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PubMed1998

Medical ethics research between theory and practice.

The main object of criticism of present-day medical ethics is the standard view of the relationship between theory and practice. Medical ethics is more than the application of moral theories and principles, and health care is more than the domain of application of moral theories. Moral theories and principles are necessarily abstract, and therefore fail to take account of the sometimes idiosyncratic reality of clinical work and the actual experiences of practitioners. Suggestions to remedy the illness of contemporary medical ethics focus on re-establishing the connection between the internal and external morality of medicine. This article discusses the question how to develop a theoretical perspective on medical ethical issues that connects philosophical reflection with the everyday realities of medical practice. Four steps in a comprehensive approach of medical ethics research are distinguished: (1) examine health care contexts in order to obtain a better understanding of the internal morality of these practices; this requires empirical research; (2) analyze and interpret the external morality governing health care practices; sociological study of prevalent values, norms, and attitudes concerning medical-ethical issues is required; (3) creation of new theoretical perspectives on health care practices; Jensen's theory of healthcare practices will be useful here; (4) develop a new conception of bioethics that illuminates and clarifies the complex interaction between the internal and external morality of health care practices. Hermeneutical ethics can be helpful for integrating the experiences disclosed in the empirical ethical studies, as well as utilizing the insights gained from describing the value-contexts of health care practices. For a critical and normative perspective, hermeneutical ethics has to examine and explain the moral experiences uncovered, in order to understand what they tell us.

Anthropology, Cultural↗
PubMed1999

Faulty judgment, expert opinion, and decision-making capacity.

An assessment of decision-making capacity is the accepted procedure for determining when a person is not competent. An inferential gap exists between the criteria for capacity specific abilities and the legal requirements to understand relevant information and appreciate the consequences of a decision. This gap extends to causal influences on a person's capacity to decide. Using a published case of depression, we illustrate that assessors' uses of diagnostic information is frequently not up to the task of bridging this inferential gap in a justifiable way. We then describe cases of faulty judgement which challenge the understanding of diagnostic causal influences. These cases help to clarify the nature of the expertise required for capacity assessments. In practice, the requirements of decision-making capacity are often abandoned to other considerations due to a lack of requisite expertise. The legal policy supporting decision-making capacity as a means to protective intervention is justified only if the requisite expertise is developed. We propose the requisite expertise to be developed in the long term as a distinct multidisciplinary endeavour.

Beneficence↗
PubMed1999

Multi-disciplinary competence assessment: a case study in consensus and culture.

The case of May Redwing, an American Indian woman assessed for competence is examined in detail. The case highlights the interconnections between the cultures of medicine and law and notes the importance of criteria of competence assessment, but also underscores the necessity of attention to the patient's cultural background in a multi-disciplinary competence assessment team process. Three interrelated areas of inquiry are explored: (1) Can we expect a morally and politically justifiable assessment of competence from a multi-disciplinary approach? (2) What pitfalls threaten a multi-disciplinary approach? and (3) How are the patient's cultural background and values relevant to a proper assessment of competence? These questions are investigated in the context of analyzing and evaluating a particularly difficult case. Although focused on a specific case, the study is instructive and cautionary for any group undertaking the challenges of multi-disciplinary competence assessment.

Cultural Diversity↗
PubMed2001

Theory and the organic bioethicist.

This article argues for the importance of theoretical reflections that originate from patients' experiences. Traditionally academic philosophers have linked their ability to theorize about the moral basis of medical practice to their role as outside observer. The author contends that recently a new type of reflection has come from within particular patient populations. Drawing upon a distinction created by Antonio Gramsci, it is argued that one can distinguish the theory generated by traditional bioethicists, who are academically trained, from that of "organic" bioethicists, who identify themselves with a particular patient community. The characteristics of this new type of bioethicist that are explored in this article include a close association of memoir and philosophy, an interrelationship of theory and praxis, and an intimate connection between the individual and a particular patient community.

Bioethics↗
PubMed2001

The Institute on Human Values in Medicine: its role and influence in the conception and evolution of bioethics.

For ten years, 1971-1981, the Institute on Human Values in Medicine (IHVM) played a key role in the development of Bioethics as a field. We have written this history and analysis to bring to new generations of Bioethicists information about the development of their field within both the humanities disciplines and the health professions. The pioneers in medical humanities and ethics came together with medical professionals in the decade of the 1960s. By the 1980s Bioethics was a fully recognized discipline. We show the role that IHVM programs played in defining the field, training faculty and helping schools to develop programs. We review, the beginnings of the IHVM in the crucible of social and technological change that led to the establishment of the IHVM's parent organization, the Society for Health and Human Values. We then turn to the IHVM programs through which Faculty members received fellowships to explore new crossovers between the humanities and the health professions. We have not only described the Fellows Program as it existed in 1973-1980, but have completed a survey of the fellows a quarter of a century after they held their fellowships. We describe other IHVM programs designed to facilitate the initiation and development of new humanities programs, to explore conceptual issues between medicine and five humanities fields, to conduct issue driven or educational method conferences and to advance humanities programs into graduate education through the Directors of Medical Education.

Academies and Institutes↗
PubMed2001

Ethical boundary work: geneticization, philosophy and the social sciences.

This paper is a response to Henk ten Have's "Genetics and Culture: The Geneticization thesis". In it, I refute Ten Have's suggestion that geneticization is not the sort of process that can be measured and commented on in terms of empirical evidence, even if he is correct in suggesting that it should be seen as part of 'philosophical discourse'. At the end, I relate this discussion to broader debates within bioethics between the social science and philosophy, and suggest the need for philosophical approaches to take the social sciences seriously.

Bioethics↗
PubMed2004

Collaboration and social inquiry: multiple meanings of a construct and its role in creating useful and valid knowledge.

The concept of collaboration in community research and intervention, although not new, has grown tremendously in importance in the past 20 years. Yet, it is both a contested concept in terms of its intent and a still evolving idea in terms of its meaning and implications. The purpose of this monograph is to begin to "unpack" the collaboration construct in terms of its many meanings, rationales, goals, models, dynamics, and accomplishments. Although models of collaboration are often well articulated there is "partial paradigm acquisition" (E. J. Trickett, 1984) in terms of understanding their behavioral and ethical implications. There is more theology than conclusion. The promise of collaboration, although considerable, is still in need of multiple and varied empirical examples of how collaboration contributes to both the process and goals of community research and intervention, however defined. The monograph closes with a brief overview of what we have learned from reviewing this literature, an articulation of the kinds of questions that need to be addressed, and a series of recommendations for how to increase our understanding of the collaboration construct in community research and intervention.

Cognition↗
PubMed2004

Making explicit the implicit knowledge assets in healthcare: the case of multidisciplinary teams in care and cure environments.

Research in Australia and the United States offers evidence of sophisticated, implicit, knowledge assets in two diverse healthcare environments, care and cure. Two case studies representing these two distinct archetypal environments are presented (a palliative care organization in Australia and a spinal care unit in the United States); both are based around multidisciplinary service delivery and demonstrate the existence of implicit knowledge assets. Yet the full potential of these knowledge assets is not being realized. A Knowledge Management Infrastructure model is proffered as a way of making explicit the elements of these knowledge assets in both case studies. In addition, this model provides a systematic and robust approach to structuring the conceptualization of knowledge assets across a range of healthcare environments.

Australia↗
PubMed2004

[Sensible anticancer treatment in the very old].

Significant numerical increase of elderly people augments in parallel the number of geriatric oncological situations. It is thus necessary to bridge between two apparently divergent worlds. This will allow to look at and evaluate the elderly cancer person with the accuracy of the specialist while remaining at the appropriate distance ordered by the geriatrician eye. It becomes then possible to undertake diagnostic and therapeutic manoeuvres in the respect of everybody's individuality. This contributes to maintain the best quality of life possible until the end. Pater(mater)nalism is to be abandoned and knowledge is to be shared. Daily interdisciplinarity, humanitarian spirit and ethical sensibility are essentials tools to make this enterprise a success.

Age Factors↗
PubMed2006

The impact of a multidisciplinary, integrated approach on improving the health and quality of care for individuals dealing with multiple chronic conditions.

This study examined the effects of using a multidisciplinary, integrated, whole-person, team advocate approach to educate and empower participants with multiple chronic illnesses and coordinate, monitor, and support their health care process. Individuals (N = 39) from Midwest hospitals participated and completed self-report instruments. Changes in participants' functioning were also measured with diagnostic measures completed by the team advocates. The results indicate that the participants' perceptions of physical functioning, physical well-being, control, self-efficacy, and life satisfaction increased. Additionally, health-related behavior changes were reported, and short-term costs were significantly lower than projected costs. Finally, the participants rated their health care services in the program as more effective than previous health care services.

Adolescent↗
PubMed2003

Can disability studies and psychology join hands?

Although the field of disabilities studies incorporates psychology within its interdisciplinary purview, it embodies a distinct perspective consonant with the new paradigm of disability. This perspective is contrasted with that of psychology, and the place of disability within psychology is examined. Although psychology has begun to embrace diversity, disability has remained marginalized. Four areas are presented in this article: (a) the foundational ideas of disability studies, (b) training in disability within psychology, (c) the paradigms of disability reflected in research on disability, and (d) future research directions.

Humans↗
PubMed2006

In search of the unifying principles of psychotherapy: conceptual, empirical, and clinical convergence.

The search for the principles of unified psychotherapy is an important stage in the advancement of the field. Converging evidence from various streams of clinical science allows the identification of some of the major domains of human functioning, adaptation, and dysfunction. These principles, supported by animal modeling, neuroscience, and developmental psychopathology, along with new theoretical constructs, are demonstrating that human functioning is best conceptualized as holistic and highly interrelated at all domain levels of the total ecological system. Incorporating these findings with evidence accrued over the past century of psychotherapy practice and study allows psychologists to begin to explore the development of a unified system of psychotherapy that is rooted in the clinical sciences. One such attempt to develop a unified framework is presented as a starting point. ((c) 2006 APA, all rights reserved).

Empirical Research↗