Les sages-femmes en France incarnent une subtile synthèse du cure et du care, entretenant une ambiguïté qui fonde une partie de leur identité professionnelle et qui brouille les pistes des stéréotypes de genre. En fonction du contexte social et politique qui conditionne leur mode d’exercice, ces professionnel.le.s développent spontanément des stratégies pour équilibrer les tensions qui existent entre ces deux pôles. Elles/ils vont ainsi promouvoir tantôt leurs compétences dans le care comme valeur ajoutée par rapport aux autres (...) acteurs médicaux, tantôt leur expertise médico-technique et leur autonomie de pratique, affirmant ainsi leur appartenance au monde médical et scientifique. Cet article s’inscrit dans une double approche d’analyse en sciences sociales et d’expérience professionnelle de trente années en tant que sage-femme. (shrink)

Although current literature about the “cure versus care” issue tends to promote a patient-centered approach, the disease-centered approach remains the prevailing model in practice. The perceived dichotomy between the two approaches has created a barrier that could make it difficult for medical students and physicians to integrate psychosocial aspects of patient care into the prevailing disease-based model. This article examines the influence of the formal and hidden curricula on the perception of these two approaches and finds that (...) the hidden curriculum perpetuates the notion that “cure” and “care” based approaches are dichotomous despite significant changes in formal curricula that promote a more integrated approach. The authors argue that it is detrimental for clinicians to view the two approaches as oppositional rather than complementary and attempt to give recommendations on how the influence of the hidden curriculum can be reduced to get a both-cure-and-care-approach, rather than an either-cure-or-care-approach. (shrink)

_Slow Cures and Bad Philosophers_ uses insights from the philosophy of Ludwig Wittgenstein to rethink bioethics. Although Wittgenstein produced little formal writing on ethics, this volume shows that, in fact, ethical issues permeate the entirety of his work. The scholars whom Carl Elliott has assembled in this volume pay particular attention to Wittgenstein’s concern with the thick context of moral problems, his suspicion of theory, and his belief in description as the real aim of philosophy. Their aim is not to (...) examine Wittgenstein’s personal moral convictions but rather to explore how a deep engagement with his work can illuminate some of the problems that medicine and biological science present. As Elliott explains in his introduction, Wittgenstein’s philosophy runs against the grain of most contemporary bioethics scholarship, which all too often ignores the context in which moral problems are situated and pays little attention to narrative, ethnography, and clinical case studies in rendering bioethical judgments. Such anonymous, impersonal, rule-writing directives in which health care workers are advised how to behave is what this volume intends to counteract. Instead, contributors stress the value of focusing on the concrete particulars of moral problems and write in the spirit of Wittgenstein’s belief that philosophy should be useful. Specific topics include the concept of “good dying,” the nature of clinical decision making, the treatment of neurologically damaged patients, the moral treatment of animals, and the challenges of moral particularism. Inspired by a philosopher who deplored “professional philosophy,” this work brings some startling insights and clarifications to contemporary ethical problems posed by the realities of modern medicine. _Contributors._ Larry Churchill, David DeGrazia, Cora Diamond, James Edwards, Carl Elliott, Grant Gillett, Paul Johnston, Margaret Olivia Little, James Lindemann Nelson, Knut Erik Tranoy. (shrink)

Two cases of carcinoma of the stomach presenting during the same month and dying within four weeks of one another less than one year later are presented. One was treated symptomatically and the other received radical surgery. The care they received depended on decisions about diagnosis and treatment; the outcomes of these and the difficulties involved in evaluating monetary costs and quality of care are discussed in the light of recent interest in medical audit.

Substance addiction has been historically conceived and widely researched as a brain disease. There have been ample criticisms of brain-centred approaches to addiction, and this paper aims to align with one such criticism by applying insights from phenomenology of psychiatry. More precisely, this work will apply Merleau-Ponty’s insightful distinction between the biological and lived body. In this light, the disease model emerges as an incomplete account of substance addiction because it captures only its biological aspects. When considering addiction as a (...) brain disorder, it will be shown that research fails to account for the contextual, functional, and emotional aspects inherent to subjective health. It is concluded that, while the disease model is fundamental to our understanding of what happens in the brain, its brain-centred approach is cure-oriented. Instead, we suggest a care-orientated approach, which understands and treats the psychological feel as bodily experience situated in an environment, allowing for a more encompassing therapeutic perspective. (shrink)

Phenomenology, Uncertainty and Care in the Therapeutic Encounter is the latest in a series of books where Mark Leffert explores the therapeutic encounter as both process and situation; looking for evidence of therapeutic effectiveness rather than accepting existing psychoanalytic concepts of theory or cure without question. Phenomenology, Uncertainty and Care in the Therapeutic Encounter contributes a new understanding of familiar material and brings a new focus to the care-giving and healing aspects of psychoanalysis and psychotherapy leading (...) to a shift in the analyst's identity from that of one who analyses to one who cares for and heals. This book will be of interest to Psychoanalysts and psychotherapists, neuroscientists and academics in the fields of psychiatry, comparative literature and literature and the mind. (shrink)

Summary Care and cure have been described as different kinds of ethical approaches to clinical situations. Female concerns in nursing care have been contrasted with masculine, cure orientated physician's attitudes. Ethics in such different voices may have sociologic determinants, but they do not represent intrinsic distinctions. Medicine has shown a divergent development, on the one hand stressing cure in a deterministic and instrumental way, on the other hand being aware that disease is as much a (...) pathographic as a biographic, care‐requiring existential situation. Disease is a breakdown of the living organism, to be cured by therapeutic efforts, but it is also the distressing failure of the lived body, requiring concern and care. Based on Lévinas’ ethics of encounter, it is suggested that any interpersonal relatedness is based on concern for the other, being grounded on an essentially ethical interaction. The clinical encounter is a paradigm of such ethics‐based relationships, which necessarily builds on awareness of the other qua other, and is concerned with fulfilling the therapeutic mandate. Caring for the other means doing one's best to help her/him, so that care and cure are inextricably interwoven, although care is the more fundamental form of human relatedness. Thus, neither gender nor professional tasks can allow for a caring attitude to develop without curing concerns, just as trying to cure without caring is unthinkable. (shrink)

This paper provides a philosophical critique of professional stereotypes in medicine. In the course of this critique, we also offer a detailed analysis of the concept of care in health care. The paper first considers possible explanations for the traditional stereotype that caring is a province of nurses and women, while curing is an arena suited for physicians and men. It then dispels this stereotype and fine tunes the concept of care. A distinction between ‘caring for’ and (...) ‘caring about’ is made, and concomitant notions of parentalism are elaborated. Finally, the paper illustrates, through the use of cases, diverse models of caring. Our discussion reveals the complexity of care and the alternative modes of caring in health care. (shrink)

Providing a groundbreaking approach to reinventing health care, this book is a practical guide to placing patient healing back at the center of the hospital's mission. Drawing on a wealth of practical experience, the authors show health care professionals how to decrease costs and improve quality by restructuring hospital services around patients and their needs and by utilizing design and architecture to enhance the healing environment. Using the core concepts of systems theory, extensive research, and lessons from pioneering (...) hospitals, they present state-of-the-art health care practices that heal as well as cure. (shrink)

Concepts. Health ; Disease ; Death -- Models and kinds. Causation and kinds ; Holism and reductionism ; Controversial diseases -- Evidence and inference. Evidence in medicine ; Objectivity and the social structure of science ; Inference ; Effectiveness, skepticism, and alternatives ; Diagnosis and screening -- Values and policy. Psychiatry: care or control? ; Policy ; Public health.

This article gives a practice-based and theoretical overview of the transformation from a traditional hierarchical organization in the care and cure sector towards a so-called Community-driven organization providing human happiness to 6000 elderly people. The actual case study is intertwined with conceptual information for better understanding of the innovative transition which took place at Humanitas. The case description includes its initial situation, its new core values, mission and objectives and shows the sequence of emerging policies and interventions that (...) resulted in a stakeholder oriented business model for the care sector. The selected concepts are Graves'' Emerging Cyclical Level of Existence Theory (or Spiral Dynamics), Ken Wilber''s Four Quadrant Model, Roberts Simons'' Four Levers of Control and various elements from the European Corporate Sustainability Framework sponsored by the European Commission. The conclusion marks the match between theory and practice in transforming Humanitas Rotterdam into providing cure, care, housing and well-being to elderly people. (shrink)

This paper applies crip theory (McRuer, 2006, 2018) as well as other key conceptual tools from disabled childhood studies (Runswick-Cole et al., 2018) and disability studies in education (Cousik & Maconochie, 2017) as a tactic intended to question and resist the story of overcoming as it manifests itself within the discourses and practices of self-regulation in early learning classrooms. This paper offers a brief overview of the range of self-regulation strategies enacted within educational settings in Ontario, Canada, that purport to (...) support young children in overcoming themselves on their way to normalcy. This paper also engages in crip theory as a strategy to both question and disrupt the taken for granted assumption that self-regulation entails a return towards or a sustaining of the efficient and productive neoliberal individual in school systems. Finally, this paper considers how we might not only invite but embrace the disruptions that occur when embodied differences refuse to be overcome by demands to self-regulate. Ultimately, a key aim of this paper is to resist how discourses and practices of self-regulation in Early Childhood Education and Care (ECEC) establish the overcoming narrative as a means to cure, fix or exclude embodied differences while contemplating the vibrant possibilities embedded within learning with and from disabled childhoods. (shrink)

Background: Decisions regarding whether or not to institute mechanical ventilation during the later stages of chronic obstructive pulmonary disease is challenging both ethically, emotionally and medically. Caring for these patients is a multifaceted process where nurses play a crucial role. Research question and design: We have investigated how nurses experienced their own role in decision-making processes regarding mechanical ventilation in later stages of chronic obstructive pulmonary disease and how they consider the patients’ role in these processes. We applied a qualitative (...) approach, with six focus-group interviews of nurses (n = 26). Ethical considerations: The Regional Committees for Medical and Health Research Ethics approved the study. Voluntary informed consent was obtained. Findings: The nurses found themselves operating within a cure-directed treatment culture wherein they were unable to stand up for the caring values. They perceived their roles and responsibilities in decision-making processes regarding mechanical ventilation to patients as unclear and unsatisfactory. They also experienced inadequate interdisciplinary cooperation. Discussion: Lack of communication skills, the traditional hierarchical hospital culture together with operating in a medical-orientated treatment culture where caring values is rated as less important might explain the nurses’ absence in participation in the decision about mechanical ventilation. Conclusion: To be able to advocate for the patients’ and their own right to be included in decision-making processes, nurses need an awareness of their own responsibilities. This requires personal courage, leadership who are capable of organising common interpersonal meetings and willingness on the part of the physicians to include and value the nurses’ participation in decision-making processes. (shrink)

Two of the most important concepts in medicine are “curing” and “caring”. Patients should enter clinical trials with the understanding that they benefit from the treatment or that there may be some benefit to others. In many cancer trials, for example, the best that can be hoped for is a prolongation of life. Whether or not life is prolonged, we argue that there exists an obligation which can be termed a “bond of responsibility” to provide appropriate palliative care within (...) the patient’s own cultural context.The Declaration of Helsinki,1 the principal code governing the conduct of medical research, shows this “bond of responsibility” to be at its core. A number of statements stand out: “the health of my patient will be my first consideration”2 and “a physician shall only act in a patient’s best interest when providing medical care which might have the effect of weakening the physical and mental …. (shrink)

Talk therapy is, by definition, difficult, if not impossible, to represent materially. Whereas other scholars have sought to do so by referencing Sigmund Freud’s drawings or the setting of his consulting room, this article looks instead to the use of cloth in Joanne Greenberg’s 1964 semiautobiographical novel I Never Promised You a Rose Garden. The two main treatments given to protagonist Deborah Blau were therapy sessions with Dr. Clara Fried, based on Frieda Fromm-Reichmann, and the “cold pack,” in which the (...) patient was restrained and wrapped in sheets drenched with ice water. The two treatments, this article argues, can be considered in parallel, and through analysis of the material descriptions of the cold pack, one can learn more about the talking cure. Namely, this article analyzes the care in both cases as one of constraint, giving material form to the metaphorical “holding environment” of psychoanalyst D. W. Winnicott. Deborah uses the cold pack to endure her psychosis and return to reality. Similarly, Winnicott describes the ideal therapeutic space as one that, by its reliability, allows regression in service of finding a new self and distinguishing between fantasy and the outside world. The aim of this article is thus twofold: one, to further elucidate the role of cloth in treating mental distress, and two, to understand more fully the therapeutic relationship via the literal and figurative constraint of treatment. (shrink)

Research on doctor-patient communication has characterized such interactions as being asymmetrical. The present article tries to shift emphasis away from the different orientations individuals bring to the communicative setting and attempts to highlight the different orientations ("voices") within a given individual. We draw on an in-depth analysis of discourse between a 2 l-year-old man who can be ascribed the roles of both patient and potential research subject and an interviewer who acts in both the role of medical staff and researcher. (...) Focusing our analysis on a limited number of linguistic forms (pronouns and demonstratives), it is argued that the use of the same form for different referents signals a conflation of two voices - the voice of health care ("caring") and the voice of "research." Furthermore, we argue that the voice of research is most likely to be interpreted by the patient/research subject within the framework of curing. As such, the present article promotes a shift in emphasis from different institutional - and as such often assumed to be preexisting - orientations between the communicating parties to differing orientations within the individual that cannot help but be misconstrued in terms of the curing voice. Our conclusion focuses on the ethical and discourse analytic implications of analyzing voices in a discussion. (shrink)

BackgroundHIV cure research involving cell and gene therapy has intensified in recent years. There is a growing need to identify ethical standards and safeguards to ensure cell and gene therapy (CGT) HIV cure research remains valued and acceptable to as many stakeholders as possible as it advances on a global scale.MethodsTo elicit preliminary ethical and practical considerations to guide CGT HIV cure research, we implemented a qualitative, in-depth interview study with three key stakeholder groups in the United (...) States: (1) biomedical HIV cure researchers, (2) bioethicists, and (3) community stakeholders. Interviews permitted evaluation of informants’ perspectives on how CGT HIV cure research should ethically occur, and were transcribed verbatim. We applied conventional content analysis focused on inductive reasoning to analyze the rich qualitative data and derive key ethical and practical considerations related to CGT towards an HIV cure.ResultsWe interviewed 13 biomedical researchers, 5 community members, and 1 bioethicist. Informants generated considerations related to: perceived benefits of CGT towards an HIV cure, perceived risks, considerations necessary to ensure an acceptable benefit/risk balance, CGT strategies considered unacceptable, additional ethical considerations, and considerations for first-in-human CGT HIV cure trials. Informants also proposed important safeguards to developing CGT approaches towards an HIV cure, such as the importance of mitigating off-target effects, mitigating risks associated with long-term duration of CGT interventions, and mitigating risks of immune overreactions.ConclusionOur study identified preliminary considerations for CGT-based HIV cure across three key stakeholder groups. Respondents identified an ideal cure strategy as one which would durably control HIV infection, protect the individual from re-acquisition, and eliminate transmission to others. Known and unknown risks should be anticipated and perceived as learning opportunities to preserve and honor the altruism of participants. Preclinical studies should support these considerations and be transparently reviewed by regulatory experts and peers prior to first-in-human studies. To protect the public trust in CGT HIV cure research, ethical and practical considerations should be periodically revisited and updated as the science continues to evolve. Additional ethics studies are required to expand stakeholder participation to include traditionally marginalized groups and clinical care providers. (shrink)

Among the philosophies of special sciences, Philosophy of Medicine is an emerging field, even though the relationship between philosophy and medicine dates back to ancient times. Since the 1980s, t...

In a new and important book entitled TheManagedCareBluesandHowtoCureThem, a lifetime consumer advocate and a surgeon who witnessed the excesses and unaccountable errors of his colleagues under fee for service explain with deft hands the promise of managed care, its problems, and solutions to them. Walter Zelman and Robert Berenson show empathy for the consumer backlash, provider resentment, and the patients' rights movement that has spawned a thousand bills to prevent possibly unethical actions. Yet they believe these efforts to regulate (...) managed care are misdirected and will prevent it from realizing its potential. (shrink)

This creative-critical piece reflects on the practices of recording, communicating, and caring that took place on social media and in digital spaces during the COVID-19 pandemic. Using my own experience of contracting COVID-19 as a starting point, the piece looks at the ways in which epidemics have often been recorded in collaborative ways, with the personal, professional, and familial converging in historical texts that could be used as sources of medical authority. COVID-19 has similarly been immortalized across a variety of (...) forms and by different communities. The piece particularly explores the ways in which collective epidemic experience has been represented online through autopathographical Tweets, TikTok cures, and group chat messages and the future purposes that such collaborative patient narratives can serve. (shrink)

Modern medicine has done much in the fields of infectious diseases and emergencies to aid cure. In most other fields, it is mostly control that it aims for, which is another name for palliation. Pharmacology, psychopharmacology included, is mostly directed towards such control and palliation too. The thrust, both of clinicians and research, must now turn decisively towards prevention and cure. Also, longevity with well-being is modern medicine's other big challenge. Advances in vaccines for hypertension, diabetes, cancers etc, (...) deserve attention; as also, the role of meditation, yoga, spirituality etc in preventing disease at various levels. Studies on longevity, life style changes and healthy centenarians deserve special scrutiny to find what aids longevity with wellbeing. A close look at complementary and alternative medicine is needed to find any suitable models they may have, cutting aside their big talk and/or hostility towards mainstream medical care. Medicine is a manifestation of the human eros, and should not become a means of its thanatos. It must realise its true potential, so that eros prevails, and thanatos prevails only ultimately, not prematurely. (shrink)

Abstract In his discourses on ‘the lily of the field and the bird of the air,’ Kierkegaard presents faith as the best possible response to our precarious and uncertain condition, and as the ideal way to cope with the insecurities and concerns that his readers will recognize as common features of human existence. Reading these discourses together, we are introduced to the portrait of a potential believer who, like the ‘divinely appointed teachers’—the lily and the bird—succeeds in leading a life (...) that is full of care, but free of worry. Such a portrait, we claim, echoes Kierkegaard’s portrait of the knight of faith in Fear and Trembling . In this essay we suggest that faith, as characterized in the ‘lily and bird’ discourses, is a kind of existential trust that would allow us to overcome worry, while remaining wholeheartedly engaged in the finite realm of our cares and concerns. We claim that Kierkegaard’s goal in these discourses is not to belittle our earthly cares, but to invite us to develop a modified attitude toward all that we are susceptible to worry about. Content Type Journal Article Category Article Pages 1-19 DOI 10.1007/s11153-011-9322-5 Authors Sharon Krishek, Department of Philosophy, The Hebrew University of Jerusalem, Jerusalem, Israel Rick Anthony Furtak, Department of Philosophy, Colorado College, Colorado Springs, CO, USA Journal International Journal for Philosophy of Religion Online ISSN 1572-8684 Print ISSN 0020-7047. (shrink)

My assigned task in today’s colloquium is to review philosophers’ perspectives on the broad question of whether health care rationing ought to target the elderly. This is a revolutionary question, particularly in a society that is so sensitive to apparent discrimination, and the question must be approached carefully if it is to be successfully dealt with. Three subordinate questions attend this one and must be addressed in the course of answering it. The first such question has to do with (...) the issue of justice: how is it fair to target the elderly in achieving reductions in health care costs? Isn’t the proposal, or for that matter, isn’t targeting any age group, morally objectionable as a species of ageism, just as targeting members of a particular race or sex would be racist or sexist? The second subordinate question has to do with the issue of fittingness. Given that we can show in some way that targeting the elderly is not inherently unjust, why would limiting health care to them be a fitting thing for medicine to do? How would it fit, for example, with the traditional commitments of medicine, to sustain life, to relieve suffering, to heal and cure and restore function? And in particular, if medicine has the ability to save and relieve and restore the elderly, why should it replace that set of commitments with a different set for this particular population? The third subordinate question seems political, an arena reserved for one of my speaker colleagues today. There are, I believe, some underlying philosophical dimensions to its answer, and so I will say something about it. The philosophical/political questions is, Given that rationing health care to the elderly is not patently unjust, and given that a case can be made out that the ends of medicine are not violated by such limitation, shy should the elderly, as a group, assent to such a limitation? I want to address these subordinate questions, for I believe them to be the chief stumbling blocks for the possibility of an affirmative answer to our... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Deep Listening and Virtuous Friendship:Spiritual Care in the Context of Religious MultiplicityDuane R. BidwellA monk asked Zen master Yunmen: “What is the teaching of the Buddha’s entire lifetime?” Yunmen answered:“An appropriate response.”1In a pivotal scene from the 1988 film A Fish Called Wanda, con artist Wanda Gershwitz is fed up—finally—with her partner, Otto West. When his jealousy and ersatz intellectualism repeatedly jeopardize their attempts to steal $20 million (...) in diamonds, Wanda yells: “Now let me correct you on a few things, okay? Aristotle was not Belgian. The central message of Buddhism is not ‘Every Man for Himself.’ And the London Underground is not a political movement. Those are all mistakes, Otto, I looked them up.”2 It’s a funny moment, of course. But Otto’s (mis)understanding of Gautama’s teaching demonstrates a challenge in translating a spiritual-religious tradition from one cultural setting to another. Too often, and usually without intention, we are like Otto; we colonize and domesticate unfamiliar ideas, assimilating them into our existing worldview instead of experiencing and accommodating their challenging differences. Otto’s facile appropriation of Buddhism confirms rather than confronts his pre-critical, individualistic, and perhaps Darwinist worldview. A Buddhist caregiver might say that Otto was not “listening deeply” to the myriad voices that shaped his perspective.Similar hazards face someone writing about deep listening in relation to religious multiplicity.3 Deep listening, as a caring practice, “belongs” to the emerging field of Buddhist contemplative care,4 in which it has a technical (although perhaps undertheorized) usage richly informed by Buddhist thought and practice. But when I reflect as a pastoral theologian and spiritual caregiver trained in the Christian traditions of cura animarum, the cure or care of souls, deep listening can become unmoored from its origins. Someone marinated in the discourses and practices of Christian care can easily and perhaps unintentionally conflate deep listening with classic Christian [End Page 3] concepts of care such as the ministry of presence, the practice of unconditional positive regard,5 and the giving of oneself to God for the sake of the care seeker. Although I identify as a Buddhist Christian, habitual Christian views shape my thinking the way a canyon or streambed shapes the flow of water; unless I am attentive to the ways that Buddhist thought and practice seek fissures and carve new channels through the sediment of Christian spiritual care, I risk appropriating or erasing the practices that Buddhist caregivers call deep listening.Mindful of these waters, I want to immerse myself and readers in a particular question: In the context of spiritual care, what happens at the confluence of deep listening and a practitioner’s multiple religious voices? In responding to this question I have three aims: to describe deep listening, to provide a theoretical and experiential account of deep listening in the context of religious multiplicity, and to suggest an image from the Pāli canon that can help practitioners engage religious multiplicity in ways that minimize harm, increase compassion, and realize wisdom. A particular moment in spiritually integrative psychotherapy serves as a touchstone for my reflection; thus, I begin where the canyon creates a slender and fast-moving channel for deep listening: psychotherapy with Julie.6violence, karma, and compassionAt twenty-seven years of age, Julie was a soft-spoken, biracial graduate student who radiated mindful presence. She identifies as Asian American, and with her shaved head and tendency to wear dark colors and dramatic scarves, she might seem a typical LA hipster to other passengers on the commuter train she rode to and from our appointments. One year before our psychotherapeutic work, Julie had been beaten and raped by a boyfriend; subsequent thoughts of suicide led to a brief hospitalization. At that time she was assigned diagnoses of bipolar II and post-traumatic stress disorders. Daily, she swallowed a powerful mood stabilizer; monthly, she visited a psychiatrist. The symptoms of bipolar disorder, substance abuse, addiction, schizophrenia, depression, and suicide were present in her extended family. Julie sought counseling because of tension between what she called her “Buddhist identity” and the mental health diagnoses assigned to her. She said she... (shrink)

Over the past twenty years there has been a shift in medical law and practise to increasingly distrust the judgement of health professionals. An increasing number of codes of conduct, disciplinary bodies, ethics committees and bureaucratic policies now prescribe how health professional and health researchers should act and relate to their patients. The result of this, Mark Henaghan argues, has been to undermine trust and professional judgement in health professionals, while simultaneously failing to trust the patient to make decisions about (...) their care. This book will look at the issue of health professionals and trust comparatively in a number of countries including the USA, Canada, Australia, New Zealand and the UK. The book will show by historical analysis of legislation, case law, disciplinary proceedings reports, articles in medical and law journals and protocols produced by management teams in hospitals, how the shift from trust to lack of trust has happened. Drawing comparisons between situations where trust is respected such as in emergency situations, and where it is not for example routine decisions such as obtaining consent for an anaesthetic procedure, the book shows how this erosion of trust has the potential to dehumanise the special nature of the relationship between healthcare professionals and patients. The effect of this is that the practice of health care is turned into a mechanistic enterprise controlled by "management processes" rather than governed by trust and individual care and judgement. This book will be an invaluable resource for students and scholars of medical law and medical sociology, public policy-makers and a range of associated professionals, from health service managers to medical science and clinical researchers. (shrink)

Communication about diagnosis and medical treatment for children suffering from life-threatening illnesses is complex. It is a primary step in involving underage patients and families in care and lays the foundation for obtaining parental permission and patient assent for treatment. In practice child participation in care is often difficult to obtain due to patients' different and sometimes fluctuating preferences, but also parents' protective strategies. Physicians may be susceptible to parental wishes to limit information and feel uncomfortable discussing issues (...) related to uncertainty of cure with patients. A qualitative study in Romanian paediatric oncology units was conducted to explore children's involvement from the perspectives of parents and oncologists. Interviews with participants discussed 18 patient cases. Data were transcribed and thematic analysis was used to interpret and mine patients' involvement during treatment. Different facets of patient participation were identified: restricting, widening and enhancing involvement. A fourth category, unintentional involvement, occurred for all patients due to children's observations during long-term hospitalisations and access to Internet. Uncertainty overarched parental attitudes regarding the extent to which children should be included. Physicians usually complied with parental wishes to limit involvement, but together with parents involved patients at least in a practical way. Adults' protective attitude may backfire, as adolescents' online searches often expose patients to worse-case scenarios. Further research should acknowledge the hazards of restricted diagnosis disclosure and develop clinician tools to support families in communicating with patients. This should be paralleled by physician efforts to elicit patients' needs regarding participation. (shrink)

Lack of guidance and regulation for authorizing medical cannabis for conditions involving the health and neurodevelopment of children is ethically problematic as it promulgates access inequities, risk-benefit inconsistencies, and inadequate consent mechanisms. In two virtual sessions using participatory action research and consensus-building methods, we obtained perspectives of stakeholders on ethics and medical cannabis for children and youth. The sessions focused on the scientific and regulatory landscape of medical cannabis, surrogate decision-making and assent, and the social and political culture of medical (...) cannabis. We found that evidence-gathering and data dissemination, pressures on clinical relationships, and the lack of integration of culturally diverse perspectives and Indigenous knowledges were key areas of concern. Participants emphasized the importance of utilizing adaptive study designs, highlighted the importance of trust-building between clinicians, patients and caregivers, and discussed barriers including historical and ongoing stigmatization of medical cannabis. We conclude that continued public consultation and strength-based research that integrate diverse perspectives are critical steps forward. (shrink)

A number of dichotomies bedevil the concept of care, among them, the question of whether healthcare is posited on care or cure. On one side the question is whether it is enough to cure without caring (to cure is to care) and on the other whether caring is sufficient without a cure. This has received attention in recent years from feminists, particularly in the nursing profession, and from renewed interest in virtue ethics. This (...) paper describes a study that was undertaken to explore what a group of experienced United Kingdom based osteopaths understand care to be. Following interviews and transcript analysis using Grounded Theory, a number of themes were identified: Care as communication; Care as understanding the patient; Care as the therapeutic relationship; Care as action; Care as most beneficial outcome. The relationships between the various themes were explored and a ‘model of osteopathic care’ was proposed. Most of the respondents put beneficial outcome of some kind at the heart of their understanding but the process of caring was not regarded as particularly important on its own. In fact the expressed intention of osteopathic care was to facilitate a beneficial outcome. However, beneficial outcome was described in very broad terms and was not confined to the resolution of patients' presenting symptoms. In placing beneficial outcome at the heart of their model of care, respondents did not appear to recognize the dichotomy between care and cure, a finding that contrasts sharply with a number of nursing studies. The paper concludes by suggesting how it may be possible to differentiate between care and good practice. (shrink)

Hal Luft’s new book, Total Cure: The Antidote to the Health Care Crisis, ‘‘focuses on how the [health care] system should be restructured to improve care for everyone’’. As he warns at the outset, he does not address the issue that has been the focus of so many other health system reformers– expanding health insurance coverage and finding financing so care can be delivered to everyone. Instead, Luft has concentrated on how we might improve health (...) care—and he is explicit about the fact that his proposal is not about cost containment, but rather about obtaining value for the money we currently spend on health care. (shrink)

The aim of this paper is to present and discuss nurses’ and physicians’ comments in a questionnaire relating to patients’ transition from curative treatment to palliative care. The four-page questionnaire relating to experiences of and attitudes towards communication, decision-making, documentation and responsibility of nurses and physicians and towards the competence of patients was developed and sent to a random sample of 1672 nurses and physicians of 10 specialties. The response rate was 52% , and over one-third made comments. The (...) respondents differed in their comments about three areas: the concept of palliative care, experiences of unclear decision-making and difficulties in acceptance of the patient’s situation. The responses are analysed in terms of four ethical theories: virtue ethics, deontology, consequentialism and casuistry. Many virtues considered to be appropriate for healthcare personnel to possess were invoked. Compassion, honesty, justice and prudence are especially important. However, principles of medical ethics, such as the deontological principle of respect for self-determination and the consequence of avoidance of harm, are also implied. Casuistry may be particularly helpful in analysing certain areas of difficulty—namely, what is meant by “palliative care”, decision-making and accepting the patient’s situation. Keeping a patient in a state of uncertainty often causes more suffering than necessary. Communication among the staff and with patients must be explicit. Many of the staff have not had adequate training in communicating with patients who are at the end of their life. Time for joint reflection has to be regained, and training in decision-making is essential. In our opinion, palliative care in Sweden is in need of improvement. (shrink)

Although COVID-19 pandemic has re-orientated humans to be more physically healthy and hygienic, it has also persuaded humans to create affiliations and experience a sense of belongingness through social networks and digital technologies. However, amidst these changes, experiences of COVID-19 patients and their perception of the outside world's attitudes toward them appears to be less attended in literature which formed the basis for the current study's objectives. Using qualitative methodology, the present study explored the experiences, perceptions and attitudes of patients (...) and their care-givers' toward COVID-19. The thematic analysis emerged with four major themes. Psychological Experiences of People was generated prominently with sub-themes indicating the perceived experiences like fear of spreading diseases to others, and the need for psychological counseling. Attitude of others toward patients and caregivers revealed that family members and relatives played a major positive role on the patient's mental health, however, the neighbor's stigmatized attitude led to several undesired behaviors. Social Connectedness was another major theme derived from the study. Altruistic volunteers, a sub-theme of Social connectedness have indicated that amidst these negative factors, one can spread social harmony by motivating and supporting the victims with basic needs, financial support, hope and social empathy. Opinions of participants for digital technology through technological aids and preventive measures emphasized an overall positive attitude as it helped the society, in general to maintain social connections as well to curb the rate of COVID-19 cases. (shrink)

A rising number of patients require continuing or palliative services and this means that they will need to transition from one model of healthcare delivery to another. If it is generally recognised that patient vulnerability to inadequate services increases when the setting in which patient receives care changes, it is usually taken to be the result of poor coordination of services or personnel. Recognising that an integrated system is essential to adequate access, the point that I put forward in (...) this paper is that the centrality of acute care services affects the way in which chronic and palliative services are structured and, consequently, their availability. I argue that the problem originates in the manner in which some of the foundational concepts of the acute care model are imported into the other models of care delivery. In order to make this case, I review the three main models of healthcare service delivery by focusing my analysis along three axes: the goal of the care model; the predominant understanding of autonomy implicit in the model; and, the main actors in the care relationship. By examining how the various concepts translate from one model to the next, I discuss what I identify to be one of the main conceptual obstacles to less problematic transitioning, the notion of autonomy and the corresponding view of the patient as an isolated agent. (shrink)

The development of gene therapy has always come with the expectation that it will offer a cure for various disorders, of which hemophilia is a paradigm example. However, although the term is used regularly, it is unclear what exactly is meant with “cure”. Therefore, the aim of this paper is to analyse how the concept of cure is used in practice and evaluate which of the interpretations is most suitable in discussions surrounding gene therapy. We analysed how (...) cure is used in four different medical fields where the concept raises discussion. We show that cure can be used in three different ways: cure as normalization of the body, cure as obtaining a normal life, or cure as a change in identity. We argue that since cure is a practical term, its interpretation should be context-specific and the various uses can exist simultaneously, as long as their use is suitable to the function the notion of cure plays in each of the settings. We end by highlighting three different settings in the domain of hemophilia gene therapy in which the term cure is used and explore the function(s) it serves in each setting. We conclude that in the clinical application of gene therapy, it could be better to abandon the term cure, whereas more modest and specified definitions of cure are required in the context of health resource allocation decisions and decisions on research funding. (shrink)

Two decades of research on euthanasia in the Netherlands have resulted into clear insights in the frequency and characteristics of euthanasia and other medical end-of-life decisions in the Netherlands. These empirical studies have contributed to the quality of the public debate, and to the regulating and public control of euthanasia and physician-assisted suicide. No slippery slope seems to have occurred. Physicians seem to adhere to the criteria for due care in the large majority of cases. Further, it has been (...) shown that the majority of physicians think that the euthanasia Act has improved their legal certainty and contributes to the carefulness of life-terminating acts. In 2005, eighty percent of the euthanasia cases were reported to the review committees. Thus, the transparency envisaged by the Act still does not extend to all cases. Unreported cases almost all involve the use of opioids, and are not considered to be euthanasia by physicians. More education and debate is needed to disentangle in these situations which acts should be regarded as euthanasia and which should not. Medical end-of-life decision-making is a crucial part of end-of-life care. It should therefore be given continuous attention in health care policy and medical training. Systematic periodic research is crucial for enhancing our understanding of end-of-life care in modern medicine, in which the pursuit of a good quality of dying is nowadays widely recognized as an important goal, in addition to the traditional goals such as curing diseases and prolonging life. (shrink)

Palliative care serves both as an integrated part of treatment and as a last effort to care for those we cannot cure. The extent to which palliative care should be provided and our reasons for doing so have been curiously overlooked in the debate about distributive justice in health and healthcare. We argue that one prominent approach, the Rawlsian approach developed by Norman Daniels, is unable to provide such reasons and such care. This is because (...) of a central feature in Daniels' account, namely that care should be provided to restore people's opportunities. Daniels' view is both unable to provide pain relief to those who need it as a supplement to treatment and, without justice-based reasons to provide palliative care to those whose opportunities cannot be restored. We conclude that this makes Daniels' framework much less attractive. (shrink)

Background and objective: Code status discussions may fail to address patients’ treatment-related goals and their knowledge of cardiopulmonary resuscitation (CPR). This study aimed to investigate patients’ resuscitation preferences, knowledge of CPR and goals of care. Design, setting, patients and measurements: 135 adults were interviewed within 48 h of admission to a general medical service in an academic medical centre, querying code status preferences, knowledge about CPR and its outcome probabilities and goals of care. Medical records were reviewed for (...) clinical information and code status documentation. Results: 41 (30.4%) patients had discussed CPR with their doctor, 116 (85.9%) patients preferred full code status and 11 (8.1%) patients expressed code status preferences different from the code status documented in their medical record. When queried about seven possible goals of care, patients affirmed an average of 4.9 goals; their single most important goals were broadly distributed, ranging from being cured (n = 36; 26.7%) to being comfortable (n = 8; 5.9%). Patients’ mean estimate of survival to discharge after CPR was 60.4%. Most patients believed it was helpful to discuss goals of care (n = 95; 70.4%) and the chances of surviving inhospital CPR (n = 112; 83.0%). Some patients expressed a desire to change their code status after receiving information about survival following inhospital CPR (n = 11; 8.1%) or after discussing goals of care (n = 2; 1.5%). Conclusions: Doctors need to address patients’ knowledge about CPR and take steps to avoid discrepancies between treatment orders and patients’ preferences. Addressing CPR outcome probabilities and goals of care during code status discussions may improve patients’ knowledge and influence their preferences. (shrink)

This paper explores the ethics of introducing genome-editing technologies as a new reproductive option. In particular, it focuses on whether genome editing can be considered a morally valuable alternative to preimplantation genetic diagnosis (PGD). Two arguments against the use of genome editing in reproduction are analysed, namely safety concerns and germline modification. These arguments are then contrasted with arguments in favour of genome editing, in particular with the argument of the child’s welfare and the argument of parental reproductive autonomy. In (...) addition to these two arguments, genome editing could be considered as a worthy alternative to PGD as it may not be subjected to some of the moral critiques moved against this technology. Even if these arguments offer sound reasons in favour of introducing genome editing as a new reproductive option, I conclude that these benefits should be balanced against other considerations. More specifically, I maintain that concerns regarding the equality of access to assisted reproduction and the allocation of scarce resources should be addressed prior to the adoption of genome editing as a new reproductive option. (shrink)

When a serious crime—say a murder—is committed by someone who has been discharged or has absconded from prison the public reaction is extreme. And public anger is not appeased by psychiatrists and sociologists who argue in the media the case either for all mental disorders being capable of treatment leading at least to partial cure or that all crime springs from unfortunate social circumstances. In the two papers which follow the situation is described how psychopathic and other mentally abnormal (...) offenders are dealt with at the present time, and how the Aarvold and Butler Committees were set up. The Aarvold Committee (Chairman, Mr Justice Aarvold) was to be concerned with tightening the provisions of the law as it now stands whereas the Butler Committee (Chairman, Lord Butler) was asked to look into and recommend changes in the law relating to these offenders. The Aarvold Committee reported swiftly and the Butler Committee made its final report in 1975. (An interim report was produced in 1974.) It is with the Butler Report that Dr Rollin and Dr Norton are principally concerned here. The fundamental aim of both committees was to maintain a balance between `what is best for those guilty of dangerous offences and the right of the public to be protected'. Both writers describe the various forms of detention for psychopathic offenders in operation and proposed, and both conclude that the Butler Report offers wise and realistic guidance but fear that continuing official inertia will preclude the recommendations ever being implemented. Dr Norton deals particularly with the concept of `dangerousness', and the controversial issue of the Butler `reviewable sentences' for mentally abnormal offenders. (shrink)