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Biomedical subjects

R S Downie

Publications and source records attributed to R S Downie.

18 recordsLinked to original sources
PubMed2003

Research on dead infants.

This paper examines the ethical problems that arise when research is carried out after autopsy on dead infants. It compares the right of parents against that of the public interest in matters of research on dead minors. The basis for the respect that is widely accorded to the body of a dead person is examined and is shown to ground the parental interest. A discussion of the nature of the family suggests that 'informed consent' is not the best term to apply to the process of parental consultation. Some reasons are provided against using this term in the context in which bereaved parents are consulted about autopsy and research on their dead infants. It is suggested that a term such as 'authorize' might better apply to this situation.

Attitude to Death↗
PubMed2002

Supererogation and altruism: a comment.

Supererogation can be distinguished from altruism, in that the former is located in the category of duty but exceeds the strict requirements of duty, whereas altruism belongs to a different moral category from duty. It follows that doctors do not act altruistically in their professional roles. Individual doctors may sometimes show supererogation, but supererogation is not a necessary feature of the medical profession. The aim of medicine is to act in the best interests of patients. This aim involves neither supererogation nor even the moral quality of beneficence. It is simply a job description. Morality enters medicine through the quality of the individual doctor's work, not by the definition of that work.

Altruism↗
PubMed1998

Images of health.

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Attitude to Health↗
PubMed1997

Parenting and the best interests of minors.

The treatment decisions of competent adults, especially treatment refusals, are generally respected. In the case of minors something turns on their age, and older minors ought increasingly to make their own decisions. On the other hand, parents decide on behalf of infants and young children. Their right to do so can best be justified in terms of the importance of preserving intimate family relationships, rather than in terms of the child's best interests, although the child's best interests will most often follow from this arrangement. Nevertheless, there are and ought to be legal, ethical, and financial constraints on parental decision making.

Adolescent↗
PubMed1997

Humanizing medicine: a special study module.

As medical schools begin to implement their new curricula under the guidance of Tomorrow's Doctors, the authors wish to raise some discussion on the form and content of the special study module (SSM) component. In order to do this they put forward in this paper proposals for an SSM in Medicine and Literature. This course has been designed jointly and will be run concurrently in three Scottish medical schools: Glasgow, Aberdeen and Dundee. Arguments for the course's acceptability to faculties of medicine and to students are discussed and its inclusion in the curriculum in terms of its educational impact, skills training, effect on personal development and broadening of the student's perspective are justified. The course structure, content and assessment procedures are described and a reading list proposed. The General Medical Council points out that SSMs should be seen as opportunities for innovation and this course demands a different educational approach from the standard objectives-led approach of most medical education. A process-led model is more appropriate as it stresses the way that students develop while taking the course rather than the end point reached at its finish.

Curriculum↗
PubMed1994

Definition.

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Humans↗
PubMed1993

The ethics of medical involvement in torture.

The difficulties of establishing a definition of torture are discussed, and a definition is suggested. It is then argued that, irrespective of general ethical questions, doctors in particular should never be involved because of their social role.

Codes of Ethics↗
PubMed1991

Literature and medicine.

There are various ways in which medicine and literature interact, but this paper concentrates on the contribution which literature can make to 'whole person understanding'. Scientific understanding is concerned with seeing events and actions in terms of patterns or similarities. But 'whole person understanding' is concerned with uniqueness or with what it is for a given person to have an illness. Literature can in various ways develop this kind of understanding.

Attitude to Health↗
PubMed1988

Literature and medicine: a short course for medical students.

A course on literature and medicine for medical students is described. A wide range of books, plays and poems were used with medical and non-medical themes. Students enjoyed the course and particularly welcomed the non-medical components. The staff learned at least as much as the students. Several book lists were developed with input from the students. Such a course might have a part to play in several parts of the medical course, such as in the teaching of ethics.

Attitude of Health Personnel↗
PubMed1988

Education and training in medicine.

Education and training are terms which are often used loosely, interchangeably, and require definition. Training is often seen as a series of activities which are related to the acquisition of specific skills and may be narrowly based. Education, on the other hand, has an important value base and is broader in concept. The arguments for and against an 'educated' doctor or a 'trained' doctor are considered, and it is concluded that for medical practice both education and training are required. The implication of this for the preparation of doctors and for their continuing learning is considered.

Education, Medical↗
PubMed1987

Practical problems in the teaching of ethics to medical students.

Some practical problems in the teaching of ethics to medical students are described. The definition of the objectives of the course remains the central aspect, and is more important than the specific content. The use of student projects, buzz groups, case histories and discussion points is described. There is a need for student assessment or examination at the end of the course. The teachers require a broad background in philosophy, clinical medicine and teaching skills. The learning of the teachers may be as important as that of the students.

Curriculum↗
PubMed1984

Ethics and surveys.

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Attitude of Health Personnel↗
PubMed1982

Collective responsibility in health care.

There is a widespread assumption that responsibility in health care is vested in the last resort in the individual doctor who is caring for a given patient. In the first section of this article I shall try to bring out the plausibility of this assumption, and examine the concept of collective responsibility which it allows. In the second and third sections I shall try to show the fatal weaknesses of the assumption in its unmodified form, and shall argue that if we are to understand the nature of health care at the present time we must take the norm to be collective and not individual responsibility. I shall discuss the two relevant senses of collective responsibility and try to show how they can be reconciled with what is acceptable in the widespread assumption of individual responsibility.

Delivery of Health Care↗
PubMed1975

Determinism.

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Behavior↗
PubMedDate not supplied

The value and quality of life.

A medical view on 'the value of life' can be inferred from medical accounts of the quality of life: a life has value if it embodies certain qualities. Scales have been developed to quantify quality of life. While the term 'quality of life', is used frequently in everyday discourse, perceptions of what it might actually mean differ greatly and are often incompatible. This incompatibility can be illustrated through an examination and development of the Greek myth of Sisyphus. The different models that the author explores rest on 'significant toil', 'choice', 'happiness or well-being', or 'social factors' being the prerequisite for quality of existence. These models are incommensurable and, as intangible concepts, cannot be quantified. Decision-making in medicine does not require a complex evaluation of quality of life: it consists of the doctor's offer of treatment based on the best evidence, and the patient's consent to, or refusal of, that offer. Apart from the need to obtain consent, the main ethical constraint on the doctor is equity.

Decision Making↗