Biomedical subjects
D C Thomasma
Publications and source records attributed to D C Thomasma.
Reflections on the offspring's ethical role in decisions for incompetent patients: a response to Sonnenblick, Friedlander, and Steinberg.
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Functional status care categories and national health policy.
Our society clearly needs to set limits on health care. The United States health care delivery system is the fourth largest economy in the world, yet its inflation continues to grow at twice the normal rate of other products and services. The inefficiencies are built in in such a way that while intensive care beds are plentiful, and very expensive, 37 million Americans cannot gain access to health care because they are either uninsured or underinsured. It is estimated that this figure will approach 39 million by the end of the decade. Since many of these individuals are young, the problem, it is said, has no real practical consequences because the young are relatively healthy. Yet evidence exists that the uninsured and underinsured receive poorer care than covered individuals. This and other inequities in the system have led many thinkers like Leonard Fleck to ask how just we must be in society. The answer to this question would presumably help us determine the lengths we must go in correcting the inequities. Even if the peace-dividend emerges from the new political events around the world, and we are able to spend more of our money on health care, our resources are not a bottomless pit. If need alone drives the system, just performing open-heart surgery on everyone who needs it would cost more than the annual budget itself. Virtually everyone agrees, then, that escalating health care costs are a moral problem because justice is involved, a political problem because public interest is involved, and that limits must be set that are moral and public.
Models of the doctor-patient relationship and the ethics committee: Part One.
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Ethical issues and transplantation technology.
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The ethics of caring for the older patient with cancer: defining the issues.
Cancer in any age group can be devastating. Elderly cancer patients, however, must face their own mortality while reflecting on their past life and the personal set of moral codes they have formulated over the years. This review examines these issues and reflects on "the dynamics of cancer," the way that these dynamics influence patient autonomy, and how disrupted autonomy creates suffering that is sometimes misunderstood by caregivers eager to prolong life--sometimes at any cost. Further, various routes open to patients and caregivers, including termination of therapy, aid in dying, and life-support systems, are discussed. Finally, the emotional and spiritual needs of patients, as well as their rights and freedoms, are examined.
Point and counterpoint. Are ethics committees of an enduring nature?
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Why philosophers should offer ethics consultations.
Considerable debate has occurred about the proper role of philosophers when offering ethics consultations. Some argue that only physicians or clinical experienced personnel should offer ethics consultations in the clinical setting. Others argue still further that philosophers are ill-equipped to offer such advice, since to do so rests on no social warrant, and violates the abstract and neutral nature of the discipline itself. I argue that philosophers not only can offer such consultations but ought to. To be a bystander when one's discipline does offer insights and methods of value discernment is pusillanimous. But this position requires a view of clinical medical ethics as one that arises out of the clinical practice of medicine, and not just from an application of general ethical principles to the practice of medicine. I conclude with some skills that trained philosophers can bring to the consultation service, and note that all consultations are in the form of recommendations that the patient, family, and physician are still free to accept or reject. Philosophers in the clinical setting do not make decisions.
Disclosing HIV status. Ethical issues explored.
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The Cruzan decision and medical practice.
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Establishing the moral basis of medicine: Edmund D. Pellegrino's philosophy of medicine.
Edmund D. Pellegrino's philosophy of medicine is explored in categories such as the motivation in constructing a philosophy of medicine, the method, the starting point of the doctor-patient relationship, negotiation about values in this relationship, the goal of the relationship, the moral basis of medicine, and additional concerns in the relationship (concerns such as gatekeeping, philosophical anthropology, axiology, philosophy of the body, and the general disjunction between science and morals). A critique of this philosophy is presented in the following areas: methodology, relation to ontology and sociology, the dynamic of individual and social concerns, and the new social condition of medicine. Finally, some suggestions for the future revitalization of philosophy of medicine are made based on Pellegrino's ideas. The focus throughout is on the moral basis and moral consequences of the philosophy of medicine, and not on other important themes.
Surrogate decisions at risk. The Cruzan case.
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Ethical concerns about AIDS.
The HIV/ARC/AIDS story continues to unfold. It is both the old, sadly familiar experience of plague and disease, of lepers isolated as unclean, of smallpox decimating the American Indians, of a Black Death sweeping medieval Europe, of the 1918 influenza. It is also a new story, one in which medical scientists rather quickly identified the causative infectious agent but, as yet, have been unable to cure the infection, although some amelioration of the basic course of the illness appear possible if treatment with AZT is begun relatively early. The ethical problems are numerous and constantly change as the understanding of the disease and its potency evolves. The social answers have, after initial delay, received positive action on an official level. On the more personal level of the average American there remains animosity, prejudice, and a deeply rooted fear, the ancient fear of the leper, of the plague victim. The health professionals have also officially responded well to the challenge of AIDS. Personally, as in society generally, there has been a mixed response. We believe that the ethical concerns enumerated in this article will be resolved in favor of persons with AIDS. Nevertheless, the personal, spiritual, emotional, and economic isolation experienced by persons with AIDS and their families challenge us about what kind of society we wish to be. We will ultimately be measured as a civilization by the way in which we treated the least fortunate. America's track record in this regard has been mixed. AIDS presents us with a chance to change.
Ethics and professional practice in oncology.
All cancer treatment should be guided by patient values. These values can be ascertained either through dialogue about treatment modalities, interventions and their consequences, or through the expressed wishes of patients or their surrogates. A balance should be struck between always following patient wishes and traditional health care paternalism, whereby patients have had little or no say about their treatment. The best way to strike this balance is through advanced directives and intensive dialogue with the patient or surrogates about the patient's values throughout the course of treatment. In this way, the care of the cancer patient can become a truly fiduciary responsibility. Health care providers can salvage their traditional obligation to preserve life through a commitment to the preservation of the meaning of the patient's life. Conflicts about treatment are difficult to resolve, but a mechanism does exist for making ethical decisions. Institutions should support such mechanisms and guarantee the protection of the conscience of all individuals caring for patients, with the right to withdraw without prejudice to one's job, and without abandoning the patient.
The clinical medical humanities program at Loyola University of Chicago.
The authors emphasize that an effective medical humanities program must be based on clinically oriented training. They then describe in detail such a program at Loyola University of Chicago Medical Center; the program consists of a four-year required curriculum that is clinically reinforced by having the students accompany attending physicians on rounds and is taught by faculty representing a wide range of disciplines in medicine and other fields. The paper offers several guidelines to the person or persons who would organize and direct a clinical medical humanities program, describes obstacles that the Loyola program faced when it was getting started, presents the purpose, focus, and curricular topics of the program, and discusses its future. The authors conclude that the use of the clinically oriented approach will continue to prevail in medical humanities teaching, both at Loyola and in medical humanities programs overall. This approach challenges good teachers to make their best efforts at reconciling their own disciplines with that of medicine; in this process, a new medical humanities discipline emerges that is not so much an application of the humanities to medicine as it is an evocation of humanities themes from the clinical encounter itself.
Moving the aged into the house of the dead. A critique of ageist social policy.
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Clinical ethics and public policy: reflections on the Linares case.
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