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PubMedDate not supplied

The uncertainty of certainty in clinical ethics.

Physicians accept fallibility in technical matters as a condition of medical practice. When it comes to moral considerations, physicians are often loathe to act without a good deal more certitude and seem less willing to accept error. This article argues that ethics is intrinsic to medical decision making, that error is the inevitable risk of any action and that inaction (clearly action by default) carries even greater risk of error. Whether in the moral or the technical sphere, error must be accepted by physicians as part of the learning process which informs and enriches future decisions. Moral virtue, it is concluded, resides more in the making of a decision and in the agony of making it than it does in the potentially fallible decision itself.

Decision Making↗
PubMedDate not supplied

Physicians, battery, and the duty to give informed consent.

This essay discusses the issue of informed consent as it relates not only to physician duty but also to patient duty. The author is particularly concerned with the possibility of battery charges against the physician unless a clear patient duty is articulated. In summary, the author concludes that we can prevent doctors from being forced to commit battery in a way which allows them to make reasonable choices for their patients without being open to the charge of having committed battery. At the same time, we would not allow doctors to abuse this privelege.

Disclosure↗
PubMedDate not supplied

Bioethics and the breakdown of the bicameral mind: Sacks and Luria revisited.

Since antiquity, individuals have attempted to relate mental processes to circumscribed areas of the brain. In 1935 the neurologist Wilder Penfield purported to know, "the humming of the mind's machinery, and where words come from," after he electrically stimulated areas of the exposed human cortex. Recent theories have suggested a functional separation of the dominant and the nondominant hemispheres, the right brain/left brain concept of thought and personality. One author has even proposed that human consciousness and modern civilization developed when the bicameral mind broke down, and the left brain achieved mastery over the right nondominant temporal lobe. Compared to these mechanistic approaches to brain function and human personality, the Russian neurologist, A.R. Luria and his American follower, Oliver Sacks, have developed a more intellectually satisfying and clinically useful approach which relies on a fuller understanding of the doctor-patient....

Bioethics↗
PubMed1991

Hypothetical contractarianism and the disclosure requirement problem in informed consent.

Two of the more deeply problematic issues surrounding the doctrine of informed consent are providing a justification for the practice of informed consent and providing an account of the nature and amount of information that must be disclosed in order for informed consent to take place. This paper is concerned with the latter problem, the problem of disclosure requirements, but it deals with this problem in a novel way; it approaches the problem by asking what fully informed and fully rational agents would agree to under certain hypothetical conditions. In general terms I juxtapose the hypothetical contractarianism found in Rawls' A Theory of Justice with that found in Gauthier's Morals By Agreement and ask what their respective hypothetical contractors would agree to with respect to choosing a particular standard of disclosure to govern the practice of informed consent. In more specific terms a contrast is made between what a Rawlsian agent behind a veil of ignorance would choose as compared to what, in Gauthier's terms, an ideal actor making an Archimedean choice would choose. The idea of an Archimedean point, and the subsequent choice made from that point, although technically identified by Rawls, originated with Archimedes of Syracuse.

Altruism↗
PubMed1992

Coping with ambiguity and uncertainty in patient-physician relationships: I. Leadership of a physician.

A patient-physician relationship provides a milieu for a patient to achieve healing, solace, and reintegration of personhood. A patient's primary physician assumes a leadership role in that regard, coordinating and facilitating a regimen of analysis and therapy. The quality, quantity, and rapidity of technological advancements in the delivery of medical care, render any individual physician incomplete in terms of his ability to provide total care. Consequently, a succession of professional and paraprofessional personnel must be involved to maximize the care rendered. Nevertheless, a patient's primary physician must fulfill a leadership role as he coordinates consultations and interprets the data they provide, placing it in the appropriate situational context for his patient as part of a collective and mutual decision-making process. A patient's primary physician must be acknowledged to possess the power and authority to effect the care provided, as he must also accept the accountability, duty, obligation, and responsibility for the result of that care. By these means ambiguity and uncertainty are mitigated.

Delivery of Health Care↗
PubMed1994

Towards authentic conversations. Authenticity in the patient-professional relationship.

The purpose of this paper is to evaluate the significance of the existential notion of authenticity for medical ethics. This is done by analyzing authenticity and examining its implications for the patient-professional relationship and for ethical decision-making in medical situations. It is argued that while authenticity implies important demand for individual responsibility, which has therapeutic significance, it perpetuates ideas which are antithetical both to authentic interaction between patients and professionals and to fruitful deliberation of moral dilemmas. In order to counteract these consequences, an alternative idea of authenticity is introduced. According to this idea, authenticity is not regarded primarily as individual sovereignty, but as an ability to participate in a dialogue in which the subjectivity of both partners is respected. Such practice, based on mutual trust and responsibility, would enhance common decision-making and overcome the alienation between patients and professionals.

Communication↗
PubMedDate not supplied

Raw data vs. wisdom.

Explore the source record for details and available documents.

Abortion, Induced↗
PubMed2003

Coping strategies in civilians during air attacks.

BACKGROUND: Coping strategies may influence the psychological outcome after a stressful event, both as coping at the time of the event and as strategies of dealing with its consequences after the event. The aim of the study was to investigate coping strategies used by civilians during the air attacks in Yugoslavia in 1999, and their association with the level of exposure, gender and psychological symptoms 1 year later. METHOD: The sample is a non-selective group of 139 medical students from the University of Belgrade, Yugoslavia. Open questions and content analysis were used to assess coping strategies. Symptoms of intrusion and avoidance were assessed, as well as general psychological symptoms. RESULTS: Content analysis of answers to open questions revealed nine categories of coping strategies (sport and walks, leisure activities, talking and gathering, humor, avoidance, philosophical approach, getting information, work, and substance abuse). A cluster analysis identified three groups of students with different styles of coping. Students that used dominantly 'talking and gathering' had the highest, and the ones that mostly used 'leisure activities' the lowest scores on intrusion. There were significant gender differences in how coping strategies were associated with intrusive symptoms. CONCLUSION: The type of coping strategies used during the air attacks may contribute to the level of intrusive symptoms 1 year after the event. Different coping strategies might be effective in men and women to reduce intrusive symptoms. Longitudinal and prospective studies are needed to draw definite conclusions on causal relationships between coping strategies and levels of posttraumatic stress.

Adaptation, Psychological↗
PubMed2006

A compromise method to facilitate under-represented minority admissions to medical school.

Ranked purely on the basis of the available reliable and valid measures, the demographic composition of incoming medical students fails to meet societal concerns regarding under-represented minorities (URM). Admissions offices are squeezed, administratively and legally, between honouring objectively measured individual merit and addressing societal needs. Until more successful recruitment and preparation of URM applicants closes that gap, compromise methods balancing those discordant ideals can be applied. Indeed, as progress over time decreases the relative societal need for affirmative action, compromise methods are mandated by no less a voice than that of the United States Supreme Court. This article proffers one such method, based upon the work of Hofstee, and demonstrates how it can be practically applied to a specific URM challenge. As perspective, past and present philosophical approaches to this discordance are categorized.

Educational Measurement↗
PubMed2004

From human ability to ethical principle: an intercultural perspective on autonomy.

Based on an empirical study regarding ethical challenges within intercultural health care, the focus of this article is upon autonomy and disclosure, discussed in light of philosophy and anthropology. What are the consequences for patients if the patients' right to be autonomous and to participate in treatment and care decisions by health care workers is interpreted as an obligation to participate? To force a person to make independent choices who is socio-culturally unprepared to do so, may violate his/her integrity. This may in turn jeopardise the respect, integrity and human worth the principle of autonomy was meant to ensure, and if so, may damage any relationship of trust that may exist between patient and health care worker. There is necessarily a link between autonomy and disclosure. Western disclosure practices may make the relationship between patients and health care workers difficult--even distrustful. To confront a patient with a very serious diagnosis may be seen not only as a tactless action, but also an unforgivable one. Hence, among many ethnic groups it is a family member's duty to shield patients from bad or disquieting news, e.g., a cancer diagnosis. If a family member is used to interpret in such situations, will the information given equal the information communicated by that interpreter? Even though respect for a person's autonomy is part of the respect for a person, one's respect for the person in question should not depend on his/her ability or aptitude to act autonomously.

Choice Behavior↗
PubMed1992

Method of moments and treatment of nonrandom error.

If one has a convoluted fluorescence decay and wishes to analyze it for a sum of exponential, then one can begin by asking either of two questions: (1) What sum of exponentials best fits the data? (2) What physical decay parameters gave rise to the data? At first these two questions may sound equivalent; in fact, they represent different philosophical approaches to data analysis. In resolving the first question, one adjusts the decay parameters until a calculated curve agrees within arbitrarily chosen limits to the original data. This is what we did in the fourth section of Table II. The fit obtained was decent, but the resulting parameters were wrong. A more difficult approach is to design a method of data analysis which is intrinsically insensitive to the presence of anticipated errors, aiming directly at recovering the decay parameters without regard to the fit. This is what we have done with the method of moments with MD. If particular errors do not have much effect on the recovered parameters, then such a method of data analysis is said to be robust with respect to those errors. Robust methods are widely used in engineering but have not seen much introduction yet to biophysics. Least-squares, the basis of the commonly used data fitting methods for pulse fluorometry, is nonrobust with respect to underlying noise distributions. Isenberg has shown that least-squares is nonrobust with respect to the nonrandom light scatter, time origin shift, and lamp width errors as well. As shown in Isenberg's paper, as well as here, the method of moments with MD is quite robust with respect to these nonrandom errors. Perhaps question (1) could be modified to include all of the errors that might be present in the data; but then, how would one decide which errors to include and whether an error is present? What fitting criterion would tell one this? Why choose a method which depends so strongly on this information when robust alternatives exist? As a rule, fitting should not be used as a criterion for correct decay parameters, unless all of the significant nonrandom errors have been included in the fit. If one fits the data but has not incorporated an important error, then the best fit will necessarily give the wrong answer. The method of moments provides clear criteria for accepting or rejecting an analysis.(ABSTRACT TRUNCATED AT 400 WORDS)

Data Interpretation, Statistical↗
PubMedDate not supplied

Development of an academic nurse-midwifery service program. A partnership model between medicine and midwifery.

Academic nurse-midwifery services have shown themselves to be strong collaborators with medical education. The development and functioning of an academic nurse-midwifery service program built on a partnership model between medicine and midwifery are highlighted. Organizational relationships, philosophical approach, and practice dimensions including responsibilities for clinical practice, medical student, and obstetrical resident education are explored. As the obstetrical patient pool diminishes in academic service settings, this model may prove useful.

Faculty, Nursing↗
PubMed1982

The basis of privacy and autonomy in medical practice. A model.

Most of the medical literature concerned with privacy seems to be based on the implicit assumptions that there is such a thing as right-to-privacy and that privacy is a worthwhile end unto itself. This paper develops a model which should permit a better and more pragmatic understanding of the moral, ethical and psychosocial bases of these assumptions. Arguments are offered that privacy is, indeed, not mainly an intrinsic value but is more of an instrumental value. It is suggested that privacy, per se, is not an end but is, rather, a means to another end, autonomy. It is important to differentiate autonomy as used here from narcissism; the former is viewed as an advanced stage of cognitive development whereas the latter is a social deviance. The model is developed which states: the analogy of a person is as a unit consisting of a matrix which is unique and autonomous because of its separation from other units by means of a wall-of-privacy; the relationship between persons is measured by their social distance. Derived from this is the 'equation', A approximately equal to (P)(D). Intimacy, substitutive judgement, confidentiality and patient-physician relationship are conceptualized within this model.

Confidentiality↗
PubMed1982

The justification of medical paternalism.

This paper examines the moral justification of medical paternalism. It is shown that while there are sufficient grounds to justify the practice of medical paternalism in some instances, there are many instances of the practice which cannot be justified. The application of the utilization principle of paternalism is considered in detail. It is argued that the physician can justifiably apply the principle in a particular case only after he has determined both that there are no alternate non-paternalistic courses of action which will have the same results and that he is in the same privileged position with respect to any relevant non-medical considerations as he is in with respect to medical considerations. The moral constraints on paternalistic action flowing from the concept of personal autonomy are also examined. It is concluded that medical paternalism is justified only when utilitarian considerations apply and when they do not violate personal rights. This occurs only when the subject of paternalism is not fully competent, when he has explicitly or by implication given consent, or when it can be reasonably concluded, from the knowledge of his emotional and cognitive make up, that he would approve of such treatment. For the most part, only the physician with a more intimate knowledge of his patient than is possible in most modern medical practice is in the position to undertake medical paternalism with moral propriety.

Attitude↗