This essay argues that while we have examined clinical ethics quite extensively in the literature, too little attention has been paid to the complex question of how clinical ethics is learned. Competing approaches to ethics pedagogy have relied on outmoded understandings of the way moral learning takes place in ethics. It is argued that the better approach, framed in the work of Aristotle, is the idea of phronesis, which depends on a long-term mentorship in clinical medicine for either medical students or clinical ethics students. Such an approach is articulated and defended.

Casuistry↗

PubMed1996

Waiting for Godot: where is the philosophy of nursing?

Explore the source record for details and available documents.

Empathy↗

PubMed1995

A rare complication of splenic artery aneurysm. Mesenteric steal syndrome.

Splenic artery aneurysms are relatively common lesions that remain asymptomatic in the vast majority of patients. The commencement of symptoms is generally a morbid development because it frequently heralds either frank rupture or an erosive process that involves neighboring structures. Erosion into the splenic vein has been reported but is extremely rare. When this event occurs, the central arteriovenous fistula almost inevitably leads to a dramatic increase in portal venous pressures, which may subsequently be manifested as upper gastrointestinal tract hemorrhage. Herein, we report an unusual case of splenic artery aneurysm that was complicated by arteriovenous fistula formation in which high flow through the central splenic shunt led to the development of nontransmural small-bowel ischemia due to a mesenteric steal syndrome, which presented as acute lower gastrointestinal tract hemorrhage. Diagnostic modalities and therapeutic interventions used in this case are detailed, followed by a brief review of the pertinent literature.

Adult↗

PubMed1992

Multipractice analysis of laparoscopic cholecystectomy in 1,983 patients.

We analyzed the results of laparoscopic cholecystectomy in 1,983 patients from a variety of practice settings in order to evaluate a large, cross-sectional experience for this new procedure. Twenty general surgeons from 9 clinics in 4 states examined the records and outcome of their laparoscopic cholecystectomy patients through March 1991. In 88 patients (4.5%), the operation was converted to an open procedure, usually because of marked inflammation and unclear anatomy. A total of 644 cases were performed with laser dissection and 1,339 with cautery, and the results of these 2 methods were similar. There were 41 complications. Reoperation for repair was necessary in 18 patients, including 5 with common duct injuries, and, to date, the outcome has been good in each patient. Seventy-six patients (3.8%) have had recognized common duct stones; these were removed preoperatively by endoscopic sphincterotomy (ERS) in 20 patients, during cholecystectomy in 46 patients, and postoperatively by ERS in 4 patients. In six patients, common duct stones became apparent 1 to 4 months after cholecystectomy. We conclude that trained general surgeons can perform laparoscopic cholecystectomy safely with risks comparable to those for conventional open cholecystectomy.

Adolescent↗

PubMed1988