This book completes medical care by adding the comprehensive humanistic perspectives and philosophy of medicine.

Since Alasdair MacIntyre’s landmark book After Virtue, there has been renewed interest in the role of the virtues in the moral life and attention paid to reappropriating the Aristotelian notion of "practice." Recent reappropriations of the virtues and virtue theory in medical ethics have contributed to conceiving more adequately the nature of good medicine. I wish to explore some of these insights and the special relevance the notion of practice has in an account of good medicine. (...) Yet, I also want to suggest that much remains to be done. This renewed attention to the virtues needs to be supplemented by a similar reappropriation and transposition of the notion of nature in order to navigate successfully the Dardanelles of an ahistorical essentialism and the Bosphorus of a historical relativism. (shrink)

Introduction Illegal practice of medicine by medical students is a worldwide problem. In Brazil, information about this issue is scarce.Objective To describe the perception of illegal practice of medicine by medical students.Methods A cross-sectional study in a stratified random sample of 130 medical students in the 6th to 12th semesters from a private faculty of medicine in Salvador, State of Bahia, Brazil, from September to October 2011. Students responded to a standardised questionnaire about the illegal (...) practice of medicine by medical students.Results Knowing medical students who practised medical activities without supervision was reported by 86% of the respondents, and 93.8% had heard about someone who performed such practices. Medical specialties most often associated with illegal practice were general medicine and occupational health . Illegal practice of medicine was more common in peripheral cities/towns than in the State capital, Salvador City . Only 10.5% of illegal activities were reported to the authorities. Unsupervised medical practice was more often reported in the 8th–9th semester and 10th–11th semester of medical school.Conclusions Illegal practice of medicine was commonly reported by the medical students questioned. The high frequency of reported illegal practice for financial reasons highlights the need for greater availability of paid internships for medical students. Educational institutions represent the social control responsible for supervising the activities of academics. (shrink)

How Doctors Think defines the nature and importance of clinical judgment. Although physicians make use of science, this book argues that medicine is not itself a science but rather an interpretive practice that relies on clinical reasoning. A physician looks at the patient's history along with the presenting physical signs and symptoms and juxtaposes these with clinical experience and empirical studies to construct a tentative account of the illness. How Doctors Think is divided into four parts. Part one (...) introduces the concept of medicine as a practice rather than a science; part two discusses the idea of causation; part three delves into the process of forming clinical judgment; and part four considers clinical judgment within the uncertain nature of medicine itself. In How Doctors Think, Montgomery contends that assuming medicine is strictly a science can have adverse side effects, and suggests reducing these by recognizing the vital role of clinical judgment. (shrink)

This contribution focuses on Ficino's letters and woks in which he defends the art of medicine and its value for the human beings.

Objective The President's Council on Bioethics in 2008 reaffirmed the necessity of the dead donor rule and the legitimacy of the current criteria for diagnosing both neurological and cardiac death. In spite of this report, many have continued to express concerns about the ethics of donation after circulatory death, the validity of determining death using neurological criteria and the necessity for maintaining the dead donor rule for organ donation. I analysed the dead donor rule for its effect on the virtuous (...) practice of medicine by physicians caring for potential organ donors.Results The dead donor rule consistently impedes physicians in fulfilling their primary duty to act for the good of their prospective donor patients. This compromises the virtue of fidelity. It also weakens many other virtues necessary for physicians to provide excellent end-of-life care.Conclusions The dead donor rule, while ethically powerful in theory, loses its force during translation to the bedside. This is so because the rule mandates simultaneous life and death within the same body for organ donation, a biological status that is inherently contradictory. The rule should be rejected as an ethical norm governing vital organ transplantation at the end of life. Its elimination will strengthen the doctor–patient relationship and foster trustworthiness in organ procurement. (shrink)

This essay argues that an account of vocation that ties one’s work with divine calling stands counter to the biblical witness of calling in the New Testament. Rather than calling to a particular profession, the biblical account of calling is to a unique way of living that is to exemplify the followers of Christ. Therefore, the re-enchantment of medicine is not accomplished when one makes the practice itself sacred simply by imagining it as one’s divine calling. Rather, the (...) sacredness of medicine is rooted in the character of the physician whose daily decisions and patient interactions are the outcomes of virtues inculcated in worship, prayer, Bible study, and all other practices that mark the life of faith. Thus, the practitioner avoiding burnout asks not “Am I called to be a physician?” but “How as a physician in the daily practice of medicine might I exemplify my calling to Christ-likeness?”. (shrink)

This essay argues that the practice ofmedicine is not a phronetic activity in theoriginal Aristotelian sense of that term. Jonsen andToulmin are two philosophers who have conflated thetechne of medicine with phronesis. Thisconflation ignores Aristotle's crucial distinctionbetween techne and phronesis and his useof the medical analogy. It is argued that medicalreasoning is similar to phronesis but does notexemplify it. Phronesis will not save thelife of medical ethics. The concept could be utilized as amoral prosthetic.

In the following essay, the theoretical apparatus for distinguishing various types of collectivities (aggregates and conglomerates) is described. This is followed by a consideration of how responsibility ascriptions to different types of collectivities are to be understood vis à vis those to individual group members. It is suggested that the "medical profession" (distinctly different from the "medical team" and the "hospital corporation") is an aggregate collectivity. That is, the "medical profession" consists of the "sum" of the identities of its membership, (...) which can be shown to entail that if the "profession" is held responsible for something, each of its members is responsible, in some way, for it. This is to suggest that the "medical profession" is not a shield that hides individual medical practitioners from responsibility for the general state of health care. Quite the contrary. The use of the name of the aggregate in such a responsibility ascription puts each and every one of them "on call." CiteULike Connotea Del.icio.us What's this? (shrink)

Background Defensive medicine is physicians’ deviation from standard medical care which is primarily intended either to reduce or avoid medico legal litigation. Although the Federal Ethics Committee review in Ethiopia has shown that applications for medical/surgical error investigation claims are increasing at an alarming rate, there is no study to date done to estimate the degree of defensive practice done by the physicians with an intention of avoiding this increasing legal claim. This study assessed the practice of (...) defensive medicine among highly litigious disciplines (surgery) and described factors associated with its practice. Methods Cross sectional quantitative study using online survey questionnaires was conducted to assess the degree of defensive practice and six factors (age, years of experience, specialty, monthly income, place of practice and previous medico legal history) associated with its practice were assessed among surgeons working in Ethiopia. Results A total of 430 surgeons directly received an online survey questionnaire and 236 of them successfully completed the questionnaire making the response rate 51.2%. Nearly half of the study participants (51.7%) were aware of the concept of defensive medicine and 174 (74%) reported performing one form of defensive practice. Twenty-nine (12.3%) of the participants have legal dispute history, though only 1.3% of them ended up in penalty. Avoiding high risk procedures was the commonest defensive act performed by 60% of the participants, followed by ordering tests unnecessarily (52.1%). Multinomial logistic regression model showed that there was no association between age of the participant, place of practice, year of experience and defensive practice. This model also showed that cardiothoracic and vascular surgeons perform less defensively than surgeons with other specialty with P value of 0.02. Conclusion The practice of defensive medicine is widespread among surveyed Ethiopian surgeons and further studies are required to objectively estimate the effect of defensive practice on the health care system of the country. Policy makers need to develop strategy towards decreasing this high rate of defensive practice. (shrink)

Hippocrates, celebrated as the Father of Medicine, emphasized the importance of observation in diagnosis and prognosis. In so doing, he argued that the observant physician could draw on both senses and logic in interpreting clinical findings for the benefit of the patient. Among his many writings is a collection of aphorisms that remain highly relevant to the practice of medicine to this day. The first of these is the best known: which can be translated as: Deceptively simple (...) in structure, this aphorism offers many levels of meaning and interpretation that, as I will show, remain highly relevant to the contemporary practice of medicine. Containing a richness of... (shrink)

There is currently an unrecognised conflict between the utilitarian nature of the overall NHS and the basic deontology of the doctor-patient interaction. This conflict leads to mistrust and misunderstanding between managers and clinicians. This misunderstanding is bad for both doctors and managers, and also leads to waste of time and resources, and poorer services to patients. The utilitarian thinkers tend to value finite, short term, evidence based technical interventions, delivered according to specifications and contracts. They appear happy to break care (...) up into smaller pieces, which can then be commissioned from multiple providers. The deontological thinkers tend to think about care delivered through a long term continuous relationship, and regard that relationship as therapeutic and salutogenic in itself. To them breaking care up into smaller fragments is a denial of what caring is really about. Very rarely are either or both sides of this debate fully aware of where their powerfully felt and often well argued positions start from. In this paper we offer an appraisal of the strengths and weaknesses of both moral viewpoints as applied in the UK NHS context and we suggest a way in which they can be reconciled, provided neither is pushed too far or too hard against the other. We believe this reconciliation would be good for patients, doctors, managers and improve the service as a whole. (shrink)

Defensive medicine is defined as a doctor’s deviation from standard practice to reduce or prevent complaints or criticism. The objectives of this study were to assess the prevalence of the practice of defensive medicine in the UK among hospital doctors and the factors affecting it.

Moral pluralism is the norm in contemporary society. Even the best philosophical arguments rarely persuade moral opponents who differ at a foundational level. This has been vividly illustrated in contemporary debates in bioethics surrounding contentious issues such as abortion and euthanasia. It is readily apparent that bioethics discourse lacks an empirical explanation for the broad differences about various topics in bioethics and health policy. In recent years, social and cognitive psychology has generated novel approaches for defining basic differences in moral (...) intuitions generally. We propose that if empirical research using social intuitionist theory explains why people disagree with one another over moral issues, then the results of such research might help people debate their moral differences in a more constructive and civil manner. We illustrate the utility of social intuitionism with data from a national physician survey. (shrink)

This article presents an interpretive phenomenological study that explores how physicians experience dilemmas of conscience in their day-to-day practice. Eighteen physicians of various ages and professional backgrounds were interviewed and asked to identify and discuss three instances when they experienced a dilemma of conscience. Preliminary findings from narrative analyses of these physician interviews suggest that dilemmas of conscience are ubiquitous, temporal and context-dependent; they cannot be reduced and understood as a focal phenomenon. Moral development appears to parallel acquisition of (...) medical knowledge; participants' specific concerns and their clinical contexts evolved as they gained experience and insight. Participants learned how to negotiate dilemmas of conscience through time, mistakes, examples, actualization, rehearsals and struggles. Remaining engaged in care, developing partnerships and protecting spaces for dialogue can help create practices of accountability when dilemmas of conscience occur. (shrink)

First Published in 1999. Routledge is an imprint of Taylor & Francis, an informa company.

There is an assumption in virtue epistemology that epistemic virtues are the same in different times and places. In this paper, however, I examine this assumption in the practice of medicine as a paradigm example. I identify two different paradigms of medical practice, one before and the other after the rise of bioethics in 1960s. I discuss the socially defined role and function of physicians and the epistemic goals of medical practice in these two periods to (...) see how these elements affect the necessary epistemic virtues for physicians. I conclude that epistemic virtues of medical practice differ in these two periods according to the differing epistemic goals and the socially defined function of physicians. In the end, I respond to the possible objections to my thesis based on the distinction between skill and virtue. (shrink)

One contested moral commitment shared by the American Medical Association and American Nurses Association has to do with the place of conscience in the practice of medicine. These organizations, each in their own way, urge their respective members to engage in careful moral discernment regarding their professional life, and they assert the existence of an obligation on the part of others to respect the conscientious objections of healthcare professionals and to accommodate objecting individuals. Yet despite the value that (...) these organizations place on conscience and objector rights, these organizations do not offer elaborate philosophical defenses of their positions. This shortcoming is exposed by the light of contemporary philosophical challenges to conscience-friendly policies. What such challenges demand is a philosophical defense of these organizations’ moral commitments and corresponding policy recommendations. The point of this article is to indicate how the Catholic philosophical tradition’s account of the nature and importance of conscience can philosophically underwrite these organizations’ conscience-related principles and practices. It can be seen, then, that the Catholic tradition is far from inimical to the contemporary practice of medicine and that, on the contrary, this tradition offers philosophically serious grounds on which to rest some of the most morally significant values and guidelines endorsed by these contemporary health-professional organizations and their members. (shrink)

The medical profession, challenged by critics and reformers, is hard-pressed to give account of itself. Just what do physicians stand for? What do they revere? Where are they headed? These questions are becoming increasingly important yet increasingly difficult to answer, by established physicians and aspiring medical students alike. The perceived paralysis in the face of such questions and challenges is the central problem around which this book was written. To correct this failure, Dr. Trotter proposes the application of Josiah Royce's (...) "philosophy of loyalty" and the related thought of Alasdair MacIntyre to the practice of medicine. Uniquely qualified as both a professionally trained philosopher and an experienced physician, Trotter is the first to apply systematic philosophical precepts to this fundamentally important professional discipline. (shrink)

Book reviewed in this article: Abortion and the Private Practice of Medicine. By Jonathan B. Imber.

Bioethics as a field began some years before it was finally named in the early 1970s. In many ways, bioethics originated in response to urgent matters of the moment, including the controversy over disconnecting Karen Quinlan's respirator, the egregious paternalism of Donald Cowart's doctors in the famous “Dax” case, the abuse of research subjects in the notorious Tuskegee Syphilis Study, and the need to devise an intellectual framework for the development of federal regulations to protect human subjects of research. The (...) phrase “new and unprecedented” became a common description of the topics and issues to which people who later came to be called “bioethicists” responded. It should come as no surprise that bioethics and its practitioners soon came to the self-understanding that their work was new and unprecedented, much as the innovations of biomedical science and their clinical applications were thought to be. (shrink)

A collection of personal narratives and essays, Living Professionalism is designed to help medical students and residents understand and internalize various aspects of professionalism. These essays are meant for personal reflection and above all, for thoughtful discussion with mentors, with peers, with others throughout the health care provider community who care about acting professionally.

During the 2016 election, Donald Trump won conservative support by promising that he would, if elected, nominate “pro‐life” justices to the U.S. Supreme Court. Whether President Trump makes good on his campaign promise to restrict abortion rights may come down to competing impulses of the chief justice, John Roberts. These dueling dispositions—from the man whom many see as the new “swing justice”—hold the key to a blockbuster new case that legal historians call “the most unpredictable the Supreme Court has been (...) on abortion in decades.” The case, June Medical Services v. Russo, turns on arduous new requirements that Louisiana has imposed on facilities and clinicians that provide abortion. But the case is not just about abortion access. The Court will have to decide whether a clinic has a right to challenge the law in the first place. (shrink)

Debates about the ethics of health care and medical research in contemporary pluralistic democracies often arise partly from competing religious and secular values. Such disagreements raise challenges of balancing claims of religious liberty with claims to equal treatment in health care. This paper proposes several mid-level principles to help in framing sound policies for resolving such disputes. We develop and illustrate these principles, exploring their application to conscientious objection by religious providers and religious institutions, accommodation of religious priorities in biomedical (...) research, and treatment of patients’ religious views in doctor–patient encounters. Given that no sound set of guiding principles yields precise solutions for every policy dispute, we explore how morally sound democracies might deliberatively resolve such policy issues, following our proposed principles. Taken together and carefully interpreted, these principles may help in guiding difficult decision making in the indefinitely large realm where government, medical providers, and patients encounter problems concerning religion and medicine. (shrink)

The paper presented here illustrates the issue of philosophy within the contemporary practice of American medicine. Four forms of relationship between both disciplines will be discussed: philosophy and medicine, philosophy within medicine, medical philosophy, and philosophy of medicine. The aim of the paper is to illustrate the specificity of the proposed forms of relationship, i.e. the contrast between the autonomous approach of the both disciplines and the realistic philosophy of medicine promoted by Edmund D. (...) Pellegrin, which closely links the issue of the nature and theory of medicine with the undertaking of philosophical reflection. The issue of the topicality of Edmund D. Pellegrin's philosophy of medicine in the context of the current challenges of American health care will also be discussed. (shrink)