52% female) and 268 nurses (aged between 22 and 69 years old,M= 34.96;SD= 9.52; 27% male and 73% female). An online survey was created using Qualtrics and participants were recruited via Facebook and LinkedIn. The data were collected during 29 days (between the 45th and the 74th days after the first diagnosed case of COVID-19 in Portugal). The results showed that workload was a significant risk factor, except for disengagement in physicians. The most consistent protectors across samples were procedural justice (for both dimensions of burnout, both in physicians and nurses) and professional identification (for disengagement, both in physicians and nurses; for exhaustion only in physicians). This study suggests that decreasing workload and promoting procedural justice and professional identification are key factors that might be simultaneously and independently addressed in interventions for reducing the risk of burnout or preventing it from occurring in the first place. (shrink)

The Healer's Art curriculum is one of the best-known educational strategies to support medical student professional identity formation. HART has been widely used as an elective curriculum. We evaluated students’ experience with HART when the curriculum was required. All one hundred eleven members of the class of 2019 University of New Mexico School of Medicine students were required to enroll in HART. We surveyed the students before and after the course to assess its self-reported impact on key elements of (...) professional identity formation such as empathy towards patients and peers, commitment to service, and burnout. A majority of students reported positive effects of the course on their empathy towards other students. This finding was significantly associated with self-reported willingness to have elected the course had it not been required. One-half of respondents reported positive effects on their empathy towards future patients. At least one-quarter to one-third of respondents reported positive influences on commitment to service, conceptions about being a physician, and self-perceived burnout. Students report benefits on their professional identity formation after participating in a required course on humanism. Empathy-building among peers is one valuable outcome of such curricula. (shrink)

William James is known as a nineteenth-century philosopher, psychologist, and psychical researcher. Less well-known are the medical fixations that united his multiple identities and drove his ambition to change the way American society conceived of itself in body, mind, and soul. William James, M.D. offers an account of the development and cultural significance of James's ideas and works, and establishes, for the first time, the relevance of medical themes to his major lines of thought. James lived at a time when (...) old assumptions about faith and the moral and religious possibilities for human worth and redemption were increasingly displaced by a concern with the medically "normal" and the perfectibility of the body. Woven into treatises warning of the degeneration of humanity, these ideas comprised the origins of the eugenics movement and were manifest in a growing social stigma attached to illness and invalidism, a disturbing intellectual current in which James felt personally implicated. Most chronicles of James's life have portrayed a distressed young man, a psychological or spiritual crisis, followed by the emergence of a mature thinker who threw off his pallor of mental sickness for good. In contrast, Emma Sutton draws on his personal correspondence, unpublished notebooks, and diaries to show that James considered himself a genuine invalid to the end of his days. Sutton makes the compelling case that his philosophizing was not an abstract occupation but an impassioned response to his own life experiences and challenges. To ignore the medical James is to misread James altogether. Sales points: First book to map William James's preoccupation with medical ideas, concerns, and values across the disciplinary breadth of his work Reveals how themes of invalidism, health, and healing underpinned the genesis of many of James's major philosophical, psychological, and political ideas Draws on the approximately 9,400 items of Jamesian correspondence, together with his private notes and reading lists. (shrink)

Bioethicists have long advocated for patients’ rights by deliberating on what physicians should or should not do for the well-being of patients. Part of this advocacy has involved challenging a paternalistic medical model where physicians are seen as authoritative figures above reproach. Through ombudsperson offices, patients can submit complaints that may lead to medical examiners conducting detailed examinations of physicians’ conduct and decision-making. Prior research indicates that complaints can have serious and broad effects on physicians. We conducted a scoping review (...) to explore and evaluate the extent of the quantitative and qualitative literature examining the effects of complaints on physicians in European and Commonwealth countries. We systematically searched electronic databases (CINAHL, MEDLINE and PsycInfo) and grey literature for primary research that collected information directly from physicians on at least one potential effect of formal complaints. After screening the titles/abstracts of 14,913 records and reviewing 137 full-texts, 25 studies were included. The 25 studies reported on several potential effects, including the patient-physician relationship (3 studies), defensive medicine (14 studies), anxiety (8 studies), depression (8 studies), one’s identity as a physician (5 studies), and anger (5 studies). Generally, the effects evaluated in the included studies were negative. Although the existing literature covered a range of possible effects, few studies assessed the same effects via different methods, and in different regions and contexts. The findings of this scoping review suggest that complaints processes can have negative effects on physicians. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Misprision of IdentityHarold Merskey (bio)Misprision the deliberate concealment of one's knowledge of a crime...A misreading, misunderstanding, etc.A failure to appreciate the value of a thing...(Concise Oxford Dictionary)There are options in the forms of identity that Charland's subjects assume. There are options as well in the meaning of this title, which may apply severally or individually to the choices under consideration. Are those who change their identity with (...) labels—or reject labels—correctly assuming accurate descriptions, or incorrectly misleading themselves and some others? In which of these cases are observation and intervention ethical, and do they pose demands on medical ethicists, or should they simply be ignored?Types of AutonomyParticipants in chat rooms on the Internet may justifiably be considered to be individuals who are seeking a current method of communication to promote a view of themselves, or ideas that they possess, or projects that they endorse. In this they may resemble others who have used more traditional methods of presenting their ideas, their claims, their wares, hard merchandise, literary material, or political or philosophical propositions to the public at large. These others may be sales persons, advertisers, poets, singers, clowns, buskers, politicians, preachers, missionaries, learned public speakers, television presenters, news commentators (but not necessarily reporters), and anyone indeed who talks to other people in public about matters that she or he wishes to bring forward. They have a point they want to make. They may be grouping themselves as 'survivors' or pro-anorexia, or Multiple Personality Disorder victims, but they are not necessarily operating as patients who are looking for a fiduciary relationship with physicians or other health care practitioners. It is thus a long step to turn them into individuals who may have a claim on the doctor–patient relationship.Do we wish to undertake research on them? Research or study in the first instance for these circumstances must be in the field of social science. The rules of what it is ethical for a sociologist to do apply first. The rules of situations where one person has more power and the other depends on that individual for assistance without exploitation may differ considerably from case to case. In so far as there may be some special rules as to what is fair, reasonable, just, kind, merciful, or prudent to study individuals who expose themselves and their interests publicly, this is perhaps best done first by reference to standards for journalists.That criterion may be too lenient a standard for most health professionals because journalists seem to be quite willing to expose the subjects of their observations to public obloquy and to [End Page 351] present information about many individuals—information that the persons themselves do not consent to see in the public domain, but that the journalist, having acquired, feels entitled to make known. Still there are believed to be some standards that journalists observe and these tend to protect the weak and the more vulnerable, although that does not mean that they are regularly followed. They tend to emphasize not printing material that is salacious or very lewd and would have personal reference, but they do not withhold comparable information if they consider that it is accurate and describes the behavior of individuals who are of interest to the public which, in certain circumstances, may mean almost anybody.So up to this point it seems that our normal respect for the autonomy of the individual in chat rooms can be balanced against our interest in freedom of speech, which leads to open and very broadly based publication of information and observations.The Burden of the LabelOnce the medical label is affixed, a different level of stringency begins to apply to what may be studied or published. Because we feel that individuals' self-esteem is at risk and perhaps their lives, we hesitate to make cutting or pejorative comments about distressed people. Such diagnoses as cancer or depression may be held back from the patient (and, certainly, in the case of depression, even more may be kept from others around the patient). Likewise unspoken thoughts may be automatically acknowledged and, like radical material, may be carefully segregated and... (shrink)

Witnessing suffering and death in palliative care can cause moral distress, emotional exhaustion and maladaptive coping strategies. How sense and meaning is made from these experiences influences how physicians think, feel and act as professionals (professional identity formation or PIF). It also determines how they cope with their roles, care for patients and interact with other professionals. Timely, personalised and appropriate support is key as shaping how these physicians develop and contend with sometimes competing beliefs and roles. The Ring (...) Theory of Personhood (RToP) and the Krishna-Pisupati Model (KPM) offer a means of mapping PIF and thus moulding, coping and meaning making. This study uses the RToP and KPM to explore how caring for end-of-life patients impacts the personhood of palliative care physicians. Semi-structured interviews with a purposive sample of 13 palliative care physicians—eleven females and two males aged between 35 and 50 years—at a cancer specialist centre were conducted. Transcripts of the audio-recorded interviews underwent content and thematic analysis where complementary themes and categories identified were combined to form domains that highlighted the physicians’ key experience of providing end-of-life care. The domains identified were (1) identity formation, (2) conflicts, (3) KPM elements and (4) support systems. Together, results revealed that palliative care physicians are driven by Innate, Individual, Relational and Societal belief systems that create an intertwined professional and personal identity, enabling them to find meaning in their experiences and adapt to present contexts within cultural norms and professional expectations. However, their failure to recognise their need for support when hampered by evolving personal, existential and clinical factors underlines the exigency for ongoing surveillance and a potential role for a RToP-based tool and portfolio system that can detect and direct timely, appropriate support to in-need physicians. (shrink)

A number of studies show that when doctors become ill, there is often ambiguity in the division of roles and responsibilities in the medical encounter. Yet little is known about how the dilemma of the sick doctor has changed over time. This article explores the experience of illness among physicians by applying an historical, narratological approach to three doctor’s narratives about personal cases of cardiac disease: Max Pinner’s from the 1940s, Robert Seaver’s from the 1980s, and John Mulligan’s from 2015. (...) Drawing on Erving Goffman’s principles of social interaction, I argue that part of the challenge in the analysed narratives is because when doctors seek medical attention for themselves, the ensuing medical ‘drama’ suffers. I compare the three narratives to argue that the experience of becoming a patient while simultaneously remaining a doctor is a challenge that has changed over time. In Pinner’s narrative, the patient identity is both undesirable and inaccessible; in Seaver’s, role ambivalence between doctor and patient is the most salient feature; for Mulligan, his personal rather than professional experience of illness is the overarching theme of the narrative. Finally, I suggest that an awareness of how the medical drama often changes when doctors are patients might prove beneficial both for the doctor-patients and providers of medical care. (shrink)

This study aims to develop a valid and reliable scale to assess whether a physician is inclined to take conscientious objection when asked to perform medical services that clash with his/her personal beliefs. The scale, named the Inclination toward Conscientious Objection Scale, was developed for physicians in Turkey. Face validity, content validity, criterion-related validity, and construct validity of the scale were evaluated in the development process. While measuring criterion-related validity, Student’s t-test was used to identify the groups that did (...) and did not show inclination toward conscientious objection. There were 126 items in the initial item pool, which reduced to 42 after content validity evaluation by five experts. After necessary adjustments, the scale was administered to 224 participants. Both exploratory and confirmatory factor analyses were performed to investigate factor structure. The split-half method was employed to assess scale reliability, and the Spearman-Brown coefficient was calculated. Cronbach’s alpha reliability coefficient was used to estimate the internal consistency of the scale items. The distinctiveness of the items was evaluated using Student’s t-test. The lower and upper 27% groups were compared to assess the distinctiveness of the scale. The items were loaded on four factors that explained 85.46% of the variance: “Conscientious Objection – Medical Profession Relationship,” “Conscientious Objection in Medical Education and Medical Practice,” “Conscientious Objection with regard to the Concept of Rights” and “Conscientious Objection – Physician’s Professional Identity and Role.” The final scale has 40 items, and was found to be valid and reliable with high internal consistency. (shrink)

During his royal progress in the summer of 1620, King James I stopped in Wiltshire. In his party were the architect Inigo Jones and a royal physician, William Harvey. The king sent Jones and Harvey to Stonehenge, which was nearby, to make drawings and measurements of the mysterious monument. In addition, Harvey was to perform excavations. This visit, described by Jones in his posthumous book The Most Notable Antiquity of Great Britain, vulgarly called Stone-Heng on Salisbury Plain, Restored (1655), (...) raises many questions, particularly about Harvey’s role in this expedition. The answers to these questions involve Harvey’s underexamined role as a courtier, the place of antiquarianism in the establishment of royal legitimacy and national identity, and debates in early modern Europe surrounding fossil bones and ancient monuments. There is a good chance that Harvey was looking for the fossil bones of giant ancestors. (shrink)

Funding: Research funded by Canadian Institutes of Health Research, NNF 80045, States of Mind: Emerging Issues in Neuroethics. While there are those who object to the prospective use of propranolol to prevent or treat post-traumatic stress disorder (PTSD), most obstreperous among them the President’s Council on Bioethics, the use of propranolol can be justified for patients with severe PTSD. Propranolol, if effective, will alter the quality of certain memories in the brain. But this is not a serious threat to the (...) self understood in terms of narrative identity. A narrative identity framework acknowledges that memory is always being subtly altered or modified. For severe cases of PTSD propranolol may help victims who don’t respond to any other therapy or therapy combination regain their authentic self-narrative and engage once more in life activities. For those whose symptoms are not so severe the potential risks and side-effects of the drug may outweigh the benefits. Patients and family members should be allowed to decide, in consultation with their physician, whether this drug is appropriate in their case. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Buddhist-Christian Studies 20 (2000) 115-125 [Access article in PDF] Pretending to Be Buddhist and Christian: Thich Nhat Hanh and the Two Truths of Religious Identity Jeffrey CarlsonDePaul University Nagarjuna replies: "The teaching by the Buddhas of the dharma has recourse to two truths: / The world-ensconced truth and the truth which is the highest sense. / Those who do not know the distribution (vibhagam) of the two kinds (...) of truth / Do not know the profound 'point' (tattva) in the teaching of the Buddha. / The highest sense [of the truth] is not taught apart from practical behavior, / And without having understood the highest sense one cannot understand nirvana. / Emptiness, having been dimly perceived, utterly destroys the slow-witted. / It is like a snake wrongly grasped or [magical] knowledge incorrectly applied." 1I would like to offer a response to Thich Nhat Hanh's book Living Buddha, Living Christ, a response which suggests that Nhat Hanh embodies and propounds this classical Buddhist notion of "two truths," in a way that sheds much light on the very notion of "religious identity."The fact that Buddhist teachings involve two kinds of truths is a familiar one in Buddhist studies. T.R.V. Murti describes worldly truth as "truth so called; truth as conventionally believed in common parlance.... It is the truth that does not do any violence to what obtains in our everyday world, being in close conformity with linguistic conventions and ideas." 2 Edward Conze notes that "... in some places the Buddhas have spoken of a 'self', in others they have taught a 'notself', and in addition they have also taught that there is neither a self nor a notself. Candrakirti convincingly explains this aphorism by pointing out that the Buddhas are physicians rather than teachers, that they always consider the mentality and spiritual maturity of their interlocutors, and vary their teachings accordingly." 3Ultimate truth, again characterized by Streng, is "the realization of dependent coorigination whereby there is no attachment to fabricated 'things'--not even to the formulation of dependent coorigination." 4 [End Page 115] 1. Thich Nhat Hanh on Conventional Truth and Religious Identity Thich Nhat Hanh writes: "We need roots to be able to stand straight and grow strong. When young people come to Plum Village, I always encourage them to practice in a way that will help them go back to their own tradition and get re-rooted. If they succeed at becoming reintegrated, they will be an important instrument in transforming and renewing their tradition." 5 An advocate of interreligious dialogue, he nonetheless maintains that "sharing does not mean wanting others to abandon their own spiritual roots and embrace your faith. That would be cruel. People are stable and happy only when they are firmly rooted in their own tradition and culture. To uproot them would make them suffer. There are already enough people uprooted from their tradition today, and they suffer greatly, wandering around like hungry ghosts, looking for something to fill their spiritual needs. We must help them return to their tradition." 6He cites the suffering caused by Christian missionaries who, he writes, "came to Vietnam several hundred years ago, [and] urged us to abandon the cult of ancestral worship and to abandon our Buddhist tradition. Later, when they offered to help us in refugee camps in Thailand and Hong Kong, they also urged us to give up our roots. The good will to help and to save us was there, but the correct understanding was not. People cannot be happy if they are rootless." 7Nhat Hanh tells a compelling story of six children he met in Sri Lanka. Coming upon them Nhat Hanh began chanting in Pali, "I take refuge in the Buddha. I take refuge in the Dharma. I take refuge in the Sangha." Nhat Hanh recounts that four of the children joined their palms and chanted, while the other two stood respectfully. "I motioned to the two children who were not chanting to join us. They smiled, placed their palms together and chanted in Pali, 'I... (shrink)

The residency years comprise the last period of a physician’s formal training. It is at this stage that trainees consolidate the clinical skills required for independent practice and achieve a level of ethical development essential to their work as physicians, a process known as professional identity formation (PIF). Ethics education is thought to contribute to ethical development and to that end the Royal College of Physicians and Surgeons of Canada (RCPSC) requires that formal ethics education be integrated within (...) all postgraduate specialty training programs. However, a formal ethics curriculum can operate in parallel with informal and hidden ethics curricula, the latter being more subtle, pervasive, and influential in shaping learner attitudes and behavior. This paper reports on a study of the formal, informal, and hidden ethics curricula at two postgraduate psychiatry programs in Canada. Based on the analysis of data sources, we relate the divergences between the formal, informal, and hidden ethics curricula to two aspects of professional identity formation (PIF) during psychiatry residency training. The first is the idea of group membership. Adherence to the hidden curriculum in certain circumstances determines whether residents become part of an in-group or demonstrate a sense of belonging to that group. The second aspect of PIF we explore is the ambiguous role of the resident as a student and a practitioner. In ethically challenging situations, adherence to the messages of the hidden curriculum is influenced by and influences whether residents act as students, practitioners, or both. This paper describes the hidden curriculum in action and in interaction with PIF. Our analysis offers a complementary, empirical perspective to the theoretical literature concerning PIF in medical education. This literature tends to position sound ethical decision-making as the end result of PIF. Our analysis points out that the mechanism works in both directions: how residents respond to hidden curriculum in ethics can be a driver of professional identity formation. (shrink)