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At least 343 records · Page 19Linked to original sources

Technical expertise as an ethical form: towards an ethics of distance.

The present article proceeds from the observation that the therapeutic relationship is basically unequal. This inequality essentially concerns the respective situation of the patient and his or her doctor vis-à-vis medical knowledge. A strict professionalism guarantees that this inequality remains factual and without essential value. Yet, if both partners unreflectively allow affectivity excessively to intrude into their relationship, their behaviour may then be inspired by subconscious, rather than rational, motives. In that case, the unverifiable allegations of philanthropy or paternalism may be used to rationalise a kind of 'medical sadism' which attempts to justify the will to humiliate the patient by means of the constraints inherent in medical care. The concept of ethical form is introduced as a non-verbal criterion of ethical reliability. It is mainly a way of training the will through the application of rationally justified rules of behaviour. In this context, it is suggested that an effort to remain constantly within the limits of professionalism represents a method of training for the achievement of some degree of ethical credibility in the therapeutic relationship. In the long term, such abstinence could constitute a sort of catharsis, and thereby help to reveal the non-rational motives in medical behaviour. Contrary to the belief prevailing in modern society, the established limits of medical knowledge are not so broad. The application of these limits would probably be the best method of preventing emotions from interfering undesirably in the therapeutic relationship.

Dehumanization↗

Specialists without spirit: crisis in the nursing profession.

This paper examines the crisis in the nursing profession in Western industrial societies in the light of Max Weber's theory of rationalisation. The domination of instrumental rational action in modern industrial societies in evident in the field of modern medicine. The burgeoning mechanistic approach to the human body and health makes modern health care services increasingly devoid of human values. Although the nursing profession has been influenced by various changes that took place in health care during the last few decades (for example greater reliance on technology), the underlying values of the nursing profession still emphasise a broad definition of the well-being of patients. Hence, in recent years the irrational consequences of growing technological medicine in North America has resulted in a serious crisis in the nursing profession. To resolve this crisis the authors propose a reorganisation of modern health care services on the basis of a new paradigm which is compatible with both the health care needs of the people and the main emphasis in education and training of the nursing profession.

Altruism↗

Prostitutes, workers and kidneys: Brecher on the kidney trade.

Brecher argues that the practices of selling blood and kidneys are akin to the practices of prostitution and wage-labour since they all involve commodification and, by implication, should be subject to legal prohibition. I suggest that these practices need not involve commodification and that they should only be condemned if people are forced into them because of their lack of power. Rather than these practices being prohibited, I suggest that it would be preferable if they were subject to state regulation in order to protect the weak from exploitation.

Commerce↗

Buying human kidneys: autonomy, commodity and power.

Buttle's reply to my objections to buying kidneys is helpful but unconvincing in two respects. Doing something freely leaves quite open the possibility that one is thereby making a commodity of a person; and the effects of institutionalising such a practice is itself a matter for concern. And while his emphasis on 'power' is important, the concept is hardly less problematic than 'commodification'.

Commerce↗

Imagination in practice.

Current focus in the health care ethics literature on the character of the practitioner has a reputable pedigree. Rather than offer a staple diet of Aristotelian ethics in the undergraduate curricula, perhaps instead one should follow Murdoch's suggestion and help the practitioner to develop vision and moral imagination, because this has a practical rather than a theoretical aim. The imaginative capacity of the practitioner plays an important part in both the quality of the nurse's role enactment and the moral strategies which the nurse uses. It also plays a central part in the practitioner's ability to communicate with a patient and in the type of person which the practitioner becomes. Can the moral imagination be stimulated and nurtured? Some philosophers and literary critics argue that not only is this possible, but that literature is the means of doing so. If this is the case then a place should be made for literature in already crowded health care curricula.

Dehumanization↗

Defending commercial surrogate motherhood against Van Niekerk and Van Zyl.

The arguments of Van Niekerk and Van Zyl that, on the grounds that it involves an inappropriate commodification and alienation of women's labour, commercial surrogate motherhood (CSM) is morally suspect are discussed and considered to be defective. In addition, doubt is cast on the notion that CSM should be illegal.

Commerce↗

Autonomy in the face of a devastating diagnosis.

Literary accounts of traumatic events can be more informative and insightful than personal testimonials. In particular, reference to works of literature can give us a more vivid sense of what it is like to receive a devastating diagnosis. In turn this can lead us to question some common assumptions about the nature of autonomy, particularly for patients in these circumstances. The literature of concentration camp and labour camp experiences can help us understand what it is like to have one's life-plans altered utterly and unexpectedly. Contrary to common views of autonomy which have difficulty in characterising autonomous action when long-standing assumptions are suddenly lost, these examples show that autonomy is possible in these circumstances. We need a theory of autonomy which can deal with traumatic events and is useful in the clinical context.

Dehumanization↗

Do studies of the nature of cases mislead about the reality of cases? A response to Pattison et al.

This article questions whether many are misled by current case studies. Three broad types of style of case study are described. A stark style, based on medical case studies, a fictionalised style in reaction, and a personal statement made in discussion groups by an original protagonist. Only the second type fits Pattison's category. Language remains an important issue, but to be examined as the case is lived in discussion rather than as a potentially reductionist study of the case as text.

Bias↗

Ethical aspects of clinical chemistry.

The work performed by the clinical chemist may deeply affect the decisions of the doctor and the well-being of the patient. Yet in contrast to the doctor and to the nurse the clinical chemist usually has no personal relationship with the patient. Being encumbered by much technology and anonymity is itself a reason for scrutinising his involvement in issues of health care ethics. This is an attempt at clarifying some major aspects: the relationship of his professional ethics to medical ethics as a whole, his ethical obligations to the patient and to society, and other aspects.

Chemistry, Clinical↗

What price dissection? Dissection literally dissected.

Hamlet: Has this fellow no feelings of his business, that he sings at grave-making? Horatio: Custom hath made it in him a property of easiness. (Hamlet Act V, scene i) Hamlet is appalled by the gravedigger's insensitivity towards death and corpses. Horatio explains that the gravedigger is so accustomed to such things that he no longer shares Hamlet's seriousness. We contend that human dissection may make in medical students and doctors the "property of easiness" in dealing with death and the human body, and that this may have negative consequences for medics and patients. It is perhaps worth emphasising at the outset what this essay is NOT about. We do not wish to call into question the value of dissection in medical education; to charge dissection with being an inefficient or ineffective means of teaching and learning human anatomy is not our intent. Instead, we explore, through the medium of literature, experiences of dissection, and what kind of student and doctor may be encouraged or produced by the dissection room; what price might be paid for a practical, first-hand experience of human anatomy.

Anatomy↗

The commodification of the body and its parts.

The human body--and its parts--has long been a target for commodification within myriad cultural settings. A discussion of commodification requires that one consider, first, the significance of the body within anthropology and, second, what defines a body "part." After exploring these initial questions, this article outlines dominant theoretical approaches to commodification within anthropology, with Mauss and Marx figuring prominently. The discussion then turns to historically well-documented forms of body commodification: These include slavery and other oppressive labor practices; female reproduction; and the realms of sorcery and endocannibalism. An analysis here uncovers dominant established approaches that continue to drive current studies. The remainder of this article concerns emergent biotechnologies, whose application in clinical and other related scientific arenas marks a paradigmatic shift in anthropological understandings of the commodified, fragmented body. The following contexts are explored with care: reproductive technologies; organ transplantation; cosmetic and transsexual surgeries; genetics and immunology; and, finally, the category of the cyborg. The article concludes with suggestions for an integrated theoretical vision, advocating greater cross-fertilization of analytical approaches and the inclusion of an ethics of body commodification within anthropology.

Anthropology, Cultural↗

Human embryo research and the language of moral uncertainty.

In bioethics as in the sciences, enormous discussions often concern the very small. Central to public debate over emerging reproductive and regenerative biotechnologies is the question of the moral status of the human embryo. Because news media have played a prominent role in framing the vocabulary of the debate, this study surveyed the use of language reporting on human embryo research in news articles spanning a two-year period. Terminology that devalued moral status-for example, the descriptors things, property, tissue, or experimental material -was found to outnumber fivefold those that affirmed any degree of moral status above that of inanimate cellular matter; for example, living, human life, or human being. A quarter of the articles failed to note that the embryos under discussion were human. These findings confirm that even among scientific and philosophical experts a diversity of opinion exists on society's moral obligations to nascent human life. The skewed linguistic distribution also indicates a distinct bias. Concerned readers should take notice when any category of humanity becomes subject to prejudicial and disparaging language and the value of vulnerable human life is trivialized alongside sensational assertions of anticipated medical cures. The responsibility for holding the media to a higher standard of truth and fairness falls to us all.

Beginning of Human Life↗