Four of the works attributed to Arnau de Vilanova may be considered consilia, which is the name of the genre of texts that expound medical treatments for illnesses suffered by specific individuals. In this paper, I first address the problem of their authenticity within the framework of the so-called "Arnaldian question". The evidence presented here confirms that Arnau de Vilanova was the author of the Regimen podagre and the Epistola ad Bremundum Montisferrarii, while the question regarding the authorship (...) of the Regimen quartane and the Cura febris ethice remains unresolved. This article furthermore documents the degree to which the actual cures prescribed by the physician in the consilia agreed with the doctrinal works of the Galenic tradition. It is explained how medieval university-trained physician had to compete with other practitioners and how they tried to outrival them by applying the doctrines of learned medicine to the individual cases at hand. (shrink)

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

Summary Principles Timely support for patients and people close to them, and effective, sensitive communication are essential. Decisions must be based on the individual patient's circumstances and reviewed regularly. Sensitive advance discussion should always be encouraged, but not forced. Information about CPR and the chances of a successful outcome needs to be realistic. Practical matters Information about CPR policies should be displayed for patients and staff. Leaflets should be available for patients and people close to them explaining about CPR, how (...) decisions are made and their involvement in decisions. Decisions about attempting CPR must be communicated effectively to relevant health professionals. In emergencies If no advance decision has been made or is known, CPR should be attempted unless: the patient has refused CPR; the patient is clearly in the terminal phase of illness; or the burdens of the treatment outweigh the benefits. Advance decision making Competent patients should be involved in discussions about attempting CPR unless they indicate that they do not want to be. Where patients lack competence to participate, people close to them can be helpful in reflecting their views. Legal issues Patients' rights under the Human Rights Act must be taken into account in decision making. Neither patients nor relatives can demand treatment which the health care team judges to be inappropriate, but all efforts will be made to accommodate wishes and preferences. In England, Wales and Northern Ireland relatives and people close to the patient are not entitled in law to take health care decisions for the patient. In Scotland, adults may appoint a health care proxy to give consent to medical treatment. Health professionals need to be aware of the law in relation to decision making for children and young people.IntroductionWhy policies are neededCardiopulmonary resuscitation can be attempted on any person whose cardiac or respiratory functions cease. Failure of these functions is part of dying and thus …. (shrink)

This code of practice for health professionals was prepared by a multi-professional group and reflects good clinical practice in encouraging dialogue about individuals' wishes concerning their future treatment. It has a broad practical approach, considers a range of advance statements, advises of dangers and benefits of making treatment decisions in advance and combines annotated code of practice with a quick pull out guide for easy reference.

This article presents an analysis of contractual relations in sport from the standpoint of the Croatian legislative system. Due to the complexity of the subject matter, the author considers only a small fragment of it - the significance and the role of sport in Croatian society and the law of contracts „as a cornerstone on which „sports law“ has been built and which is of primary importance in most areas where there is an interface between sport and the law, irrespective (...) of whether the sport is being played at an elite level or at a more humble one“. Bearing in mind the limited extent of this article, the autor tries to provide some clarifications and some guidance on how to deal with the designation and the determination of the applicable law for contracts in the sporting context. Considering that there are different legal regimes which may come into play with regard to the designation of the law applicable to contracts in the sporting context, the author first presents the determination of the applicable law according to the Rome I Regulation and then according to the Croatian Arbitration Act, Swiss Private International Law Act and the CAS Code of Sports-related Arbitration, as the most common in sports practice. Then, the author deals with contracts concluded with minor athletes and the determination of the law applicable to some preliminary questions. Finally, the author presents her perception of the problems encountered and some suggestions for the improvement of the existing legal framework. (shrink)

1. Aim of the guidelines2. Principles of good practice3. Circumcision for medical purposes4. Non-therapeutic circumcision 4.1. The law 4.1.1. Summary: the law 4.2. Consent and refusal 4.2.1. Children’s own consent 4.2.2. Parents’ consent 4.2.3. Summary: consent and refusal 4.3. Best interests 4.3.1. Summary: best interests 4.4. Health issues 4.5. Standards 4.6. Facilities 4.7. Charging patients 4.8. Conscientious objection5. Useful addresses.

Few subjects provoke as much controversy or debate as that of medical care, and the law that governs such an emotive area finds itself with the near-impossible task of simultaneously trying to regulate the medical profession and healthcare provision whilst upholding the rights of the millions of people who use those services every year. Medical Law combines an accessible explanation of the complex and challenging legal rules of medical care in England and Wales with a stimulating (...) examination of the social, political and ethical arguments such care provokes. It examines a broad range of issues, from the structure and organisation of the NHS, through the rules of clinical negligence, as well as focussing on the legal and ethical concerns around such deeply contentious areas as surrogacy, organ donation, abortion and euthanasia. Written very much with newcomers to the area in mind, Leanne Bell lucidly outlines not just what the law is, but how it has developed over time and also provides insights as to how advances in medical technology and techniques may call for it to evolve in the future. (shrink)

This paper suggests that medical education be revised to assist in diffusing potential ethical dilemmas that arise during health care provision. A revised medical education would emphasize the role of the humanities in the training of physicians, especially in light of recent critiques of the canonical scientific model in general, and more specifically in the use of that model for medical training and practice.

Alongside clinical practice, medical schools now confront mounting reasons to examine nontraditional approaches to ethics. Increasing awareness of systems of oppression and their effects on the experiences of trainees, patients, professionals, and generally on medical care, is pushing medical curriculum into an unfamiliar territory. While there is room throughout medical school to take up these concerns, ethics curricula are well-positioned to explore new pedagogical approaches. Feminist ethics has long addressed systems of oppression and broader structures of (...) power. Some of its established concepts can offer distinct value as medical climates change and adapt in response to increased awareness of the experiences of marginalized individuals and populations. In this essay, we offer a set of concepts from feminist ethics that have a fundamental role to play in medical school curriculum: relationality, relational autonomy, and epistemic justice. Though these concepts are not exhaustive, they can be taught in tandem with the concepts that have historically grounded ethics education in medical school, such as autonomy and beneficence. Ultimately, we contend that these concepts hold particular value in ethics curriculum insofar as they diversify mainstream ethical approaches, directly address the pervasiveness of systems of oppression in medicine, and recognize the voices and concerns that may be marginalized in standard approaches. (shrink)

*Disclaimer: The views expressed are the author's and should not be ascribed to the American Medical Association.

*The views expressed are the author's own. This article should not be construed as representing policies of the American Medical Association.

This book, written both for a Canadian and an international readership, provides a multidisciplinary review of the framework and performance of the Canadian Medical Assistance in Dying (MAID) program. In the first five years (2015-2021) of operation, this program delivered voluntary euthanasia and assistance in suicide to over 30,000 Canadian residents, presently representing a 30% annual growth. Looking back on these first five years, the 30 Canadian scholars and clinicians contributing to this volume raise important issues and attempt to (...) answer key questions that have arisen in regards to its operation and its stated objectives. This volume strikes the most appropriate balance between the autonomy of persons who seek medical assistance, versus the interests and protection of vulnerable persons. Finally, the book makes suggestions on how the program can presently be improved. It identifies gaps in knowledge about MAID’s operational program and its impact on individuals, families and society in order to stimulate the necessary research that is essential to the evolution of a healthy and well-balanced program. As a first, comprehensive examination of medically assisted deaths in Canada, this publication will be of great value to lay, professional, academic, political audiences both domestically and internationally, especially in jurisdictions that are examining their options of permitting assisted deaths. (shrink)

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

Canada’s rapid rise in deaths from euthanasia and physician assisted suicide, termed Medical Assistance in Dying (MAID) in the country, now ranks it second only to the Netherlands in terms of MAiD deaths as percentage of overall deaths, with one province already hosting the highest rate of all jurisdictions in the world. Analyzing Health Canada’s annual MAID reports, which show that up to 336 out of 1837 providers are likely responsible for the majority of MAID deaths in a given (...) year, we discuss how the rapid increase likely reflects not a broad Canadian consensus but the capture of a policy-making and implementation process by a small group of activists and clinicians colonizing medicine to become an ideologically driven vehicle for expanding MAID access and delivery. As a remedy and to reprioritize patient safety and protection against premature death, a more transparent, relevant, and safeguarded compliance regime based on evidence-based, multi-perspective policy-making is needed. (shrink)

Confidentiality is both a fundamental principle of medical ethics and a legal obligation.In exceptional situations not covered by legal provisions, doctors may want to waive confidentiality against the wishes of the patient. Swiss law calls for an authority to rule on such cases. In the Canton of Geneva this authority is the Commission for Professional Confidentiality. This paper concerns 41 cases managed by this commission. The study shows that the majority of these requests to the Commission concern the reporting (...) of patients who are not incompetent but need the protection of a legal guardianship. In rare cases, there is another interest higher than confidentiality: public order or functioning of justice. The Commission found that the measure requested was justified in the majority of cases brought before it. This study focuses on exceptional cases but it throws into relief the conflict between the principle of autonomy on the one hand and the need for patient protection and social justice on the other. (shrink)

One hundred years ago, Flexner emphasized the role of science in medical education. With a 21st-century perspective, the question may be posed anew: is science relevant to medical education and practice? If so, then which areas of science are fundamental to learning and making ongoing decisions in medicine? The answers to these questions should determine what is needed in the preparation of an undergraduate student for medical school.Educators and students alike question the relevance of current premedical requirements, (...) and there is concern that these in fact diminish student interest in medical or biomedical research careers. For example, premedical science courses are viewed by many students (including those who .. (shrink)

Current law does not adequately protect patients' privacy or their medical records. Proposals to computerize these records could further erode confidentiality unless new federal laws are enacted.

In this paper, we argue that lack of access to the fruits of modern medicine and the science that informs it is an important and neglected topic within bioethics and medical ethics. This is especially clear to those working in what are now termed 'resource-poor settings'- to those working, in plain language, among populations living in dire poverty. We draw on our experience with infectious diseases in some of the poorest communities in the world to interrogate the central imperatives (...) of bioethics and medical ethics. AIDS, tuberculosis, and malaria are the three leading infectious killers of adults in the world today. Because each disease is treatable with already available therapies, the lack of access to medical care is widely perceived in heavily disease-burdened areas as constituting an ethical and moral dilemma. In settings in which research on these diseases are conducted but there is little in the way of therapy, there is much talk of first world diagnostics and third world therapeutics. Here we call for the 'resocialising' of ethics. To resocialise medical ethics will involve using the socialising disciplines to contextualise fully ethical dilemmas in settings of poverty and, a related gambit, the systematic participation of the destitute sick. Clinical research across steep gradients also needs to be linked with the interventions that are demanded by the poor and otherwise marginalised. We conclude that medical ethics must grapple more persistently with the growing problem posed by the yawning 'outcome gap' between rich and poor. (shrink)

Tоday there is a strong tendency to incorporate the bioethical principle of social justice in healthcare in cross-cultural communication. Considering cultural differences makes it possible to ensure that the human right to medical care and wellbeing is fully respected. Several types of most vulnerable populations were identified – immigrants and social minorities. When seeking medical care they face a number of problems such as culture and language barriers, lower socio-economic status, lack of literacy, which impede effective communication and (...) care provision. The most promising ways of coping with the problem are developing cultural competence and practicing a patient-centered approach. New curricula aiming at raising cultural awareness have been elaborated for practical use in medical schools. (shrink)

When discussing the allocation of medical resources, it is common to distinguish between macroallocation and microallocation. The former refers to an entire system of healthcare; it determines who gets access to what healthcare and on the basis of what criteria.

The COVID-19 pandemic laid bare systemic inequities shaped by social determinants of health (SDoH). Public health agencies, legislators, health systems, and community organizations took notice, and there is currently unprecedented interest in identifying and implementing programs to address SDoH. This special issue focuses on the role of medical-legal partnerships (MLPs) in addressing SDoH and racial and social inequities, as well as the need to support these efforts with evidence-based research, data, and meaningful partnerships and funding.

This paper explores evolving treatments for hysteria in the eighteenth century by examining a selection of works by both physician-writers and educated literary women. The treatments I identify—which range from aggressive bloodlettings, diets, and beatings, to exercise, fresh air, and writing cures—reveal a unique culture of therapy in which female sufferers and doctors exert an influence on one another's notions of what constitutes appropriate management of women's mental illness. A scrutiny of this exchange of ideas suggests that female patients were (...) not simply oppressed and silenced by male practitioners; rather, their collective voice, intellect, and expertise helped to form progressive treatments for eighteenth-century hysteria. (shrink)

Although the AAMC requires annual reporting of medical humanities teaching, most literature is based on single-school case reports and studies using information reported on schools’ websites. This study sought to discover what medical humanities is offered in North American allopathic and osteopathic undergraduate medical schools. An 18-question, semi-structured survey was distributed to all 146 member schools of the American Association of Medical Colleges and the American Association of Colleges of Osteopathic Medicine. The survey sought information on (...) required and elective humanities content, hours of humanities instruction, types of disciplines, participation rates, and humanities administrative structure. The survey was completed by 134 schools. 70.8% of schools offered required and 80.6% offered electives in humanities. Global health and writing were the most common disciplines. Schools required 43.9 mean and 30 median hours in humanities. In the first two years, most humanities are integrated into other course work; most electives are offered as stand-alone classes. 50.0% of schools report only 0-25% of students participating in humanities electives. Presence of a certificate, concentration or arts journal increased likelihood of humanities content but decreased mean hours. Schools with a medical humanities MA had a higher number of required humanities hours. Medical humanities content in undergraduate curriculum is lower than is indicated in the AAMC annual report. Schools with a formal structure have a greater humanities presence in the curriculum and are taken by more students. (shrink)

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

The extensive participation of German physicians in the atrocities of the Holocaust raises many questions concerning the potential for moral erosion in medicine. What circumstances and methods of rationalisation allowed doctors to turn from healers into accomplices of genocide? Are physicians still vulnerable to corruption of their guiding principles and, if so, what can be done to prevent this process from occurring? With these thoughts in mind, the author reflects on his experiences participating in the Fellowships at Auschwitz for the (...) Study of Professional Ethics program and offers a medical student's perspective on the ethical issues encountered in clinical training and the practice of medicine. (shrink)

The advent of the internet age has impacted every sphere of modern medicine, including medical education. The new generation of trainees require novel approaches to teaching to make the requisite impacts on their minds. Conventional classroom teaching might be considered obsolete by some, especially when the subject being talked about is ethics and philosophy of medicine. An untapped resource for the teachers lies perhaps in the colossal reserve of decades of cinema. This novel concept of using movies to teach (...) is enumerated in this article by using the 1979 film “Apocalypse Now” to draw parallels between the situations occurring in the film with the ethical dilemmas that a clinician might face or philosophies that may be of utility to a physician. This article presents a conceptual framework of this ideology by exploring a film that might be considered by some to have no correlation with the queries that a medical mind might have while proving that it might not be the content of the film but the viewpoint of the teacher/trainee that may define the interpretations that may be drawn from it. Soldiers and doctors both work in a strict structure of hierarchy and are both put in situations where ethical dilemmas have life and death implications. This core philosophy has served as an inspiration for this article. (shrink)

Like the authors of some of the other responses to Schneiderman, Jecker, and Jonsen, I too was one of the group that produced “An Official ATS/AACN/ACCP/ESICM/SCCM Policy Statement: Responding to Requests for Futile and Potentially Inappropriate Treatments in Intensive Care Units”. Furthermore, ethical and legal issues surrounding futile and potentially inappropriate medical treatment have been a primary focus of my scholarship for more than a decade. Schneiderman, Jecker, and Jonsen offer a strong critique of the Multiorganization Statement, but they (...) do not describe it with sufficient precision. There are points of true normative disagreement between the... (shrink)

Dolores Dooley Clarke describes how the course in medical ethics at University College, Cork is structured, how it has changed and how it is likely to change as time goes on. Originally, the students seemed to view it as an intrusion 'to be tolerated' in their programme of 'strictly medical' studies. However, having moved on from that and away from the lecturer always being a Roman Catholic priest as well as a member of the Philosophy Department, the students (...) now appear to view it as producing a stimulus for a new interest in the area of ethics for physicians. This seems to have come about through the more extensive participation of students in researching and presenting issues of medical ethics. (shrink)

The present study was aimed at gaining a broad opinion regarding bioethical reasoning amongst student fraternity. These students had been admitted to medical schools after completion of their high school . Ethnically all the students were of Indian origin though they belonged to a diverse socio-economic-cultural background. The mean age of students was 18 years and a total of 125 first year medical students were questioned in 1998 , using the questionnaire designed by Macer with some modifications. The (...) observations revealed the fact that even though fair amount of awareness regarding the wide perspectives of bioethics did prevail amongst many, yet some sense of ignorance was reflected as well. However, the respondents were divided on various sensitive issues like cloning, in vitro fertilisation etc. The results suggest enforcement of both individual and collective efforts to arouse the consciousness of students regarding bioethics and application of bioethical decision making to dilemmas posed by science and technology. (shrink)

Now I know why so many stories have been written with the theme: “everything changed in one moment.” More than 1,000 days have come and gone, and I still remember one Sunday morning and still follow and feel the effects of one decision.

Diversas investigaciones confirman que la evaluación de la información estadística constituye una limitante para el profesional de la Medicina. Incluso en ocasiones se tiende a posturas éticas y bioéticas inadecuadas que generan problemas para las ciencias médicas; y por ende, para la sociedad. Por esa razón, el objetivo del artículo consistió en fundamentar teóricamente la competencia evaluar información estadística para el profesional de la Medicina. Los resultados obtenidos evidencian la necesidad de concebir el proceso de evaluación de la información estadística (...) como una competencia para dicho profesional. Various investigations confirm that the evaluation of statistical information constitutes a limitation for health professionals. There are potentially inappropriate ethical and bioethical positions garnered from data with limited evaluation that can generate problems for the medical science fields and potentially, for society as a whole. For that reason, the objective of this article was to theoretically support the health professional's skill to evaluate statistical information. The results obtained suggest the need to develop a competency process for health professionals in the evaluation of statistical information. (shrink)

In an article titled, "Who Shall Live When Not All Can?", James Childress proposes a system for allocating scarce lifesaving medical resources based on random selection procedures. Childress writes of random selection procedures, [They] "cannot be dismissed as a ‘non-rational’ and ‘non-human’... without an inquiry into the reasons, including human values which might justify it." My thesis is that once we concentrate on determining the rationality of random selection procedures, we will see that Childress's claim that we cannot dismiss (...) such procedures as ‘non-rational’ is open to question. My claim will be that while both random selection and social worth procedures are rationally defensible systems, random selection procedures easily lead to specific choices that are objectively irrational, apart from the limited perspective of the random selection process itself. Keywords: allocation, random selection, rationality, rational decision-making, scarce resources, social worth CiteULike Connotea Del.icio.us What's this? (shrink)

Homeopathy has been the subject of intense academic, media and public debate in recent months. Those opposed to the practice, which treats like with like by using ultra-dilute remedies, argue that it is an ineffective non-treatment that is not supported by evidence and should not be funded on the National Health Service. Its proponents claim that it is effective (although they disagree about whether it is more effective than placebo) and argue its use is appropriate for certain conditions. This paper (...) examines homeopathy from the perspective of the four principal principles of medical ethics and two example cases. It transpires that homeopathic practice is in contravention of all four of these principles, and is by its very nature unethical. (shrink)

This collection of 49 readings with extensive background description exposes students to the breadth of theoretical perspectives and issues in the field of medical anthropology. The text provides specific examples and case studies of research as it is applied to a range of health settings: from cross-cultural clinical encounters to cultural analysis of new biomedical technologies to the implementation of programs in global health settings.

This volume addresses the interdependencies between visual technologies and epistemology with regard to our perception of the medical body. It explores the relationships between the imagination, the body, and concrete forms of visual representations: Ranging from the Renaissance paradigm of anatomy, to Foucault's "birth of the clinic" and the institutionalised construction of a "medical gaze"; from "visual" archives of madness, psychiatric art collections, the politicisation and economisation of the body, to the post-human in mass media representations. Contributions to (...) this volume investigate medical bodies as historical, technological, and political constructs, constituted where knowledge formation and visual cultures intersect. Contributors are: Axel Fliethmann, Michael Hau, Birgit Lang, Carolyn Lau, Heikki Lempa, Stefanie Lenk, Joanna Madloch, Barry Murnane, Jill Redner, Claudia Stein, Elizabeth Stephens, Corinna Wagner, and Christiane Weller. (shrink)